Bill Text: IL HB0027 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Creates the Excellence in Academic Medicine Act of 2013 with provisions similar to those of the Excellence in Academic Medicine Act as it existed before its repeal by Public Act 97-689 and creates special funds in accordance with the new Act. Amends the State Finance Act. Removes provisions added by Public Act 97-691 concerning the maximum amounts of annual unpaid Medical Assistance bills that may be paid in total from future fiscal year Medical Assistance appropriations. Restores provisions concerning fiscal year limitations relating to payments for medical care as those provisions existed before the enactment of Public Act 97-691. Amends the Senior Citizens and Disabled Persons Property Tax Relief Act by reinstituting the pharmaceutical assistance program that was eliminated by Public Act 97-689 and changing the short title to the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. Amends various Acts by restoring various provisions concerning nursing home staffing requirements, the moratorium on the expansion of eligibility for medical assistance, rate reductions and payments for various Medicaid services, vendor enrollment, care coordination, and other matters as those provisions existed before the enactment of Public Acts 97-687 and 97-689. Repeals various provisions added by Public Act 97-689 concerning safety-net hospitals, the elimination and limitation of certain medical assistance services, medical assistance for medically fragile and technology dependent children, and other matters. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2014-12-03 - Session Sine Die [HB0027 Detail]

Download: Illinois-2013-HB0027-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB0027 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
See Index
Creates the Excellence in Academic Medicine Act of 2013 with provisions similar to those of the Excellence in Academic Medicine Act as it existed before its repeal by Public Act 97-689 and creates special funds in accordance with the new Act. Amends the State Finance Act. Removes provisions added by Public Act 97-691 concerning the maximum amounts of annual unpaid Medical Assistance bills that may be paid in total from future fiscal year Medical Assistance appropriations. Restores provisions concerning fiscal year limitations relating to payments for medical care as those provisions existed before the enactment of Public Act 97-691. Amends the Senior Citizens and Disabled Persons Property Tax Relief Act by reinstituting the pharmaceutical assistance program that was eliminated by Public Act 97-689 and changing the short title to the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. Amends various Acts by restoring various provisions concerning nursing home staffing requirements, the moratorium on the expansion of eligibility for medical assistance, rate reductions and payments for various Medicaid services, vendor enrollment, care coordination, and other matters as those provisions existed before the enactment of Public Acts 97-687 and 97-689. Repeals various provisions added by Public Act 97-689 concerning safety-net hospitals, the elimination and limitation of certain medical assistance services, medical assistance for medically fragile and technology dependent children, and other matters. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning State government.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
ARTICLE 1.
Section 1-1. Short title. This Act may be cited as the
Excellence in Academic Medicine Act of 2013.
Section 1-5. Purpose. This Act is intended to stimulate
excellence in academic medicine in Illinois for this and future
generations, to elevate Illinois as a national center for
academic medicine and for health care innovation in the United
States, and to reverse the current health care trade imbalance
so that Illinois citizens may obtain highest quality
post-tertiary care at home in Illinois.
Section 1-10. Findings. Medical research and development
is required for placing Illinois health care in the position of
national leadership appropriate to Illinois' location and
institutional infrastructure. A reduction in the total cost of
care for Illinois citizens can be accomplished by an assertion
of local medical science leadership, which leads to greater
provision of excellent care within the State avoiding
out-migration.

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Excellence in academic medicine must be regarded not as a
cost drag on the economy but as a stimulant to economic growth
because it reduces the cost of work force replacement, further
develops an academic medical center hospital network in
Illinois, and stimulates spin-off technological breakthroughs
with positive economic consequences.
Research and development is an essential strategy for
controlling current costs of medical care. Such developments as
biologic alternatives to skin for trauma-necessitated
grafting, minimally invasive surgery, understanding, managing,
and avoiding excessive cerebral vascular events in minority
communities, and developments in pediatric eye trauma are
fundamental to avoidance of lengthy periods of
hospitalization.
The General Assembly hereby finds that Title XIX of the
Social Security Act has fundamentally changed the structure of
medical delivery in the State of Illinois. The failure of
Congress to match its desire to broaden access to health care
with commensurate fiscal resources has led to a growing burden
of Congressional access mandates falling upon the State and its
medical provider partners. Development of medical services and
research on medical technology is increasingly captive to the
Title XIX program and its strait-jacketing fiscal and
programmatic limitations. Advanced medical technology is
likely to be a successful method of controlling Title XIX
expenditures.

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Section 1-15. Definitions. As used in this Act:
"Academic medical center hospital" means a hospital
located in Illinois which is either (i) under common ownership
with the college of medicine of a college or university or (ii)
a free-standing hospital in which the majority of the clinical
chiefs of service are department chairmen in an affiliated
medical school.
"Academic medical center children's hospital" means a
children's hospital which is separately incorporated and
non-integrated into the academic medical center hospital but
which is the pediatric partner for an academic medical center
hospital and which serves as the primary teaching hospital for
pediatrics for its affiliated medical school; children's
hospitals which are separately incorporated but integrated
into the academic medical center hospital are considered part
of the academic medical center hospital.
"Chicago Medicare Metropolitan Statistical Area academic
medical center hospital" means an academic medical center
hospital located in the Chicago Medicare Metropolitan
Statistical Area.
"Independent academic medical center hospital" means the
primary teaching hospital for the University of Illinois at
Urbana.
"Non-Chicago Medicare Metropolitan Statistical Area
academic medical center hospital" means an academic medical

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center hospital located outside the Chicago Medicare
Metropolitan Statistical Area.
"Qualified Chicago Medicare Metropolitan Statistical Area
academic medical center hospital" means any Chicago Medicare
Metropolitan Statistical Area academic medical center hospital
that either directly or in connection with its affiliated
medical school receives in excess of $8,000,000 in grants or
contracts from the National Institutes of Health during the
calendar year preceding the beginning of the State fiscal year;
except that for the purposes of Section 1-25, the term also
includes the entity specified in subsection (e) of that
Section.
"Qualified Non-Chicago Medicare Metropolitan Statistical
Area academic medical center hospital" means the primary
teaching hospital for the University of Illinois School of
Medicine at Peoria and the primary teaching hospital for the
University of Illinois School of Medicine at Rockford and the
primary teaching hospitals for Southern Illinois University
School of Medicine in Springfield.
"Qualified academic medical center hospital" means (i) a
qualified Chicago Medicare Metropolitan Statistical Area
academic medical center hospital, (ii) a qualified Non-Chicago
Medicare Metropolitan Statistical Area academic medical center
hospital, or (iii) an academic medical center children's
hospital.
"Qualified programs" include:

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(i) Thoracic Transplantation: heart and lung, in
particular;
(ii) Cancer: particularly biologic modifiers of tumor
response, and mechanisms of drug resistance in cancer
therapy;
(iii) Shock/Burn: development of biological
alternatives to skin for grafting in burn injury, and
research in mechanisms of shock and tissue injury in severe
injury;
(iv) Abdominal transplantation: kidney, liver,
pancreas, and development of islet cell and small bowel
transplantation technologies;
(v) Minimally invasive surgery: particularly
laparoscopic surgery;
(vi) High performance medical computing: telemedicine
and teleradiology;
(vii) Transmyocardial laser revascularization: a laser
creates holes in heart muscles to allow new blood flow;
(viii) Pet scanning: viewing how organs function (CT
and MRI only allow viewing of the structure of an organ);
(ix) Strokes in the African-American community:
particularly risk factors for cerebral vascular accident
(strokes) in the African-American community at much higher
risk than the general population;
(x) Neurosurgery: particularly focusing on
interventional neuroradiology;

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(xi) Comprehensive eye center: including further
development in pediatric eye trauma;
(xii) Cancers: particularly melanoma, head and neck;
(xiii) Pediatric cancer;
(xiv) Invasive pediatric cardiology;
(xv) Pediatric organ transplantation: transplantation
of solid organs, marrow, and other stem cells; and
(xvi) Such other programs as may be identified.
Section 1-20. Establishment of Funds.
(a) The Medical Research and Development Fund is created in
the State Treasury to which the General Assembly may from time
to time appropriate funds and from which the Comptroller shall
pay amounts as authorized by law. The amount appropriated for
any fiscal year after 2014 shall not be less than the amount
appropriated for fiscal year 2014.
(i) The following accounts are created in the Medical
Research and Development Fund: The National Institutes of
Health Account; the Philanthropic Medical Research
Account; and the Market Medical Research Account.
(ii) Funds appropriated to the Medical Research and
Development Fund shall be assigned in equal amounts to each
account within the Fund, subject to transferability of
funds under subsection (c) of Section 1-25.
(b) The Post-Tertiary Clinical Services Fund is created in
the State Treasury to which the General Assembly may from time

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to time appropriate funds and from which the Comptroller shall
pay amounts as authorized by law. The amount appropriated for
any fiscal year after 2014 shall not be less than the amount
appropriated for fiscal year 2014.
(c) The Independent Academic Medical Center Fund is created
as a special fund in the State Treasury, to which the General
Assembly shall from time to time appropriate funds for the
purposes of the Independent Academic Medical Center Program.
The amount appropriated for any fiscal year after 2014 shall
not be less than the amount appropriated for fiscal year 2014.
The State Comptroller shall pay amounts from the Fund as
authorized by law.
Section 1-25. Medical Research and Development Challenge
Program.
(a) The State shall provide the following financial
incentives to draw private and federal funding for biomedical
research, technology, and programmatic development:
(1) Each qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital shall
receive a percentage of the amount available for
distribution from the National Institutes of Health
Account, equal to that hospital's percentage of the total
contracts and grants from the National Institutes of Health
awarded to qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospitals and

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their affiliated medical schools during the preceding
calendar year. These amounts shall be paid from the
National Institutes of Health Account.
(2) Each qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital shall
receive a payment from the State equal to 25% of all funded
grants (other than grants funded by the State of Illinois
or the National Institutes of Health) for biomedical
research, technology, or programmatic development received
by that qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital during
the preceding calendar year. These amounts shall be paid
from the Philanthropic Medical Research Account.
(3) Each qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital that (i)
contributes 40% of the funding for a biomedical research or
technology project or a programmatic development project
and (ii) obtains contributions from the private sector
equal to 40% of the funding for the project shall receive
from the State an amount equal to 20% of the funding for
the project upon submission of documentation demonstrating
those facts to the Comptroller; however, the State shall
not be required to make the payment unless the contribution
of the qualified Chicago Medicare Metropolitan Statistical
Area academic medical center hospital exceeds $100,000.
The documentation must be submitted within 180 days of the

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beginning of the fiscal year. These amounts shall be paid
from the Market Medical Research Account.
(b) No hospital under the Medical Research and Development
Challenge Program shall receive more than 20% of the total
amount appropriated to the Medical Research and Development
Fund.
The amounts received under the Medical Research and
Development Challenge Program by the Southern Illinois
University School of Medicine in Springfield and its affiliated
primary teaching hospitals, considered as a single entity,
shall not exceed an amount equal to one-sixth of the total
amount available for distribution from the Medical Research and
Development Fund, multiplied by a fraction, the numerator of
which is the amount awarded the Southern Illinois University
School of Medicine and its affiliated teaching hospitals in
grants or contracts by the National Institutes of Health and
the denominator of which is $8,000,000.
(c) On or after the 180th day of the fiscal year the
Comptroller may transfer unexpended funds in any account of the
Medical Research and Development Fund to pay appropriate claims
against another account.
(d) The amounts due each qualified Chicago Medicare
Metropolitan Statistical Area academic medical center hospital
under the Medical Research and Development Fund from the
National Institutes of Health Account, the Philanthropic
Medical Research Account, and the Market Medical Research

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Account shall be combined and one quarter of the amount payable
to each qualified Chicago Medicare Metropolitan Statistical
Area academic medical center hospital shall be paid on the
fifteenth working day after July 1, October 1, January 1, and
March 1 or on a schedule determined by the Department of
Healthcare and Family Services by rule that results in a more
expeditious payment of the amounts due.
(e) The Southern Illinois University School of Medicine in
Springfield and its affiliated primary teaching hospitals,
considered as a single entity, shall be deemed to be a
qualified Chicago Medicare Metropolitan Statistical Area
academic medical center hospital for the purposes of this
Section.
(f) In each State fiscal year, beginning in fiscal year
2014, the full amount appropriated for the Medical research and
development challenge program for that fiscal year shall be
distributed as described in this Section.
Section 1-30. Post-Tertiary Clinical Services Program. The
State shall provide incentives to develop and enhance
post-tertiary clinical services. Qualified academic medical
center hospitals as defined in Section 1-15 may receive funding
under the Post-Tertiary Clinical Services Program for up to 3
qualified programs as defined in Section 1-15 in any given
year; however, qualified academic medical center hospitals may
receive continued funding for previously funded qualified

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programs rather than receive funding for a new program so long
as the number of qualified programs receiving funding does not
exceed 3. Each qualified academic medical center hospital as
defined in Section 1-15 shall receive an equal percentage of
the Post-Tertiary Clinical Services Fund to be used in the
funding of qualified programs. In each State fiscal year,
beginning in fiscal year 2014, the full amount appropriated for
the Post-Tertiary Clinical Services Program for that fiscal
year shall be distributed as described in this Section. One
quarter of the amount payable to each qualified academic
medical center hospital shall be paid on the fifteenth working
day after July 1, October 1, January 1, and March 1 or on a
schedule determined by the Department of Healthcare and Family
Services by rule that results in a more expeditious payment of
the amounts due.
Section 1-35. Independent Academic Medical Center Program.
There is created an Independent Academic Medical Center Program
to provide incentives to develop and enhance the independent
academic medical center hospital. In each State fiscal year,
beginning in fiscal year 2014, the independent academic medical
center hospital shall receive funding under the Program, equal
to the full amount appropriated for that purpose for that
fiscal year. In each fiscal year, one quarter of the amount
payable to the independent academic medical center hospital
shall be paid on the fifteenth working day after July 1,

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October 1, January 1, and March 1 or on a schedule determined
by the Department of Healthcare and Family Services by rule
that results in a more expeditious payment of the amounts due.
Section 1-55. Payment of funds. The Comptroller shall pay
funds appropriated to the Post-Tertiary Clinical Services Fund
and the Medical Research and Development Fund to the
appropriate qualified academic medical center hospitals as the
funds are appropriated by the General Assembly and come due
under this Act. The payment of all funds under this Act by the
State shall be made directly to the academic medical center
hospital due the funds, except any funds due to any institution
of the University of Illinois as defined in Section 1-15 shall
be paid to the University of Illinois at Chicago Medical
Center, which shall be bound to expend the funds on the
institution due the funds.
Section 1-60. Restriction on funds. No academic medical
center hospital shall be eligible for payments from the Medical
Research and Development Fund unless the academic medical
center hospital qualifies under Section 1-15 as a qualified
Chicago Medicare Metropolitan Statistical Area academic
medical center hospital which in connection with its affiliated
medical school received at least $8,000,000 in the preceding
calendar year in grants or contracts from the National
Institutes of Health; except that this restriction does not

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apply to the entity specified in subsection (e) of Section 25.
If a hospital is eligible for funds from the Independent
Academic Medical Center Fund, that hospital shall not receive
funds from the Medical Research and Development Fund or the
Post-Tertiary Clinical Services Fund. If a hospital receives
funds from the Medical Research and Development Fund or the
Post-Tertiary Clinical Services Fund, that hospital is
ineligible to receive funds from the Independent Academic
Medical Center Fund.
Section 1-65. Reporting requirements. On or before May 1 of
each year, the chief executive officer of each Qualified
Academic Medical Center Hospital shall submit a report to the
Comptroller regarding the effects of the programs authorized by
this Act. The report shall also report the total amount of
grants from and contracts with the National Institutes of
Health in the preceding calendar year. It shall assess whether
the programs funded are likely to be successful, require
further study, or no longer appear to be promising avenues of
research. It shall discuss the probable use of the
developmental program in mainstream medicine including both
cost impact and medical effect. The report shall address the
effects the programs may have on containing Title XIX and Title
XXI costs in Illinois. The Comptroller shall immediately
forward the report to the Director of Healthcare and Family
Services and the Director of Public Health who shall evaluate

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the contents in a letter submitted to the President of the
Senate and the Speaker of the House of Representatives.
Section 1-70. Restriction on advertising as a State
designated center of excellence in health care. A hospital
receiving funds under this Act shall not advertise itself to
the public or to government or private funding sources as a
State designated center of excellence in health care.
Hospitals that qualify for funding under this Act are
permitted to inform the public and government or private
funding sources that they are eligible for State matching
funds. If sufficient evidence is found that hospitals are
violating this prohibition, the Comptroller may summarily
remove them from the program.
Section 1-74. Reimbursement methodology. The Department of
Healthcare and Family Services may develop a reimbursement
methodology consistent with this Act for distribution of moneys
from the funds in a manner that would allow distributions from
these funds to be matchable under Title XIX of the Social
Security Act. The Department may promulgate rules necessary to
make these distributions matchable.
Section 1-75. Reimbursements or payments by the State.
Nothing in this Act may be used to reduce reimbursements or
payments by the State to a hospital under any other Act.

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Section 1-80. Contravention of law. Funds received under
this Act shall not be used in contravention of any law of this
State.
ARTICLE 2.
Section 2-1. The Illinois Administrative Procedure Act is
amended by changing Section 5-45 as follows:
(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
Sec. 5-45. Emergency rulemaking.
(a) "Emergency" means the existence of any situation that
any agency finds reasonably constitutes a threat to the public
interest, safety, or welfare.
(b) If any agency finds that an emergency exists that
requires adoption of a rule upon fewer days than is required by
Section 5-40 and states in writing its reasons for that
finding, the agency may adopt an emergency rule without prior
notice or hearing upon filing a notice of emergency rulemaking
with the Secretary of State under Section 5-70. The notice
shall include the text of the emergency rule and shall be
published in the Illinois Register. Consent orders or other
court orders adopting settlements negotiated by an agency may
be adopted under this Section. Subject to applicable
constitutional or statutory provisions, an emergency rule

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becomes effective immediately upon filing under Section 5-65 or
at a stated date less than 10 days thereafter. The agency's
finding and a statement of the specific reasons for the finding
shall be filed with the rule. The agency shall take reasonable
and appropriate measures to make emergency rules known to the
persons who may be affected by them.
(c) An emergency rule may be effective for a period of not
longer than 150 days, but the agency's authority to adopt an
identical rule under Section 5-40 is not precluded. No
emergency rule may be adopted more than once in any 24 month
period, except that this limitation on the number of emergency
rules that may be adopted in a 24 month period does not apply
to (i) emergency rules that make additions to and deletions
from the Drug Manual under Section 5-5.16 of the Illinois
Public Aid Code or the generic drug formulary under Section
3.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
emergency rules adopted by the Pollution Control Board before
July 1, 1997 to implement portions of the Livestock Management
Facilities Act, (iii) emergency rules adopted by the Illinois
Department of Public Health under subsections (a) through (i)
of Section 2 of the Department of Public Health Act when
necessary to protect the public's health, (iv) emergency rules
adopted pursuant to subsection (n) of this Section, (v)
emergency rules adopted pursuant to subsection (o) of this
Section, or (vi) emergency rules adopted pursuant to subsection
(c-5) of this Section. Two or more emergency rules having

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substantially the same purpose and effect shall be deemed to be
a single rule for purposes of this Section.
(c-5) To facilitate the maintenance of the program of group
health benefits provided to annuitants, survivors, and retired
employees under the State Employees Group Insurance Act of
1971, rules to alter the contributions to be paid by the State,
annuitants, survivors, retired employees, or any combination
of those entities, for that program of group health benefits,
shall be adopted as emergency rules. The adoption of those
rules shall be considered an emergency and necessary for the
public interest, safety, and welfare.
(d) In order to provide for the expeditious and timely
implementation of the State's fiscal year 1999 budget,
emergency rules to implement any provision of Public Act 90-587
or 90-588 or any other budget initiative for fiscal year 1999
may be adopted in accordance with this Section by the agency
charged with administering that provision or initiative,
except that the 24-month limitation on the adoption of
emergency rules and the provisions of Sections 5-115 and 5-125
do not apply to rules adopted under this subsection (d). The
adoption of emergency rules authorized by this subsection (d)
shall be deemed to be necessary for the public interest,
safety, and welfare.
(e) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2000 budget,
emergency rules to implement any provision of this amendatory

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Act of the 91st General Assembly or any other budget initiative
for fiscal year 2000 may be adopted in accordance with this
Section by the agency charged with administering that provision
or initiative, except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (e). The adoption of emergency rules authorized by
this subsection (e) shall be deemed to be necessary for the
public interest, safety, and welfare.
(f) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2001 budget,
emergency rules to implement any provision of this amendatory
Act of the 91st General Assembly or any other budget initiative
for fiscal year 2001 may be adopted in accordance with this
Section by the agency charged with administering that provision
or initiative, except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (f). The adoption of emergency rules authorized by
this subsection (f) shall be deemed to be necessary for the
public interest, safety, and welfare.
(g) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2002 budget,
emergency rules to implement any provision of this amendatory
Act of the 92nd General Assembly or any other budget initiative
for fiscal year 2002 may be adopted in accordance with this

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Section by the agency charged with administering that provision
or initiative, except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (g). The adoption of emergency rules authorized by
this subsection (g) shall be deemed to be necessary for the
public interest, safety, and welfare.
(h) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2003 budget,
emergency rules to implement any provision of this amendatory
Act of the 92nd General Assembly or any other budget initiative
for fiscal year 2003 may be adopted in accordance with this
Section by the agency charged with administering that provision
or initiative, except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (h). The adoption of emergency rules authorized by
this subsection (h) shall be deemed to be necessary for the
public interest, safety, and welfare.
(i) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2004 budget,
emergency rules to implement any provision of this amendatory
Act of the 93rd General Assembly or any other budget initiative
for fiscal year 2004 may be adopted in accordance with this
Section by the agency charged with administering that provision
or initiative, except that the 24-month limitation on the

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adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (i). The adoption of emergency rules authorized by
this subsection (i) shall be deemed to be necessary for the
public interest, safety, and welfare.
(j) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2005 budget as provided under the Fiscal Year 2005 Budget
Implementation (Human Services) Act, emergency rules to
implement any provision of the Fiscal Year 2005 Budget
Implementation (Human Services) Act may be adopted in
accordance with this Section by the agency charged with
administering that provision, except that the 24-month
limitation on the adoption of emergency rules and the
provisions of Sections 5-115 and 5-125 do not apply to rules
adopted under this subsection (j). The Department of Public Aid
may also adopt rules under this subsection (j) necessary to
administer the Illinois Public Aid Code and the Children's
Health Insurance Program Act. The adoption of emergency rules
authorized by this subsection (j) shall be deemed to be
necessary for the public interest, safety, and welfare.
(k) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2006 budget, emergency rules to implement any provision of this
amendatory Act of the 94th General Assembly or any other budget
initiative for fiscal year 2006 may be adopted in accordance

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with this Section by the agency charged with administering that
provision or initiative, except that the 24-month limitation on
the adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (k). The Department of Healthcare and Family
Services may also adopt rules under this subsection (k)
necessary to administer the Illinois Public Aid Code, the
Senior Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, the Senior Citizens and
Disabled Persons Prescription Drug Discount Program Act (now
the Illinois Prescription Drug Discount Program Act), and the
Children's Health Insurance Program Act. The adoption of
emergency rules authorized by this subsection (k) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(l) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2007 budget, the Department of Healthcare and Family Services
may adopt emergency rules during fiscal year 2007, including
rules effective July 1, 2007, in accordance with this
subsection to the extent necessary to administer the
Department's responsibilities with respect to amendments to
the State plans and Illinois waivers approved by the federal
Centers for Medicare and Medicaid Services necessitated by the
requirements of Title XIX and Title XXI of the federal Social
Security Act. The adoption of emergency rules authorized by

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this subsection (l) shall be deemed to be necessary for the
public interest, safety, and welfare.
(m) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2008 budget, the Department of Healthcare and Family Services
may adopt emergency rules during fiscal year 2008, including
rules effective July 1, 2008, in accordance with this
subsection to the extent necessary to administer the
Department's responsibilities with respect to amendments to
the State plans and Illinois waivers approved by the federal
Centers for Medicare and Medicaid Services necessitated by the
requirements of Title XIX and Title XXI of the federal Social
Security Act. The adoption of emergency rules authorized by
this subsection (m) shall be deemed to be necessary for the
public interest, safety, and welfare.
(n) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2010 budget, emergency rules to implement any provision of this
amendatory Act of the 96th General Assembly or any other budget
initiative authorized by the 96th General Assembly for fiscal
year 2010 may be adopted in accordance with this Section by the
agency charged with administering that provision or
initiative. The adoption of emergency rules authorized by this
subsection (n) shall be deemed to be necessary for the public
interest, safety, and welfare. The rulemaking authority
granted in this subsection (n) shall apply only to rules

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promulgated during Fiscal Year 2010.
(o) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2011 budget, emergency rules to implement any provision of this
amendatory Act of the 96th General Assembly or any other budget
initiative authorized by the 96th General Assembly for fiscal
year 2011 may be adopted in accordance with this Section by the
agency charged with administering that provision or
initiative. The adoption of emergency rules authorized by this
subsection (o) is deemed to be necessary for the public
interest, safety, and welfare. The rulemaking authority
granted in this subsection (o) applies only to rules
promulgated on or after the effective date of this amendatory
Act of the 96th General Assembly through June 30, 2011.
(p) (Blank). In order to provide for the expeditious and
timely implementation of the provisions of this amendatory Act
of the 97th General Assembly, emergency rules to implement any
provision of this amendatory Act of the 97th General Assembly
may be adopted in accordance with this subsection (p) by the
agency charged with administering that provision or
initiative. The 150-day limitation of the effective period of
emergency rules does not apply to rules adopted under this
subsection (p), and the effective period may continue through
June 30, 2013. The 24-month limitation on the adoption of
emergency rules does not apply to rules adopted under this
subsection (p). The adoption of emergency rules authorized by

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this subsection (p) is deemed to be necessary for the public
interest, safety, and welfare.
(Source: P.A. 96-45, eff. 7-15-09; 96-958, eff. 7-1-10;
96-1500, eff. 1-18-11; 97-689, eff. 6-14-12; 97-695, eff.
7-1-12; revised 7-10-12.)
Section 2-2. The State Comptroller Act is amended by
changing Section 10.05 as follows:
(15 ILCS 405/10.05) (from Ch. 15, par. 210.05)
Sec. 10.05. Deductions from warrants; statement of reason
for deduction. Whenever any person shall be entitled to a
warrant or other payment from the treasury or other funds held
by the State Treasurer, on any account, against whom there
shall be any then due and payable account or claim in favor of
the State, the United States upon certification by the
Secretary of the Treasury of the United States, or his or her
delegate, pursuant to a reciprocal offset agreement under
subsection (i-1) of Section 10 of the Illinois State Collection
Act of 1986, or a unit of local government, a school district,
a public institution of higher education, as defined in Section
1 of the Board of Higher Education Act, or the clerk of a
circuit court, upon certification by that entity, the
Comptroller, upon notification thereof, shall ascertain the
amount due and payable to the State, the United States, the
unit of local government, the school district, the public

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institution of higher education, or the clerk of the circuit
court, as aforesaid, and draw a warrant on the treasury or on
other funds held by the State Treasurer, stating the amount for
which the party was entitled to a warrant or other payment, the
amount deducted therefrom, and on what account, and directing
the payment of the balance; which warrant or payment as so
drawn shall be entered on the books of the Treasurer, and such
balance only shall be paid. The Comptroller may deduct any one
or more of the following: (i) the entire amount due and payable
to the State or a portion of the amount due and payable to the
State in accordance with the request of the notifying agency;
(ii) the entire amount due and payable to the United States or
a portion of the amount due and payable to the United States in
accordance with a reciprocal offset agreement under subsection
(i-1) of Section 10 of the Illinois State Collection Act of
1986; or (iii) the entire amount due and payable to the unit of
local government, school district, public institution of
higher education, or clerk of the circuit court, or a portion
of the amount due and payable to that entity, in accordance
with an intergovernmental agreement authorized under this
Section and Section 10.05d. No request from a notifying agency,
the Secretary of the Treasury of the United States, a unit of
local government, a school district, a public institution of
higher education, or the clerk of a circuit court for an amount
to be deducted under this Section from a wage or salary
payment, or from a contractual payment to an individual for

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personal services, shall exceed 25% of the net amount of such
payment. "Net amount" means that part of the earnings of an
individual remaining after deduction of any amounts required by
law to be withheld. For purposes of this provision, wage,
salary or other payments for personal services shall not
include final compensation payments for the value of accrued
vacation, overtime or sick leave. Whenever the Comptroller
draws a warrant or makes a payment involving a deduction
ordered under this Section, the Comptroller shall notify the
payee and the State agency that submitted the voucher of the
reason for the deduction and he or she shall retain a record of
such statement in his or her records. As used in this Section,
an "account or claim in favor of the State" includes all
amounts owing to "State agencies" as defined in Section 7 of
this Act. However, the Comptroller shall not be required to
accept accounts or claims owing to funds not held by the State
Treasurer, where such accounts or claims do not exceed $50, nor
shall the Comptroller deduct from funds held by the State
Treasurer under the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act or for
payments to institutions from the Illinois Prepaid Tuition
Trust Fund (unless the Trust Fund moneys are used for child
support). The Comptroller shall not deduct from payments to be
disbursed from the Child Support Enforcement Trust Fund as
provided for under Section 12-10.2 of the Illinois Public Aid
Code, except for payments representing interest on child

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support obligations under Section 10-16.5 of that Code. The
Comptroller and the Department of Revenue shall enter into an
interagency agreement to establish responsibilities, duties,
and procedures relating to deductions from lottery prizes
awarded under Section 20.1 of the Illinois Lottery Law. The
Comptroller may enter into an intergovernmental agreement with
the Department of Revenue and the Secretary of the Treasury of
the United States, or his or her delegate, to establish
responsibilities, duties, and procedures relating to
reciprocal offset of delinquent State and federal obligations
pursuant to subsection (i-1) of Section 10 of the Illinois
State Collection Act of 1986. The Comptroller may enter into
intergovernmental agreements with any unit of local
government, school district, public institution of higher
education, or clerk of a circuit court to establish
responsibilities, duties, and procedures to provide for the
offset, by the Comptroller, of obligations owed to those
entities.
For the purposes of this Section, "clerk of a circuit
court" means the clerk of a circuit court in any county in the
State.
(Source: P.A. 97-269, eff. 12-16-11 (see Section 15 of P.A.
97-632 for the effective date of changes made by P.A. 97-269);
97-632, eff. 12-16-11; 97-689, eff. 6-14-12; 97-884, eff.
8-2-12; 97-970, eff. 8-16-12; revised 8-23-12.)

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Section 2-12. The Personnel Code is amended by changing
Section 4d as follows:
(20 ILCS 415/4d) (from Ch. 127, par. 63b104d)
Sec. 4d. Partial exemptions. The following positions in
State service are exempt from jurisdictions A, B, and C to the
extent stated for each, unless those jurisdictions are extended
as provided in this Act:
(1) In each department, board or commission that now
maintains or may hereafter maintain a major administrative
division, service or office in both Sangamon County and
Cook County, 2 private secretaries for the director or
chairman thereof, one located in the Cook County office and
the other located in the Sangamon County office, shall be
exempt from jurisdiction B; in all other departments,
boards and commissions one private secretary for the
director or chairman thereof shall be exempt from
jurisdiction B. In all departments, boards and commissions
one confidential assistant for the director or chairman
thereof shall be exempt from jurisdiction B. This paragraph
is subject to such modifications or waiver of the
exemptions as may be necessary to assure the continuity of
federal contributions in those agencies supported in whole
or in part by federal funds.
(2) The resident administrative head of each State
charitable, penal and correctional institution, the

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chaplains thereof, and all member, patient and inmate
employees are exempt from jurisdiction B.
(3) The Civil Service Commission, upon written
recommendation of the Director of Central Management
Services, shall exempt from jurisdiction B other positions
which, in the judgment of the Commission, involve either
principal administrative responsibility for the
determination of policy or principal administrative
responsibility for the way in which policies are carried
out, except positions in agencies which receive federal
funds if such exemption is inconsistent with federal
requirements, and except positions in agencies supported
in whole by federal funds.
(4) All beauticians and teachers of beauty culture and
teachers of barbering, and all positions heretofore paid
under Section 1.22 of "An Act to standardize position
titles and salary rates", approved June 30, 1943, as
amended, shall be exempt from jurisdiction B.
(5) Licensed attorneys in positions as legal or
technical advisors, positions in the Department of Natural
Resources requiring incumbents to be either a registered
professional engineer or to hold a bachelor's degree in
engineering from a recognized college or university,
licensed physicians in positions of medical administrator
or physician or physician specialist (including
psychiatrists), and registered nurses (except those

HB0027 - 30 - LRB098 00027 KTG 30027 b
registered nurses employed by the Department of Public
Health), except those in positions in agencies which
receive federal funds if such exemption is inconsistent
with federal requirements and except those in positions in
agencies supported in whole by federal funds, are exempt
from jurisdiction B only to the extent that the
requirements of Section 8b.1, 8b.3 and 8b.5 of this Code
need not be met.
(6) All positions established outside the geographical
limits of the State of Illinois to which appointments of
other than Illinois citizens may be made are exempt from
jurisdiction B.
(7) Staff attorneys reporting directly to individual
Commissioners of the Illinois Workers' Compensation
Commission are exempt from jurisdiction B.
(8) Twenty Twenty-one senior public service
administrator positions within the Department of
Healthcare and Family Services, as set forth in this
paragraph (8), requiring the specific knowledge of
healthcare administration, healthcare finance, healthcare
data analytics, or information technology described are
exempt from jurisdiction B only to the extent that the
requirements of Sections 8b.1, 8b.3, and 8b.5 of this Code
need not be met. The General Assembly finds that these
positions are all senior policy makers and have
spokesperson authority for the Director of the Department

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of Healthcare and Family Services. When filling positions
so designated, the Director of Healthcare and Family
Services shall cause a position description to be published
which allots points to various qualifications desired.
After scoring qualified applications, the Director shall
add Veteran's Preference points as enumerated in Section
8b.7 of this Code. The following are the minimum
qualifications for the senior public service administrator
positions provided for in this paragraph (8):
(A) HEALTHCARE ADMINISTRATION.
Medical Director: Licensed Medical Doctor in
good standing; experience in healthcare payment
systems, pay for performance initiatives, medical
necessity criteria or federal or State quality
improvement programs; preferred experience serving
Medicaid patients or experience in population
health programs with a large provider, health
insurer, government agency, or research
institution.
Chief, Bureau of Quality Management: Advanced
degree in health policy or health professional
field preferred; at least 3 years experience in
implementing or managing healthcare quality
improvement initiatives in a clinical setting.
Quality Management Bureau: Manager, Care
Coordination/Managed Care Quality: Clinical degree

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or advanced degree in relevant field required;
experience in the field of managed care quality
improvement, with knowledge of HEDIS measurements,
coding, and related data definitions.
Quality Management Bureau: Manager, Primary
Care Provider Quality and Practice Development:
Clinical degree or advanced degree in relevant
field required; experience in practice
administration in the primary care setting with a
provider or a provider association or an
accrediting body; knowledge of practice standards
for medical homes and best evidence based
standards of care for primary care.
Director of Care Coordination Contracts and
Compliance: Bachelor's degree required; multi-year
experience in negotiating managed care contracts,
preferably on behalf of a payer; experience with
health care contract compliance.
Manager, Long Term Care Policy: Bachelor's
degree required; social work, gerontology, or
social service degree preferred; knowledge of
Olmstead and other relevant court decisions
required; experience working with diverse long
term care populations and service systems, federal
initiatives to create long term care community
options, and home and community-based waiver

HB0027 - 33 - LRB098 00027 KTG 30027 b
services required. The General Assembly finds that
this position is necessary for the timely and
effective implementation of this amendatory Act of
the 97th General Assembly.
Manager, Behavioral Health Programs: Clinical
license or Advanced degree required, preferably in
psychology, social work, or relevant field;
knowledge of medical necessity criteria and
governmental policies and regulations governing
the provision of mental health services to
Medicaid populations, including children and
adults, in community and institutional settings of
care. The General Assembly finds that this
position is necessary for the timely and effective
implementation of this amendatory Act of the 97th
General Assembly.
Chief, Bureau of Pharmacy Services: Bachelor's
degree required; pharmacy degree preferred; in
formulary development and management from both a
clinical and financial perspective, experience in
prescription drug utilization review and
utilization control policies, knowledge of retail
pharmacy reimbursement policies and methodologies
and available benchmarks, knowledge of Medicare
Part D benefit design.
Chief, Bureau of Maternal and Child Health

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Promotion: Bachelor's degree required, advanced
degree preferred, in public health, health care
management, or a clinical field; multi-year
experience in health care or public health
management; knowledge of federal EPSDT
requirements and strategies for improving health
care for children as well as improving birth
outcomes.
Director of Dental Program: Bachelor's degree
required, advanced degree preferred, in healthcare
management or relevant field; experience in
healthcare administration; experience in
administering dental healthcare programs,
knowledge of practice standards for dental care
and treatment services; knowledge of the public
dental health infrastructure.
Manager of Medicare/Medicaid Coordination:
Bachelor's degree required, knowledge and
experience with Medicare Advantage rules and
regulations, knowledge of Medicaid laws and
policies; experience with contract drafting
preferred.
Chief, Bureau of Eligibility Integrity:
Bachelor's degree required, advanced degree in
public administration or business administration
preferred; experience equivalent to 4 years of

HB0027 - 35 - LRB098 00027 KTG 30027 b
administration in a public or business
organization required; experience with managing
contract compliance required; knowledge of
Medicaid eligibility laws and policy preferred;
supervisory experience preferred. The General
Assembly finds that this position is necessary for
the timely and effective implementation of this
amendatory Act of the 97th General Assembly.
(B) HEALTHCARE FINANCE.
Director of Care Coordination Rate and
Finance: MBA, CPA, or Actuarial degree required;
experience in managed care rate setting,
including, but not limited to, baseline costs and
growth trends; knowledge and experience with
Medical Loss Ratio standards and measurements.
Director of Encounter Data Program: Bachelor's
degree required, advanced degree preferred,
preferably in business or information systems; at
least 2 years healthcare data reporting
experience, including, but not limited to, data
definitions, submission, and editing; strong
background in HIPAA transactions relevant to
encounter data submission; knowledge of healthcare
claims systems.
Chief, Bureau of Rate Development and
Analysis: Bachelor's degree required, advanced

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degree preferred, with preferred coursework in
business or public administration, accounting,
finance, data analysis, or statistics; experience
with Medicaid reimbursement methodologies and
regulations; experience with extracting data from
large systems for analysis.
Manager of Medical Finance, Division of
Finance: Requires relevant advanced degree or
certification in relevant field, such as Certified
Public Accountant; coursework in business or
public administration, accounting, finance, data
analysis, or statistics preferred; experience in
control systems and GAAP; financial management
experience in a healthcare or government entity
utilizing Medicaid funding.
(C) HEALTHCARE DATA ANALYTICS.
Data Quality Assurance Manager: Bachelor's
degree required, advanced degree preferred,
preferably in business, information systems, or
epidemiology; at least 3 years of extensive
healthcare data reporting experience with a large
provider, health insurer, government agency, or
research institution; previous data quality
assurance role or formal data quality assurance
training.
Data Analytics Unit Manager: Bachelor's degree

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required, advanced degree preferred, in
information systems, applied mathematics, or
another field with a strong analytics component;
extensive healthcare data reporting experience
with a large provider, health insurer, government
agency, or research institution; experience as a
business analyst interfacing between business and
information technology departments; in-depth
knowledge of health insurance coding and evolving
healthcare quality metrics; working knowledge of
SQL and/or SAS.
Data Analytics Platform Manager: Bachelor's
degree required, advanced degree preferred,
preferably in business or information systems;
extensive healthcare data reporting experience
with a large provider, health insurer, government
agency, or research institution; previous
experience working on a health insurance data
analytics platform; experience managing contracts
and vendors preferred.
(D) HEALTHCARE INFORMATION TECHNOLOGY.
Manager of Recipient Provider Reference Unit:
Bachelor's degree required; experience equivalent
to 4 years of administration in a public or
business organization; 3 years of administrative
experience in a computer-based management

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information system.
Manager of MMIS Claims Unit: Bachelor's degree
required, with preferred coursework in business,
public administration, information systems;
experience equivalent to 4 years of administration
in a public or business organization; working
knowledge with design and implementation of
technical solutions to medical claims payment
systems; extensive technical writing experience,
including, but not limited to, the development of
RFPs, APDs, feasibility studies, and related
documents; thorough knowledge of IT system design,
commercial off the shelf software packages and
hardware components.
Assistant Bureau Chief, Office of Information
Systems: Bachelor's degree required, with
preferred coursework in business, public
administration, information systems; experience
equivalent to 5 years of administration in a public
or private business organization; extensive
technical writing experience, including, but not
limited to, the development of RFPs, APDs,
feasibility studies and related documents;
extensive healthcare technology experience with a
large provider, health insurer, government agency,
or research institution; experience as a business

HB0027 - 39 - LRB098 00027 KTG 30027 b
analyst interfacing between business and
information technology departments; thorough
knowledge of IT system design, commercial off the
shelf software packages and hardware components.
Technical System Architect: Bachelor's degree
required, with preferred coursework in computer
science or information technology; prior
experience equivalent to 5 years of computer
science or IT administration in a public or
business organization; extensive healthcare
technology experience with a large provider,
health insurer, government agency, or research
institution; experience as a business analyst
interfacing between business and information
technology departments.
The provisions of this paragraph (8), other than this
sentence, are inoperative after January 1, 2014.
(Source: P.A. 97-649, eff. 12-30-11; 97-689, eff. 6-14-12.)
(30 ILCS 5/2-20 rep.)
Section 2-14. The Illinois State Auditing Act is amended by
repealing Section 2-20.
Section 2-15. The State Finance Act is amended by changing
Sections 6z-52 and 6z-81 and by adding Sections 5.826, 5.827,
and 5.828 as follows:

HB0027 - 40 - LRB098 00027 KTG 30027 b
(30 ILCS 105/5.826 new)
Sec. 5.826. The Medical Research and Development Fund.
(30 ILCS 105/5.827 new)
Sec. 5.827. The Post-Tertiary Clinical Services Fund.
(30 ILCS 105/5.828 new)
Sec. 5.828. The Independent Academic Medical Center Fund.
(30 ILCS 105/6z-52)
Sec. 6z-52. Drug Rebate Fund.
(a) There is created in the State Treasury a special fund
to be known as the Drug Rebate Fund.
(b) The Fund is created for the purpose of receiving and
disbursing moneys in accordance with this Section.
Disbursements from the Fund shall be made, subject to
appropriation, only as follows:
(1) For payments for reimbursement or coverage for
prescription drugs and other pharmacy products provided to
a recipient of medical assistance under the Illinois Public
Aid Code, the Children's Health Insurance Program Act, the
Covering ALL KIDS Health Insurance Act, and the Veterans'
Health Insurance Program Act of 2008, and the Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act.

HB0027 - 41 - LRB098 00027 KTG 30027 b
(2) For reimbursement of moneys collected by the
Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) through error or
mistake.
(3) For payments of any amounts that are reimbursable
to the federal government resulting from a payment into
this Fund.
(4) (Blank). For payments of operational and
administrative expenses related to providing and managing
coverage for prescription drugs and other pharmacy
products provided to a recipient of medical assistance
under the Illinois Public Aid Code, the Children's Health
Insurance Program Act, the Covering ALL KIDS Health
Insurance Act, the Veterans' Health Insurance Program Act
of 2008, and the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act.
(c) The Fund shall consist of the following:
(1) Upon notification from the Director of Healthcare
and Family Services, the Comptroller shall direct and the
Treasurer shall transfer the net State share (disregarding
the reduction in net State share attributable to the
American Recovery and Reinvestment Act of 2009 or any other
federal economic stimulus program) of all moneys received
by the Department of Healthcare and Family Services
(formerly Illinois Department of Public Aid) from drug
rebate agreements with pharmaceutical manufacturers

HB0027 - 42 - LRB098 00027 KTG 30027 b
pursuant to Title XIX of the federal Social Security Act,
including any portion of the balance in the Public Aid
Recoveries Trust Fund on July 1, 2001 that is attributable
to such receipts.
(2) All federal matching funds received by the Illinois
Department as a result of expenditures made by the
Department that are attributable to moneys deposited in the
Fund.
(3) Any premium collected by the Illinois Department
from participants under a waiver approved by the federal
government relating to provision of pharmaceutical
services.
(4) All other moneys received for the Fund from any
other source, including interest earned thereon.
(Source: P.A. 96-8, eff. 4-28-09; 96-1100, eff. 1-1-11; 97-689,
eff. 7-1-12.)
(30 ILCS 105/6z-81)
Sec. 6z-81. Healthcare Provider Relief Fund.
(a) There is created in the State treasury a special fund
to be known as the Healthcare Provider Relief Fund.
(b) The Fund is created for the purpose of receiving and
disbursing moneys in accordance with this Section.
Disbursements from the Fund shall be made only as follows:
(1) Subject to appropriation, for payment by the
Department of Healthcare and Family Services or by the

HB0027 - 43 - LRB098 00027 KTG 30027 b
Department of Human Services of medical bills and related
expenses, including administrative expenses, for which the
State is responsible under Titles XIX and XXI of the Social
Security Act, the Illinois Public Aid Code, the Children's
Health Insurance Program Act, the Covering ALL KIDS Health
Insurance Act, and the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act. and
the Long Term Acute Care Hospital Quality Improvement
Transfer Program Act.
(2) For repayment of funds borrowed from other State
funds or from outside sources, including interest thereon.
(c) The Fund shall consist of the following:
(1) Moneys received by the State from short-term
borrowing pursuant to the Short Term Borrowing Act on or
after the effective date of this amendatory Act of the 96th
General Assembly.
(2) All federal matching funds received by the Illinois
Department of Healthcare and Family Services as a result of
expenditures made by the Department that are attributable
to moneys deposited in the Fund.
(3) All federal matching funds received by the Illinois
Department of Healthcare and Family Services as a result of
federal approval of Title XIX State plan amendment
transmittal number 07-09.
(4) All other moneys received for the Fund from any
other source, including interest earned thereon.

HB0027 - 44 - LRB098 00027 KTG 30027 b
(d) In addition to any other transfers that may be provided
for by law, on the effective date of this amendatory Act of the
97th General Assembly, or as soon thereafter as practical, the
State Comptroller shall direct and the State Treasurer shall
transfer the sum of $365,000,000 from the General Revenue Fund
into the Healthcare Provider Relief Fund.
(e) In addition to any other transfers that may be provided
for by law, on July 1, 2011, or as soon thereafter as
practical, the State Comptroller shall direct and the State
Treasurer shall transfer the sum of $160,000,000 from the
General Revenue Fund to the Healthcare Provider Relief Fund.
(f) Notwithstanding any other State law to the contrary,
and in addition to any other transfers that may be provided for
by law, the State Comptroller shall order transferred and the
State Treasurer shall transfer $500,000,000 to the Healthcare
Provider Relief Fund from the General Revenue Fund in equal
monthly installments of $100,000,000, with the first transfer
to be made on July 1, 2012, or as soon thereafter as practical,
and with each of the remaining transfers to be made on August
1, 2012, September 1, 2012, October 1, 2012, and November 1,
2012, or as soon thereafter as practical. This transfer may
assist the Department of Healthcare and Family Services in
improving Medical Assistance bill processing timeframes or in
meeting the possible requirements of Senate Bill 3397, or other
similar legislation, of the 97th General Assembly should it
become law.

HB0027 - 45 - LRB098 00027 KTG 30027 b
(Source: P.A. 96-820, eff. 11-18-09; 96-1100, eff. 1-1-11;
97-44, eff. 6-28-11; 97-641, eff. 12-19-11; 97-689, eff.
6-14-12; 97-732, eff. 6-30-12; revised 7-10-12.)
Section 2-25. The Illinois Procurement Code is amended by
changing Section 1-10 as follows:
(30 ILCS 500/1-10)
Sec. 1-10. Application.
(a) This Code applies only to procurements for which
contractors were first solicited on or after July 1, 1998. This
Code shall not be construed to affect or impair any contract,
or any provision of a contract, entered into based on a
solicitation prior to the implementation date of this Code as
described in Article 99, including but not limited to any
covenant entered into with respect to any revenue bonds or
similar instruments. All procurements for which contracts are
solicited between the effective date of Articles 50 and 99 and
July 1, 1998 shall be substantially in accordance with this
Code and its intent.
(b) This Code shall apply regardless of the source of the
funds with which the contracts are paid, including federal
assistance moneys. This Code shall not apply to:
(1) Contracts between the State and its political
subdivisions or other governments, or between State
governmental bodies except as specifically provided in

HB0027 - 46 - LRB098 00027 KTG 30027 b
this Code.
(2) Grants, except for the filing requirements of
Section 20-80.
(3) Purchase of care.
(4) Hiring of an individual as employee and not as an
independent contractor, whether pursuant to an employment
code or policy or by contract directly with that
individual.
(5) Collective bargaining contracts.
(6) Purchase of real estate, except that notice of this
type of contract with a value of more than $25,000 must be
published in the Procurement Bulletin within 7 days after
the deed is recorded in the county of jurisdiction. The
notice shall identify the real estate purchased, the names
of all parties to the contract, the value of the contract,
and the effective date of the contract.
(7) Contracts necessary to prepare for anticipated
litigation, enforcement actions, or investigations,
provided that the chief legal counsel to the Governor shall
give his or her prior approval when the procuring agency is
one subject to the jurisdiction of the Governor, and
provided that the chief legal counsel of any other
procuring entity subject to this Code shall give his or her
prior approval when the procuring entity is not one subject
to the jurisdiction of the Governor.
(8) Contracts for services to Northern Illinois

HB0027 - 47 - LRB098 00027 KTG 30027 b
University by a person, acting as an independent
contractor, who is qualified by education, experience, and
technical ability and is selected by negotiation for the
purpose of providing non-credit educational service
activities or products by means of specialized programs
offered by the university.
(9) Procurement expenditures by the Illinois
Conservation Foundation when only private funds are used.
(10) Procurement expenditures by the Illinois Health
Information Exchange Authority involving private funds
from the Health Information Exchange Fund. "Private funds"
means gifts, donations, and private grants.
(11) Public-private agreements entered into according
to the procurement requirements of Section 20 of the
Public-Private Partnerships for Transportation Act and
design-build agreements entered into according to the
procurement requirements of Section 25 of the
Public-Private Partnerships for Transportation Act.
(c) This Code does not apply to the electric power
procurement process provided for under Section 1-75 of the
Illinois Power Agency Act and Section 16-111.5 of the Public
Utilities Act.
(d) Except for Section 20-160 and Article 50 of this Code,
and as expressly required by Section 9.1 of the Illinois
Lottery Law, the provisions of this Code do not apply to the
procurement process provided for under Section 9.1 of the

HB0027 - 48 - LRB098 00027 KTG 30027 b
Illinois Lottery Law.
(e) This Code does not apply to the process used by the
Capital Development Board to retain a person or entity to
assist the Capital Development Board with its duties related to
the determination of costs of a clean coal SNG brownfield
facility, as defined by Section 1-10 of the Illinois Power
Agency Act, as required in subsection (h-3) of Section 9-220 of
the Public Utilities Act, including calculating the range of
capital costs, the range of operating and maintenance costs, or
the sequestration costs or monitoring the construction of clean
coal SNG brownfield facility for the full duration of
construction.
(f) This Code does not apply to the process used by the
Illinois Power Agency to retain a mediator to mediate sourcing
agreement disputes between gas utilities and the clean coal SNG
brownfield facility, as defined in Section 1-10 of the Illinois
Power Agency Act, as required under subsection (h-1) of Section
9-220 of the Public Utilities Act.
(g) This Code does not apply to the processes used by the
Illinois Power Agency to retain a mediator to mediate contract
disputes between gas utilities and the clean coal SNG facility
and to retain an expert to assist in the review of contracts
under subsection (h) of Section 9-220 of the Public Utilities
Act. This Code does not apply to the process used by the
Illinois Commerce Commission to retain an expert to assist in
determining the actual incurred costs of the clean coal SNG

HB0027 - 49 - LRB098 00027 KTG 30027 b
facility and the reasonableness of those costs as required
under subsection (h) of Section 9-220 of the Public Utilities
Act.
(h) (Blank). This Code does not apply to the process to
procure or contracts entered into in accordance with Sections
11-5.2 and 11-5.3 of the Illinois Public Aid Code.
(i) (h) Each chief procurement officer may access records
necessary to review whether a contract, purchase, or other
expenditure is or is not subject to the provisions of this
Code, unless such records would be subject to attorney-client
privilege.
(Source: P.A. 96-840, eff. 12-23-09; 96-1331, eff. 7-27-10;
97-96, eff. 7-13-11; 97-239, eff. 8-2-11; 97-502, eff. 8-23-11;
97-689, eff. 6-14-12; 97-813, eff. 7-13-12; 97-895, eff.
8-3-12; revised 8-23-12.)
Section 2-26. The Downstate Public Transportation Act is
amended by changing Sections 2-15.2 and 2-15.3 as follows:
(30 ILCS 740/2-15.2)
Sec. 2-15.2. Free services; eligibility.
(a) Notwithstanding any law to the contrary, no later than
60 days following the effective date of this amendatory Act of
the 95th General Assembly and until subsection (b) is
implemented, any fixed route public transportation services
provided by, or under grant or purchase of service contracts

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of, every participant, as defined in Section 2-2.02 (1)(a),
shall be provided without charge to all senior citizen
residents of the participant aged 65 and older, under such
conditions as shall be prescribed by the participant.
(b) Notwithstanding any law to the contrary, no later than
180 days following the effective date of this amendatory Act of
the 96th General Assembly, any fixed route public
transportation services provided by, or under grant or purchase
of service contracts of, every participant, as defined in
Section 2-2.02 (1)(a), shall be provided without charge to
senior citizens aged 65 and older who meet the income
eligibility limitation set forth in subsection (a-5) of Section
4 of the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act, under such
conditions as shall be prescribed by the participant. The
Department on Aging shall furnish all information reasonably
necessary to determine eligibility, including updated lists of
individuals who are eligible for services without charge under
this Section. Nothing in this Section shall relieve the
participant from providing reduced fares as may be required by
federal law.
(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
(30 ILCS 740/2-15.3)
Sec. 2-15.3. Transit services for disabled individuals.
Notwithstanding any law to the contrary, no later than 60 days

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following the effective date of this amendatory Act of the 95th
General Assembly, all fixed route public transportation
services provided by, or under grant or purchase of service
contract of, any participant shall be provided without charge
to all disabled persons who meet the income eligibility
limitation set forth in subsection (a-5) of Section 4 of the
Senior Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, under such procedures as shall
be prescribed by the participant. The Department on Aging shall
furnish all information reasonably necessary to determine
eligibility, including updated lists of individuals who are
eligible for services without charge under this Section.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-27. The Property Tax Code is amended by changing
Sections 15-172, 15-175, 20-15, and 21-27 as follows:
(35 ILCS 200/15-172)
Sec. 15-172. Senior Citizens Assessment Freeze Homestead
Exemption.
(a) This Section may be cited as the Senior Citizens
Assessment Freeze Homestead Exemption.
(b) As used in this Section:
"Applicant" means an individual who has filed an
application under this Section.
"Base amount" means the base year equalized assessed value

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of the residence plus the first year's equalized assessed value
of any added improvements which increased the assessed value of
the residence after the base year.
"Base year" means the taxable year prior to the taxable
year for which the applicant first qualifies and applies for
the exemption provided that in the prior taxable year the
property was improved with a permanent structure that was
occupied as a residence by the applicant who was liable for
paying real property taxes on the property and who was either
(i) an owner of record of the property or had legal or
equitable interest in the property as evidenced by a written
instrument or (ii) had a legal or equitable interest as a
lessee in the parcel of property that was single family
residence. If in any subsequent taxable year for which the
applicant applies and qualifies for the exemption the equalized
assessed value of the residence is less than the equalized
assessed value in the existing base year (provided that such
equalized assessed value is not based on an assessed value that
results from a temporary irregularity in the property that
reduces the assessed value for one or more taxable years), then
that subsequent taxable year shall become the base year until a
new base year is established under the terms of this paragraph.
For taxable year 1999 only, the Chief County Assessment Officer
shall review (i) all taxable years for which the applicant
applied and qualified for the exemption and (ii) the existing
base year. The assessment officer shall select as the new base

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year the year with the lowest equalized assessed value. An
equalized assessed value that is based on an assessed value
that results from a temporary irregularity in the property that
reduces the assessed value for one or more taxable years shall
not be considered the lowest equalized assessed value. The
selected year shall be the base year for taxable year 1999 and
thereafter until a new base year is established under the terms
of this paragraph.
"Chief County Assessment Officer" means the County
Assessor or Supervisor of Assessments of the county in which
the property is located.
"Equalized assessed value" means the assessed value as
equalized by the Illinois Department of Revenue.
"Household" means the applicant, the spouse of the
applicant, and all persons using the residence of the applicant
as their principal place of residence.
"Household income" means the combined income of the members
of a household for the calendar year preceding the taxable
year.
"Income" has the same meaning as provided in Section 3.07
of the Senior Citizens and Disabled Persons Property Tax Relief
and Pharmaceutical Assistance Act, except that, beginning in
assessment year 2001, "income" does not include veteran's
benefits.
"Internal Revenue Code of 1986" means the United States
Internal Revenue Code of 1986 or any successor law or laws

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relating to federal income taxes in effect for the year
preceding the taxable year.
"Life care facility that qualifies as a cooperative" means
a facility as defined in Section 2 of the Life Care Facilities
Act.
"Maximum income limitation" means:
(1) $35,000 prior to taxable year 1999;
(2) $40,000 in taxable years 1999 through 2003;
(3) $45,000 in taxable years 2004 through 2005;
(4) $50,000 in taxable years 2006 and 2007; and
(5) $55,000 in taxable year 2008 and thereafter.
"Residence" means the principal dwelling place and
appurtenant structures used for residential purposes in this
State occupied on January 1 of the taxable year by a household
and so much of the surrounding land, constituting the parcel
upon which the dwelling place is situated, as is used for
residential purposes. If the Chief County Assessment Officer
has established a specific legal description for a portion of
property constituting the residence, then that portion of
property shall be deemed the residence for the purposes of this
Section.
"Taxable year" means the calendar year during which ad
valorem property taxes payable in the next succeeding year are
levied.
(c) Beginning in taxable year 1994, a senior citizens
assessment freeze homestead exemption is granted for real

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property that is improved with a permanent structure that is
occupied as a residence by an applicant who (i) is 65 years of
age or older during the taxable year, (ii) has a household
income that does not exceed the maximum income limitation,
(iii) is liable for paying real property taxes on the property,
and (iv) is an owner of record of the property or has a legal or
equitable interest in the property as evidenced by a written
instrument. This homestead exemption shall also apply to a
leasehold interest in a parcel of property improved with a
permanent structure that is a single family residence that is
occupied as a residence by a person who (i) is 65 years of age
or older during the taxable year, (ii) has a household income
that does not exceed the maximum income limitation, (iii) has a
legal or equitable ownership interest in the property as
lessee, and (iv) is liable for the payment of real property
taxes on that property.
In counties of 3,000,000 or more inhabitants, the amount of
the exemption for all taxable years is the equalized assessed
value of the residence in the taxable year for which
application is made minus the base amount. In all other
counties, the amount of the exemption is as follows: (i)
through taxable year 2005 and for taxable year 2007 and
thereafter, the amount of this exemption shall be the equalized
assessed value of the residence in the taxable year for which
application is made minus the base amount; and (ii) for taxable
year 2006, the amount of the exemption is as follows:

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(1) For an applicant who has a household income of
$45,000 or less, the amount of the exemption is the
equalized assessed value of the residence in the taxable
year for which application is made minus the base amount.
(2) For an applicant who has a household income
exceeding $45,000 but not exceeding $46,250, the amount of
the exemption is (i) the equalized assessed value of the
residence in the taxable year for which application is made
minus the base amount (ii) multiplied by 0.8.
(3) For an applicant who has a household income
exceeding $46,250 but not exceeding $47,500, the amount of
the exemption is (i) the equalized assessed value of the
residence in the taxable year for which application is made
minus the base amount (ii) multiplied by 0.6.
(4) For an applicant who has a household income
exceeding $47,500 but not exceeding $48,750, the amount of
the exemption is (i) the equalized assessed value of the
residence in the taxable year for which application is made
minus the base amount (ii) multiplied by 0.4.
(5) For an applicant who has a household income
exceeding $48,750 but not exceeding $50,000, the amount of
the exemption is (i) the equalized assessed value of the
residence in the taxable year for which application is made
minus the base amount (ii) multiplied by 0.2.
When the applicant is a surviving spouse of an applicant
for a prior year for the same residence for which an exemption

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under this Section has been granted, the base year and base
amount for that residence are the same as for the applicant for
the prior year.
Each year at the time the assessment books are certified to
the County Clerk, the Board of Review or Board of Appeals shall
give to the County Clerk a list of the assessed values of
improvements on each parcel qualifying for this exemption that
were added after the base year for this parcel and that
increased the assessed value of the property.
In the case of land improved with an apartment building
owned and operated as a cooperative or a building that is a
life care facility that qualifies as a cooperative, the maximum
reduction from the equalized assessed value of the property is
limited to the sum of the reductions calculated for each unit
occupied as a residence by a person or persons (i) 65 years of
age or older, (ii) with a household income that does not exceed
the maximum income limitation, (iii) who is liable, by contract
with the owner or owners of record, for paying real property
taxes on the property, and (iv) who is an owner of record of a
legal or equitable interest in the cooperative apartment
building, other than a leasehold interest. In the instance of a
cooperative where a homestead exemption has been granted under
this Section, the cooperative association or its management
firm shall credit the savings resulting from that exemption
only to the apportioned tax liability of the owner who
qualified for the exemption. Any person who willfully refuses

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to credit that savings to an owner who qualifies for the
exemption is guilty of a Class B misdemeanor.
When a homestead exemption has been granted under this
Section and an applicant then becomes a resident of a facility
licensed under the Assisted Living and Shared Housing Act, the
Nursing Home Care Act, the Specialized Mental Health
Rehabilitation Act, or the ID/DD Community Care Act, the
exemption shall be granted in subsequent years so long as the
residence (i) continues to be occupied by the qualified
applicant's spouse or (ii) if remaining unoccupied, is still
owned by the qualified applicant for the homestead exemption.
Beginning January 1, 1997, when an individual dies who
would have qualified for an exemption under this Section, and
the surviving spouse does not independently qualify for this
exemption because of age, the exemption under this Section
shall be granted to the surviving spouse for the taxable year
preceding and the taxable year of the death, provided that,
except for age, the surviving spouse meets all other
qualifications for the granting of this exemption for those
years.
When married persons maintain separate residences, the
exemption provided for in this Section may be claimed by only
one of such persons and for only one residence.
For taxable year 1994 only, in counties having less than
3,000,000 inhabitants, to receive the exemption, a person shall
submit an application by February 15, 1995 to the Chief County

HB0027 - 59 - LRB098 00027 KTG 30027 b
Assessment Officer of the county in which the property is
located. In counties having 3,000,000 or more inhabitants, for
taxable year 1994 and all subsequent taxable years, to receive
the exemption, a person may submit an application to the Chief
County Assessment Officer of the county in which the property
is located during such period as may be specified by the Chief
County Assessment Officer. The Chief County Assessment Officer
in counties of 3,000,000 or more inhabitants shall annually
give notice of the application period by mail or by
publication. In counties having less than 3,000,000
inhabitants, beginning with taxable year 1995 and thereafter,
to receive the exemption, a person shall submit an application
by July 1 of each taxable year to the Chief County Assessment
Officer of the county in which the property is located. A
county may, by ordinance, establish a date for submission of
applications that is different than July 1. The applicant shall
submit with the application an affidavit of the applicant's
total household income, age, marital status (and if married the
name and address of the applicant's spouse, if known), and
principal dwelling place of members of the household on January
1 of the taxable year. The Department shall establish, by rule,
a method for verifying the accuracy of affidavits filed by
applicants under this Section, and the Chief County Assessment
Officer may conduct audits of any taxpayer claiming an
exemption under this Section to verify that the taxpayer is
eligible to receive the exemption. Each application shall

HB0027 - 60 - LRB098 00027 KTG 30027 b
contain or be verified by a written declaration that it is made
under the penalties of perjury. A taxpayer's signing a
fraudulent application under this Act is perjury, as defined in
Section 32-2 of the Criminal Code of 1961. The applications
shall be clearly marked as applications for the Senior Citizens
Assessment Freeze Homestead Exemption and must contain a notice
that any taxpayer who receives the exemption is subject to an
audit by the Chief County Assessment Officer.
Notwithstanding any other provision to the contrary, in
counties having fewer than 3,000,000 inhabitants, if an
applicant fails to file the application required by this
Section in a timely manner and this failure to file is due to a
mental or physical condition sufficiently severe so as to
render the applicant incapable of filing the application in a
timely manner, the Chief County Assessment Officer may extend
the filing deadline for a period of 30 days after the applicant
regains the capability to file the application, but in no case
may the filing deadline be extended beyond 3 months of the
original filing deadline. In order to receive the extension
provided in this paragraph, the applicant shall provide the
Chief County Assessment Officer with a signed statement from
the applicant's physician stating the nature and extent of the
condition, that, in the physician's opinion, the condition was
so severe that it rendered the applicant incapable of filing
the application in a timely manner, and the date on which the
applicant regained the capability to file the application.

HB0027 - 61 - LRB098 00027 KTG 30027 b
Beginning January 1, 1998, notwithstanding any other
provision to the contrary, in counties having fewer than
3,000,000 inhabitants, if an applicant fails to file the
application required by this Section in a timely manner and
this failure to file is due to a mental or physical condition
sufficiently severe so as to render the applicant incapable of
filing the application in a timely manner, the Chief County
Assessment Officer may extend the filing deadline for a period
of 3 months. In order to receive the extension provided in this
paragraph, the applicant shall provide the Chief County
Assessment Officer with a signed statement from the applicant's
physician stating the nature and extent of the condition, and
that, in the physician's opinion, the condition was so severe
that it rendered the applicant incapable of filing the
application in a timely manner.
In counties having less than 3,000,000 inhabitants, if an
applicant was denied an exemption in taxable year 1994 and the
denial occurred due to an error on the part of an assessment
official, or his or her agent or employee, then beginning in
taxable year 1997 the applicant's base year, for purposes of
determining the amount of the exemption, shall be 1993 rather
than 1994. In addition, in taxable year 1997, the applicant's
exemption shall also include an amount equal to (i) the amount
of any exemption denied to the applicant in taxable year 1995
as a result of using 1994, rather than 1993, as the base year,
(ii) the amount of any exemption denied to the applicant in

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taxable year 1996 as a result of using 1994, rather than 1993,
as the base year, and (iii) the amount of the exemption
erroneously denied for taxable year 1994.
For purposes of this Section, a person who will be 65 years
of age during the current taxable year shall be eligible to
apply for the homestead exemption during that taxable year.
Application shall be made during the application period in
effect for the county of his or her residence.
The Chief County Assessment Officer may determine the
eligibility of a life care facility that qualifies as a
cooperative to receive the benefits provided by this Section by
use of an affidavit, application, visual inspection,
questionnaire, or other reasonable method in order to insure
that the tax savings resulting from the exemption are credited
by the management firm to the apportioned tax liability of each
qualifying resident. The Chief County Assessment Officer may
request reasonable proof that the management firm has so
credited that exemption.
Except as provided in this Section, all information
received by the chief county assessment officer or the
Department from applications filed under this Section, or from
any investigation conducted under the provisions of this
Section, shall be confidential, except for official purposes or
pursuant to official procedures for collection of any State or
local tax or enforcement of any civil or criminal penalty or
sanction imposed by this Act or by any statute or ordinance

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imposing a State or local tax. Any person who divulges any such
information in any manner, except in accordance with a proper
judicial order, is guilty of a Class A misdemeanor.
Nothing contained in this Section shall prevent the
Director or chief county assessment officer from publishing or
making available reasonable statistics concerning the
operation of the exemption contained in this Section in which
the contents of claims are grouped into aggregates in such a
way that information contained in any individual claim shall
not be disclosed.
(d) Each Chief County Assessment Officer shall annually
publish a notice of availability of the exemption provided
under this Section. The notice shall be published at least 60
days but no more than 75 days prior to the date on which the
application must be submitted to the Chief County Assessment
Officer of the county in which the property is located. The
notice shall appear in a newspaper of general circulation in
the county.
Notwithstanding Sections 6 and 8 of the State Mandates Act,
no reimbursement by the State is required for the
implementation of any mandate created by this Section.
(Source: P.A. 96-339, eff. 7-1-10; 96-355, eff. 1-1-10;
96-1000, eff. 7-2-10; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
97-689, eff. 6-14-12; 97-813, eff. 7-13-12.)
(35 ILCS 200/15-175)

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Sec. 15-175. General homestead exemption.
(a) Except as provided in Sections 15-176 and 15-177,
homestead property is entitled to an annual homestead exemption
limited, except as described here with relation to
cooperatives, to a reduction in the equalized assessed value of
homestead property equal to the increase in equalized assessed
value for the current assessment year above the equalized
assessed value of the property for 1977, up to the maximum
reduction set forth below. If however, the 1977 equalized
assessed value upon which taxes were paid is subsequently
determined by local assessing officials, the Property Tax
Appeal Board, or a court to have been excessive, the equalized
assessed value which should have been placed on the property
for 1977 shall be used to determine the amount of the
exemption.
(b) Except as provided in Section 15-176, the maximum
reduction before taxable year 2004 shall be $4,500 in counties
with 3,000,000 or more inhabitants and $3,500 in all other
counties. Except as provided in Sections 15-176 and 15-177, for
taxable years 2004 through 2007, the maximum reduction shall be
$5,000, for taxable year 2008, the maximum reduction is $5,500,
and, for taxable years 2009 and thereafter, the maximum
reduction is $6,000 in all counties. If a county has elected to
subject itself to the provisions of Section 15-176 as provided
in subsection (k) of that Section, then, for the first taxable
year only after the provisions of Section 15-176 no longer

HB0027 - 65 - LRB098 00027 KTG 30027 b
apply, for owners who, for the taxable year, have not been
granted a senior citizens assessment freeze homestead
exemption under Section 15-172 or a long-time occupant
homestead exemption under Section 15-177, there shall be an
additional exemption of $5,000 for owners with a household
income of $30,000 or less.
(c) In counties with fewer than 3,000,000 inhabitants, if,
based on the most recent assessment, the equalized assessed
value of the homestead property for the current assessment year
is greater than the equalized assessed value of the property
for 1977, the owner of the property shall automatically receive
the exemption granted under this Section in an amount equal to
the increase over the 1977 assessment up to the maximum
reduction set forth in this Section.
(d) If in any assessment year beginning with the 2000
assessment year, homestead property has a pro-rata valuation
under Section 9-180 resulting in an increase in the assessed
valuation, a reduction in equalized assessed valuation equal to
the increase in equalized assessed value of the property for
the year of the pro-rata valuation above the equalized assessed
value of the property for 1977 shall be applied to the property
on a proportionate basis for the period the property qualified
as homestead property during the assessment year. The maximum
proportionate homestead exemption shall not exceed the maximum
homestead exemption allowed in the county under this Section
divided by 365 and multiplied by the number of days the

HB0027 - 66 - LRB098 00027 KTG 30027 b
property qualified as homestead property.
(e) The chief county assessment officer may, when
considering whether to grant a leasehold exemption under this
Section, require the following conditions to be met:
(1) that a notarized application for the exemption,
signed by both the owner and the lessee of the property,
must be submitted each year during the application period
in effect for the county in which the property is located;
(2) that a copy of the lease must be filed with the
chief county assessment officer by the owner of the
property at the time the notarized application is
submitted;
(3) that the lease must expressly state that the lessee
is liable for the payment of property taxes; and
(4) that the lease must include the following language
in substantially the following form:
"Lessee shall be liable for the payment of real
estate taxes with respect to the residence in
accordance with the terms and conditions of Section
15-175 of the Property Tax Code (35 ILCS 200/15-175).
The permanent real estate index number for the premises
is (insert number), and, according to the most recent
property tax bill, the current amount of real estate
taxes associated with the premises is (insert amount)
per year. The parties agree that the monthly rent set
forth above shall be increased or decreased pro rata

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(effective January 1 of each calendar year) to reflect
any increase or decrease in real estate taxes. Lessee
shall be deemed to be satisfying Lessee's liability for
the above mentioned real estate taxes with the monthly
rent payments as set forth above (or increased or
decreased as set forth herein).".
In addition, if there is a change in lessee, or if the
lessee vacates the property, then the chief county assessment
officer may require the owner of the property to notify the
chief county assessment officer of that change.
This subsection (e) does not apply to leasehold interests
in property owned by a municipality.
(f) "Homestead property" under this Section includes
residential property that is occupied by its owner or owners as
his or their principal dwelling place, or that is a leasehold
interest on which a single family residence is situated, which
is occupied as a residence by a person who has an ownership
interest therein, legal or equitable or as a lessee, and on
which the person is liable for the payment of property taxes.
For land improved with an apartment building owned and operated
as a cooperative or a building which is a life care facility as
defined in Section 15-170 and considered to be a cooperative
under Section 15-170, the maximum reduction from the equalized
assessed value shall be limited to the increase in the value
above the equalized assessed value of the property for 1977, up
to the maximum reduction set forth above, multiplied by the

HB0027 - 68 - LRB098 00027 KTG 30027 b
number of apartments or units occupied by a person or persons
who is liable, by contract with the owner or owners of record,
for paying property taxes on the property and is an owner of
record of a legal or equitable interest in the cooperative
apartment building, other than a leasehold interest. For
purposes of this Section, the term "life care facility" has the
meaning stated in Section 15-170.
"Household", as used in this Section, means the owner, the
spouse of the owner, and all persons using the residence of the
owner as their principal place of residence.
"Household income", as used in this Section, means the
combined income of the members of a household for the calendar
year preceding the taxable year.
"Income", as used in this Section, has the same meaning as
provided in Section 3.07 of the Senior Citizens and Disabled
Persons Property Tax Relief and Pharmaceutical Assistance Act,
except that "income" does not include veteran's benefits.
(g) In a cooperative where a homestead exemption has been
granted, the cooperative association or its management firm
shall credit the savings resulting from that exemption only to
the apportioned tax liability of the owner who qualified for
the exemption. Any person who willfully refuses to so credit
the savings shall be guilty of a Class B misdemeanor.
(h) Where married persons maintain and reside in separate
residences qualifying as homestead property, each residence
shall receive 50% of the total reduction in equalized assessed

HB0027 - 69 - LRB098 00027 KTG 30027 b
valuation provided by this Section.
(i) In all counties, the assessor or chief county
assessment officer may determine the eligibility of
residential property to receive the homestead exemption and the
amount of the exemption by application, visual inspection,
questionnaire or other reasonable methods. The determination
shall be made in accordance with guidelines established by the
Department, provided that the taxpayer applying for an
additional general exemption under this Section shall submit to
the chief county assessment officer an application with an
affidavit of the applicant's total household income, age,
marital status (and, if married, the name and address of the
applicant's spouse, if known), and principal dwelling place of
members of the household on January 1 of the taxable year. The
Department shall issue guidelines establishing a method for
verifying the accuracy of the affidavits filed by applicants
under this paragraph. The applications shall be clearly marked
as applications for the Additional General Homestead
Exemption.
(j) In counties with fewer than 3,000,000 inhabitants, in
the event of a sale of homestead property the homestead
exemption shall remain in effect for the remainder of the
assessment year of the sale. The assessor or chief county
assessment officer may require the new owner of the property to
apply for the homestead exemption for the following assessment
year.

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(k) Notwithstanding Sections 6 and 8 of the State Mandates
Act, no reimbursement by the State is required for the
implementation of any mandate created by this Section.
(Source: P.A. 97-689, eff. 6-14-12; 97-1125, eff. 8-28-12;
revised 9-20-12.)
(35 ILCS 200/20-15)
Sec. 20-15. Information on bill or separate statement.
There shall be printed on each bill, or on a separate slip
which shall be mailed with the bill:
(a) a statement itemizing the rate at which taxes have
been extended for each of the taxing districts in the
county in whose district the property is located, and in
those counties utilizing electronic data processing
equipment the dollar amount of tax due from the person
assessed allocable to each of those taxing districts,
including a separate statement of the dollar amount of tax
due which is allocable to a tax levied under the Illinois
Local Library Act or to any other tax levied by a
municipality or township for public library purposes,
(b) a separate statement for each of the taxing
districts of the dollar amount of tax due which is
allocable to a tax levied under the Illinois Pension Code
or to any other tax levied by a municipality or township
for public pension or retirement purposes,
(c) the total tax rate,

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(d) the total amount of tax due, and
(e) the amount by which the total tax and the tax
allocable to each taxing district differs from the
taxpayer's last prior tax bill.
The county treasurer shall ensure that only those taxing
districts in which a parcel of property is located shall be
listed on the bill for that property.
In all counties the statement shall also provide:
(1) the property index number or other suitable
description,
(2) the assessment of the property,
(3) the equalization factors imposed by the county and
by the Department, and
(4) the equalized assessment resulting from the
application of the equalization factors to the basic
assessment.
In all counties which do not classify property for purposes
of taxation, for property on which a single family residence is
situated the statement shall also include a statement to
reflect the fair cash value determined for the property. In all
counties which classify property for purposes of taxation in
accordance with Section 4 of Article IX of the Illinois
Constitution, for parcels of residential property in the lowest
assessment classification the statement shall also include a
statement to reflect the fair cash value determined for the
property.

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In all counties, the statement must include information
that certain taxpayers may be eligible for tax exemptions,
abatements, and other assistance programs and that, for more
information, taxpayers should consult with the office of their
township or county assessor and with the Illinois Department of
Revenue.
In all counties, the statement shall include information
that certain taxpayers may be eligible for the Senior Citizens
and Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act and that applications are available from the
Illinois Department on Aging.
In counties which use the estimated or accelerated billing
methods, these statements shall only be provided with the final
installment of taxes due. The provisions of this Section create
a mandatory statutory duty. They are not merely directory or
discretionary. The failure or neglect of the collector to mail
the bill, or the failure of the taxpayer to receive the bill,
shall not affect the validity of any tax, or the liability for
the payment of any tax.
(Source: P.A. 97-689, eff. 6-14-12.)
(35 ILCS 200/21-27)
Sec. 21-27. Waiver of interest penalty.
(a) On the recommendation of the county treasurer, the
county board may adopt a resolution under which an interest
penalty for the delinquent payment of taxes for any year that

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otherwise would be imposed under Section 21-15, 21-20, or 21-25
shall be waived in the case of any person who meets all of the
following criteria:
(1) The person is determined eligible for a grant under
the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act with respect to
the taxes for that year.
(2) The person requests, in writing, on a form approved
by the county treasurer, a waiver of the interest penalty,
and the request is filed with the county treasurer on or
before the first day of the month that an installment of
taxes is due.
(3) The person pays the installment of taxes due, in
full, on or before the third day of the month that the
installment is due.
(4) The county treasurer approves the request for a
waiver.
(b) With respect to property that qualifies as a brownfield
site under Section 58.2 of the Environmental Protection Act,
the county board, upon the recommendation of the county
treasurer, may adopt a resolution to waive an interest penalty
for the delinquent payment of taxes for any year that otherwise
would be imposed under Section 21-15, 21-20, or 21-25 if all of
the following criteria are met:
(1) the property has delinquent taxes and an
outstanding interest penalty and the amount of that

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interest penalty is so large as to, possibly, result in all
of the taxes becoming uncollectible;
(2) the property is part of a redevelopment plan of a
unit of local government and that unit of local government
does not oppose the waiver of the interest penalty;
(3) the redevelopment of the property will benefit the
public interest by remediating the brownfield
contamination;
(4) the taxpayer delivers to the county treasurer (i) a
written request for a waiver of the interest penalty, on a
form approved by the county treasurer, and (ii) a copy of
the redevelopment plan for the property;
(5) the taxpayer pays, in full, the amount of up to the
amount of the first 2 installments of taxes due, to be held
in escrow pending the approval of the waiver, and enters
into an agreement with the county treasurer setting forth a
schedule for the payment of any remaining taxes due; and
(6) the county treasurer approves the request for a
waiver.
(Source: P.A. 97-655, eff. 1-13-12; 97-689, eff. 6-14-12.)
Section 2-28. The Mobile Home Local Services Tax Act is
amended by changing Section 7 as follows:
(35 ILCS 515/7) (from Ch. 120, par. 1207)
Sec. 7. The local services tax for owners of mobile homes

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who (a) are actually residing in such mobile homes, (b) hold
title to such mobile home as provided in the Illinois Vehicle
Code, and (c) are 65 years of age or older or are disabled
persons within the meaning of Section 3.14 of the "Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act" on the annual billing date shall
be reduced to 80 percent of the tax provided for in Section 3
of this Act. Proof that a claimant has been issued an Illinois
Person with a Disability Identification Card stating that the
claimant is under a Class 2 disability, as provided in Section
4A of the Illinois Identification Card Act, shall constitute
proof that the person thereon named is a disabled person within
the meaning of this Act. An application for reduction of the
tax shall be filed with the county clerk by the individuals who
are entitled to the reduction. If the application is filed
after May 1, the reduction in tax shall begin with the next
annual bill. Application for the reduction in tax shall be done
by submitting proof that the applicant has been issued an
Illinois Person with a Disability Identification Card
designating the applicant's disability as a Class 2 disability,
or by affidavit in substantially the following form:
APPLICATION FOR REDUCTION OF MOBILE HOME LOCAL SERVICES TAX
I hereby make application for a reduction to 80% of the
total tax imposed under "An Act to provide for a local services
tax on mobile homes".
(1) Senior Citizens

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(a) I actually reside in the mobile home ....
(b) I hold title to the mobile home as provided in the
Illinois Vehicle Code ....
(c) I reached the age of 65 on or before either January 1
(or July 1) of the year in which this statement is filed. My
date of birth is: ...
(2) Disabled Persons
(a) I actually reside in the mobile home...
(b) I hold title to the mobile home as provided in the
Illinois Vehicle Code ....
(c) I was totally disabled on ... and have remained
disabled until the date of this application. My Social
Security, Veterans, Railroad or Civil Service Total Disability
Claim Number is ... The undersigned declares under the penalty
of perjury that the above statements are true and correct.
Dated (insert date).
...........................
Signature of owner
...........................
(Address)
...........................
(City) (State) (Zip)
Approved by:
.............................
(Assessor)

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This application shall be accompanied by a copy of the
applicant's most recent application filed with the Illinois
Department on Aging under the Senior Citizens and Disabled
Persons Property Tax Relief Act.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12;
97-1064, eff. 1-1-13; revised 9-20-12.)
Section 2-29. The Metropolitan Transit Authority Act is
amended by changing Sections 51 and 52 as follows:
(70 ILCS 3605/51)
Sec. 51. Free services; eligibility.
(a) Notwithstanding any law to the contrary, no later than
60 days following the effective date of this amendatory Act of
the 95th General Assembly and until subsection (b) is
implemented, any fixed route public transportation services
provided by, or under grant or purchase of service contracts
of, the Board shall be provided without charge to all senior
citizens of the Metropolitan Region (as such term is defined in
70 ILCS 3615/1.03) aged 65 and older, under such conditions as
shall be prescribed by the Board.
(b) Notwithstanding any law to the contrary, no later than
180 days following the effective date of this amendatory Act of
the 96th General Assembly, any fixed route public
transportation services provided by, or under grant or purchase
of service contracts of, the Board shall be provided without

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charge to senior citizens aged 65 and older who meet the income
eligibility limitation set forth in subsection (a-5) of Section
4 of the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act, under such
conditions as shall be prescribed by the Board. The Department
on Aging shall furnish all information reasonably necessary to
determine eligibility, including updated lists of individuals
who are eligible for services without charge under this
Section. Nothing in this Section shall relieve the Board from
providing reduced fares as may be required by federal law.
(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
(70 ILCS 3605/52)
Sec. 52. Transit services for disabled individuals.
Notwithstanding any law to the contrary, no later than 60 days
following the effective date of this amendatory Act of the 95th
General Assembly, all fixed route public transportation
services provided by, or under grant or purchase of service
contract of, the Board shall be provided without charge to all
disabled persons who meet the income eligibility limitation set
forth in subsection (a-5) of Section 4 of the Senior Citizens
and Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act, under such procedures as shall be prescribed by
the Board. The Department on Aging shall furnish all
information reasonably necessary to determine eligibility,
including updated lists of individuals who are eligible for

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services without charge under this Section.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-30. The Local Mass Transit District Act is
amended by changing Sections 8.6 and 8.7 as follows:
(70 ILCS 3610/8.6)
Sec. 8.6. Free services; eligibility.
(a) Notwithstanding any law to the contrary, no later than
60 days following the effective date of this amendatory Act of
the 95th General Assembly and until subsection (b) is
implemented, any fixed route public transportation services
provided by, or under grant or purchase of service contracts
of, every District shall be provided without charge to all
senior citizens of the District aged 65 and older, under such
conditions as shall be prescribed by the District.
(b) Notwithstanding any law to the contrary, no later than
180 days following the effective date of this amendatory Act of
the 96th General Assembly, any fixed route public
transportation services provided by, or under grant or purchase
of service contracts of, every District shall be provided
without charge to senior citizens aged 65 and older who meet
the income eligibility limitation set forth in subsection (a-5)
of Section 4 of the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act, under
such conditions as shall be prescribed by the District. The

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Department on Aging shall furnish all information reasonably
necessary to determine eligibility, including updated lists of
individuals who are eligible for services without charge under
this Section. Nothing in this Section shall relieve the
District from providing reduced fares as may be required by
federal law.
(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
(70 ILCS 3610/8.7)
Sec. 8.7. Transit services for disabled individuals.
Notwithstanding any law to the contrary, no later than 60 days
following the effective date of this amendatory Act of the 95th
General Assembly, all fixed route public transportation
services provided by, or under grant or purchase of service
contract of, any District shall be provided without charge to
all disabled persons who meet the income eligibility limitation
set forth in subsection (a-5) of Section 4 of the Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, under such procedures as shall
be prescribed by the District. The Department on Aging shall
furnish all information reasonably necessary to determine
eligibility, including updated lists of individuals who are
eligible for services without charge under this Section.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-31. The Regional Transportation Authority Act is

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amended by changing Sections 3A.15, 3A.16, 3B.14, and 3B.15 as
follows:
(70 ILCS 3615/3A.15)
Sec. 3A.15. Free services; eligibility.
(a) Notwithstanding any law to the contrary, no later than
60 days following the effective date of this amendatory Act of
the 95th General Assembly and until subsection (b) is
implemented, any fixed route public transportation services
provided by, or under grant or purchase of service contracts
of, the Suburban Bus Board shall be provided without charge to
all senior citizens of the Metropolitan Region aged 65 and
older, under such conditions as shall be prescribed by the
Suburban Bus Board.
(b) Notwithstanding any law to the contrary, no later than
180 days following the effective date of this amendatory Act of
the 96th General Assembly, any fixed route public
transportation services provided by, or under grant or purchase
of service contracts of, the Suburban Bus Board shall be
provided without charge to senior citizens aged 65 and older
who meet the income eligibility limitation set forth in
subsection (a-5) of Section 4 of the Senior Citizens and
Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act, under such conditions as shall be prescribed by
the Suburban Bus Board. The Department on Aging shall furnish
all information reasonably necessary to determine eligibility,

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including updated lists of individuals who are eligible for
services without charge under this Section. Nothing in this
Section shall relieve the Suburban Bus Board from providing
reduced fares as may be required by federal law.
(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
(70 ILCS 3615/3A.16)
Sec. 3A.16. Transit services for disabled individuals.
Notwithstanding any law to the contrary, no later than 60 days
following the effective date of this amendatory Act of the 95th
General Assembly, all fixed route public transportation
services provided by, or under grant or purchase of service
contract of, the Suburban Bus Board shall be provided without
charge to all disabled persons who meet the income eligibility
limitation set forth in subsection (a-5) of Section 4 of the
Senior Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, under such procedures as shall
be prescribed by the Board. The Department on Aging shall
furnish all information reasonably necessary to determine
eligibility, including updated lists of individuals who are
eligible for services without charge under this Section.
(Source: P.A. 97-689, eff. 6-14-12.)
(70 ILCS 3615/3B.14)
Sec. 3B.14. Free services; eligibility.
(a) Notwithstanding any law to the contrary, no later than

HB0027 - 83 - LRB098 00027 KTG 30027 b
60 days following the effective date of this amendatory Act of
the 95th General Assembly and until subsection (b) is
implemented, any fixed route public transportation services
provided by, or under grant or purchase of service contracts
of, the Commuter Rail Board shall be provided without charge to
all senior citizens of the Metropolitan Region aged 65 and
older, under such conditions as shall be prescribed by the
Commuter Rail Board.
(b) Notwithstanding any law to the contrary, no later than
180 days following the effective date of this amendatory Act of
the 96th General Assembly, any fixed route public
transportation services provided by, or under grant or purchase
of service contracts of, the Commuter Rail Board shall be
provided without charge to senior citizens aged 65 and older
who meet the income eligibility limitation set forth in
subsection (a-5) of Section 4 of the Senior Citizens and
Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act, under such conditions as shall be prescribed by
the Commuter Rail Board. The Department on Aging shall furnish
all information reasonably necessary to determine eligibility,
including updated lists of individuals who are eligible for
services without charge under this Section. Nothing in this
Section shall relieve the Commuter Rail Board from providing
reduced fares as may be required by federal law.
(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)

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(70 ILCS 3615/3B.15)
Sec. 3B.15. Transit services for disabled individuals.
Notwithstanding any law to the contrary, no later than 60 days
following the effective date of this amendatory Act of the 95th
General Assembly, all fixed route public transportation
services provided by, or under grant or purchase of service
contract of, the Commuter Rail Board shall be provided without
charge to all disabled persons who meet the income eligibility
limitation set forth in subsection (a-5) of Section 4 of the
Senior Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, under such procedures as shall
be prescribed by the Board. The Department on Aging shall
furnish all information reasonably necessary to determine
eligibility, including updated lists of individuals who are
eligible for services without charge under this Section.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-32. The Senior Citizen Courses Act is amended by
changing Section 1 as follows:
(110 ILCS 990/1) (from Ch. 144, par. 1801)
Sec. 1. Definitions. For the purposes of this Act:
(a) "Public institutions of higher education" means the
University of Illinois, Southern Illinois University, Chicago
State University, Eastern Illinois University, Governors State
University, Illinois State University, Northeastern Illinois

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University, Northern Illinois University, Western Illinois
University, and the public community colleges subject to the
"Public Community College Act".
(b) "Credit Course" means any program of study for which
public institutions of higher education award credit hours.
(c) "Senior citizen" means any person 65 years or older
whose annual household income is less than the threshold amount
provided in Section 4 of the "Senior Citizens and Disabled
Persons Property Tax Relief and Pharmaceutical Assistance
Act", approved July 17, 1972, as amended.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-45. The Nursing Home Care Act is amended by
changing Section 3-202.05 as follows:
(210 ILCS 45/3-202.05)
Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
thereafter.
(a) For the purpose of computing staff to resident ratios,
direct care staff shall include:
(1) registered nurses;
(2) licensed practical nurses;
(3) certified nurse assistants;
(4) psychiatric services rehabilitation aides;
(5) rehabilitation and therapy aides;
(6) psychiatric services rehabilitation coordinators;

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(7) assistant directors of nursing;
(8) 50% of the Director of Nurses' time; and
(9) 30% of the Social Services Directors' time.
The Department shall, by rule, allow certain facilities
subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
S) and 300.6000 and following (Subpart T) to utilize
specialized clinical staff, as defined in rules, to count
towards the staffing ratios.
Within 120 days of the effective date of this amendatory
Act of the 97th General Assembly, the Department shall
promulgate rules specific to the staffing requirements for
facilities federally defined as Institutions for Mental
Disease. These rules shall recognize the unique nature of
individuals with chronic mental health conditions, shall
include minimum requirements for specialized clinical staff,
including clinical social workers, psychiatrists,
psychologists, and direct care staff set forth in paragraphs
(4) through (6) and any other specialized staff which may be
utilized and deemed necessary to count toward staffing ratios.
Within 120 days of the effective date of this amendatory
Act of the 97th General Assembly, the Department shall
promulgate rules specific to the staffing requirements for
facilities licensed under the Specialized Mental Health
Rehabilitation Act. These rules shall recognize the unique
nature of individuals with chronic mental health conditions,
shall include minimum requirements for specialized clinical

HB0027 - 87 - LRB098 00027 KTG 30027 b
staff, including clinical social workers, psychiatrists,
psychologists, and direct care staff set forth in paragraphs
(4) through (6) and any other specialized staff which may be
utilized and deemed necessary to count toward staffing ratios.
(b) Beginning January 1, 2011, and thereafter, light
intermediate care shall be staffed at the same staffing ratio
as intermediate care.
(c) Facilities shall notify the Department within 60 days
after the effective date of this amendatory Act of the 96th
General Assembly, in a form and manner prescribed by the
Department, of the staffing ratios in effect on the effective
date of this amendatory Act of the 96th General Assembly for
both intermediate and skilled care and the number of residents
receiving each level of care.
(d)(1) Effective July 1, 2010, for each resident needing
skilled care, a minimum staffing ratio of 2.5 hours of nursing
and personal care each day must be provided; for each resident
needing intermediate care, 1.7 hours of nursing and personal
care each day must be provided.
(2) Effective January 1, 2011, the minimum staffing ratios
shall be increased to 2.7 hours of nursing and personal care
each day for a resident needing skilled care and 1.9 hours of
nursing and personal care each day for a resident needing
intermediate care.
(3) Effective January 1, 2012, the minimum staffing ratios
shall be increased to 3.0 hours of nursing and personal care

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each day for a resident needing skilled care and 2.1 hours of
nursing and personal care each day for a resident needing
intermediate care.
(4) Effective January 1, 2013, the minimum staffing ratios
shall be increased to 3.4 hours of nursing and personal care
each day for a resident needing skilled care and 2.3 hours of
nursing and personal care each day for a resident needing
intermediate care.
(5) Effective January 1, 2014, the minimum staffing ratios
shall be increased to 3.8 hours of nursing and personal care
each day for a resident needing skilled care and 2.5 hours of
nursing and personal care each day for a resident needing
intermediate care.
(e) (Blank). Ninety days after the effective date of this
amendatory Act of the 97th General Assembly, a minimum of 25%
of nursing and personal care time shall be provided by licensed
nurses, with at least 10% of nursing and personal care time
provided by registered nurses. These minimum requirements
shall remain in effect until an acuity based registered nurse
requirement is promulgated by rule concurrent with the adoption
of the Resource Utilization Group classification-based payment
methodology, as provided in Section 5-5.2 of the Illinois
Public Aid Code. Registered nurses and licensed practical
nurses employed by a facility in excess of these requirements
may be used to satisfy the remaining 75% of the nursing and
personal care time requirements. Notwithstanding this

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subsection, no staffing requirement in statute in effect on the
effective date of this amendatory Act of the 97th General
Assembly shall be reduced on account of this subsection.
(Source: P.A. 96-1372, eff. 7-29-10; 96-1504, eff. 1-27-11;
97-689, eff. 6-14-12.)
Section 2-50. The Emergency Medical Services (EMS) Systems
Act is amended by changing Section 3.86 as follows:
(210 ILCS 50/3.86)
Sec. 3.86. Stretcher van providers.
(a) In this Section, "stretcher van provider" means an
entity licensed by the Department to provide non-emergency
transportation of passengers on a stretcher in compliance with
this Act or the rules adopted by the Department pursuant to
this Act, utilizing stretcher vans.
(b) The Department has the authority and responsibility to
do the following:
(1) Require all stretcher van providers, both publicly
and privately owned, to be licensed by the Department.
(2) Establish licensing and safety standards and
requirements for stretcher van providers, through rules
adopted pursuant to this Act, including but not limited to:
(A) Vehicle design, specification, operation, and
maintenance standards.
(B) Safety equipment requirements and standards.

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(C) Staffing requirements.
(D) Annual license renewal.
(3) License all stretcher van providers that have met
the Department's requirements for licensure.
(4) Annually inspect all licensed stretcher van
providers, and relicense providers that have met the
Department's requirements for license renewal.
(5) Suspend, revoke, refuse to issue, or refuse to
renew the license of any stretcher van provider, or that
portion of a license pertaining to a specific vehicle
operated by a provider, after an opportunity for a hearing,
when findings show that the provider or one or more of its
vehicles has failed to comply with the standards and
requirements of this Act or the rules adopted by the
Department pursuant to this Act.
(6) Issue an emergency suspension order for any
provider or vehicle licensed under this Act when the
Director or his or her designee has determined that an
immediate or serious danger to the public health, safety,
and welfare exists. Suspension or revocation proceedings
that offer an opportunity for a hearing shall be promptly
initiated after the emergency suspension order has been
issued.
(7) Prohibit any stretcher van provider from
advertising, identifying its vehicles, or disseminating
information in a false or misleading manner concerning the

HB0027 - 91 - LRB098 00027 KTG 30027 b
provider's type and level of vehicles, location, response
times, level of personnel, licensure status, or EMS System
participation.
(8) Charge each stretcher van provider a fee, to be
submitted with each application for licensure and license
renewal.
(c) A stretcher van provider may provide transport of a
passenger on a stretcher, provided the passenger meets all of
the following requirements:
(1) He or she needs no medical equipment, except
self-administered medications. (Blank).
(2) He or she needs no medical monitoring or medical
observation clinical observation.
(3) He or she needs routine transportation to or from a
medical appointment or service if the passenger is
convalescent or otherwise bed-confined and does not
require medical monitoring clinical observation, aid,
care, or treatment during transport.
(d) A stretcher van provider may not transport a passenger
who meets any of the following conditions:
(1) He or she is currently admitted to a hospital or is
being transported to a hospital for admission or emergency
treatment. He or she is being transported to a hospital for
emergency medical treatment.
(2) He or she is acutely ill, wounded, or medically

HB0027 - 92 - LRB098 00027 KTG 30027 b
unstable as determined by a licensed physician. He or she
is experiencing an emergency medical condition or needs
active medical monitoring, including isolation
precautions, supplemental oxygen that is not
self-administered, continuous airway management,
suctioning during transport, or the administration of
intravenous fluids during transport.
(3) He or she is experiencing an emergency medical
condition, an acute medical condition, an exacerbation of a
chronic medical condition, or a sudden illness or injury.
(4) He or she was administered a medication that might
prevent the passenger from caring for himself or herself.
(5) He or she was moved from one environment where
24-hour medical monitoring or medical observation will
take place by certified or licensed nursing personnel to
another such environment. Such environments shall include,
but not be limited to, hospitals licensed under the
Hospital Licensing Act or operated under the University of
Illinois Hospital Act, and nursing facilities licensed
under the Nursing Home Care Act.
(e) The Stretcher Van Licensure Fund is created as a
special fund within the State treasury. All fees received by
the Department in connection with the licensure of stretcher
van providers under this Section shall be deposited into the
fund. Moneys in the fund shall be subject to appropriation to
the Department for use in implementing this Section.

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(Source: P.A. 96-702, eff. 8-25-09; 96-1469, eff. 1-1-11;
97-689, eff. 6-14-12.)
Section 2-53. The Long Term Acute Care Hospital Quality
Improvement Transfer Program Act is amended by changing
Sections 35, 40, and 45 as follows:
(210 ILCS 155/35)
Sec. 35. LTAC supplemental per diem rate.
(a) The Department must pay an LTAC supplemental per diem
rate calculated under this Section to LTAC hospitals that meet
the requirements of Section 15 of this Act for patients:
(1) who upon admission to the LTAC hospital meet LTAC
hospital criteria; and
(2) whose care is primarily paid for by the Department
under Title XIX of the Social Security Act or whose care is
primarily paid for by the Department after the patient has
exhausted his or her benefits under Medicare.
(b) The Department must not pay the LTAC supplemental per
diem rate calculated under this Section if any of the following
conditions are met:
(1) the LTAC hospital no longer meets the requirements
under Section 15 of this Act or terminates the agreement
specified under Section 15 of this Act;
(2) the patient does not meet the LTAC hospital
criteria upon admission; or

HB0027 - 94 - LRB098 00027 KTG 30027 b
(3) the patient's care is primarily paid for by
Medicare and the patient has not exhausted his or her
Medicare benefits, resulting in the Department becoming
the primary payer.
(c) The Department may adjust the LTAC supplemental per
diem rate calculated under this Section based only on the
conditions and requirements described under Section 40 and
Section 45 of this Act.
(d) The LTAC supplemental per diem rate shall be calculated
using the LTAC hospital's inflated cost per diem, defined in
subsection (f) of this Section, and subtracting the following:
(1) The LTAC hospital's Medicaid per diem inpatient
rate as calculated under 89 Ill. Adm. Code 148.270(c)(4).
(2) The LTAC hospital's disproportionate share (DSH)
rate as calculated under 89 Ill. Adm. Code 148.120.
(3) The LTAC hospital's Medicaid Percentage Adjustment
(MPA) rate as calculated under 89 Ill. Adm. Code 148.122.
(4) The LTAC hospital's Medicaid High Volume
Adjustment (MHVA) rate as calculated under 89 Ill. Adm.
Code 148.290(d).
(e) LTAC supplemental per diem rates are effective for 12
months beginning on October 1 of each year and must be updated
every 12 months July 1, 2012 shall be the amount in effect as
of October 1, 2010. No new hospital may qualify for the program
after the effective date of this amendatory Act of the 97th
General Assembly.

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(f) For the purposes of this Section, "inflated cost per
diem" means the quotient resulting from dividing the hospital's
inpatient Medicaid costs by the hospital's Medicaid inpatient
days and inflating it to the most current period using
methodologies consistent with the calculation of the rates
described in paragraphs (2), (3), and (4) of subsection (d).
The data is obtained from the LTAC hospital's most recent cost
report submitted to the Department as mandated under 89 Ill.
Adm. Code 148.210.
(g) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Act or
the Illinois Public Aid Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code.
(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)
(210 ILCS 155/40)
Sec. 40. Rate adjustments for quality measures.
(a) The Department may adjust the LTAC supplemental per
diem rate calculated under Section 35 of this Act based on the
requirements of this Section.
(b) After the first year of operation of the Program
established by this Act, the Department may reduce the LTAC
supplemental per diem rate calculated under Section 35 of this
Act by no more than 5% for an LTAC hospital that does not meet

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benchmarks or targets set by the Department under paragraph (2)
of subsection (b) of Section 50.
(c) After the first year of operation of the Program
established by this Act, the Department may increase the LTAC
supplemental per diem rate calculated under Section 35 of this
Act by no more than 5% for an LTAC hospital that exceeds the
benchmarks or targets set by the Department under paragraph (2)
of subsection (a) of Section 50.
(d) If an LTAC hospital misses a majority of the benchmarks
for quality measures for 3 consecutive years, the Department
may reduce the LTAC supplemental per diem rate calculated under
Section 35 of this Act to zero.
(e) An LTAC hospital whose rate is reduced under subsection
(d) of this Section may have the LTAC supplemental per diem
rate calculated under Section 35 of this Act reinstated once
the LTAC hospital achieves the necessary benchmarks or targets.
(f) The Department may apply the reduction described in
subsection (d) of this Section after one year instead of 3 to
an LTAC hospital that has had its rate previously reduced under
subsection (d) of this Section and later has had it reinstated
under subsection (e) of this Section.
(g) The rate adjustments described in this Section shall be
determined and applied only at the beginning of each rate year.
(h) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Act or

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the Illinois Public Aid Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code.
(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)
(210 ILCS 155/45)
Sec. 45. Program evaluation.
(a) After the Program completes the 3rd full year of
operation on September 30, 2013 By September 30, 2012, the
Department must complete an evaluation of the Program to
determine the actual savings or costs generated by the Program,
both on an aggregate basis and on an LTAC hospital-specific
basis. The evaluation must be conducted in each subsequent
year.
(b) The Department and shall consult with qualified LTAC
hospitals must to determine the appropriate methodology to
accurately calculate the Program's savings and costs. The
calculation shall take into consideration, but shall not be
limited to, the length of stay in an acute care hospital prior
to transfer, the length of stay in the LTAC taking into account
the acuity of the patient at the time of the LTAC admission,
and admissions to the LTAC from settings other than an STAC
hospital.
(c) The evaluation must also determine the effects the
Program has had in improving patient satisfaction and health
outcomes.

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(d) If the evaluation indicates that the Program generates
a net cost to the Department, the Department may prospectively
adjust an individual hospital's LTAC supplemental per diem rate
under Section 35 of this Act to establish cost neutrality. The
rate adjustments applied under this subsection (d) do not need
to be applied uniformly to all qualified LTAC hospitals as long
as the adjustments are based on data from the evaluation on
hospital-specific information. Cost neutrality under this
Section means that the cost to the Department resulting from
the LTAC supplemental per diem rate must not exceed the savings
generated from transferring the patient from a STAC hospital.
(e) The rate adjustment described in subsection (d) of this
Section, if necessary, shall be applied to the LTAC
supplemental per diem rate for the rate year beginning October
1, 2014. The Department may apply this rate adjustment in
subsequent rate years if the conditions under subsection (d) of
this Section are met. The Department must apply the rate
adjustment to an individual LTAC hospital's LTAC supplemental
per diem rate only in years when the Program evaluation
indicates a net cost for the Department.
(f) The rate adjustments described in this Section shall be
determined and applied only at the beginning of each rate year.
The Department may establish a shared savings program for
qualified LTAC hospitals.
(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)

HB0027 - 99 - LRB098 00027 KTG 30027 b
(210 ILCS 155/55 rep.)
Section 2-54. The Long Term Acute Care Hospital Quality
Improvement Transfer Program Act is amended by repealing
Section 55.
Section 2-65. The Children's Health Insurance Program Act
is amended by changing Sections 25 and 40 as follows:
(215 ILCS 106/25)
Sec. 25. Health benefits for children.
(a) The Department shall, subject to appropriation,
provide health benefits coverage to eligible children by:
(1) Subsidizing the cost of privately sponsored health
insurance, including employer based health insurance, to
assist families to take advantage of available privately
sponsored health insurance for their eligible children;
and
(2) Purchasing or providing health care benefits for
eligible children. The health benefits provided under this
subdivision (a)(2) shall, subject to appropriation and
without regard to any applicable cost sharing under Section
30, be identical to the benefits provided for children
under the State's approved plan under Title XIX of the
Social Security Act. Providers under this subdivision
(a)(2) shall be subject to approval by the Department to
provide health care under the Illinois Public Aid Code and

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shall be reimbursed at the same rate as providers under the
State's approved plan under Title XIX of the Social
Security Act. In addition, providers may retain
co-payments when determined appropriate by the Department.
(b) The subsidization provided pursuant to subdivision
(a)(1) shall be credited to the family of the eligible child.
(c) The Department is prohibited from denying coverage to a
child who is enrolled in a privately sponsored health insurance
plan pursuant to subdivision (a)(1) because the plan does not
meet federal benchmarking standards or cost sharing and
contribution requirements. To be eligible for inclusion in the
Program, the plan shall contain comprehensive major medical
coverage which shall consist of physician and hospital
inpatient services. The Department is prohibited from denying
coverage to a child who is enrolled in a privately sponsored
health insurance plan pursuant to subdivision (a)(1) because
the plan offers benefits in addition to physician and hospital
inpatient services.
(d) The total dollar amount of subsidizing coverage per
child per month pursuant to subdivision (a)(1) shall be equal
to the average dollar payments, less premiums incurred, per
child per month pursuant to subdivision (a)(2). The Department
shall set this amount prospectively based upon the prior fiscal
year's experience adjusted for incurred but not reported claims
and estimated increases or decreases in the cost of medical
care. Payments obligated before July 1, 1999, will be computed

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using State Fiscal Year 1996 payments for children eligible for
Medical Assistance and income assistance under the Aid to
Families with Dependent Children Program, with appropriate
adjustments for cost and utilization changes through January 1,
1999. The Department is prohibited from providing a subsidy
pursuant to subdivision (a)(1) that is more than the
individual's monthly portion of the premium.
(e) An eligible child may obtain immediate coverage under
this Program only once during a medical visit. If coverage
lapses, re-enrollment shall be completed in advance of the next
covered medical visit and the first month's required premium
shall be paid in advance of any covered medical visit.
(f) In order to accelerate and facilitate the development
of networks to deliver services to children in areas outside
counties with populations in excess of 3,000,000, in the event
less than 25% of the eligible children in a county or
contiguous counties has enrolled with a Health Maintenance
Organization pursuant to Section 5-11 of the Illinois Public
Aid Code, the Department may develop and implement
demonstration projects to create alternative networks designed
to enhance enrollment and participation in the program. The
Department shall prescribe by rule the criteria, standards, and
procedures for effecting demonstration projects under this
Section.
(g) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other

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payments or alter any methodologies authorized by this Act or
the Illinois Public Aid Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code.
(Source: P.A. 97-689, eff. 6-14-12.)
(215 ILCS 106/40)
Sec. 40. Waivers. (a) The Department shall request any
necessary waivers of federal requirements in order to allow
receipt of federal funding for: .
(1) the coverage of families with eligible children
under this Act; and
(2) the coverage of children who would otherwise be
eligible under this Act, but who have health insurance.
(b) The failure of the responsible federal agency to
approve a waiver for children who would otherwise be eligible
under this Act but who have health insurance shall not prevent
the implementation of any Section of this Act provided that
there are sufficient appropriated funds.
(c) Eligibility of a person under an approved waiver due to
the relationship with a child pursuant to Article V of the
Illinois Public Aid Code or this Act shall be limited to such a
person whose countable income is determined by the Department
to be at or below such income eligibility standard as the
Department by rule shall establish. The income level
established by the Department shall not be below 90% of the

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federal poverty level. Such persons who are determined to be
eligible must reapply, or otherwise establish eligibility, at
least annually. An eligible person shall be required, as
determined by the Department by rule, to report promptly those
changes in income and other circumstances that affect
eligibility. The eligibility of a person may be redetermined
based on the information reported or may be terminated based on
the failure to report or failure to report accurately. A person
may also be held liable to the Department for any payments made
by the Department on such person's behalf that were
inappropriate. An applicant shall be provided with notice of
these obligations.
(Source: P.A. 96-328, eff. 8-11-09; 97-689, eff. 6-14-12.)
Section 2-70. The Covering ALL KIDS Health Insurance Act is
amended by changing Sections 30 and 35 as follows:
(215 ILCS 170/30)
(Section scheduled to be repealed on July 1, 2016)
Sec. 30. Program outreach and marketing. The Department may
provide grants to application agents and other community-based
organizations to educate the public about the availability of
the Program. The Department shall adopt rules regarding
performance standards and outcomes measures expected of
organizations that are awarded grants under this Section,
including penalties for nonperformance of contract standards.

HB0027 - 104 - LRB098 00027 KTG 30027 b
The Department shall annually publish electronically on a
State website and in no less than 2 newspapers in the State the
premiums or other cost sharing requirements of the Program.
(Source: P.A. 97-689, eff. 6-14-12.)
(215 ILCS 170/35)
(Section scheduled to be repealed on July 1, 2016)
Sec. 35. Health care benefits for children.
(a) The Department shall purchase or provide health care
benefits for eligible children that are identical to the
benefits provided for children under the Illinois Children's
Health Insurance Program Act, except for non-emergency
transportation.
(b) As an alternative to the benefits set forth in
subsection (a), and when cost-effective, the Department may
offer families subsidies toward the cost of privately sponsored
health insurance, including employer-sponsored health
insurance.
(c) Notwithstanding clause (i) of subdivision (a)(3) of
Section 20, the Department may consider offering, as an
alternative to the benefits set forth in subsection (a),
partial coverage to children who are enrolled in a
high-deductible private health insurance plan.
(d) Notwithstanding clause (i) of subdivision (a)(3) of
Section 20, the Department may consider offering, as an
alternative to the benefits set forth in subsection (a), a

HB0027 - 105 - LRB098 00027 KTG 30027 b
limited package of benefits to children in families who have
private or employer-sponsored health insurance that does not
cover certain benefits such as dental or vision benefits.
(e) The content and availability of benefits described in
subsections (b), (c), and (d), and the terms of eligibility for
those benefits, shall be at the Department's discretion and the
Department's determination of efficacy and cost-effectiveness
as a means of promoting retention of private or
employer-sponsored health insurance.
(f) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Act or
the Illinois Public Aid Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-71. The Citizens Utility Board Act is amended by
changing Section 9 as follows:
(220 ILCS 10/9) (from Ch. 111 2/3, par. 909)
Sec. 9. Mailing procedure.
(1) As used in this Section:
(a) "Enclosure" means a card, leaflet, envelope or
combination thereof furnished by the corporation under
this Section.

HB0027 - 106 - LRB098 00027 KTG 30027 b
(b) "Mailing" means any communication by a State
agency, other than a mailing made under the Senior Citizens
and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, that is sent through the
United States Postal Service to more than 50,000 persons
within a 12-month period.
(c) "State agency" means any officer, department,
board, commission, institution or entity of the executive
or legislative branches of State government.
(2) To accomplish its powers and duties under Section 5
this Act, the corporation, subject to the following
limitations, may prepare and furnish to any State agency an
enclosure to be included with a mailing by that agency.
(a) A State agency furnished with an enclosure shall
include the enclosure within the mailing designated by the
corporation.
(b) An enclosure furnished by the corporation under
this Section shall be provided to the State agency a
reasonable period of time in advance of the mailing.
(c) An enclosure furnished by the corporation under
this Section shall be limited to informing the reader of
the purpose, nature and activities of the corporation as
set forth in this Act and informing the reader that it may
become a member in the corporation, maintain membership in
the corporation and contribute money to the corporation
directly.

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(d) Prior to furnishing an enclosure to the State
agency, the corporation shall seek and obtain approval of
the content of the enclosure from the Illinois Commerce
Commission. The Commission shall approve the enclosure if
it determines that the enclosure (i) is not false or
misleading and (ii) satisfies the requirements of this Act.
The Commission shall be deemed to have approved the
enclosure unless it disapproves the enclosure within 14
days from the date of receipt.
(3) The corporation shall reimburse each State agency for
all reasonable incremental costs incurred by the State agency
in complying with this Section above the agency's normal
mailing and handling costs, provided that:
(a) The State agency shall first furnish the
corporation with an itemized accounting of such additional
cost; and
(b) The corporation shall not be required to reimburse
the State agency for postage costs if the weight of the
corporation's enclosure does not exceed .35 ounce
avoirdupois. If the corporation's enclosure exceeds that
weight, then it shall only be required to reimburse the
State agency for postage cost over and above what the
agency's postage cost would have been had the enclosure
weighed only .35 ounce avoirdupois.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)

HB0027 - 108 - LRB098 00027 KTG 30027 b
Section 2-75. The Illinois Public Aid Code is amended by
changing Sections 3-1.2, 3-5, 4-1.6, 4-2, 5-2, 5-4, 5-4.1,
5-4.2, 5-5, 5-5.02, 5-5.05, 5-5.2, 5-5.3, 5-5.4, 5-5.4e, 5-5.5,
5-5.8b, 5-5.12, 5-5.17, 5-5.20, 5-5.23, 5-5.24, 5-5.25,
5-16.7, 5-16.7a, 5-16.8, 5-16.9, 5-17, 5-19, 5-24, 5-30, 5A-1,
5A-2, 5A-3, 5A-4, 5A-5, 5A-6, 5A-8, 5A-10, 5A-12.2, 5A-14,
6-1.2, 6-2, 6-11, 11-13, 11-26, 12-4.25, 12-4.38, 12-4.39,
12-9, 12-10.5, 12-13.1, 14-8, and 15-1 and by adding Sections
5-5.4h and 5-5.4i as follows:
(305 ILCS 5/3-1.2) (from Ch. 23, par. 3-1.2)
Sec. 3-1.2. Need. Income available to the person, when
added to contributions in money, substance, or services from
other sources, including contributions from legally
responsible relatives, must be insufficient to equal the grant
amount established by Department regulation for such person.
In determining earned income to be taken into account,
consideration shall be given to any expenses reasonably
attributable to the earning of such income. If federal law or
regulations permit or require exemption of earned or other
income and resources, the Illinois Department shall provide by
rule and regulation that the amount of income to be disregarded
be increased (1) to the maximum extent so required and (2) to
the maximum extent permitted by federal law or regulation in
effect as of the date this Amendatory Act becomes law. The
Illinois Department may also provide by rule and regulation

HB0027 - 109 - LRB098 00027 KTG 30027 b
that the amount of resources to be disregarded be increased to
the maximum extent so permitted or required. Subject to federal
approval, resources (for example, land, buildings, equipment,
supplies, or tools), including farmland property and personal
property used in the income-producing operations related to the
farmland (for example, equipment and supplies, motor vehicles,
or tools), necessary for self-support, up to $6,000 of the
person's equity in the income-producing property, provided
that the property produces a net annual income of at least 6%
of the excluded equity value of the property, are exempt.
Equity value in excess of $6,000 shall not be excluded if the
activity produces income that is less than 6% of the exempt
equity due to reasons beyond the person's control (for example,
the person's illness or crop failure) and there is a reasonable
expectation that the property will again produce income equal
to or greater than 6% of the equity value (for example, a
medical prognosis that the person is expected to respond to
treatment or that drought-resistant corn will be planted). If
the person owns more than one piece of property and each
produces income, each piece of property shall be looked at to
determine whether the 6% rule is met, and then the amounts of
the person's equity in all of those properties shall be totaled
to determine whether the total equity is $6,000 or less. The
total equity value of all properties that is exempt shall be
limited to $6,000.
In determining the resources of an individual or any

HB0027 - 110 - LRB098 00027 KTG 30027 b
dependents, the Department shall exclude from consideration
the value of funeral and burial spaces, grave markers and other
funeral and burial merchandise, funeral and burial insurance
the proceeds of which can only be used to pay the funeral and
burial expenses of the insured and funds specifically set aside
for the funeral and burial arrangements of the individual or
his or her dependents, including prepaid funeral and burial
plans, to the same extent that such items are excluded from
consideration under the federal Supplemental Security Income
program (SSI).
Prepaid funeral or burial contracts are exempt to the
following extent:
(1) Funds in a revocable prepaid funeral or burial
contract are exempt up to $1,500, except that any portion
of a contract that clearly represents the purchase of
burial space, as that term is defined for purposes of the
Supplemental Security Income program, is exempt regardless
of value.
(2) Funds in an irrevocable prepaid funeral or burial
contract are exempt up to $5,874, except that any portion
of a contract that clearly represents the purchase of
burial space, as that term is defined for purposes of the
Supplemental Security Income program, is exempt regardless
of value. This amount shall be adjusted annually for any
increase in the Consumer Price Index. The amount exempted
shall be limited to the price of the funeral goods and

HB0027 - 111 - LRB098 00027 KTG 30027 b
services to be provided upon death. The contract must
provide a complete description of the funeral goods and
services to be provided and the price thereof. Any amount
in the contract not so specified shall be treated as a
transfer of assets for less than fair market value.
(3) A prepaid, guaranteed-price funeral or burial
contract, funded by an irrevocable assignment of a person's
life insurance policy to a trust, is exempt. The amount
exempted shall be limited to the amount of the insurance
benefit designated for the cost of the funeral goods and
services to be provided upon the person's death. The
contract must provide a complete description of the funeral
goods and services to be provided and the price thereof.
Any amount in the contract not so specified shall be
treated as a transfer of assets for less than fair market
value. The trust must include a statement that, upon the
death of the person, the State will receive all amounts
remaining in the trust, including any remaining payable
proceeds under the insurance policy up to an amount equal
to the total medical assistance paid on behalf of the
person. The trust is responsible for ensuring that the
provider of funeral services under the contract receives
the proceeds of the policy when it provides the funeral
goods and services specified under the contract. The
irrevocable assignment of ownership of the insurance
policy must be acknowledged by the insurance company.

HB0027 - 112 - LRB098 00027 KTG 30027 b
Notwithstanding any other provision of this Code to the
contrary, an irrevocable trust containing the resources of a
person who is determined to have a disability shall be
considered exempt from consideration. Such trust must be
established and managed by a non-profit association that pools
funds but maintains a separate account for each beneficiary.
The trust may be established by the person, a parent,
grandparent, legal guardian, or court. It must be established
for the sole benefit of the person and language contained in
the trust shall stipulate that any amount remaining in the
trust (up to the amount expended by the Department on medical
assistance) that is not retained by the trust for reasonable
administrative costs related to wrapping up the affairs of the
subaccount shall be paid to the Department upon the death of
the person. After a person reaches age 65, any funding by or on
behalf of the person to the trust shall be treated as a
transfer of assets for less than fair market value unless the
person is a ward of a county public guardian or the State
guardian pursuant to Section 13-5 of the Probate Act of 1975 or
Section 30 of the Guardianship and Advocacy Act and lives in
the community, or the person is a ward of a county public
guardian or the State guardian pursuant to Section 13-5 of the
Probate Act of 1975 or Section 30 of the Guardianship and
Advocacy Act and a court has found that any expenditures from
the trust will maintain or enhance the person's quality of
life. If the trust contains proceeds from a personal injury

HB0027 - 113 - LRB098 00027 KTG 30027 b
settlement, any Department charge must be satisfied in order
for the transfer to the trust to be treated as a transfer for
fair market value.
The homestead shall be exempt from consideration except to
the extent that it meets the income and shelter needs of the
person. "Homestead" means the dwelling house and contiguous
real estate owned and occupied by the person, regardless of its
value. Subject to federal approval, a person shall not be
eligible for long-term care services, however, if the person's
equity interest in his or her homestead exceeds the minimum
home equity as allowed and increased annually under federal
law. Subject to federal approval, on and after the effective
date of this amendatory Act of the 97th General Assembly,
homestead property transferred to a trust shall no longer be
considered homestead property.
Occasional or irregular gifts in cash, goods or services
from persons who are not legally responsible relatives which
are of nominal value or which do not have significant effect in
meeting essential requirements shall be disregarded. The
eligibility of any applicant for or recipient of public aid
under this Article is not affected by the payment of any grant
under the "Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act" or any distributions
or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act.

HB0027 - 114 - LRB098 00027 KTG 30027 b
The Illinois Department may, after appropriate
investigation, establish and implement a consolidated standard
to determine need and eligibility for and amount of benefits
under this Article or a uniform cash supplement to the federal
Supplemental Security Income program for all or any part of the
then current recipients under this Article; provided, however,
that the establishment or implementation of such a standard or
supplement shall not result in reductions in benefits under
this Article for the then current recipients of such benefits.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/3-5) (from Ch. 23, par. 3-5)
Sec. 3-5. Amount of aid. The amount and nature of financial
aid granted to or in behalf of aged, blind, or disabled persons
shall be determined in accordance with the standards, grant
amounts, rules and regulations of the Illinois Department. Due
regard shall be given to the requirements and conditions
existing in each case, and to the amount of property owned and
the income, money contributions, and other support, and
resources received or obtainable by the person, from whatever
source. However, the amount and nature of any financial aid is
not affected by the payment of any grant under the "Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act" or any distributions or items of
income described under subparagraph (X) of paragraph (2) of
subsection (a) of Section 203 of the Illinois Income Tax Act.

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The aid shall be sufficient, when added to all other income,
money contributions and support, to provide the person with a
grant in the amount established by Department regulation for
such a person, based upon standards providing a livelihood
compatible with health and well-being. Financial aid under this
Article granted to persons who have been found ineligible for
Supplemental Security Income (SSI) due to expiration of the
period of eligibility for refugees and asylees pursuant to 8
U.S.C. 1612(a)(2) shall not exceed $500 per month.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/4-1.6) (from Ch. 23, par. 4-1.6)
Sec. 4-1.6. Need. Income available to the family as defined
by the Illinois Department by rule, or to the child in the case
of a child removed from his or her home, when added to
contributions in money, substance or services from other
sources, including income available from parents absent from
the home or from a stepparent, contributions made for the
benefit of the parent or other persons necessary to provide
care and supervision to the child, and contributions from
legally responsible relatives, must be equal to or less than
the grant amount established by Department regulation for such
a person. For purposes of eligibility for aid under this
Article, the Department shall disregard all earned income
between the grant amount and 50% of the Federal Poverty Level.
In considering income to be taken into account,

HB0027 - 116 - LRB098 00027 KTG 30027 b
consideration shall be given to any expenses reasonably
attributable to the earning of such income. Three-fourths of
the earned income of a household eligible for aid under this
Article shall be disregarded when determining the level of
assistance for which a household is eligible. The Illinois
Department may also permit all or any portion of earned or
other income to be set aside for the future identifiable needs
of a child. The Illinois Department may provide by rule and
regulation for the exemptions thus permitted or required. The
eligibility of any applicant for or recipient of public aid
under this Article is not affected by the payment of any grant
under the "Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act" or any distributions
or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act.
The Illinois Department may, by rule, set forth criteria
under which an assistance unit is ineligible for cash
assistance under this Article for a specified number of months
due to the receipt of a lump sum payment.
(Source: P.A. 96-866, eff. 7-1-10; 97-689, eff. 6-14-12.)
(305 ILCS 5/4-2) (from Ch. 23, par. 4-2)
Sec. 4-2. Amount of aid.
(a) The amount and nature of financial aid shall be
determined in accordance with the grant amounts, rules and

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regulations of the Illinois Department. Due regard shall be
given to the self-sufficiency requirements of the family and to
the income, money contributions and other support and resources
available, from whatever source. However, the amount and nature
of any financial aid is not affected by the payment of any
grant under the "Senior Citizens and Disabled Persons Property
Tax Relief and Pharmaceutical Assistance Act" or any
distributions or items of income described under subparagraph
(X) of paragraph (2) of subsection (a) of Section 203 of the
Illinois Income Tax Act. The aid shall be sufficient, when
added to all other income, money contributions and support to
provide the family with a grant in the amount established by
Department regulation.
Subject to appropriation, beginning on July 1, 2008, the
Department of Human Services shall increase TANF grant amounts
in effect on June 30, 2008 by 15%. The Department is authorized
to administer this increase but may not otherwise adopt any
rule to implement this increase.
(b) The Illinois Department may conduct special projects,
which may be known as Grant Diversion Projects, under which
recipients of financial aid under this Article are placed in
jobs and their grants are diverted to the employer who in turn
makes payments to the recipients in the form of salary or other
employment benefits. The Illinois Department shall by rule
specify the terms and conditions of such Grant Diversion
Projects. Such projects shall take into consideration and be

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coordinated with the programs administered under the Illinois
Emergency Employment Development Act.
(c) The amount and nature of the financial aid for a child
requiring care outside his own home shall be determined in
accordance with the rules and regulations of the Illinois
Department, with due regard to the needs and requirements of
the child in the foster home or institution in which he has
been placed.
(d) If the Department establishes grants for family units
consisting exclusively of a pregnant woman with no dependent
child or including her husband if living with her, the grant
amount for such a unit shall be equal to the grant amount for
an assistance unit consisting of one adult, or 2 persons if the
husband is included. Other than as herein described, an unborn
child shall not be counted in determining the size of an
assistance unit or for calculating grants.
Payments for basic maintenance requirements of a child or
children and the relative with whom the child or children are
living shall be prescribed, by rule, by the Illinois
Department.
Grants under this Article shall not be supplemented by
General Assistance provided under Article VI.
(e) Grants shall be paid to the parent or other person with
whom the child or children are living, except for such amount
as is paid in behalf of the child or his parent or other
relative to other persons or agencies pursuant to this Code or

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the rules and regulations of the Illinois Department.
(f) Subject to subsection (f-5), an assistance unit,
receiving financial aid under this Article or temporarily
ineligible to receive aid under this Article under a penalty
imposed by the Illinois Department for failure to comply with
the eligibility requirements or that voluntarily requests
termination of financial assistance under this Article and
becomes subsequently eligible for assistance within 9 months,
shall not receive any increase in the amount of aid solely on
account of the birth of a child; except that an increase is not
prohibited when the birth is (i) of a child of a pregnant woman
who became eligible for aid under this Article during the
pregnancy, or (ii) of a child born within 10 months after the
date of implementation of this subsection, or (iii) of a child
conceived after a family became ineligible for assistance due
to income or marriage and at least 3 months of ineligibility
expired before any reapplication for assistance. This
subsection does not, however, prevent a unit from receiving a
general increase in the amount of aid that is provided to all
recipients of aid under this Article.
The Illinois Department is authorized to transfer funds,
and shall use any budgetary savings attributable to not
increasing the grants due to the births of additional children,
to supplement existing funding for employment and training
services for recipients of aid under this Article IV. The
Illinois Department shall target, to the extent the

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supplemental funding allows, employment and training services
to the families who do not receive a grant increase after the
birth of a child. In addition, the Illinois Department shall
provide, to the extent the supplemental funding allows, such
families with up to 24 months of transitional child care
pursuant to Illinois Department rules. All remaining
supplemental funds shall be used for employment and training
services or transitional child care support.
In making the transfers authorized by this subsection, the
Illinois Department shall first determine, pursuant to
regulations adopted by the Illinois Department for this
purpose, the amount of savings attributable to not increasing
the grants due to the births of additional children. Transfers
may be made from General Revenue Fund appropriations for
distributive purposes authorized by Article IV of this Code
only to General Revenue Fund appropriations for employability
development services including operating and administrative
costs and related distributive purposes under Article IXA of
this Code. The Director, with the approval of the Governor,
shall certify the amount and affected line item appropriations
to the State Comptroller.
Nothing in this subsection shall be construed to prohibit
the Illinois Department from using funds under this Article IV
to provide assistance in the form of vouchers that may be used
to pay for goods and services deemed by the Illinois
Department, by rule, as suitable for the care of the child such

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as diapers, clothing, school supplies, and cribs.
(f-5) Subsection (f) shall not apply to affect the monthly
assistance amount of any family as a result of the birth of a
child on or after January 1, 2004. As resources permit after
January 1, 2004, the Department may cease applying subsection
(f) to limit assistance to families receiving assistance under
this Article on January 1, 2004, with respect to children born
prior to that date. In any event, subsection (f) shall be
completely inoperative on and after July 1, 2007.
(g) (Blank).
(h) Notwithstanding any other provision of this Code, the
Illinois Department is authorized to reduce payment levels used
to determine cash grants under this Article after December 31
of any fiscal year if the Illinois Department determines that
the caseload upon which the appropriations for the current
fiscal year are based have increased by more than 5% and the
appropriation is not sufficient to ensure that cash benefits
under this Article do not exceed the amounts appropriated for
those cash benefits. Reductions in payment levels may be
accomplished by emergency rule under Section 5-45 of the
Illinois Administrative Procedure Act, except that the
limitation on the number of emergency rules that may be adopted
in a 24-month period shall not apply and the provisions of
Sections 5-115 and 5-125 of the Illinois Administrative
Procedure Act shall not apply. Increases in payment levels
shall be accomplished only in accordance with Section 5-40 of

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the Illinois Administrative Procedure Act. Before any rule to
increase payment levels promulgated under this Section shall
become effective, a joint resolution approving the rule must be
adopted by a roll call vote by a majority of the members
elected to each chamber of the General Assembly.
(Source: P.A. 96-1000, eff. 7-2-10; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
Sec. 5-2. Classes of Persons Eligible. Medical assistance
under this Article shall be available to any of the following
classes of persons in respect to whom a plan for coverage has
been submitted to the Governor by the Illinois Department and
approved by him:
1. Recipients of basic maintenance grants under
Articles III and IV.
2. Persons otherwise eligible for basic maintenance
under Articles III and IV, excluding any eligibility
requirements that are inconsistent with any federal law or
federal regulation, as interpreted by the U.S. Department
of Health and Human Services, but who fail to qualify
thereunder on the basis of need or who qualify but are not
receiving basic maintenance under Article IV, and who have
insufficient income and resources to meet the costs of
necessary medical care, including but not limited to the
following:
(a) All persons otherwise eligible for basic

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maintenance under Article III but who fail to qualify
under that Article on the basis of need and who meet
either of the following requirements:
(i) their income, as determined by the
Illinois Department in accordance with any federal
requirements, is equal to or less than 70% in
fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official
poverty line, as defined by the federal Office of
Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus
Budget Reconciliation Act of 1981, applicable to
families of the same size; or
(ii) their income, after the deduction of
costs incurred for medical care and for other types
of remedial care, is equal to or less than 70% in
fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official
poverty line, as defined in item (i) of this
subparagraph (a).

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(b) All persons who, excluding any eligibility
requirements that are inconsistent with any federal
law or federal regulation, as interpreted by the U.S.
Department of Health and Human Services, would be
determined eligible for such basic maintenance under
Article IV by disregarding the maximum earned income
permitted by federal law.
3. Persons who would otherwise qualify for Aid to the
Medically Indigent under Article VII.
4. Persons not eligible under any of the preceding
paragraphs who fall sick, are injured, or die, not having
sufficient money, property or other resources to meet the
costs of necessary medical care or funeral and burial
expenses.
5.(a) Women during pregnancy, after the fact of
pregnancy has been determined by medical diagnosis, and
during the 60-day period beginning on the last day of the
pregnancy, together with their infants and children born
after September 30, 1983, whose income and resources are
insufficient to meet the costs of necessary medical care to
the maximum extent possible under Title XIX of the Federal
Social Security Act.
(b) The Illinois Department and the Governor shall
provide a plan for coverage of the persons eligible under
paragraph 5(a) by April 1, 1990. Such plan shall provide
ambulatory prenatal care to pregnant women during a

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presumptive eligibility period and establish an income
eligibility standard that is equal to 133% of the nonfarm
income official poverty line, as defined by the federal
Office of Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus Budget
Reconciliation Act of 1981, applicable to families of the
same size, provided that costs incurred for medical care
are not taken into account in determining such income
eligibility.
(c) The Illinois Department may conduct a
demonstration in at least one county that will provide
medical assistance to pregnant women, together with their
infants and children up to one year of age, where the
income eligibility standard is set up to 185% of the
nonfarm income official poverty line, as defined by the
federal Office of Management and Budget. The Illinois
Department shall seek and obtain necessary authorization
provided under federal law to implement such a
demonstration. Such demonstration may establish resource
standards that are not more restrictive than those
established under Article IV of this Code.
6. Persons under the age of 18 who fail to qualify as
dependent under Article IV and who have insufficient income
and resources to meet the costs of necessary medical care
to the maximum extent permitted under Title XIX of the
Federal Social Security Act.

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7. Persons who are under 21 years of age and would
qualify as disabled as defined under the Federal
Supplemental Security Income Program, provided medical
service for such persons would be eligible for Federal
Financial Participation, and provided the Illinois
Department determines that: (Blank).
(a) the person requires a level of care provided by
a hospital, skilled nursing facility, or intermediate
care facility, as determined by a physician licensed to
practice medicine in all its branches;
(b) it is appropriate to provide such care outside
of an institution, as determined by a physician
licensed to practice medicine in all its branches;
(c) the estimated amount which would be expended
for care outside the institution is not greater than
the estimated amount which would be expended in an
institution.
8. Persons who become ineligible for basic maintenance
assistance under Article IV of this Code in programs
administered by the Illinois Department due to employment
earnings and persons in assistance units comprised of
adults and children who become ineligible for basic
maintenance assistance under Article VI of this Code due to
employment earnings. The plan for coverage for this class
of persons shall:
(a) extend the medical assistance coverage for up

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to 12 months following termination of basic
maintenance assistance; and
(b) offer persons who have initially received 6
months of the coverage provided in paragraph (a) above,
the option of receiving an additional 6 months of
coverage, subject to the following:
(i) such coverage shall be pursuant to
provisions of the federal Social Security Act;
(ii) such coverage shall include all services
covered while the person was eligible for basic
maintenance assistance;
(iii) no premium shall be charged for such
coverage; and
(iv) such coverage shall be suspended in the
event of a person's failure without good cause to
file in a timely fashion reports required for this
coverage under the Social Security Act and
coverage shall be reinstated upon the filing of
such reports if the person remains otherwise
eligible.
9. Persons with acquired immunodeficiency syndrome
(AIDS) or with AIDS-related conditions with respect to whom
there has been a determination that but for home or
community-based services such individuals would require
the level of care provided in an inpatient hospital,
skilled nursing facility or intermediate care facility the

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cost of which is reimbursed under this Article. Assistance
shall be provided to such persons to the maximum extent
permitted under Title XIX of the Federal Social Security
Act.
10. Participants in the long-term care insurance
partnership program established under the Illinois
Long-Term Care Partnership Program Act who meet the
qualifications for protection of resources described in
Section 15 of that Act.
11. Persons with disabilities who are employed and
eligible for Medicaid, pursuant to Section
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
subject to federal approval, persons with a medically
improved disability who are employed and eligible for
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
the Social Security Act, as provided by the Illinois
Department by rule. In establishing eligibility standards
under this paragraph 11, the Department shall, subject to
federal approval:
(a) set the income eligibility standard at not
lower than 350% of the federal poverty level;
(b) exempt retirement accounts that the person
cannot access without penalty before the age of 59 1/2,
and medical savings accounts established pursuant to
26 U.S.C. 220;
(c) allow non-exempt assets up to $25,000 as to

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those assets accumulated during periods of eligibility
under this paragraph 11; and
(d) continue to apply subparagraphs (b) and (c) in
determining the eligibility of the person under this
Article even if the person loses eligibility under this
paragraph 11.
12. Subject to federal approval, persons who are
eligible for medical assistance coverage under applicable
provisions of the federal Social Security Act and the
federal Breast and Cervical Cancer Prevention and
Treatment Act of 2000. Those eligible persons are defined
to include, but not be limited to, the following persons:
(1) persons who have been screened for breast or
cervical cancer under the U.S. Centers for Disease
Control and Prevention Breast and Cervical Cancer
Program established under Title XV of the federal
Public Health Services Act in accordance with the
requirements of Section 1504 of that Act as
administered by the Illinois Department of Public
Health; and
(2) persons whose screenings under the above
program were funded in whole or in part by funds
appropriated to the Illinois Department of Public
Health for breast or cervical cancer screening.
"Medical assistance" under this paragraph 12 shall be
identical to the benefits provided under the State's

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approved plan under Title XIX of the Social Security Act.
The Department must request federal approval of the
coverage under this paragraph 12 within 30 days after the
effective date of this amendatory Act of the 92nd General
Assembly.
In addition to the persons who are eligible for medical
assistance pursuant to subparagraphs (1) and (2) of this
paragraph 12, and to be paid from funds appropriated to the
Department for its medical programs, any uninsured person
as defined by the Department in rules residing in Illinois
who is younger than 65 years of age, who has been screened
for breast and cervical cancer in accordance with standards
and procedures adopted by the Department of Public Health
for screening, and who is referred to the Department by the
Department of Public Health as being in need of treatment
for breast or cervical cancer is eligible for medical
assistance benefits that are consistent with the benefits
provided to those persons described in subparagraphs (1)
and (2). Medical assistance coverage for the persons who
are eligible under the preceding sentence is not dependent
on federal approval, but federal moneys may be used to pay
for services provided under that coverage upon federal
approval.
13. Subject to appropriation and to federal approval,
persons living with HIV/AIDS who are not otherwise eligible
under this Article and who qualify for services covered

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under Section 5-5.04 as provided by the Illinois Department
by rule.
14. Subject to the availability of funds for this
purpose, the Department may provide coverage under this
Article to persons who reside in Illinois who are not
eligible under any of the preceding paragraphs and who meet
the income guidelines of paragraph 2(a) of this Section and
(i) have an application for asylum pending before the
federal Department of Homeland Security or on appeal before
a court of competent jurisdiction and are represented
either by counsel or by an advocate accredited by the
federal Department of Homeland Security and employed by a
not-for-profit organization in regard to that application
or appeal, or (ii) are receiving services through a
federally funded torture treatment center. Medical
coverage under this paragraph 14 may be provided for up to
24 continuous months from the initial eligibility date so
long as an individual continues to satisfy the criteria of
this paragraph 14. If an individual has an appeal pending
regarding an application for asylum before the Department
of Homeland Security, eligibility under this paragraph 14
may be extended until a final decision is rendered on the
appeal. The Department may adopt rules governing the
implementation of this paragraph 14.
15. Family Care Eligibility.
(a) Through December 31, 2013 On and after July 1,

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2012, a caretaker relative who is 19 years of age or
older when countable income is at or below 185% 133% of
the Federal Poverty Level Guidelines, as published
annually in the Federal Register, for the appropriate
family size. Beginning January 1, 2014, a caretaker
relative who is 19 years of age or older when countable
income is at or below 133% of the Federal Poverty Level
Guidelines, as published annually in the Federal
Register, for the appropriate family size. A person may
not spend down to become eligible under this paragraph
15.
(b) Eligibility shall be reviewed annually.
(c) Caretaker relatives enrolled under this
paragraph 15 in families with countable income above
150% and at or below 185% of the Federal Poverty Level
Guidelines shall be counted as family members and pay
premiums as established under the Children's Health
Insurance Program Act. (Blank).
(d) Premiums shall be billed by and payable to the
Department or its authorized agent, on a monthly basis.
(Blank).
(e) The premium due date is the last day of the
month preceding the month of coverage. (Blank).
(f) Individuals shall have a grace period through
60 days of coverage to pay the premium. (Blank).
(g) Failure to pay the full monthly premium by the

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last day of the grace period shall result in
termination of coverage. (Blank).
(h) Partial premium payments shall not be
refunded. (Blank).
(i) Following termination of an individual's
coverage under this paragraph 15, the following action
is required before the individual can be re-enrolled:
individual must be determined eligible before the
person can be re-enrolled.
(1) A new application must be completed and the
individual must be determined otherwise eligible.
(2) There must be full payment of premiums due
under this Code, the Children's Health Insurance
Program Act, the Covering ALL KIDS Health
Insurance Act, or any other healthcare program
administered by the Department for periods in
which a premium was owed and not paid for the
individual.
(3) The first month's premium must be paid if
there was an unpaid premium on the date the
individual's previous coverage was canceled.
The Department is authorized to implement the
provisions of this amendatory Act of the 98th General
Assembly by adopting the medical assistance rules in effect
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
89 Ill. Admin. Code 120.32 along with only those changes

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necessary to conform to federal Medicaid requirements,
federal laws, and federal regulations, including but not
limited to Section 1931 of the Social Security Act (42
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
of Health and Human Services, and the countable income
eligibility standard authorized by this paragraph 15. The
Department may not otherwise adopt any rule to implement
this increase except as authorized by law, to meet the
eligibility standards authorized by the federal government
in the Medicaid State Plan or the Title XXI Plan, or to
meet an order from the federal government or any court.
16. Subject to appropriation, uninsured persons who
are not otherwise eligible under this Section who have been
certified and referred by the Department of Public Health
as having been screened and found to need diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment, for prostate or testicular cancer. For the
purposes of this paragraph 16, uninsured persons are those
who do not have creditable coverage, as defined under the
Health Insurance Portability and Accountability Act, or
have otherwise exhausted any insurance benefits they may
have had, for prostate or testicular cancer diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment. To be eligible, a person must furnish a Social
Security number. A person's assets are exempt from
consideration in determining eligibility under this

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paragraph 16. Such persons shall be eligible for medical
assistance under this paragraph 16 for so long as they need
treatment for the cancer. A person shall be considered to
need treatment if, in the opinion of the person's treating
physician, the person requires therapy directed toward
cure or palliation of prostate or testicular cancer,
including recurrent metastatic cancer that is a known or
presumed complication of prostate or testicular cancer and
complications resulting from the treatment modalities
themselves. Persons who require only routine monitoring
services are not considered to need treatment. "Medical
assistance" under this paragraph 16 shall be identical to
the benefits provided under the State's approved plan under
Title XIX of the Social Security Act. Notwithstanding any
other provision of law, the Department (i) does not have a
claim against the estate of a deceased recipient of
services under this paragraph 16 and (ii) does not have a
lien against any homestead property or other legal or
equitable real property interest owned by a recipient of
services under this paragraph 16.
17. (Blank). Persons who, pursuant to a waiver approved
by the Secretary of the U.S. Department of Health and Human
Services, are eligible for medical assistance under Title
XIX or XXI of the federal Social Security Act.
Notwithstanding any other provision of this Code and
consistent with the terms of the approved waiver, the

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Illinois Department, may by rule:
(a) Limit the geographic areas in which the waiver
program operates.
(b) Determine the scope, quantity, duration, and
quality, and the rate and method of reimbursement, of
the medical services to be provided, which may differ
from those for other classes of persons eligible for
assistance under this Article.
(c) Restrict the persons' freedom in choice of
providers.
In implementing the provisions of Public Act 96-20, the
Department is authorized to adopt only those rules necessary,
including emergency rules. Nothing in Public Act 96-20 permits
the Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.
The Illinois Department and the Governor shall provide a
plan for coverage of the persons eligible under paragraph 7 as
soon as possible after July 1, 1984.
The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant
under the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act or any distributions

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or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act. The Department shall by rule establish the
amounts of assets to be disregarded in determining eligibility
for medical assistance, which shall at a minimum equal the
amounts to be disregarded under the Federal Supplemental
Security Income Program. The amount of assets of a single
person to be disregarded shall not be less than $2,000, and the
amount of assets of a married couple to be disregarded shall
not be less than $3,000.
To the extent permitted under federal law, any person found
guilty of a second violation of Article VIIIA shall be
ineligible for medical assistance under this Article, as
provided in Section 8A-8.
The eligibility of any person for medical assistance under
this Article shall not be affected by the receipt by the person
of donations or benefits from fundraisers held for the person
in cases of serious illness, as long as neither the person nor
members of the person's family have actual control over the
donations or benefits or the disbursement of the donations or
benefits.
Notwithstanding any other provision of this Code, if the
United States Supreme Court holds Title II, Subtitle A, Section
2001(a) of Public Law 111-148 to be unconstitutional, or if a
holding of Public Law 111-148 makes Medicaid eligibility
allowed under Section 2001(a) inoperable, the State or a unit

HB0027 - 138 - LRB098 00027 KTG 30027 b
of local government shall be prohibited from enrolling
individuals in the Medical Assistance Program as the result of
federal approval of a State Medicaid waiver on or after the
effective date of this amendatory Act of the 97th General
Assembly, and any individuals enrolled in the Medical
Assistance Program pursuant to eligibility permitted as a
result of such a State Medicaid waiver shall become immediately
ineligible.
Notwithstanding any other provision of this Code, if an Act
of Congress that becomes a Public Law eliminates Section
2001(a) of Public Law 111-148, the State or a unit of local
government shall be prohibited from enrolling individuals in
the Medical Assistance Program as the result of federal
approval of a State Medicaid waiver on or after the effective
date of this amendatory Act of the 97th General Assembly, and
any individuals enrolled in the Medical Assistance Program
pursuant to eligibility permitted as a result of such a State
Medicaid waiver shall become immediately ineligible.
(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
7-13-12; revised 7-23-12.)
(305 ILCS 5/5-4) (from Ch. 23, par. 5-4)

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Sec. 5-4. Amount and nature of medical assistance.
(a) The amount and nature of medical assistance shall be
determined by the County Departments in accordance with the
standards, rules, and regulations of the Department of
Healthcare and Family Services, with due regard to the
requirements and conditions in each case, including
contributions available from legally responsible relatives.
However, the amount and nature of such medical assistance shall
not be affected by the payment of any grant under the Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act or any distributions or items of
income described under subparagraph (X) of paragraph (2) of
subsection (a) of Section 203 of the Illinois Income Tax Act.
The amount and nature of medical assistance shall not be
affected by the receipt of donations or benefits from
fundraisers in cases of serious illness, as long as neither the
person nor members of the person's family have actual control
over the donations or benefits or the disbursement of the
donations or benefits.
In determining the income and assets resources available to
the institutionalized spouse and to the community spouse, the
Department of Healthcare and Family Services shall follow the
procedures established by federal law. If an institutionalized
spouse or community spouse refuses to comply with the
requirements of Title XIX of the federal Social Security Act
and the regulations duly promulgated thereunder by failing to

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provide the total value of assets, including income and
resources, to the extent either the institutionalized spouse or
community spouse has an ownership interest in them pursuant to
42 U.S.C. 1396r-5, such refusal may result in the
institutionalized spouse being denied eligibility and
continuing to remain ineligible for the medical assistance
program based on failure to cooperate.
The Subject to federal approval, the community spouse
resource allowance shall be established and maintained at the
maximum higher of $109,560 or the minimum level permitted
pursuant to Section 1924(f)(2) of the Social Security Act, as
now or hereafter amended, or an amount set after a fair
hearing, whichever is greater. The monthly maintenance
allowance for the community spouse shall be established and
maintained at the maximum higher of $2,739 per month or the
minimum level permitted pursuant to Section 1924(d)(3)(C) of
the Social Security Act, as now or hereafter amended, or an
amount set after a fair hearing, whichever is greater. Subject
to the approval of the Secretary of the United States
Department of Health and Human Services, the provisions of this
Section shall be extended to persons who but for the provision
of home or community-based services under Section 4.02 of the
Illinois Act on the Aging, would require the level of care
provided in an institution, as is provided for in federal law.
(b) Spousal support for institutionalized spouses
receiving medical assistance.

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(i) The Department may seek support for an
institutionalized spouse, who has assigned his or her right
of support from his or her spouse to the State, from the
resources and income available to the community spouse.
(ii) The Department may bring an action in the circuit
court to establish support orders or itself establish
administrative support orders by any means and procedures
authorized in this Code, as applicable, except that the
standard and regulations for determining ability to
support in Section 10-3 shall not limit the amount of
support that may be ordered.
(iii) Proceedings may be initiated to obtain support,
or for the recovery of aid granted during the period such
support was not provided, or both, for the obtainment of
support and the recovery of the aid provided. Proceedings
for the recovery of aid may be taken separately or they may
be consolidated with actions to obtain support. Such
proceedings may be brought in the name of the person or
persons requiring support or may be brought in the name of
the Department, as the case requires.
(iv) The orders for the payment of moneys for the
support of the person shall be just and equitable and may
direct payment thereof for such period or periods of time
as the circumstances require, including support for a
period before the date the order for support is entered. In
no event shall the orders reduce the community spouse

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resource allowance below the level established in
subsection (a) of this Section or an amount set after a
fair hearing, whichever is greater, or reduce the monthly
maintenance allowance for the community spouse below the
level permitted pursuant to subsection (a) of this Section.
The Department of Human Services shall notify in writing
each institutionalized spouse who is a recipient of medical
assistance under this Article, and each such person's community
spouse, of the changes in treatment of income and resources,
including provisions for protecting income for a community
spouse and permitting the transfer of resources to a community
spouse, required by enactment of the federal Medicare
Catastrophic Coverage Act of 1988 (Public Law 100-360). The
notification shall be in language likely to be easily
understood by those persons. The Department of Human Services
also shall reassess the amount of medical assistance for which
each such recipient is eligible as a result of the enactment of
that federal Act, whether or not a recipient requests such a
reassessment.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
Sec. 5-4.1. Co-payments. The Department may by rule provide
that recipients under any Article of this Code shall pay a fee
as a co-payment for services. Co-payments shall be maximized to
the extent permitted by federal law, except that the Department

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shall impose a co-pay of $2 on generic drugs. Provided,
however, that any such rule must provide that no co-payment
requirement can exist for renal dialysis, radiation therapy,
cancer chemotherapy, or insulin, and other products necessary
on a recurring basis, the absence of which would be life
threatening, or where co-payment expenditures for required
services and/or medications for chronic diseases that the
Illinois Department shall by rule designate shall cause an
extensive financial burden on the recipient, and provided no
co-payment shall exist for emergency room encounters which are
for medical emergencies. The Department shall seek approval of
a State plan amendment that allows pharmacies to refuse to
dispense drugs in circumstances where the recipient does not
pay the required co-payment. In the event the State plan
amendment is rejected, co-payments may not exceed $3 for brand
name drugs, $1 for other pharmacy services other than for
generic drugs, and $2 for physician services, dental services,
optical services and supplies, chiropractic services, podiatry
services, and encounter rate clinic services. There shall be no
co-payment for generic drugs. Co-payments may not exceed $10
for emergency room use for a non-emergency situation as defined
by the Department by rule and subject to federal approval.
(Source: P.A. 96-1501, eff. 1-25-11; 97-74, eff. 6-30-11;
97-689, eff. 6-14-12.)
(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)

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Sec. 5-4.2. Ambulance services payments.
(a) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1993, the Illinois
Department shall reimburse ambulance service providers at
rates calculated in accordance with this Section. It is the
intent of the General Assembly to provide adequate
reimbursement for ambulance services so as to ensure adequate
access to services for recipients of aid under this Article and
to provide appropriate incentives to ambulance service
providers to provide services in an efficient and
cost-effective manner. Thus, it is the intent of the General
Assembly that the Illinois Department implement a
reimbursement system for ambulance services that, to the extent
practicable and subject to the availability of funds
appropriated by the General Assembly for this purpose, is
consistent with the payment principles of Medicare. To ensure
uniformity between the payment principles of Medicare and
Medicaid, the Illinois Department shall follow, to the extent
necessary and practicable and subject to the availability of
funds appropriated by the General Assembly for this purpose,
the statutes, laws, regulations, policies, procedures,
principles, definitions, guidelines, and manuals used to
determine the amounts paid to ambulance service providers under
Title XVIII of the Social Security Act (Medicare).
(b) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1996, the Illinois

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Department shall reimburse ambulance service providers based
upon the actual distance traveled if a natural disaster,
weather conditions, road repairs, or traffic congestion
necessitates the use of a route other than the most direct
route.
(c) For purposes of this Section, "ambulance services"
includes medical transportation services provided by means of
an ambulance, medi-car, service car, or taxi.
(c-1) For purposes of this Section, "ground ambulance
service" means medical transportation services that are
described as ground ambulance services by the Centers for
Medicare and Medicaid Services and provided in a vehicle that
is licensed as an ambulance by the Illinois Department of
Public Health pursuant to the Emergency Medical Services (EMS)
Systems Act.
(c-2) For purposes of this Section, "ground ambulance
service provider" means a vehicle service provider as described
in the Emergency Medical Services (EMS) Systems Act that
operates licensed ambulances for the purpose of providing
emergency ambulance services, or non-emergency ambulance
services, or both. For purposes of this Section, this includes
both ambulance providers and ambulance suppliers as described
by the Centers for Medicare and Medicaid Services.
(d) This Section does not prohibit separate billing by
ambulance service providers for oxygen furnished while
providing advanced life support services.

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(e) Beginning with services rendered on or after July 1,
2008, all providers of non-emergency medi-car and service car
transportation must certify that the driver and employee
attendant, as applicable, have completed a safety program
approved by the Department to protect both the patient and the
driver, prior to transporting a patient. The provider must
maintain this certification in its records. The provider shall
produce such documentation upon demand by the Department or its
representative. Failure to produce documentation of such
training shall result in recovery of any payments made by the
Department for services rendered by a non-certified driver or
employee attendant. Medi-car and service car providers must
maintain legible documentation in their records of the driver
and, as applicable, employee attendant that actually
transported the patient. Providers must recertify all drivers
and employee attendants every 3 years.
Notwithstanding the requirements above, any public
transportation provider of medi-car and service car
transportation that receives federal funding under 49 U.S.C.
5307 and 5311 need not certify its drivers and employee
attendants under this Section, since safety training is already
federally mandated.
(f) With respect to any policy or program administered by
the Department or its agent regarding approval of non-emergency
medical transportation by ground ambulance service providers,
including, but not limited to, the Non-Emergency

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Transportation Services Prior Approval Program (NETSPAP), the
Department shall establish by rule a process by which ground
ambulance service providers of non-emergency medical
transportation may appeal any decision by the Department or its
agent for which no denial was received prior to the time of
transport that either (i) denies a request for approval for
payment of non-emergency transportation by means of ground
ambulance service or (ii) grants a request for approval of
non-emergency transportation by means of ground ambulance
service at a level of service that entitles the ground
ambulance service provider to a lower level of compensation
from the Department than the ground ambulance service provider
would have received as compensation for the level of service
requested. The rule shall be established within 12 months after
the effective date of this amendatory Act of the 98th General
Assembly filed by December 15, 2012 and shall provide that, for
any decision rendered by the Department or its agent on or
after the date the rule takes effect, the ground ambulance
service provider shall have 60 days from the date the decision
is received to file an appeal. The rule established by the
Department shall be, insofar as is practical, consistent with
the Illinois Administrative Procedure Act. The Director's
decision on an appeal under this Section shall be a final
administrative decision subject to review under the
Administrative Review Law.
(f-5) (g) Beginning 90 days after July 20, 2012 (the

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effective date of Public Act 97-842) this amendatory Act of the
97th General Assembly, (i) no denial of a request for approval
for payment of non-emergency transportation by means of ground
ambulance service, and (ii) no approval of non-emergency
transportation by means of ground ambulance service at a level
of service that entitles the ground ambulance service provider
to a lower level of compensation from the Department than would
have been received at the level of service submitted by the
ground ambulance service provider, may be issued by the
Department or its agent unless the Department has submitted the
criteria for determining the appropriateness of the transport
for first notice publication in the Illinois Register pursuant
to Section 5-40 of the Illinois Administrative Procedure Act.
(g) (Blank). Whenever a patient covered by a medical
assistance program under this Code or by another medical
program administered by the Department is being discharged from
a facility, a physician discharge order as described in this
Section shall be required for each patient whose discharge
requires medically supervised ground ambulance services.
Facilities shall develop procedures for a physician with
medical staff privileges to provide a written and signed
physician discharge order. The physician discharge order shall
specify the level of ground ambulance services needed and
complete a medical certification establishing the criteria for
approval of non-emergency ambulance transportation, as
published by the Department of Healthcare and Family Services,

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that is met by the patient. This order and the medical
certification shall be completed prior to ordering an ambulance
service and prior to patient discharge.
Pursuant to subsection (E) of Section 12-4.25 of this Code,
the Department is entitled to recover overpayments paid to a
provider or vendor, including, but not limited to, from the
discharging physician, the discharging facility, and the
ground ambulance service provider, in instances where a
non-emergency ground ambulance service is rendered as the
result of improper or false certification.
(h) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12;
97-842, eff. 7-20-12; revised 8-3-12.)
(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
Sec. 5-5. Medical services. The Illinois Department, by
rule, shall determine the quantity and quality of and the rate
of reimbursement for the medical assistance for which payment
will be authorized, and the medical services to be provided,
which may include all or part of the following: (1) inpatient
hospital services; (2) outpatient hospital services; (3) other
laboratory and X-ray services; (4) skilled nursing home

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services; (5) physicians' services whether furnished in the
office, the patient's home, a hospital, a skilled nursing home,
or elsewhere; (6) medical care, or any other type of remedial
care furnished by licensed practitioners; (7) home health care
services; (8) private duty nursing service; (9) clinic
services; (10) dental services, including prevention and
treatment of periodontal disease and dental caries disease for
pregnant women, provided by an individual licensed to practice
dentistry or dental surgery; for purposes of this item (10),
"dental services" means diagnostic, preventive, or corrective
procedures provided by or under the supervision of a dentist in
the practice of his or her profession; (11) physical therapy
and related services; (12) prescribed drugs, dentures, and
prosthetic devices; and eyeglasses prescribed by a physician
skilled in the diseases of the eye, or by an optometrist,
whichever the person may select; (13) other diagnostic,
screening, preventive, and rehabilitative services, including
to ensure that the individual's need for intervention or
treatment of mental disorders or substance use disorders or
co-occurring mental health and substance use disorders is
determined using a uniform screening, assessment, and
evaluation process inclusive of criteria, for children and
adults; for purposes of this item (13), a uniform screening,
assessment, and evaluation process refers to a process that
includes an appropriate evaluation and, as warranted, a
referral; "uniform" does not mean the use of a singular

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instrument, tool, or process that all must utilize; (14)
transportation and such other expenses as may be necessary;
(15) medical treatment of sexual assault survivors, as defined
in Section 1a of the Sexual Assault Survivors Emergency
Treatment Act, for injuries sustained as a result of the sexual
assault, including examinations and laboratory tests to
discover evidence which may be used in criminal proceedings
arising from the sexual assault; (16) the diagnosis and
treatment of sickle cell anemia; and (17) any other medical
care, and any other type of remedial care recognized under the
laws of this State, but not including abortions, or induced
miscarriages or premature births, unless, in the opinion of a
physician, such procedures are necessary for the preservation
of the life of the woman seeking such treatment, or except an
induced premature birth intended to produce a live viable child
and such procedure is necessary for the health of the mother or
her unborn child. The Illinois Department, by rule, shall
prohibit any physician from providing medical assistance to
anyone eligible therefor under this Code where such physician
has been found guilty of performing an abortion procedure in a
wilful and wanton manner upon a woman who was not pregnant at
the time such abortion procedure was performed. The term "any
other type of remedial care" shall include nursing care and
nursing home service for persons who rely on treatment by
spiritual means alone through prayer for healing.
Notwithstanding any other provision of this Section, a

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comprehensive tobacco use cessation program that includes
purchasing prescription drugs or prescription medical devices
approved by the Food and Drug Administration shall be covered
under the medical assistance program under this Article for
persons who are otherwise eligible for assistance under this
Article.
Notwithstanding any other provision of this Code, the
Illinois Department may not require, as a condition of payment
for any laboratory test authorized under this Article, that a
physician's handwritten signature appear on the laboratory
test order form. The Illinois Department may, however, impose
other appropriate requirements regarding laboratory test order
documentation.
The On and after July 1, 2012, the Department of Healthcare
and Family Services shall may provide the following services to
persons eligible for assistance under this Article who are
participating in education, training or employment programs
operated by the Department of Human Services as successor to
the Department of Public Aid:
(1) dental services provided by or under the
supervision of a dentist; and
(2) eyeglasses prescribed by a physician skilled in the
diseases of the eye, or by an optometrist, whichever the
person may select.
Notwithstanding any other provision of this Code and
subject to federal approval, the Department may adopt rules to

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allow a dentist who is volunteering his or her service at no
cost to render dental services through an enrolled
not-for-profit health clinic without the dentist personally
enrolling as a participating provider in the medical assistance
program. A not-for-profit health clinic shall include a public
health clinic or Federally Qualified Health Center or other
enrolled provider, as determined by the Department, through
which dental services covered under this Section are performed.
The Department shall establish a process for payment of claims
for reimbursement for covered dental services rendered under
this provision.
The Illinois Department, by rule, may distinguish and
classify the medical services to be provided only in accordance
with the classes of persons designated in Section 5-2.
The Department of Healthcare and Family Services must
provide coverage and reimbursement for amino acid-based
elemental formulas, regardless of delivery method, for the
diagnosis and treatment of (i) eosinophilic disorders and (ii)
short bowel syndrome when the prescribing physician has issued
a written order stating that the amino acid-based elemental
formula is medically necessary.
The Illinois Department shall authorize the provision of,
and shall authorize payment for, screening by low-dose
mammography for the presence of occult breast cancer for women
35 years of age or older who are eligible for medical
assistance under this Article, as follows:

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(A) A baseline mammogram for women 35 to 39 years of
age.
(B) An annual mammogram for women 40 years of age or
older.
(C) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider for
women under 40 years of age and having a family history of
breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue, when medically
necessary as determined by a physician licensed to practice
medicine in all of its branches.
All screenings shall include a physical breast exam,
instruction on self-examination and information regarding the
frequency of self-examination and its value as a preventative
tool. For purposes of this Section, "low-dose mammography"
means the x-ray examination of the breast using equipment
dedicated specifically for mammography, including the x-ray
tube, filter, compression device, and image receptor, with an
average radiation exposure delivery of less than one rad per
breast for 2 views of an average size breast. The term also
includes digital mammography.
On and after January 1, 2012, providers participating in a
quality improvement program approved by the Department shall be

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reimbursed for screening and diagnostic mammography at the same
rate as the Medicare program's rates, including the increased
reimbursement for digital mammography.
The Department shall convene an expert panel including
representatives of hospitals, free-standing mammography
facilities, and doctors, including radiologists, to establish
quality standards.
Subject to federal approval, the Department shall
establish a rate methodology for mammography at federally
qualified health centers and other encounter-rate clinics.
These clinics or centers may also collaborate with other
hospital-based mammography facilities.
The Department shall establish a methodology to remind
women who are age-appropriate for screening mammography, but
who have not received a mammogram within the previous 18
months, of the importance and benefit of screening mammography.
The Department shall establish a performance goal for
primary care providers with respect to their female patients
over age 40 receiving an annual mammogram. This performance
goal shall be used to provide additional reimbursement in the
form of a quality performance bonus to primary care providers
who meet that goal.
The Department shall devise a means of case-managing or
patient navigation for beneficiaries diagnosed with breast
cancer. This program shall initially operate as a pilot program
in areas of the State with the highest incidence of mortality

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related to breast cancer. At least one pilot program site shall
be in the metropolitan Chicago area and at least one site shall
be outside the metropolitan Chicago area. An evaluation of the
pilot program shall be carried out measuring health outcomes
and cost of care for those served by the pilot program compared
to similarly situated patients who are not served by the pilot
program.
Any medical or health care provider shall immediately
recommend, to any pregnant woman who is being provided prenatal
services and is suspected of drug abuse or is addicted as
defined in the Alcoholism and Other Drug Abuse and Dependency
Act, referral to a local substance abuse treatment provider
licensed by the Department of Human Services or to a licensed
hospital which provides substance abuse treatment services.
The Department of Healthcare and Family Services shall assure
coverage for the cost of treatment of the drug abuse or
addiction for pregnant recipients in accordance with the
Illinois Medicaid Program in conjunction with the Department of
Human Services.
All medical providers providing medical assistance to
pregnant women under this Code shall receive information from
the Department on the availability of services under the Drug
Free Families with a Future or any comparable program providing
case management services for addicted women, including
information on appropriate referrals for other social services
that may be needed by addicted women in addition to treatment

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for addiction.
The Illinois Department, in cooperation with the
Departments of Human Services (as successor to the Department
of Alcoholism and Substance Abuse) and Public Health, through a
public awareness campaign, may provide information concerning
treatment for alcoholism and drug abuse and addiction, prenatal
health care, and other pertinent programs directed at reducing
the number of drug-affected infants born to recipients of
medical assistance.
Neither the Department of Healthcare and Family Services
nor the Department of Human Services shall sanction the
recipient solely on the basis of her substance abuse.
The Illinois Department shall establish such regulations
governing the dispensing of health services under this Article
as it shall deem appropriate. The Department should seek the
advice of formal professional advisory committees appointed by
the Director of the Illinois Department for the purpose of
providing regular advice on policy and administrative matters,
information dissemination and educational activities for
medical and health care providers, and consistency in
procedures to the Illinois Department.
Notwithstanding any other provision of law, a health care
provider under the medical assistance program may elect, in
lieu of receiving direct payment for services provided under
that program, to participate in the State Employees Deferred
Compensation Plan adopted under Article 24 of the Illinois

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Pension Code. A health care provider who elects to participate
in the plan does not have a cause of action against the State
for any damages allegedly suffered by the provider as a result
of any delay by the State in crediting the amount of any
contribution to the provider's plan account.
The Illinois Department may develop and contract with
Partnerships of medical providers to arrange medical services
for persons eligible under Section 5-2 of this Code.
Implementation of this Section may be by demonstration projects
in certain geographic areas. The Partnership shall be
represented by a sponsor organization. The Department, by rule,
shall develop qualifications for sponsors of Partnerships.
Nothing in this Section shall be construed to require that the
sponsor organization be a medical organization.
The sponsor must negotiate formal written contracts with
medical providers for physician services, inpatient and
outpatient hospital care, home health services, treatment for
alcoholism and substance abuse, and other services determined
necessary by the Illinois Department by rule for delivery by
Partnerships. Physician services must include prenatal and
obstetrical care. The Illinois Department shall reimburse
medical services delivered by Partnership providers to clients
in target areas according to provisions of this Article and the
Illinois Health Finance Reform Act, except that:
(1) Physicians participating in a Partnership and
providing certain services, which shall be determined by

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the Illinois Department, to persons in areas covered by the
Partnership may receive an additional surcharge for such
services.
(2) The Department may elect to consider and negotiate
financial incentives to encourage the development of
Partnerships and the efficient delivery of medical care.
(3) Persons receiving medical services through
Partnerships may receive medical and case management
services above the level usually offered through the
medical assistance program.
Medical providers shall be required to meet certain
qualifications to participate in Partnerships to ensure the
delivery of high quality medical services. These
qualifications shall be determined by rule of the Illinois
Department and may be higher than qualifications for
participation in the medical assistance program. Partnership
sponsors may prescribe reasonable additional qualifications
for participation by medical providers, only with the prior
written approval of the Illinois Department.
Nothing in this Section shall limit the free choice of
practitioners, hospitals, and other providers of medical
services by clients. In order to ensure patient freedom of
choice, the Illinois Department shall immediately promulgate
all rules and take all other necessary actions so that provided
services may be accessed from therapeutically certified
optometrists to the full extent of the Illinois Optometric

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Practice Act of 1987 without discriminating between service
providers.
The Department shall apply for a waiver from the United
States Health Care Financing Administration to allow for the
implementation of Partnerships under this Section.
The Illinois Department shall require health care
providers to maintain records that document the medical care
and services provided to recipients of Medical Assistance under
this Article. Such records must be retained for a period of not
less than 6 years from the date of service or as provided by
applicable State law, whichever period is longer, except that
if an audit is initiated within the required retention period
then the records must be retained until the audit is completed
and every exception is resolved. The Illinois Department shall
require health care providers to make available, when
authorized by the patient, in writing, the medical records in a
timely fashion to other health care providers who are treating
or serving persons eligible for Medical Assistance under this
Article. All dispensers of medical services shall be required
to maintain and retain business and professional records
sufficient to fully and accurately document the nature, scope,
details and receipt of the health care provided to persons
eligible for medical assistance under this Code, in accordance
with regulations promulgated by the Illinois Department. The
rules and regulations shall require that proof of the receipt
of prescription drugs, dentures, prosthetic devices and

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eyeglasses by eligible persons under this Section accompany
each claim for reimbursement submitted by the dispenser of such
medical services. No such claims for reimbursement shall be
approved for payment by the Illinois Department without such
proof of receipt, unless the Illinois Department shall have put
into effect and shall be operating a system of post-payment
audit and review which shall, on a sampling basis, be deemed
adequate by the Illinois Department to assure that such drugs,
dentures, prosthetic devices and eyeglasses for which payment
is being made are actually being received by eligible
recipients. Within 90 days after the effective date of this
amendatory Act of 1984, the Illinois Department shall establish
a current list of acquisition costs for all prosthetic devices
and any other items recognized as medical equipment and
supplies reimbursable under this Article and shall update such
list on a quarterly basis, except that the acquisition costs of
all prescription drugs shall be updated no less frequently than
every 30 days as required by Section 5-5.12.
The rules and regulations of the Illinois Department shall
require that a written statement including the required opinion
of a physician shall accompany any claim for reimbursement for
abortions, or induced miscarriages or premature births. This
statement shall indicate what procedures were used in providing
such medical services.
The Illinois Department shall require all dispensers of
medical services, other than an individual practitioner or

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group of practitioners, desiring to participate in the Medical
Assistance program established under this Article to disclose
all financial, beneficial, ownership, equity, surety or other
interests in any and all firms, corporations, partnerships,
associations, business enterprises, joint ventures, agencies,
institutions or other legal entities providing any form of
health care services in this State under this Article.
The Illinois Department may require that all dispensers of
medical services desiring to participate in the medical
assistance program established under this Article disclose,
under such terms and conditions as the Illinois Department may
by rule establish, all inquiries from clients and attorneys
regarding medical bills paid by the Illinois Department, which
inquiries could indicate potential existence of claims or liens
for the Illinois Department.
Enrollment of a vendor that provides non-emergency medical
transportation, defined by the Department by rule, shall be
subject to a provisional period and shall be conditional for
180 days one year. During that time the period of conditional
enrollment, the Department of Healthcare and Family Services
may terminate the vendor's eligibility to participate in, or
may disenroll the vendor from, the medical assistance program
without cause. That Unless otherwise specified, such
termination of eligibility or disenrollment is not subject to
the Department's hearing process. However, a disenrolled
vendor may reapply without penalty.

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The Department has the discretion to limit the conditional
enrollment period for vendors based upon category of risk of
the vendor.
Prior to enrollment and during the conditional enrollment
period in the medical assistance program, all vendors shall be
subject to enhanced oversight, screening, and review based on
the risk of fraud, waste, and abuse that is posed by the
category of risk of the vendor. The Illinois Department shall
establish the procedures for oversight, screening, and review,
which may include, but need not be limited to: criminal and
financial background checks; fingerprinting; license,
certification, and authorization verifications; unscheduled or
unannounced site visits; database checks; prepayment audit
reviews; audits; payment caps; payment suspensions; and other
screening as required by federal or State law.
The Department shall define or specify the following: (i)
by provider notice, the "category of risk of the vendor" for
each type of vendor, which shall take into account the level of
screening applicable to a particular category of vendor under
federal law and regulations; (ii) by rule or provider notice,
the maximum length of the conditional enrollment period for
each category of risk of the vendor; and (iii) by rule, the
hearing rights, if any, afforded to a vendor in each category
of risk of the vendor that is terminated or disenrolled during
the conditional enrollment period.
To be eligible for payment consideration, a vendor's

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payment claim or bill, either as an initial claim or as a
resubmitted claim following prior rejection, must be received
by the Illinois Department, or its fiscal intermediary, no
later than 180 days after the latest date on the claim on which
medical goods or services were provided, with the following
exceptions:
(1) In the case of a provider whose enrollment is in
process by the Illinois Department, the 180-day period
shall not begin until the date on the written notice from
the Illinois Department that the provider enrollment is
complete.
(2) In the case of errors attributable to the Illinois
Department or any of its claims processing intermediaries
which result in an inability to receive, process, or
adjudicate a claim, the 180-day period shall not begin
until the provider has been notified of the error.
(3) In the case of a provider for whom the Illinois
Department initiates the monthly billing process.
For claims for services rendered during a period for which
a recipient received retroactive eligibility, claims must be
filed within 180 days after the Department determines the
applicant is eligible. For claims for which the Illinois
Department is not the primary payer, claims must be submitted
to the Illinois Department within 180 days after the final
adjudication by the primary payer.
In the case of long term care facilities, admission

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documents shall be submitted within 30 days of an admission to
the facility through the Medical Electronic Data Interchange
(MEDI) or the Recipient Eligibility Verification (REV) System,
or shall be submitted directly to the Department of Human
Services using required admission forms. Confirmation numbers
assigned to an accepted transaction shall be retained by a
facility to verify timely submittal. Once an admission
transaction has been completed, all resubmitted claims
following prior rejection are subject to receipt no later than
180 days after the admission transaction has been completed.
Claims that are not submitted and received in compliance
with the foregoing requirements shall not be eligible for
payment under the medical assistance program, and the State
shall have no liability for payment of those claims.
To the extent consistent with applicable information and
privacy, security, and disclosure laws, State and federal
agencies and departments shall provide the Illinois Department
access to confidential and other information and data necessary
to perform eligibility and payment verifications and other
Illinois Department functions. This includes, but is not
limited to: information pertaining to licensure;
certification; earnings; immigration status; citizenship; wage
reporting; unearned and earned income; pension income;
employment; supplemental security income; social security
numbers; National Provider Identifier (NPI) numbers; the
National Practitioner Data Bank (NPDB); program and agency

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exclusions; taxpayer identification numbers; tax delinquency;
corporate information; and death records.
The Illinois Department shall enter into agreements with
State agencies and departments, and is authorized to enter into
agreements with federal agencies and departments, under which
such agencies and departments shall share data necessary for
medical assistance program integrity functions and oversight.
The Illinois Department shall develop, in cooperation with
other State departments and agencies, and in compliance with
applicable federal laws and regulations, appropriate and
effective methods to share such data. At a minimum, and to the
extent necessary to provide data sharing, the Illinois
Department shall enter into agreements with State agencies and
departments, and is authorized to enter into agreements with
federal agencies and departments, including but not limited to:
the Secretary of State; the Department of Revenue; the
Department of Public Health; the Department of Human Services;
and the Department of Financial and Professional Regulation.
Beginning in fiscal year 2013, the Illinois Department
shall set forth a request for information to identify the
benefits of a pre-payment, post-adjudication, and post-edit
claims system with the goals of streamlining claims processing
and provider reimbursement, reducing the number of pending or
rejected claims, and helping to ensure a more transparent
adjudication process through the utilization of: (i) provider
data verification and provider screening technology; and (ii)

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clinical code editing; and (iii) pre-pay, pre- or
post-adjudicated predictive modeling with an integrated case
management system with link analysis. Such a request for
information shall not be considered as a request for proposal
or as an obligation on the part of the Illinois Department to
take any action or acquire any products or services.
The Illinois Department shall establish policies,
procedures, standards and criteria by rule for the acquisition,
repair and replacement of orthotic and prosthetic devices and
durable medical equipment. Such rules shall provide, but not be
limited to, the following services: (1) immediate repair or
replacement of such devices by recipients without medical
authorization; and (2) rental, lease, purchase or
lease-purchase of durable medical equipment in a
cost-effective manner, taking into consideration the
recipient's medical prognosis, the extent of the recipient's
needs, and the requirements and costs for maintaining such
equipment. Such Subject to prior approval, such rules shall
enable a recipient to temporarily acquire and use alternative
or substitute devices or equipment pending repairs or
replacements of any device or equipment previously authorized
for such recipient by the Department.
The Department shall execute, relative to the nursing home
prescreening project, written inter-agency agreements with the
Department of Human Services and the Department on Aging, to
effect the following: (i) intake procedures and common

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eligibility criteria for those persons who are receiving
non-institutional services; and (ii) the establishment and
development of non-institutional services in areas of the State
where they are not currently available or are undeveloped; and
(iii) notwithstanding any other provision of law, subject to
federal approval, on and after July 1, 2012, an increase in the
determination of need (DON) scores from 29 to 37 for applicants
for institutional and home and community-based long term care;
if and only if federal approval is not granted, the Department
may, in conjunction with other affected agencies, implement
utilization controls or changes in benefit packages to
effectuate a similar savings amount for this population; and
(iv) no later than July 1, 2013, minimum level of care
eligibility criteria for institutional and home and
community-based long term care. In order to select the minimum
level of care eligibility criteria, the Governor shall
establish a workgroup that includes affected agency
representatives and stakeholders representing the
institutional and home and community-based long term care
interests. This Section shall not restrict the Department from
implementing lower level of care eligibility criteria for
community-based services in circumstances where federal
approval has been granted.
The Illinois Department shall develop and operate, in
cooperation with other State Departments and agencies and in
compliance with applicable federal laws and regulations,

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appropriate and effective systems of health care evaluation and
programs for monitoring of utilization of health care services
and facilities, as it affects persons eligible for medical
assistance under this Code.
The Illinois Department shall report annually to the
General Assembly, no later than the second Friday in April of
1979 and each year thereafter, in regard to:
(a) actual statistics and trends in utilization of
medical services by public aid recipients;
(b) actual statistics and trends in the provision of
the various medical services by medical vendors;
(c) current rate structures and proposed changes in
those rate structures for the various medical vendors; and
(d) efforts at utilization review and control by the
Illinois Department.
The period covered by each report shall be the 3 years
ending on the June 30 prior to the report. The report shall
include suggested legislation for consideration by the General
Assembly. The filing of one copy of the report with the
Speaker, one copy with the Minority Leader and one copy with
the Clerk of the House of Representatives, one copy with the
President, one copy with the Minority Leader and one copy with
the Secretary of the Senate, one copy with the Legislative
Research Unit, and 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

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Library Act shall be deemed sufficient to comply with this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926,
eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638,
eff. 1-1-12; 97-689, eff. 6-14-12; 97-1061, eff. 8-24-12;
revised 9-20-12.)
(305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
Sec. 5-5.02. Hospital reimbursements.
(a) Reimbursement to Hospitals; July 1, 1992 through
September 30, 1992. Notwithstanding any other provisions of
this Code or the Illinois Department's Rules promulgated under
the Illinois Administrative Procedure Act, reimbursement to
hospitals for services provided during the period July 1, 1992
through September 30, 1992, shall be as follows:

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(1) For inpatient hospital services rendered, or if
applicable, for inpatient hospital discharges occurring,
on or after July 1, 1992 and on or before September 30,
1992, the Illinois Department shall reimburse hospitals
for inpatient services under the reimbursement
methodologies in effect for each hospital, and at the
inpatient payment rate calculated for each hospital, as of
June 30, 1992. For purposes of this paragraph,
"reimbursement methodologies" means all reimbursement
methodologies that pertain to the provision of inpatient
hospital services, including, but not limited to, any
adjustments for disproportionate share, targeted access,
critical care access and uncompensated care, as defined by
the Illinois Department on June 30, 1992.
(2) For the purpose of calculating the inpatient
payment rate for each hospital eligible to receive
quarterly adjustment payments for targeted access and
critical care, as defined by the Illinois Department on
June 30, 1992, the adjustment payment for the period July
1, 1992 through September 30, 1992, shall be 25% of the
annual adjustment payments calculated for each eligible
hospital, as of June 30, 1992. The Illinois Department
shall determine by rule the adjustment payments for
targeted access and critical care beginning October 1,
1992.
(3) For the purpose of calculating the inpatient

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payment rate for each hospital eligible to receive
quarterly adjustment payments for uncompensated care, as
defined by the Illinois Department on June 30, 1992, the
adjustment payment for the period August 1, 1992 through
September 30, 1992, shall be one-sixth of the total
uncompensated care adjustment payments calculated for each
eligible hospital for the uncompensated care rate year, as
defined by the Illinois Department, ending on July 31,
1992. The Illinois Department shall determine by rule the
adjustment payments for uncompensated care beginning
October 1, 1992.
(b) Inpatient payments. For inpatient services provided on
or after October 1, 1993, in addition to rates paid for
hospital inpatient services pursuant to the Illinois Health
Finance Reform Act, as now or hereafter amended, or the
Illinois Department's prospective reimbursement methodology,
or any other methodology used by the Illinois Department for
inpatient services, the Illinois Department shall make
adjustment payments, in an amount calculated pursuant to the
methodology described in paragraph (c) of this Section, to
hospitals that the Illinois Department determines satisfy any
one of the following requirements:
(1) Hospitals that are described in Section 1923 of the
federal Social Security Act, as now or hereafter amended;
or
(2) Illinois hospitals that have a Medicaid inpatient

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utilization rate which is at least one-half a standard
deviation above the mean Medicaid inpatient utilization
rate for all hospitals in Illinois receiving Medicaid
payments from the Illinois Department; or
(3) Illinois hospitals that on July 1, 1991 had a
Medicaid inpatient utilization rate, as defined in
paragraph (h) of this Section, that was at least the mean
Medicaid inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the Illinois
Department and which were located in a planning area with
one-third or fewer excess beds as determined by the Health
Facilities and Services Review Board, and that, as of June
30, 1992, were located in a federally designated Health
Manpower Shortage Area; or
(4) Illinois hospitals that:
(A) have a Medicaid inpatient utilization rate
that is at least equal to the mean Medicaid inpatient
utilization rate for all hospitals in Illinois
receiving Medicaid payments from the Department; and
(B) also have a Medicaid obstetrical inpatient
utilization rate that is at least one standard
deviation above the mean Medicaid obstetrical
inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the
Department for obstetrical services; or
(5) Any children's hospital, which means a hospital

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devoted exclusively to caring for children. A hospital
which includes a facility devoted exclusively to caring for
children shall be considered a children's hospital to the
degree that the hospital's Medicaid care is provided to
children if either (i) the facility devoted exclusively to
caring for children is separately licensed as a hospital by
a municipality prior to September 30, 1998 or (ii) the
hospital has been designated by the State as a Level III
perinatal care facility, has a Medicaid Inpatient
Utilization rate greater than 55% for the rate year 2003
disproportionate share determination, and has more than
10,000 qualified children days as defined by the Department
in rulemaking.
(c) Inpatient adjustment payments. The adjustment payments
required by paragraph (b) shall be calculated based upon the
hospital's Medicaid inpatient utilization rate as follows:
(1) hospitals with a Medicaid inpatient utilization
rate below the mean shall receive a per day adjustment
payment equal to $25;
(2) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than the mean Medicaid
inpatient utilization rate but less than one standard
deviation above the mean Medicaid inpatient utilization
rate shall receive a per day adjustment payment equal to
the sum of $25 plus $1 for each one percent that the
hospital's Medicaid inpatient utilization rate exceeds the

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mean Medicaid inpatient utilization rate;
(3) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than one standard
deviation above the mean Medicaid inpatient utilization
rate but less than 1.5 standard deviations above the mean
Medicaid inpatient utilization rate shall receive a per day
adjustment payment equal to the sum of $40 plus $7 for each
one percent that the hospital's Medicaid inpatient
utilization rate exceeds one standard deviation above the
mean Medicaid inpatient utilization rate; and
(4) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than 1.5 standard
deviations above the mean Medicaid inpatient utilization
rate shall receive a per day adjustment payment equal to
the sum of $90 plus $2 for each one percent that the
hospital's Medicaid inpatient utilization rate exceeds 1.5
standard deviations above the mean Medicaid inpatient
utilization rate.
(d) Supplemental adjustment payments. In addition to the
adjustment payments described in paragraph (c), hospitals as
defined in clauses (1) through (5) of paragraph (b), excluding
county hospitals (as defined in subsection (c) of Section 15-1
of this Code) and a hospital organized under the University of
Illinois Hospital Act, shall be paid supplemental inpatient
adjustment payments of $60 per day. For purposes of Title XIX
of the federal Social Security Act, these supplemental

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adjustment payments shall not be classified as adjustment
payments to disproportionate share hospitals.
(e) The inpatient adjustment payments described in
paragraphs (c) and (d) shall be increased on October 1, 1993
and annually thereafter by a percentage equal to the lesser of
(i) the increase in the DRI hospital cost index for the most
recent 12 month period for which data are available, or (ii)
the percentage increase in the statewide average hospital
payment rate over the previous year's statewide average
hospital payment rate. The sum of the inpatient adjustment
payments under paragraphs (c) and (d) to a hospital, other than
a county hospital (as defined in subsection (c) of Section 15-1
of this Code) or a hospital organized under the University of
Illinois Hospital Act, however, shall not exceed $275 per day;
that limit shall be increased on October 1, 1993 and annually
thereafter by a percentage equal to the lesser of (i) the
increase in the DRI hospital cost index for the most recent
12-month period for which data are available or (ii) the
percentage increase in the statewide average hospital payment
rate over the previous year's statewide average hospital
payment rate.
(f) Children's hospital inpatient adjustment payments. For
children's hospitals, as defined in clause (5) of paragraph
(b), the adjustment payments required pursuant to paragraphs
(c) and (d) shall be multiplied by 2.0.
(g) County hospital inpatient adjustment payments. For

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county hospitals, as defined in subsection (c) of Section 15-1
of this Code, there shall be an adjustment payment as
determined by rules issued by the Illinois Department.
(h) For the purposes of this Section the following terms
shall be defined as follows:
(1) "Medicaid inpatient utilization rate" means a
fraction, the numerator of which is the number of a
hospital's inpatient days provided in a given 12-month
period to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, and the denominator of which is the total number of
the hospital's inpatient days in that same period.
(2) "Mean Medicaid inpatient utilization rate" means
the total number of Medicaid inpatient days provided by all
Illinois Medicaid-participating hospitals divided by the
total number of inpatient days provided by those same
hospitals.
(3) "Medicaid obstetrical inpatient utilization rate"
means the ratio of Medicaid obstetrical inpatient days to
total Medicaid inpatient days for all Illinois hospitals
receiving Medicaid payments from the Illinois Department.
(i) Inpatient adjustment payment limit. In order to meet
the limits of Public Law 102-234 and Public Law 103-66, the
Illinois Department shall by rule adjust disproportionate
share adjustment payments.
(j) University of Illinois Hospital inpatient adjustment

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payments. For hospitals organized under the University of
Illinois Hospital Act, there shall be an adjustment payment as
determined by rules adopted by the Illinois Department.
(k) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
(l) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 96-31, eff. 6-30-09; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.05)
Sec. 5-5.05. Hospitals; psychiatric services.
(a) On and after July 1, 2008, the inpatient, per diem rate
to be paid to a hospital for inpatient psychiatric services
shall be $363.77.
(b) For purposes of this Section, "hospital" means the
following:
(1) Advocate Christ Hospital, Oak Lawn, Illinois.
(2) Barnes-Jewish Hospital, St. Louis, Missouri.
(3) BroMenn Healthcare, Bloomington, Illinois.
(4) Jackson Park Hospital, Chicago, Illinois.
(5) Katherine Shaw Bethea Hospital, Dixon, Illinois.
(6) Lawrence County Memorial Hospital, Lawrenceville,

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Illinois.
(7) Advocate Lutheran General Hospital, Park Ridge,
Illinois.
(8) Mercy Hospital and Medical Center, Chicago,
Illinois.
(9) Methodist Medical Center of Illinois, Peoria,
Illinois.
(10) Provena United Samaritans Medical Center,
Danville, Illinois.
(11) Rockford Memorial Hospital, Rockford, Illinois.
(12) Sarah Bush Lincoln Health Center, Mattoon,
Illinois.
(13) Provena Covenant Medical Center, Urbana,
Illinois.
(14) Rush-Presbyterian-St. Luke's Medical Center,
Chicago, Illinois.
(15) Mt. Sinai Hospital, Chicago, Illinois.
(16) Gateway Regional Medical Center, Granite City,
Illinois.
(17) St. Mary of Nazareth Hospital, Chicago, Illinois.
(18) Provena St. Mary's Hospital, Kankakee, Illinois.
(19) St. Mary's Hospital, Decatur, Illinois.
(20) Memorial Hospital, Belleville, Illinois.
(21) Swedish Covenant Hospital, Chicago, Illinois.
(22) Trinity Medical Center, Rock Island, Illinois.
(23) St. Elizabeth Hospital, Chicago, Illinois.

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(24) Richland Memorial Hospital, Olney, Illinois.
(25) St. Elizabeth's Hospital, Belleville, Illinois.
(26) Samaritan Health System, Clinton, Iowa.
(27) St. John's Hospital, Springfield, Illinois.
(28) St. Mary's Hospital, Centralia, Illinois.
(29) Loretto Hospital, Chicago, Illinois.
(30) Kenneth Hall Regional Hospital, East St. Louis,
Illinois.
(31) Hinsdale Hospital, Hinsdale, Illinois.
(32) Pekin Hospital, Pekin, Illinois.
(33) University of Chicago Medical Center, Chicago,
Illinois.
(34) St. Anthony's Health Center, Alton, Illinois.
(35) OSF St. Francis Medical Center, Peoria, Illinois.
(36) Memorial Medical Center, Springfield, Illinois.
(37) A hospital with a distinct part unit for
psychiatric services that begins operating on or after July
1, 2008.
For purposes of this Section, "inpatient psychiatric
services" means those services provided to patients who are in
need of short-term acute inpatient hospitalization for active
treatment of an emotional or mental disorder.
(c) No rules shall be promulgated to implement this
Section. For purposes of this Section, "rules" is given the
meaning contained in Section 1-70 of the Illinois
Administrative Procedure Act.

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(d) This Section shall not be in effect during any period
of time that the State has in place a fully operational
hospital assessment plan that has been approved by the Centers
for Medicare and Medicaid Services of the U.S. Department of
Health and Human Services.
(e) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
Sec. 5-5.2. Payment.
(a) All nursing facilities that are grouped pursuant to
Section 5-5.1 of this Act shall receive the same rate of
payment for similar services.
(b) It shall be a matter of State policy that the Illinois
Department shall utilize a uniform billing cycle throughout the
State for the long-term care providers.
(c) Notwithstanding any other provisions of this Code,
beginning July 1, 2013 the methodologies for reimbursement of
nursing facility services as provided under this Article shall
no longer be applicable for bills payable for State fiscal
years 2014 and thereafter. The Department of Healthcare and
Family Services shall, effective July 1, 2013, implement an

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evidence-based payment methodology for the reimbursement of
nursing facility services. The methodology shall continue to
take into consideration the needs of individual residents, as
assessed and reported by the most current version of the
nursing facility Resident Assessment Instrument, adopted and
in use by the federal government. nursing services rendered on
or after a new reimbursement system based on the Resource
Utilization Groups (RUGs) has been fully operationalized,
which shall take effect for services provided on or after
January 1, 2014.
(d) (Blank). A new nursing services reimbursement
methodology utilizing RUGs IV 48 grouper model shall be
established and may include an Illinois-specific default
group, as needed. The new RUGs-based nursing services
reimbursement methodology shall be resident-driven,
facility-specific, and cost-based. Costs shall be annually
rebased and case mix index quarterly updated. The methodology
shall include regional wage adjustors based on the Health
Service Areas (HSA) groupings in effect on April 30, 2012. The
Department shall assign a case mix index to each resident class
based on the Centers for Medicare and Medicaid Services staff
time measurement study utilizing an index maximization
approach.
(e) (Blank). Notwithstanding any other provision of this
Code, the Department shall by rule develop a reimbursement
methodology reflective of the intensity of care and services

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requirements of low need residents in the lowest RUG IV
groupers and corresponding regulations.
(f) (Blank). Notwithstanding any other provision of this
Code, on and after July 1, 2012, reimbursement rates associated
with the nursing or support components of the current nursing
facility rate methodology shall not increase beyond the level
effective May 1, 2011 until a new reimbursement system based on
the RUGs IV 48 grouper model has been fully operationalized.
(g) (Blank). Notwithstanding any other provision of this
Code, on and after July 1, 2012, for facilities not designated
by the Department of Healthcare and Family Services as
"Institutions for Mental Disease", rates effective May 1, 2011
shall be adjusted as follows:
(1) Individual nursing rates for residents classified
in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
ending March 31, 2012 shall be reduced by 10%;
(2) Individual nursing rates for residents classified
in all other RUG IV groups shall be reduced by 1.0%;
(3) Facility rates for the capital and support
components shall be reduced by 1.7%.
(h) (Blank). Notwithstanding any other provision of this
Code, on and after July 1, 2012, nursing facilities designated
by the Department of Healthcare and Family Services as
"Institutions for Mental Disease" and "Institutions for Mental
Disease" that are facilities licensed under the Specialized
Mental Health Rehabilitation Act shall have the nursing,

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socio-developmental, capital, and support components of their
reimbursement rate effective May 1, 2011 reduced in total by
2.7%.
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.3) (from Ch. 23, par. 5-5.3)
Sec. 5-5.3. Conditions of Payment - Prospective Rates -
Accounting Principles. This amendatory Act establishes certain
conditions for the Department of Healthcare and Family Services
in instituting rates for the care of recipients of medical
assistance in nursing facilities and ICF/DDs. Such conditions
shall assure a method under which the payment for nursing
facility and ICF/DD services provided to recipients under the
Medical Assistance Program shall be on a reasonable cost
related basis, which is prospectively determined at least
annually by the Department of Public Aid (now Healthcare and
Family Services). The annually established payment rate shall
take effect on July 1 in 1984 and subsequent years. There shall
be no rate increase during calendar year 1983 and the first six
months of calendar year 1984.
The determination of the payment shall be made on the basis
of generally accepted accounting principles that shall take
into account the actual costs to the facility of providing
nursing facility and ICF/DD services to recipients under the
medical assistance program.
The resultant total rate for a specified type of service

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shall be an amount which shall have been determined to be
adequate to reimburse allowable costs of a facility that is
economically and efficiently operated. The Department shall
establish an effective date for each facility or group of
facilities after which rates shall be paid on a reasonable cost
related basis which shall be no sooner than the effective date
of this amendatory Act of 1977.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of Healthcare
and Family Services. The Department of Healthcare and Family
Services shall develop standards of payment of nursing facility
and ICF/DD services in facilities providing such services under
this Article which:
(1) Provide for the determination of a facility's payment
for nursing facility or ICF/DD services on a prospective basis.
The amount of the payment rate for all nursing facilities
certified by the Department of Public Health under the ID/DD
Community Care Act or the Nursing Home Care Act as Intermediate
Care for the Developmentally Disabled facilities, Long Term

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Care for Under Age 22 facilities, Skilled Nursing facilities,
or Intermediate Care facilities under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The annually
established payment rate shall take effect on July 1 in 1984
and subsequent years. No rate increase and no update for
inflation shall be provided on or after July 1, 1994 and before
July 1, 2014 January 1, 2014, unless specifically provided for
in this Section. The changes made by Public Act 93-841
extending the duration of the prohibition against a rate
increase or update for inflation are effective retroactive to
July 1, 2004.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1998
shall include an increase of 3%. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1998 shall include an
increase of 3% plus $1.10 per resident-day, as defined by the
Department. For facilities licensed by the Department of Public

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Health under the Nursing Home Care Act as Intermediate Care
Facilities for the Developmentally Disabled or Long Term Care
for Under Age 22 facilities, the rates taking effect on January
1, 2006 shall include an increase of 3%. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Intermediate Care Facilities for the
Developmentally Disabled or Long Term Care for Under Age 22
facilities, the rates taking effect on January 1, 2009 shall
include an increase sufficient to provide a $0.50 per hour wage
increase for non-executive staff.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1999
shall include an increase of 1.6% plus $3.00 per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1999 shall include an
increase of 1.6% and, for services provided on or after October
1, 1999, shall be increased by $4.00 per resident-day, as
defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 2000

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shall include an increase of 2.5% per resident-day, as defined
by the Department. For facilities licensed by the Department of
Public Health under the Nursing Home Care Act as Skilled
Nursing facilities or Intermediate Care facilities, the rates
taking effect on July 1, 2000 shall include an increase of 2.5%
per resident-day, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, a new payment methodology must
be implemented for the nursing component of the rate effective
July 1, 2003. The Department of Public Aid (now Healthcare and
Family Services) shall develop the new payment methodology
using the Minimum Data Set (MDS) as the instrument to collect
information concerning nursing home resident condition
necessary to compute the rate. The Department shall develop the
new payment methodology to meet the unique needs of Illinois
nursing home residents while remaining subject to the
appropriations provided by the General Assembly. A transition
period from the payment methodology in effect on June 30, 2003
to the payment methodology in effect on July 1, 2003 shall be
provided for a period not exceeding 3 years and 184 days after
implementation of the new payment methodology as follows:
(A) For a facility that would receive a lower nursing
component rate per patient day under the new system than
the facility received effective on the date immediately
preceding the date that the Department implements the new

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payment methodology, the nursing component rate per
patient day for the facility shall be held at the level in
effect on the date immediately preceding the date that the
Department implements the new payment methodology until a
higher nursing component rate of reimbursement is achieved
by that facility.
(B) For a facility that would receive a higher nursing
component rate per patient day under the payment
methodology in effect on July 1, 2003 than the facility
received effective on the date immediately preceding the
date that the Department implements the new payment
methodology, the nursing component rate per patient day for
the facility shall be adjusted.
(C) Notwithstanding paragraphs (A) and (B), the
nursing component rate per patient day for the facility
shall be adjusted subject to appropriations provided by the
General Assembly.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on March 1, 2001
shall include a statewide increase of 7.85%, as defined by the
Department.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or

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intermediate care facilities, except facilities participating
in the Department's demonstration program pursuant to the
provisions of Title 77, Part 300, Subpart T of the Illinois
Administrative Code, the numerator of the ratio used by the
Department of Healthcare and Family Services to compute the
rate payable under this Section using the Minimum Data Set
(MDS) methodology shall incorporate the following annual
amounts as the additional funds appropriated to the Department
specifically to pay for rates based on the MDS nursing
component methodology in excess of the funding in effect on
December 31, 2006:
(i) For rates taking effect January 1, 2007,
$60,000,000.
(ii) For rates taking effect January 1, 2008,
$110,000,000.
(iii) For rates taking effect January 1, 2009,
$194,000,000.
(iv) For rates taking effect April 1, 2011, or the
first day of the month that begins at least 45 days after
the effective date of this amendatory Act of the 96th
General Assembly, $416,500,000 or an amount as may be
necessary to complete the transition to the MDS methodology
for the nursing component of the rate. Increased payments
under this item (iv) are not due and payable, however,
until (i) the methodologies described in this paragraph are
approved by the federal government in an appropriate State

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Plan amendment and (ii) the assessment imposed by Section
5B-2 of this Code is determined to be a permissible tax
under Title XIX of the Social Security Act.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the support component of the
rates taking effect on January 1, 2008 shall be computed using
the most recent cost reports on file with the Department of
Healthcare and Family Services no later than April 1, 2005,
updated for inflation to January 1, 2006.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on April 1, 2002
shall include a statewide increase of 2.0%, as defined by the
Department. This increase terminates on July 1, 2002; beginning
July 1, 2002 these rates are reduced to the level of the rates
in effect on March 31, 2002, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, the rates taking effect on
July 1, 2001 shall be computed using the most recent cost
reports on file with the Department of Public Aid no later than
April 1, 2000, updated for inflation to January 1, 2001. For
rates effective July 1, 2001 only, rates shall be the greater

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of the rate computed for July 1, 2001 or the rate effective on
June 30, 2001.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, if the payment methodologies
required under Section 5A-12 and the waiver granted under 42
CFR 433.68 are approved by the United States Centers for
Medicare and Medicaid Services, the rates taking effect on July
1, 2004 shall be 3.0% greater than the rates in effect on June
30, 2004. These rates shall take effect only upon approval and
implementation of the payment methodologies required under
Section 5A-12.
Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the rates taking effect on
January 1, 2005 shall be 3% more than the rates in effect on
December 31, 2004.

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Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2009, the
per diem support component of the rates effective on January 1,
2008, computed using the most recent cost reports on file with
the Department of Healthcare and Family Services no later than
April 1, 2005, updated for inflation to January 1, 2006, shall
be increased to the amount that would have been derived using
standard Department of Healthcare and Family Services methods,
procedures, and inflators.
Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as intermediate care facilities that
are federally defined as Institutions for Mental Disease, or
facilities licensed by the Department of Public Health under
the Specialized Mental Health Rehabilitation Facilities Act, a
socio-development component rate equal to 6.6% of the
facility's nursing component rate as of January 1, 2006 shall
be established and paid effective July 1, 2006. The
socio-development component of the rate shall be increased by a
factor of 2.53 on the first day of the month that begins at
least 45 days after January 11, 2008 (the effective date of
Public Act 95-707). As of August 1, 2008, the socio-development
component rate shall be equal to 6.6% of the facility's nursing
component rate as of January 1, 2006, multiplied by a factor of

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3.53. For services provided on or after April 1, 2011, or the
first day of the month that begins at least 45 days after the
effective date of this amendatory Act of the 96th General
Assembly, whichever is later, the Illinois Department may by
rule adjust these socio-development component rates, and may
use different adjustment methodologies for those facilities
participating, and those not participating, in the Illinois
Department's demonstration program pursuant to the provisions
of Title 77, Part 300, Subpart T of the Illinois Administrative
Code, but in no case may such rates be diminished below those
in effect on August 1, 2008.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or as long-term care
facilities for residents under 22 years of age, the rates
taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on the first day of
the month that begins at least 45 days after the effective date
of this amendatory Act of the 95th General Assembly shall
include a statewide increase of 2.5%, as defined by the
Department.
Notwithstanding any other provision of this Section, for

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facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2005,
facility rates shall be increased by the difference between (i)
a facility's per diem property, liability, and malpractice
insurance costs as reported in the cost report filed with the
Department of Public Aid and used to establish rates effective
July 1, 2001 and (ii) those same costs as reported in the
facility's 2002 cost report. These costs shall be passed
through to the facility without caps or limitations, except for
adjustments required under normal auditing procedures.
Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January 1,
1997. Such rates will be based upon the rates calculated for
the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report filed
by each skilled care facility and intermediate care facility,
updated to the midpoint of the current rate year. In

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determining rates for services rendered on and after July 1,
1985, fixed time shall not be computed at less than zero. The
Department shall not make any alterations of regulations which
would reduce any component of the Medicaid rate to a level
below what that component would have been utilizing in the rate
effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and psycho-social
characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
The Department of Healthcare and Family Services shall
develop precise standards for payments to reimburse nursing
facilities for any utilization of appropriate rehabilitative
personnel for the provision of rehabilitative services which is
authorized by federal regulations, including reimbursement for
services provided by qualified therapists or qualified
assistants, and which is in accordance with accepted
professional practices. Reimbursement also may be made for

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utilization of other supportive personnel under appropriate
supervision.
The Department shall develop enhanced payments to offset
the additional costs incurred by a facility serving exceptional
need residents and shall allocate at least $8,000,000 of the
funds collected from the assessment established by Section 5B-2
of this Code for such payments. For the purpose of this
Section, "exceptional needs" means, but need not be limited to,
ventilator care, tracheotomy care, bariatric care, complex
wound care, and traumatic brain injury care. The enhanced
payments for exceptional need residents under this paragraph
are not due and payable, however, until (i) the methodologies
described in this paragraph are approved by the federal
government in an appropriate State Plan amendment and (ii) the
assessment imposed by Section 5B-2 of this Code is determined
to be a permissible tax under Title XIX of the Social Security
Act.
(5) Beginning July 1, 2014 January 1, 2014 the
methodologies for reimbursement of nursing facility services
as provided under this Section 5-5.4 shall no longer be
applicable for bills payable for State fiscal years 2014 and
thereafter services provided on or after January 1, 2014.
(6) No payment increase under this Section for the MDS
methodology, exceptional care residents, or the
socio-development component rate established by Public Act
96-1530 of the 96th General Assembly and funded by the

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assessment imposed under Section 5B-2 of this Code shall be due
and payable until after the Department notifies the long-term
care providers, in writing, that the payment methodologies to
long-term care providers required under this Section have been
approved by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services and the
waivers under 42 CFR 433.68 for the assessment imposed by this
Section, if necessary, have been granted by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services. Upon notification to the Department of
approval of the payment methodologies required under this
Section and the waivers granted under 42 CFR 433.68, all
increased payments otherwise due under this Section prior to
the date of notification shall be due and payable within 90
days of the date federal approval is received.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;
97-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
97-584, eff. 8-26-11; 97-689, eff. 6-14-12; 97-813, eff.
7-13-12.)

HB0027 - 199 - LRB098 00027 KTG 30027 b
(305 ILCS 5/5-5.4e)
Sec. 5-5.4e. Nursing facilities; ventilator rates. On and
after October 1, 2009, the Department of Healthcare and Family
Services shall adopt rules to provide medical assistance
reimbursement under this Article for the care of persons on
ventilators in skilled nursing facilities licensed under the
Nursing Home Care Act and certified to participate under the
medical assistance program. Accordingly, necessary amendments
to the rules implementing the Minimum Data Set (MDS) payment
methodology shall also be made to provide a separate per diem
ventilator rate based on days of service. The Department may
adopt rules necessary to implement this amendatory Act of the
96th General Assembly through the use of emergency rulemaking
in accordance with Section 5-45 of the Illinois Administrative
Procedure Act, except that the 24-month limitation on the
adoption of emergency rules under Section 5-45 and the
provisions of Sections 5-115 and 5-125 of that Act do not apply
to rules adopted under this Section. For purposes of that Act,
the General Assembly finds that the adoption of rules to
implement this amendatory Act of the 96th General Assembly is
deemed an emergency and necessary for the public interest,
safety, and welfare.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with

HB0027 - 200 - LRB098 00027 KTG 30027 b
Section 5-5e.
(Source: P.A. 96-743, eff. 8-25-09; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.4h new)
Sec. 5-5.4h. Intermediate Care Facility for the
Developmentally Disabled; bed reserve payments. The Department
shall promulgate rules that establish a policy of bed reserve
payments to ICF/DDs which addresses the needs of residents of
ICF/DDs and their families.
(a) When a resident of an ICF/DD is absent from the
facility in which he or she is a resident for purposes of
physician authorized in-patient admission to a hospital, the
Department's rules shall, at a minimum, provide (1) bed reserve
payments at a daily rate which is 100% of the client's current
per diem rate, for a period not exceeding 10 consecutive days;
(2) bed reserve payments at a daily rate which is 75% of a
client's current per diem rate, for a period which exceeds 10
consecutive days but does not exceed 30 consecutive days; and
(3) bed reserve payments at a daily rate which is 50% of a
client's current per diem rate for a period which exceeds
thirty consecutive days but does not exceed 45 consecutive
days.
(b) When a resident of an ICF/DD is absent from the
facility in which he or she is a resident for purposes of a
home visit with a family member the Department's rules shall,
at a minimum, provide (1) bed reserve payments at a rate which

HB0027 - 201 - LRB098 00027 KTG 30027 b
is 100% of a client's current per diem rate, for a period not
exceeding 10 days per State fiscal year; and (2) bed reserve
payments at a rate which is 75% of a client's current per diem
rate, for a period which exceeds 10 days per State fiscal year
but does not exceed 30 days per State fiscal year.
(c) No Department rule regarding bed reserve payments shall
require an ICF/DD to have a specified percentage of total
facility occupancy as a requirement for receiving bed reserve
payments.
This Section 5-5.4h shall not apply to any State operated
facilities.
(305 ILCS 5/5-5.4i new)
Sec. 5-5.4i. Bed reserves; approval. The Department of
Healthcare and Family Services shall approve bed reserves at a
daily rate of 75% of an individual's current Medicaid per diem,
for nursing facilities 90% or more of whose residents are
Medicaid recipients and that have occupancy levels of at least
93% for resident bed reserves not exceeding 10 days.
(305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
Sec. 5-5.5. Elements of Payment Rate.
(a) The Department of Healthcare and Family Services shall
develop a prospective method for determining payment rates for
nursing facility and ICF/DD services in nursing facilities
composed of the following cost elements:

HB0027 - 202 - LRB098 00027 KTG 30027 b
(1) Standard Services, with the cost of this component
being determined by taking into account the actual costs to
the facilities of these services subject to cost ceilings
to be defined in the Department's rules.
(2) Resident Services, with the cost of this component
being determined by taking into account the actual costs,
needs and utilization of these services, as derived from an
assessment of the resident needs in the nursing facilities.
(3) Ancillary Services, with the payment rate being
developed for each individual type of service. Payment
shall be made only when authorized under procedures
developed by the Department of Healthcare and Family
Services.
(4) Nurse's Aide Training, with the cost of this
component being determined by taking into account the
actual cost to the facilities of such training.
(5) Real Estate Taxes, with the cost of this component
being determined by taking into account the figures
contained in the most currently available cost reports
(with no imposition of maximums) updated to the midpoint of
the current rate year for long term care services rendered
between July 1, 1984 and June 30, 1985, and with the cost
of this component being determined by taking into account
the actual 1983 taxes for which the nursing homes were
assessed (with no imposition of maximums) updated to the
midpoint of the current rate year for long term care

HB0027 - 203 - LRB098 00027 KTG 30027 b
services rendered between July 1, 1985 and June 30, 1986.
(b) In developing a prospective method for determining
payment rates for nursing facility and ICF/DD services in
nursing facilities and ICF/DDs, the Department of Healthcare
and Family Services shall consider the following cost elements:
(1) Reasonable capital cost determined by utilizing
incurred interest rate and the current value of the
investment, including land, utilizing composite rates, or
by utilizing such other reasonable cost related methods
determined by the Department. However, beginning with the
rate reimbursement period effective July 1, 1987, the
Department shall be prohibited from establishing,
including, and implementing any depreciation factor in
calculating the capital cost element.
(2) Profit, with the actual amount being produced and
accruing to the providers in the form of a return on their
total investment, on the basis of their ability to
economically and efficiently deliver a type of service. The
method of payment may assure the opportunity for a profit,
but shall not guarantee or establish a specific amount as a
cost.
(c) The Illinois Department may implement the amendatory
changes to this Section made by this amendatory Act of 1991
through the use of emergency rules in accordance with the
provisions of Section 5.02 of the Illinois Administrative
Procedure Act. For purposes of the Illinois Administrative

HB0027 - 204 - LRB098 00027 KTG 30027 b
Procedure Act, the adoption of rules to implement the
amendatory changes to this Section made by this amendatory Act
of 1991 shall be deemed an emergency and necessary for the
public interest, safety and welfare.
(d) No later than January 1, 2001, the Department of Public
Aid shall file with the Joint Committee on Administrative
Rules, pursuant to the Illinois Administrative Procedure Act, a
proposed rule, or a proposed amendment to an existing rule,
regarding payment for appropriate services, including
assessment, care planning, discharge planning, and treatment
provided by nursing facilities to residents who have a serious
mental illness.
(e) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 96-1123, eff. 1-1-11; 96-1530, eff. 2-16-11;
97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.8b) (from Ch. 23, par. 5-5.8b)
Sec. 5-5.8b. Payment to Campus Facilities. There is hereby
established a separate payment category for campus facilities.
A "campus facility" is defined as an entity which consists of a
long term care facility (or group of facilities if the
facilities are on the same contiguous parcel of real estate)

HB0027 - 205 - LRB098 00027 KTG 30027 b
which meets all of the following criteria as of May 1, 1987:
the entity provides care for both children and adults;
residents of the entity reside in three or more separate
buildings with congregate and small group living arrangements
on a single campus; the entity provides three or more separate
licensed levels of care; the entity (or a part of the entity)
is enrolled with the Department of Healthcare and Family
Services as a provider of long term care services and receives
payments from that Department; the entity (or a part of the
entity) receives funding from the Department of Human Services;
and the entity (or a part of the entity) holds a current
license as a child care institution issued by the Department of
Children and Family Services.
The Department of Healthcare and Family Services, the
Department of Human Services, and the Department of Children
and Family Services shall develop jointly a rate methodology or
methodologies for campus facilities. Such methodology or
methodologies may establish a single rate to be paid by all the
agencies, or a separate rate to be paid by each agency, or
separate components to be paid to different parts of the campus
facility. All campus facilities shall receive the same rate of
payment for similar services. Any methodology developed
pursuant to this section shall take into account the actual
costs to the facility of providing services to residents, and
shall be adequate to reimburse the allowable costs of a campus
facility which is economically and efficiently operated. Any

HB0027 - 206 - LRB098 00027 KTG 30027 b
methodology shall be established on the basis of historical,
financial, and statistical data submitted by campus
facilities, and shall take into account the actual costs
incurred by campus facilities in providing services, and in
meeting licensing and certification standards imposed and
prescribed by the State of Illinois, any of its political
subdivisions or municipalities and by the United States
Department of Health and Human Services. Rates may be
established on a prospective or retrospective basis. Any
methodology shall provide reimbursement for appropriate
payment elements, including the following: standard services,
patient services, real estate taxes, and capital costs.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
Sec. 5-5.12. Pharmacy payments.
(a) Every request submitted by a pharmacy for reimbursement
under this Article for prescription drugs provided to a
recipient of aid under this Article shall include the name of
the prescriber or an acceptable identification number as
established by the Department.

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(b) Pharmacies providing prescription drugs under this
Article shall be reimbursed at a rate which shall include a
professional dispensing fee as determined by the Illinois
Department, plus the current acquisition cost of the
prescription drug dispensed. The Illinois Department shall
update its information on the acquisition costs of all
prescription drugs no less frequently than every 30 days.
However, the Illinois Department may set the rate of
reimbursement for the acquisition cost, by rule, at a
percentage of the current average wholesale acquisition cost.
(c) (Blank).
(d) The Department shall not impose requirements for prior
approval based on a preferred drug list for anti-retroviral,
anti-hemophilic factor concentrates, or any atypical
antipsychotics, conventional antipsychotics, or
anticonvulsants used for the treatment of serious mental
illnesses until 30 days after it has conducted a study of the
impact of such requirements on patient care and submitted a
report to the Speaker of the House of Representatives and the
President of the Senate. The Department shall review
utilization of narcotic medications in the medical assistance
program and impose utilization controls that protect against
abuse.
(e) When making determinations as to which drugs shall be
on a prior approval list, the Department shall include as part
of the analysis for this determination, the degree to which a

HB0027 - 208 - LRB098 00027 KTG 30027 b
drug may affect individuals in different ways based on factors
including the gender of the person taking the medication.
(f) The Department shall cooperate with the Department of
Public Health and the Department of Human Services Division of
Mental Health in identifying psychotropic medications that,
when given in a particular form, manner, duration, or frequency
(including "as needed") in a dosage, or in conjunction with
other psychotropic medications to a nursing home resident or to
a resident of a facility licensed under the ID/DD Community
Care Act, may constitute a chemical restraint or an
"unnecessary drug" as defined by the Nursing Home Care Act or
Titles XVIII and XIX of the Social Security Act and the
implementing rules and regulations. The Department shall
require prior approval for any such medication prescribed for a
nursing home resident or to a resident of a facility licensed
under the ID/DD Community Care Act, that appears to be a
chemical restraint or an unnecessary drug. The Department shall
consult with the Department of Human Services Division of
Mental Health in developing a protocol and criteria for
deciding whether to grant such prior approval.
(g) The Department may by rule provide for reimbursement of
the dispensing of a 90-day supply of a generic or brand name,
non-narcotic maintenance medication in circumstances where it
is cost effective.
(g-5) (Blank). On and after July 1, 2012, the Department
may require the dispensing of drugs to nursing home residents

HB0027 - 209 - LRB098 00027 KTG 30027 b
be in a 7-day supply or other amount less than a 31-day supply.
The Department shall pay only one dispensing fee per 31-day
supply.
(h) Effective July 1, 2011, the Department shall
discontinue coverage of select over-the-counter drugs,
including analgesics and cough and cold and allergy
medications.
(h-5) (Blank). On and after July 1, 2012, the Department
shall impose utilization controls, including, but not limited
to, prior approval on specialty drugs, oncolytic drugs, drugs
for the treatment of HIV or AIDS, immunosuppressant drugs, and
biological products in order to maximize savings on these
drugs. The Department may adjust payment methodologies for
non-pharmacy billed drugs in order to incentivize the selection
of lower-cost drugs. For drugs for the treatment of AIDS, the
Department shall take into consideration the potential for
non-adherence by certain populations, and shall develop
protocols with organizations or providers primarily serving
those with HIV/AIDS, as long as such measures intend to
maintain cost neutrality with other utilization management
controls such as prior approval. For hemophilia, the Department
shall develop a program of utilization review and control which
may include, in the discretion of the Department, prior
approvals. The Department may impose special standards on
providers that dispense blood factors which shall include, in
the discretion of the Department, staff training and education;

HB0027 - 210 - LRB098 00027 KTG 30027 b
patient outreach and education; case management; in-home
patient assessments; assay management; maintenance of stock;
emergency dispensing timeframes; data collection and
reporting; dispensing of supplies related to blood factor
infusions; cold chain management and packaging practices; care
coordination; product recalls; and emergency clinical
consultation. The Department may require patients to receive a
comprehensive examination annually at an appropriate provider
in order to be eligible to continue to receive blood factor.
(i) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(i) The Department shall seek any necessary waiver from the
federal government in order to establish a program limiting the
pharmacies eligible to dispense specialty drugs and shall issue
a Request for Proposals in order to maximize savings on these
drugs. The Department shall by rule establish the drugs
required to be dispensed in this program. (Blank).
(j) (Blank). On and after July 1, 2012, the Department
shall impose limitations on prescription drugs such that the
Department shall not provide reimbursement for more than 4
prescriptions, including 3 brand name prescriptions, for
distinct drugs in a 30-day period, unless prior approval is
received for all prescriptions in excess of the 4-prescription

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limit. Drugs in the following therapeutic classes shall not be
subject to prior approval as a result of the 4-prescription
limit: immunosuppressant drugs, oncolytic drugs, and
anti-retroviral drugs.
(k) (Blank). No medication therapy management program
implemented by the Department shall be contrary to the
provisions of the Pharmacy Practice Act.
(l) (Blank). Any provider enrolled with the Department that
bills the Department for outpatient drugs and is eligible to
enroll in the federal Drug Pricing Program under Section 340B
of the federal Public Health Services Act shall enroll in that
program. No entity participating in the federal Drug Pricing
Program under Section 340B of the federal Public Health
Services Act may exclude Medicaid from their participation in
that program, although the Department may exclude entities
defined in Section 1905(l)(2)(B) of the Social Security Act
from this requirement.
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
96-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff.
6-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; 97-689,
eff. 6-14-12; 97-813, eff. 7-13-12; revised 8-3-12.)
(305 ILCS 5/5-5.17) (from Ch. 23, par. 5-5.17)
Sec. 5-5.17. Separate reimbursement rate. The Illinois
Department may by rule establish a separate reimbursement rate
to be paid to long term care facilities for adult developmental

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training services as defined in Section 15.2 of the Mental
Health and Developmental Disabilities Administrative Act which
are provided to intellectually disabled residents of such
facilities who receive aid under this Article. Any such
reimbursement shall be based upon cost reports submitted by the
providers of such services and shall be paid by the long term
care facility to the provider within such time as the Illinois
Department shall prescribe by rule, but in no case less than 3
business days after receipt of the reimbursement by such
facility from the Illinois Department. The Illinois Department
may impose a penalty upon a facility which does not make
payment to the provider of adult developmental training
services within the time so prescribed, up to the amount of
payment not made to the provider.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-227, eff. 1-1-12; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.20)
Sec. 5-5.20. Clinic payments. For services provided by
federally qualified health centers as defined in Section 1905
(l)(2)(B) of the federal Social Security Act, on or after April
1, 1989, and as long as required by federal law, the Illinois

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Department shall reimburse those health centers for those
services according to a prospective cost-reimbursement
methodology.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.23)
Sec. 5-5.23. Children's mental health services.
(a) The Department of Healthcare and Family Services, by
rule, shall require the screening and assessment of a child
prior to any Medicaid-funded admission to an inpatient hospital
for psychiatric services to be funded by Medicaid. The
screening and assessment shall include a determination of the
appropriateness and availability of out-patient support
services for necessary treatment. The Department, by rule,
shall establish methods and standards of payment for the
screening, assessment, and necessary alternative support
services.
(b) The Department of Healthcare and Family Services, to
the extent allowable under federal law, shall secure federal
financial participation for Individual Care Grant expenditures
made by the Department of Human Services for the Medicaid

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optional service authorized under Section 1905(h) of the
federal Social Security Act, pursuant to the provisions of
Section 7.1 of the Mental Health and Developmental Disabilities
Administrative Act.
(c) The Department of Healthcare and Family Services shall
work jointly with the Department of Human Services to implement
subsections (a) and (b).
(d) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.24)
Sec. 5-5.24. Prenatal and perinatal care. The Department of
Healthcare and Family Services may provide reimbursement under
this Article for all prenatal and perinatal health care
services that are provided for the purpose of preventing
low-birthweight infants, reducing the need for neonatal
intensive care hospital services, and promoting perinatal
health. These services may include comprehensive risk
assessments for pregnant women, women with infants, and
infants, lactation counseling, nutrition counseling,
childbirth support, psychosocial counseling, treatment and
prevention of periodontal disease, and other support services

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that have been proven to improve birth outcomes. The Department
shall maximize the use of preventive prenatal and perinatal
health care services consistent with federal statutes, rules,
and regulations. The Department of Public Aid (now Department
of Healthcare and Family Services) shall develop a plan for
prenatal and perinatal preventive health care and shall present
the plan to the General Assembly by January 1, 2004. On or
before January 1, 2006 and every 2 years thereafter, the
Department shall report to the General Assembly concerning the
effectiveness of prenatal and perinatal health care services
reimbursed under this Section in preventing low-birthweight
infants and reducing the need for neonatal intensive care
hospital services. Each such report shall include an evaluation
of how the ratio of expenditures for treating low-birthweight
infants compared with the investment in promoting healthy
births and infants in local community areas throughout Illinois
relates to healthy infant development in those areas.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5.25)
Sec. 5-5.25. Access to psychiatric mental health services.

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The General Assembly finds that providing access to psychiatric
mental health services in a timely manner will improve the
quality of life for persons suffering from mental illness and
will contain health care costs by avoiding the need for more
costly inpatient hospitalization. The Department of Healthcare
and Family Services shall reimburse psychiatrists and
federally qualified health centers as defined in Section
1905(l)(2)(B) of the federal Social Security Act for mental
health services provided by psychiatrists, as authorized by
Illinois law, to recipients via telepsychiatry. The
Department, by rule, shall establish (i) criteria for such
services to be reimbursed, including appropriate facilities
and equipment to be used at both sites and requirements for a
physician or other licensed health care professional to be
present at the site where the patient is located, and (ii) a
method to reimburse providers for mental health services
provided by telepsychiatry.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-16.7)
Sec. 5-16.7. Post-parturition care. The medical assistance

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program shall provide the post-parturition care benefits
required to be covered by a policy of accident and health
insurance under Section 356s of the Illinois Insurance Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-16.7a)
Sec. 5-16.7a. Reimbursement for epidural anesthesia
services. In addition to other procedures authorized by the
Department under this Code, the Department shall provide
reimbursement to medical providers for epidural anesthesia
services when ordered by the attending practitioner at the time
of delivery.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical

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assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
Illinois Insurance Code and (ii) be subject to the provisions
of Sections 356z.19 and 364.01 of the Illinois Insurance Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-16.9)
Sec. 5-16.9. Woman's health care provider. The medical
assistance program is subject to the provisions of Section 356r
of the Illinois Insurance Code. The Illinois Department shall
adopt rules to implement the requirements of Section 356r of
the Illinois Insurance Code in the medical assistance program
including managed care components.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)

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(305 ILCS 5/5-17) (from Ch. 23, par. 5-17)
Sec. 5-17. Programs to improve access to hospital care.
(a) (1) The General Assembly finds:
(A) That while hospitals have traditionally
provided charitable care to indigent patients, this
burden is not equally borne by all hospitals operating
in this State. Some hospitals continue to provide
significant amounts of care to low-income persons
while others provide very little such care; and
(B) That access to hospital care in this State by
the indigent citizens of Illinois would be seriously
impaired by the closing of hospitals that provide
significant amounts of care to low-income persons.
(2) To help expand the availability of hospital care
for all citizens of this State, it is the policy of the
State to implement programs that more equitably distribute
the burden of providing hospital care to Illinois'
low-income population and that improve access to health
care in Illinois.
(3) The Illinois Department may develop and implement a
program that lessens the burden of providing hospital care
to Illinois' low-income population, taking into account
the costs that must be incurred by hospitals providing
significant amounts of care to low-income persons, and may
develop adjustments to increase rates to improve access to

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health care in Illinois. The Illinois Department shall
prescribe by rule the criteria, standards and procedures
for effecting such adjustments in the rates of hospital
payments for services provided to eligible low-income
persons (under Articles V, VI and VII of this Code) under
this Article.
(b) The Illinois Department shall require hospitals
certified to participate in the federal Medicaid program to:
(1) provide equal access to available services to
low-income persons who are eligible for assistance under
Articles V, VI and VII of this Code;
(2) provide data and reports on the provision of
uncompensated care.
(c) From the effective date of this amendatory Act of 1992
until July 1, 1992, nothing in this Section 5-17 shall be
construed as creating a private right of action on behalf of
any individual.
(d) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-19) (from Ch. 23, par. 5-19)
Sec. 5-19. Healthy Kids Program.

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(a) Any child under the age of 21 eligible to receive
Medical Assistance from the Illinois Department under Article V
of this Code shall be eligible for Early and Periodic
Screening, Diagnosis and Treatment services provided by the
Healthy Kids Program of the Illinois Department under the
Social Security Act, 42 U.S.C. 1396d(r).
(b) Enrollment of Children in Medicaid. The Illinois
Department shall provide for receipt and initial processing of
applications for Medical Assistance for all pregnant women and
children under the age of 21 at locations in addition to those
used for processing applications for cash assistance,
including disproportionate share hospitals, federally
qualified health centers and other sites as selected by the
Illinois Department.
(c) Healthy Kids Examinations. The Illinois Department
shall consider any examination of a child eligible for the
Healthy Kids services provided by a medical provider meeting
the requirements and complying with the rules and regulations
of the Illinois Department to be reimbursed as a Healthy Kids
examination.
(d) Medical Screening Examinations.
(1) The Illinois Department shall insure Medicaid
coverage for periodic health, vision, hearing, and dental
screenings for children eligible for Healthy Kids services
scheduled from a child's birth up until the child turns 21
years. The Illinois Department shall pay for vision,

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hearing, dental and health screening examinations for any
child eligible for Healthy Kids services by qualified
providers at intervals established by Department rules.
(2) The Illinois Department shall pay for an
interperiodic health, vision, hearing, or dental screening
examination for any child eligible for Healthy Kids
services whenever an examination is:
(A) requested by a child's parent, guardian, or
custodian, or is determined to be necessary or
appropriate by social services, developmental, health,
or educational personnel; or
(B) necessary for enrollment in school; or
(C) necessary for enrollment in a licensed day care
program, including Head Start; or
(D) necessary for placement in a licensed child
welfare facility, including a foster home, group home
or child care institution; or
(E) necessary for attendance at a camping program;
or
(F) necessary for participation in an organized
athletic program; or
(G) necessary for enrollment in an early childhood
education program recognized by the Illinois State
Board of Education; or
(H) necessary for participation in a Women,
Infant, and Children (WIC) program; or

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(I) deemed appropriate by the Illinois Department.
(e) Minimum Screening Protocols For Periodic Health
Screening Examinations. Health Screening Examinations must
include the following services:
(1) Comprehensive Health and Development Assessment
including:
(A) Development/Mental Health/Psychosocial
Assessment; and
(B) Assessment of nutritional status including
tests for iron deficiency and anemia for children at
the following ages: 9 months, 2 years, 8 years, and 18
years;
(2) Comprehensive unclothed physical exam;
(3) Appropriate immunizations at a minimum, as
required by the Secretary of the U.S. Department of Health
and Human Services under 42 U.S.C. 1396d(r).
(4) Appropriate laboratory tests including blood lead
levels appropriate for age and risk factors.
(A) Anemia test.
(B) Sickle cell test.
(C) Tuberculin test at 12 months of age and every
1-2 years thereafter unless the treating health care
professional determines that testing is medically
contraindicated.
(D) Other -- The Illinois Department shall insure
that testing for HIV, drug exposure, and sexually

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transmitted diseases is provided for as clinically
indicated.
(5) Health Education. The Illinois Department shall
require providers to provide anticipatory guidance as
recommended by the American Academy of Pediatrics.
(6) Vision Screening. The Illinois Department shall
require providers to provide vision screenings consistent
with those set forth in the Department of Public Health's
Administrative Rules.
(7) Hearing Screening. The Illinois Department shall
require providers to provide hearing screenings consistent
with those set forth in the Department of Public Health's
Administrative Rules.
(8) Dental Screening. The Illinois Department shall
require providers to provide dental screenings consistent
with those set forth in the Department of Public Health's
Administrative Rules.
(f) Covered Medical Services. The Illinois Department
shall provide coverage for all necessary health care,
diagnostic services, treatment and other measures to correct or
ameliorate defects, physical and mental illnesses, and
conditions whether discovered by the screening services or not
for all children eligible for Medical Assistance under Article
V of this Code.
(g) Notice of Healthy Kids Services.
(1) The Illinois Department shall inform any child

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eligible for Healthy Kids services and the child's family
about the benefits provided under the Healthy Kids Program,
including, but not limited to, the following: what services
are available under Healthy Kids, including discussion of
the periodicity schedules and immunization schedules, that
services are provided at no cost to eligible children, the
benefits of preventive health care, where the services are
available, how to obtain them, and that necessary
transportation and scheduling assistance is available.
(2) The Illinois Department shall widely disseminate
information regarding the availability of the Healthy Kids
Program throughout the State by outreach activities which
shall include, but not be limited to, (i) the development
of cooperation agreements with local school districts,
public health agencies, clinics, hospitals and other
health care providers, including developmental disability
and mental health providers, and with charities, to notify
the constituents of each of the Program and assist
individuals, as feasible, with applying for the Program,
(ii) using the media for public service announcements and
advertisements of the Program, and (iii) developing
posters advertising the Program for display in hospital and
clinic waiting rooms.
(3) The Illinois Department shall utilize accepted
methods for informing persons who are illiterate, blind,
deaf, or cannot understand the English language, including

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but not limited to public services announcements and
advertisements in the foreign language media of radio,
television and newspapers.
(4) The Illinois Department shall provide notice of the
Healthy Kids Program to every child eligible for Healthy
Kids services and his or her family at the following times:
(A) orally by the intake worker and in writing at
the time of application for Medical Assistance;
(B) at the time the applicant is informed that he
or she is eligible for Medical Assistance benefits; and
(C) at least 20 days before the date of any
periodic health, vision, hearing, and dental
examination for any child eligible for Healthy Kids
services. Notice given under this subparagraph (C)
must state that a screening examination is due under
the periodicity schedules and must advise the eligible
child and his or her family that the Illinois
Department will provide assistance in scheduling an
appointment and arranging medical transportation.
(h) Data Collection. The Illinois Department shall collect
data in a usable form to track utilization of Healthy Kids
screening examinations by children eligible for Healthy Kids
services, including but not limited to data showing screening
examinations and immunizations received, a summary of
follow-up treatment received by children eligible for Healthy
Kids services and the number of children receiving dental,

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hearing and vision services.
(i) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-24)
(Section scheduled to be repealed on January 1, 2014)
Sec. 5-24. Disease management programs and services for
chronic conditions; pilot project.
(a) In this Section, "disease management programs and
services" means services administered to patients in order to
improve their overall health and to prevent clinical
exacerbations and complications, using cost-effective,
evidence-based practice guidelines and patient self-management
strategies. Disease management programs and services include
all of the following:
(1) A population identification process.
(2) Evidence-based or consensus-based clinical
practice guidelines, risk identification, and matching of
interventions with clinical need.
(3) Patient self-management and disease education.
(4) Process and outcomes measurement, evaluation,
management, and reporting.

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(b) Subject to appropriations, the Department of
Healthcare and Family Services may undertake a pilot project to
study patient outcomes, for patients with chronic diseases or
patients at risk of low birth weight or premature birth,
associated with the use of disease management programs and
services for chronic condition management. "Chronic diseases"
include, but are not limited to, diabetes, congestive heart
failure, and chronic obstructive pulmonary disease. Low birth
weight and premature birth include all medical and other
conditions that lead to poor birth outcomes or problematic
pregnancies.
(c) The disease management programs and services pilot
project shall examine whether chronic disease management
programs and services for patients with specific chronic
conditions do any or all of the following:
(1) Improve the patient's overall health in a more
expeditious manner.
(2) Lower costs in other aspects of the medical
assistance program, such as hospital admissions, days in
skilled nursing homes, emergency room visits, or more
frequent physician office visits.
(d) In carrying out the pilot project, the Department of
Healthcare and Family Services shall examine all relevant
scientific literature and shall consult with health care
practitioners including, but not limited to, physicians,
surgeons, registered pharmacists, and registered nurses.

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(e) The Department of Healthcare and Family Services shall
consult with medical experts, disease advocacy groups, and
academic institutions to develop criteria to be used in
selecting a vendor for the pilot project.
(f) The Department of Healthcare and Family Services may
adopt rules to implement this Section.
(g) This Section is repealed 10 years after the effective
date of this amendatory Act of the 93rd General Assembly.
(h) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 96-799, eff. 10-28-09; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-30)
Sec. 5-30. Care coordination.
(a) At least 50% of recipients eligible for comprehensive
medical benefits in all medical assistance programs or other
health benefit programs administered by the Department,
including the Children's Health Insurance Program Act and the
Covering ALL KIDS Health Insurance Act, shall be enrolled in a
care coordination program by no later than January 1, 2015. For
purposes of this Section, "coordinated care" or "care
coordination" means delivery systems where recipients will
receive their care from providers who participate under

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contract in integrated delivery systems that are responsible
for providing or arranging the majority of care, including
primary care physician services, referrals from primary care
physicians, diagnostic and treatment services, behavioral
health services, in-patient and outpatient hospital services,
dental services, and rehabilitation and long-term care
services. The Department shall designate or contract for such
integrated delivery systems (i) to ensure enrollees have a
choice of systems and of primary care providers within such
systems; (ii) to ensure that enrollees receive quality care in
a culturally and linguistically appropriate manner; and (iii)
to ensure that coordinated care programs meet the diverse needs
of enrollees with developmental, mental health, physical, and
age-related disabilities.
(b) Payment for such coordinated care shall be based on
arrangements where the State pays for performance related to
health care outcomes, the use of evidence-based practices, the
use of primary care delivered through comprehensive medical
homes, the use of electronic medical records, and the
appropriate exchange of health information electronically made
either on a capitated basis in which a fixed monthly premium
per recipient is paid and full financial risk is assumed for
the delivery of services, or through other risk-based payment
arrangements.
(c) To qualify for compliance with this Section, the 50%
goal shall be achieved by enrolling medical assistance

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enrollees from each medical assistance enrollment category,
including parents, children, seniors, and people with
disabilities to the extent that current State Medicaid payment
laws would not limit federal matching funds for recipients in
care coordination programs. In addition, services must be more
comprehensively defined and more risk shall be assumed than in
the Department's primary care case management program as of the
effective date of this amendatory Act of the 96th General
Assembly.
(d) The Department shall report to the General Assembly in
a separate part of its annual medical assistance program
report, beginning April, 2012 until April, 2016, on the
progress and implementation of the care coordination program
initiatives established by the provisions of this amendatory
Act of the 96th General Assembly. The Department shall include
in its April 2011 report a full analysis of federal laws or
regulations regarding upper payment limitations to providers
and the necessary revisions or adjustments in rate
methodologies and payments to providers under this Code that
would be necessary to implement coordinated care with full
financial risk by a party other than the Department.
(e) (Blank). Integrated Care Program for individuals with
chronic mental health conditions.
(1) The Integrated Care Program shall encompass
services administered to recipients of medical assistance
under this Article to prevent exacerbations and

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complications using cost-effective, evidence-based
practice guidelines and mental health management
strategies.
(2) The Department may utilize and expand upon existing
contractual arrangements with integrated care plans under
the Integrated Care Program for providing the coordinated
care provisions of this Section.
(3) Payment for such coordinated care shall be based on
arrangements where the State pays for performance related
to mental health outcomes on a capitated basis in which a
fixed monthly premium per recipient is paid and full
financial risk is assumed for the delivery of services, or
through other risk-based payment arrangements such as
provider-based care coordination.
(4) The Department shall examine whether chronic
mental health management programs and services for
recipients with specific chronic mental health conditions
do any or all of the following:
(A) Improve the patient's overall mental health in
a more expeditious and cost-effective manner.
(B) Lower costs in other aspects of the medical
assistance program, such as hospital admissions,
emergency room visits, or more frequent and
inappropriate psychotropic drug use.
(5) The Department shall work with the facilities and
any integrated care plan participating in the program to

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identify and correct barriers to the successful
implementation of this subsection (e) prior to and during
the implementation to best facilitate the goals and
objectives of this subsection (e).
(f) (Blank). A hospital that is located in a county of the
State in which the Department mandates some or all of the
beneficiaries of the Medical Assistance Program residing in the
county to enroll in a Care Coordination Program, as set forth
in Section 5-30 of this Code, shall not be eligible for any
non-claims based payments not mandated by Article V-A of this
Code for which it would otherwise be qualified to receive,
unless the hospital is a Coordinated Care Participating
Hospital no later than 60 days after the effective date of this
amendatory Act of the 97th General Assembly or 60 days after
the first mandatory enrollment of a beneficiary in a
Coordinated Care program. For purposes of this subsection,
"Coordinated Care Participating Hospital" means a hospital
that meets one of the following criteria:
(1) The hospital has entered into a contract to provide
hospital services to enrollees of the care coordination
program.
(2) The hospital has not been offered a contract by a
care coordination plan that pays at least as much as the
Department would pay, on a fee-for-service basis, not
including disproportionate share hospital adjustment
payments or any other supplemental adjustment or add-on

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payment to the base fee-for-service rate.
(Source: P.A. 96-1501, eff. 1-25-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
Sec. 5A-1. Definitions. As used in this Article, unless
the context requires otherwise:
"Adjusted gross hospital revenue" shall be determined
separately for inpatient and outpatient services for each
hospital conducted, operated or maintained by a hospital
provider, and means the hospital provider's total gross
revenues less: (i) gross revenue attributable to non-hospital
based services including home dialysis services, durable
medical equipment, ambulance services, outpatient clinics and
any other non-hospital based services as determined by the
Illinois Department by rule; and (ii) gross revenues
attributable to the routine services provided to persons
receiving skilled or intermediate long-term care services
within the meaning of Title XVIII or XIX of the Social Security
Act; and (iii) Medicare gross revenue (excluding the Medicare
gross revenue attributable to clauses (i) and (ii) of this
paragraph and the Medicare gross revenue attributable to the
routine services provided to patients in a psychiatric
hospital, a rehabilitation hospital, a distinct part
psychiatric unit, a distinct part rehabilitation unit, or swing
beds). Adjusted gross hospital revenue shall be determined
using the most recent data available from each hospital's 2003

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Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on December 31,
2004, without regard to any subsequent adjustments or changes
to such data. If a hospital's 2003 Medicare cost report is not
contained in the Healthcare Cost Report Information System, the
hospital provider shall furnish such cost report or the data
necessary to determine its adjusted gross hospital revenue as
required by rule by the Illinois Department.
"Fund" means the Hospital Provider Fund.
"Hospital" means an institution, place, building, or
agency located in this State that is subject to licensure by
the Illinois Department of Public Health under the Hospital
Licensing Act, whether public or private and whether organized
for profit or not-for-profit.
"Hospital provider" means a person licensed by the
Department of Public Health to conduct, operate, or maintain a
hospital, regardless of whether the person is a Medicaid
provider. For purposes of this paragraph, "person" means any
political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited
liability company, association, joint stock association, or
trust, or a receiver, executor, trustee, guardian, or other
representative appointed by order of any court.
"Medicare bed days" means, for each hospital, the sum of
the number of days that each bed was occupied by a patient who
was covered by Title XVIII of the Social Security Act,

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excluding days attributable to the routine services provided to
persons receiving skilled or intermediate long term care
services. Medicare bed days shall be computed separately for
each hospital operated or maintained by a hospital provider.
"Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds, excluding
days attributable to the routine services provided to persons
receiving skilled or intermediate long term care services.
Occupied bed days shall be computed separately for each
hospital operated or maintained by a hospital provider.
"Outpatient gross revenue" means, for each hospital, its
total gross charges attributed to outpatient services as
reported on the Medicare cost report at Worksheet C, Part I,
Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65,
66, 67, and 68 (and any subsets of those lines).
"Proration factor" means a fraction, the numerator of which
is 53 and the denominator of which is 365.
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
(Section scheduled to be repealed on January 1, 2015)
Sec. 5A-2. Assessment.
(a) (Blank).
Subject to Sections 5A-3 and 5A-10, for State fiscal years
2009 through 2014, and from July 1, 2014 through December 31,
2014, an annual assessment on inpatient services is imposed on

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each hospital provider in an amount equal to $218.38 multiplied
by the difference of the hospital's occupied bed days less the
hospital's Medicare bed days.
For State fiscal years 2009 through 2014, and after a
hospital's occupied bed days and Medicare bed days shall be
determined using the most recent data available from each
hospital's 2005 Medicare cost report as contained in the
Healthcare Cost Report Information System file, for the quarter
ending on December 31, 2006, without regard to any subsequent
adjustments or changes to such data. If a hospital's 2005
Medicare cost report is not contained in the Healthcare Cost
Report Information System, then the Illinois Department may
obtain the hospital provider's occupied bed days and Medicare
bed days from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Illinois Department or its duly authorized agents and
employees.
(b) (Blank).
(b-5) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2013 through 2014, and July 1, 2014 through December 31,
2014, an annual assessment on outpatient services is imposed on
each hospital provider in an amount equal to .008766 multiplied
by the hospital's outpatient gross revenue.
For State fiscal years 2013 through 2014, and July 1, 2014
through December 31, 2014, a hospital's outpatient gross

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revenue shall be determined using the most recent data
available from each hospital's 2009 Medicare cost report as
contained in the Healthcare Cost Report Information System
file, for the quarter ending on June 30, 2011, without regard
to any subsequent adjustments or changes to such data. If a
hospital's 2009 Medicare cost report is not contained in the
Healthcare Cost Report Information System, then the Department
may obtain the hospital provider's outpatient gross revenue
from any source available, including, but not limited to,
records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this
Section, the Department is authorized, during this 98th General
Assembly, to adopt rules to reduce the rate of any annual
assessment imposed under this Section, as authorized by Section
5-46.2 of the Illinois Administrative Procedure Act.
(e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and Family
Services, as the Single State Medicaid Agency required by
federal law, to determine whether those assessments and

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hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
97-689, eff. 6-14-12.)
(305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3)
Sec. 5A-3. Exemptions.
(a) (Blank).
(b) A hospital provider that is a State agency, a State
university, or a county with a population of 3,000,000 or more
is exempt from the assessment imposed by Section 5A-2.

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(b-2) A hospital provider that is a county with a
population of less than 3,000,000 or a township, municipality,
hospital district, or any other local governmental unit is
exempt from the assessment imposed by Section 5A-2.
(b-5) (Blank).
(b-10) For State fiscal year 2014, a hospital provider,
described in Section 1903(w)(3)(F) of the Social Security Act,
whose hospital does not charge for its services is exempt from
the assessment imposed by Section 5A-2, unless the exemption is
adjudged to be unconstitutional or otherwise invalid, in which
case the hospital provider shall pay the assessment imposed by
Section 5A-2. (Blank).
(b-15) (Blank).
(b-20) (Blank).
(b-25) (Blank).
(c) (Blank).
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
Sec. 5A-4. Payment of assessment; penalty.
(a) Except as provided in subsection (a-5) of this Section,
the The assessment imposed by Section 5A-2 for State fiscal
year 2009 and each subsequent State fiscal year shall be due
and payable in monthly installments, each equaling one-twelfth
of the assessment for the year, on the fourteenth State
business day of each month. No installment payment of an

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assessment imposed by Section 5A-2 shall be due and payable,
however, until after : (i) the Department notifies the hospital
provider, in writing, that the payment methodologies to
hospitals required under Section 5A-12, Section 5A-12.1, or
Section 5A-12.2, whichever is applicable for that fiscal year,
have been approved by the Centers for Medicare and Medicaid
Services of the U.S. Department of Health and Human Services
and the waiver under 42 CFR 433.68 for the assessment imposed
by Section 5A-2, if necessary, has been granted by the Centers
for Medicare and Medicaid Services of the U.S. Department of
Health and Human Services; and (ii) the Comptroller has issued
the payments required under Section 5A-12, Section 5A-12.1, or
Section 5A-12.2, whichever is applicable for that fiscal year.
Upon notification to the Department of approval of the payment
methodologies required under Section 5A-12, Section 5A-12.1,
or Section 5A-12.2, whichever is applicable for that fiscal
year, and the waiver granted under 42 CFR 433.68, all
installments otherwise due under Section 5A-2 prior to the date
of notification shall be due and payable to the Department upon
written direction from the Department and issuance by the
Comptroller of the payments required under Section 5A-12.1 or
Section 5A-12.2, whichever is applicable for that fiscal year.
the Comptroller has issued the payments required under this
Article.
Except as provided in subsection (a-5) of this Section, the
assessment imposed by subsection (b-5) of Section 5A-2 for

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State fiscal year 2013 and each subsequent State fiscal year
shall be due and payable in monthly installments, each equaling
one-twelfth of the assessment for the year, on the 14th State
business day of each month. No installment payment of an
assessment imposed by subsection (b-5) of Section 5A-2 shall be
due and payable, however, until after: (i) the Department
notifies the hospital provider, in writing, that the payment
methodologies to hospitals required under Section 5A-12.4,
have been approved by the Centers for Medicare and Medicaid
Services of the U.S. Department of Health and Human Services,
and the waiver under 42 CFR 433.68 for the assessment imposed
by subsection (b-5) of Section 5A-2, if necessary, has been
granted by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services; and (ii) the
Comptroller has issued the payments required under Section
5A-12.4. Upon notification to the Department of approval of the
payment methodologies required under Section 5A-12.4 and the
waiver granted under 42 CFR 433.68, if necessary, all
installments otherwise due under subsection (b-5) of Section
5A-2 prior to the date of notification shall be due and payable
to the Department upon written direction from the Department
and issuance by the Comptroller of the payments required under
Section 5A-12.4.
(a-5) The Illinois Department may accelerate the schedule
upon which assessment installments are due and payable by
hospitals with a payment ratio greater than or equal to one.

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Such acceleration of due dates for payment of the assessment
may be made only in conjunction with a corresponding
acceleration in access payments identified in Section 5A-12.2
or Section 5A-12.4 to the same hospitals. For the purposes of
this subsection (a-5), a hospital's payment ratio is defined as
the quotient obtained by dividing the total payments for the
State fiscal year, as authorized under Section 5A-12.2 or
Section 5A-12.4, by the total assessment for the State fiscal
year imposed under Section 5A-2 or subsection (b-5) of Section
5A-2.
(b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are
unable to make installment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department.
(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty assessment equal to the
lesser of (i) 5% of the amount of the installment not paid on
or before the due date plus 5% of the portion thereof remaining
unpaid on the last day of each 30-day period thereafter or (ii)
100% of the installment amount not paid on or before the due
date. For purposes of this subsection, payments will be
credited first to unpaid installment amounts (rather than to

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penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the
Illinois Department more frequently than once per calendar
quarter shall be remitted to the Illinois Department by the
hospital provider by means of electronic funds transfer. The
Illinois Department may provide for remittance by other means
if (i) the amount due is less than $10,000 or (ii) electronic
funds transfer is unavailable for this purpose.
(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12;
97-689, eff. 6-14-12.)
(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
Sec. 5A-5. Notice; penalty; maintenance of records.
(a) The Department of Healthcare and Family Services
Illinois Department shall send a notice of assessment to every
hospital provider subject to assessment under this Article. The
notice of assessment shall notify the hospital of its
assessment and shall be sent after receipt by the Department of
notification from the Centers for Medicare and Medicaid
Services of the U.S. Department of Health and Human Services
that the payment methodologies required under Section 5A-12,
Section 5A-12.1, or Section 5A-12.2, whichever is applicable
for that fiscal year this Article and, if necessary, the waiver
granted under 42 CFR 433.68 have been approved. The notice
shall be on a form prepared by the Illinois Department and

HB0027 - 245 - LRB098 00027 KTG 30027 b
shall state the following:
(1) The name of the hospital provider.
(2) The address of the hospital provider's principal
place of business from which the provider engages in the
occupation of hospital provider in this State, and the name
and address of each hospital operated, conducted, or
maintained by the provider in this State.
(3) The occupied bed days, occupied bed days less
Medicare days, adjusted gross hospital revenue, or
outpatient gross revenue of the hospital provider
(whichever is applicable), the amount of assessment
imposed under Section 5A-2 for the State fiscal year for
which the notice is sent, and the amount of each
installment to be paid during the State fiscal year.
(4) (Blank).
(5) Other reasonable information as determined by the
Illinois Department.
(b) If a hospital provider conducts, operates, or maintains
more than one hospital licensed by the Illinois Department of
Public Health, the provider shall pay the assessment for each
hospital separately.
(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or
maintain a hospital in respect of which the person is subject
to assessment under this Article as a hospital provider, the
assessment for the State fiscal year in which the cessation

HB0027 - 246 - LRB098 00027 KTG 30027 b
occurs shall be adjusted by multiplying the assessment computed
under Section 5A-2 by a fraction, the numerator of which is the
number of days in the year during which the provider conducts,
operates, or maintains the hospital and the denominator of
which is 365. Immediately upon ceasing to conduct, operate, or
maintain a hospital, the person shall pay the assessment for
the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department, shall pay the
assessment computed under Section 5A-2 and subsection (e) in
installments on the due dates stated in the notice and on the
regular installment due dates for the State fiscal year
occurring after the due dates of the initial notice.
(e) Notwithstanding any other provision in this Article,
for State fiscal years 2009 through 2014 2015, in the case of a
hospital provider that did not conduct, operate, or maintain a
hospital in 2005, the assessment for that State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department. Notwithstanding any other provision in this
Article, for State fiscal years 2013 through 2014, and for July
1, 2014 through December 31, 2014, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
in 2009, the assessment under subsection (b-5) of Section 5A-2
for that State fiscal year shall be computed on the basis of

HB0027 - 247 - LRB098 00027 KTG 30027 b
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department.
(f) Every hospital provider subject to assessment under
this Article shall keep sufficient records to permit the
determination of adjusted gross hospital revenue for the
hospital's fiscal year. All such records shall be kept in the
English language and shall, at all times during regular
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
(g) The Illinois Department may, by rule, provide a
hospital provider a reasonable opportunity to request a
clarification or correction of any clerical or computational
errors contained in the calculation of its assessment, but such
corrections shall not extend to updating the cost report
information used to calculate the assessment.
(h) (Blank).
(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
97-689, eff. 6-14-12; revised 10-17-12.)
(305 ILCS 5/5A-6) (from Ch. 23, par. 5A-6)
Sec. 5A-6. Disposition of proceeds. The Illinois
Department shall pay deposit all moneys received from hospital
providers under this Article into the Hospital Provider Fund.
Upon certification by the Illinois Department to the State
Comptroller of its intent to withhold payments from a provider

HB0027 - 248 - LRB098 00027 KTG 30027 b
under pursuant to Section 5A-7(b), the State Comptroller shall
draw a warrant on the treasury or other fund held by the State
Treasurer, as appropriate. The warrant shall state the amount
for which the provider is entitled to a warrant, the amount of
the deduction, and the reason therefor and shall direct the
State Treasurer to pay the balance to the provider, all in
accordance with Section 10.05 of the State Comptroller Act. The
warrant also shall direct the State Treasurer to transfer the
amount of the deduction so ordered from the treasury or other
fund into the Hospital Provider Fund.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
Sec. 5A-8. Hospital Provider Fund.
(a) There is created in the State Treasury the Hospital
Provider Fund. Interest earned by the Fund shall be credited to
the Fund. The Fund shall not be used to replace any moneys
appropriated to the Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A-6 and disbursing moneys only for
the following purposes, notwithstanding any other provision of
law:
(1) For making payments to hospitals as required under
this Code, under the Children's Health Insurance Program
Act, under the Covering ALL KIDS Health Insurance Act, and
under the Long Term Acute Care Hospital Quality Improvement

HB0027 - 249 - LRB098 00027 KTG 30027 b
Transfer Program Act.
(2) For the reimbursement of moneys collected by the
Illinois Department from hospitals or hospital providers
through error or mistake in performing the activities
authorized under this Code.
(3) For payment of administrative expenses incurred by
the Illinois Department or its agent in performing
activities under this Code, under the Children's Health
Insurance Program Act, under the Covering ALL KIDS Health
Insurance Act, and under the Long Term Acute Care Hospital
Quality Improvement Transfer Program Act.
(4) For payments of any amounts which are reimbursable
to the federal government for payments from this Fund which
are required to be paid by State warrant.
(5) For making transfers, as those transfers are
authorized in the proceedings authorizing debt under the
Short Term Borrowing Act, but transfers made under this
paragraph (5) shall not exceed the principal amount of debt
issued in anticipation of the receipt by the State of
moneys to be deposited into the Fund.
(6) For making transfers to any other fund in the State
treasury, but transfers made under this paragraph (6) shall
not exceed the amount transferred previously from that
other fund into the Hospital Provider Fund plus any
interest that would have been earned by that fund on the
monies that had been transferred.

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(6.5) For making transfers to the Healthcare Provider
Relief Fund, except that transfers made under this
paragraph (6.5) shall not exceed $60,000,000 in the
aggregate.
(7) (Blank). For making transfers not exceeding the
following amounts, in State fiscal years 2013 and 2014 in
each State fiscal year during which an assessment is
imposed pursuant to Section 5A-2, to the following
designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
General Revenue Fund.................$80,000,000.
Transfers under this paragraph shall be made within 7 days
after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.1) For making transfers not exceeding the following
amounts, in State fiscal year 2015, to the following
designated funds:
Health and Human Services Medicaid Trust
Fund..............................$10,000,000
Long-Term Care Provider Fund..........$15,000,000
General Revenue Fund.................$40,000,000.
Transfers under this paragraph shall be made within 7 days
after the payments have been received pursuant to the

HB0027 - 251 - LRB098 00027 KTG 30027 b
schedule of payments provided in subsection (a) of Section
5A-4.
(7.5) (Blank).
(7.8) (Blank).
(7.9) For State fiscal year 2014, for making transfers
of the moneys received from hospital providers under
Section 5A-4 and transferred into the Hospital Provider
Fund under Section 5A-6 to the designated funds not
exceeding the following amounts in that State fiscal year:
(Blank).
Health and Human Services
Medicaid Trust Fund...................$20,000,000
Long Term Care Provider Fund..............$30,000,000
General Revenue Fund.....................$80,000,000.
Except as provided under this paragraph, transfers
under this paragraph shall be made within 7 business days
after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.10) For State fiscal years 2013 and 2014, for making
transfers of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and received from hospital
providers under Section 5A-4 and transferred into the
Hospital Provider Fund under Section 5A-6 to the designated
funds not exceeding the following amounts in that State
fiscal year:

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Health Care Provider Relief Fund......$50,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.11) For State fiscal year 2015, for making transfers
of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and received from hospital
providers under Section 5A-4 and transferred into the
Hospital Provider Fund under Section 5A-6 to the designated
funds not exceeding the following amounts in that State
fiscal year:
Health Care Provider Relief Fund.....$25,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(8) For making refunds to hospital providers pursuant
to Section 5A-10.
Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the Illinois
Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois

HB0027 - 253 - LRB098 00027 KTG 30027 b
Department from the hospital provider assessment imposed
by this Article.
(2) All federal matching funds received by the Illinois
Department as a result of expenditures made by the Illinois
Department that are attributable to moneys deposited in the
Fund.
(3) Any interest or penalty levied in conjunction with
the administration of this Article.
(4) Moneys transferred from another fund in the State
treasury.
(5) All other moneys received for the Fund from any
other source, including interest earned thereon.
(d) (Blank).
(Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821,
eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
97-689, eff. 6-14-12; revised 10-17-12.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section
5A-2 shall not take effect or shall cease to be imposed and the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if:
(1) The annual appropriation for State fiscal year

HB0027 - 254 - LRB098 00027 KTG 30027 b
2014, from the General Revenue Fund combined with the
Hospital Provider Fund as authorized in Section 5A-8 for
hospital payments under the medical assistance program, is
less than the amount appropriated for State fiscal year
2009, adjusted annually to reflect any change in the number
of recipients, excluding State fiscal year 2009
supplemental appropriations made necessary by the
enactment of the American Recovery and Reinvestment Act of
2009. The payments to hospitals required under this Article
are not eligible for federal matching funds under Title XIX
or XXI of the Social Security Act;
(2.1) (2) For State fiscal years 2009 through 2014, and
July 1, 2014 through December 31, 2014, the Department of
Healthcare and Family Services adopts any administrative
rule change to reduce payment rates or alters any payment
methodology that reduces any payment rates made to
operating hospitals under the approved Title XIX or Title
XXI State plan in effect January 1, 2008 except for:
(A) any changes for hospitals described in
subsection (b) of Section 5A-3;
(B) any rates for payments made under this Article
V-A;
(C) any changes proposed in State plan amendment
transmittal numbers 08-01, 08-02, 08-04, 08-06, and
08-07; or
(D) in relation to any admissions on or after

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January 1, 2011, a modification in the methodology for
calculating outlier payments to hospitals for
exceptionally costly stays, for hospitals reimbursed
under the diagnosis-related grouping methodology in
effect on July 1, 2011 January 1, 2011; provided that
the Department shall be limited to one such
modification during the 36-month period after the
effective date of this amendatory Act of the 96th
General Assembly; or
(E) (Blank). any changes affecting hospitals
authorized by this amendatory Act of the 97th General
Assembly.
(3) The payments to hospitals required under Section
5A-12 or Section 5A-12.2 are changed or are not eligible
for federal matching funds under Title XIX or XXI of the
Social Security Act.
(b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and the Department's
obligation to make payments shall immediately cease, if the
assessment is determined to be an impermissible tax under Title
XIX of the Social Security Act. Moneys in the Hospital Provider
Fund derived from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal
financial participation is not reduced due to the
impermissibility of the assessments, and any remaining moneys
shall be refunded to hospital providers in proportion to the

HB0027 - 256 - LRB098 00027 KTG 30027 b
amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if the payments to hospitals required under Section
5A-12.4 are not eligible for federal matching funds under Title
XIX of the Social Security Act.
(d) The assessments imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
(1) for State fiscal years 2013 through 2014, and July
1, 2014 through December 31, 2014, the Department reduces
any payment rates to hospitals as in effect on May 1, 2012,
or alters any payment methodology as in effect on May 1,
2012, that has the effect of reducing payment rates to
hospitals, except for any changes affecting hospitals
authorized in Senate Bill 2840 of the 97th General Assembly
in the form in which it becomes law, and except for any
changes authorized under Section 5A-15; or
(2) for State fiscal years 2013 through 2014, and July
1, 2014 through December 31, 2014, the Department reduces
any supplemental payments made to hospitals below the

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amounts paid for services provided in State fiscal year
2011 as implemented by administrative rules adopted and in
effect on or prior to June 30, 2011, except for any changes
affecting hospitals authorized in Senate Bill 2840 of the
97th General Assembly in the form in which it becomes law,
and except for any changes authorized under Section 5A-15.
(Source: P.A. 96-8, eff. 4-28-09; 96-1530, eff. 2-16-11; 97-72,
eff. 7-1-11; 97-74, eff. 6-30-11; 97-688, eff. 6-14-12; 97-689,
eff. 6-14-12; revised 10-17-12.)
(305 ILCS 5/5A-12.2)
(Section scheduled to be repealed on January 1, 2015)
Sec. 5A-12.2. Hospital access payments on or after July 1,
2008.
(a) To preserve and improve access to hospital services,
for hospital services rendered on or after July 1, 2008, the
Illinois Department shall, except for hospitals described in
subsection (b) of Section 5A-3, make payments to hospitals as
set forth in this Section. These payments shall be paid in 12
equal installments on or before the seventh State business day
of each month, except that no payment shall be due within 100
days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. Payments under

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this Section are not due and payable, however, until (i) the
methodologies described in this Section are approved by the
federal government in an appropriate State Plan amendment and
(ii) the assessment imposed under this Article is determined to
be a permissible tax under Title XIX of the Social Security
Act.
(a-5) The Illinois Department may, when practicable,
accelerate the schedule upon which payments authorized under
this Section are made.
(b) Across-the-board inpatient adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois general
acute care hospital an amount equal to 40% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois specialty care hospital as defined in 89 Ill. Adm.
Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
the total base inpatient payments paid to the hospital for
services provided in State fiscal year 2005.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois rehabilitation or psychiatric hospital an amount
equal to $1,000 per Medicaid inpatient day multiplied by
the increase in the hospital's Medicaid inpatient

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utilization ratio (determined using the positive
percentage change from the rate year 2005 Medicaid
inpatient utilization ratio to the rate year 2007 Medicaid
inpatient utilization ratio, as calculated by the
Department for the disproportionate share determination).
(4) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois
children's hospital an amount equal to 20% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005 and an additional amount
equal to 20% of the base inpatient payments paid to the
hospital for psychiatric services provided in State fiscal
year 2005.
(5) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois
hospital eligible for a pediatric inpatient adjustment
payment under 89 Ill. Adm. Code 148.298, as in effect for
State fiscal year 2007, a supplemental pediatric inpatient
adjustment payment equal to:
(i) For freestanding children's hospitals as
defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
multiplied by the hospital's pediatric inpatient
adjustment payment required under 89 Ill. Adm. Code
148.298, as in effect for State fiscal year 2008.
(ii) For hospitals other than freestanding
children's hospitals as defined in 89 Ill. Adm. Code

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149.50(c)(3)(B), 1.0 multiplied by the hospital's
pediatric inpatient adjustment payment required under
89 Ill. Adm. Code 148.298, as in effect for State
fiscal year 2008.
(c) Outpatient adjustment.
(1) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois
hospital an amount equal to 2.2 multiplied by the
hospital's ambulatory procedure listing payments for
categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
148.140(b), for State fiscal year 2005.
(2) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois
freestanding psychiatric hospital an amount equal to 3.25
multiplied by the hospital's ambulatory procedure listing
payments for category 5b, as defined in 89 Ill. Adm. Code
148.140(b)(1)(E), for State fiscal year 2005.
(d) Medicaid high volume adjustment. In addition to rates
paid for inpatient hospital services, the Department shall pay
to each Illinois general acute care hospital that provided more
than 20,500 Medicaid inpatient days of care in State fiscal
year 2005 amounts as follows:
(1) For hospitals with a case mix index equal to or
greater than the 85th percentile of hospital case mix
indices, $350 for each Medicaid inpatient day of care
provided during that period; and

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(2) For hospitals with a case mix index less than the
85th percentile of hospital case mix indices, $100 for each
Medicaid inpatient day of care provided during that period.
(e) Capital adjustment. In addition to rates paid for
inpatient hospital services, the Department shall pay an
additional payment to each Illinois general acute care hospital
that has a Medicaid inpatient utilization rate of at least 10%
(as calculated by the Department for the rate year 2007
disproportionate share determination) amounts as follows:
(1) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least 10%
and less than 36.94% and whose capital cost is less than
the 60th percentile of the capital costs of all Illinois
hospitals, the amount of such payment shall equal the
hospital's Medicaid inpatient days multiplied by the
difference between the capital costs at the 60th percentile
of the capital costs of all Illinois hospitals and the
hospital's capital costs.
(2) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least
36.94% and whose capital cost is less than the 75th
percentile of the capital costs of all Illinois hospitals,
the amount of such payment shall equal the hospital's
Medicaid inpatient days multiplied by the difference
between the capital costs at the 75th percentile of the
capital costs of all Illinois hospitals and the hospital's

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capital costs.
(f) Obstetrical care adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,500 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois rural hospital that had a Medicaid
obstetrical percentage (Medicaid obstetrical days divided
by Medicaid inpatient days) greater than 15% for State
fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,350 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level III perinatal center as of December 31,
2006, and that had a case mix index equal to or greater
than the 45th percentile of the case mix indices for all
level III perinatal centers.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $900 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level II or II+ perinatal center as of
December 31, 2006, and that had a case mix index equal to
or greater than the 35th percentile of the case mix indices
for all level II and II+ perinatal centers.
(g) Trauma adjustment.

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(1) In addition to rates paid for inpatient hospital
services, the Department shall pay each Illinois general
acute care hospital designated as a trauma center as of
July 1, 2007, a payment equal to 3.75 multiplied by the
hospital's State fiscal year 2005 Medicaid capital
payments.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay $400 for each Medicaid
acute inpatient day of care provided in State fiscal year
2005 by each Illinois general acute care hospital that was
designated a level II trauma center, as defined in 89 Ill.
Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
2007.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $235 for each Illinois
Medicaid acute inpatient day of care provided in State
fiscal year 2005 by each level I pediatric trauma center
located outside of Illinois that had more than 8,000
Illinois Medicaid inpatient days in State fiscal year 2005.
(h) Supplemental tertiary care adjustment. In addition to
rates paid for inpatient services, the Department shall pay to
each Illinois hospital eligible for tertiary care adjustment
payments under 89 Ill. Adm. Code 148.296, as in effect for
State fiscal year 2007, a supplemental tertiary care adjustment
payment equal to the tertiary care adjustment payment required
under 89 Ill. Adm. Code 148.296, as in effect for State fiscal

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year 2007.
(i) Crossover adjustment. In addition to rates paid for
inpatient services, the Department shall pay each Illinois
general acute care hospital that had a ratio of crossover days
to total inpatient days for medical assistance programs
administered by the Department (utilizing information from
2005 paid claims) greater than 50%, and a case mix index
greater than the 65th percentile of case mix indices for all
Illinois hospitals, a rate of $1,125 for each Medicaid
inpatient day including crossover days.
(j) Magnet hospital adjustment. In addition to rates paid
for inpatient hospital services, the Department shall pay to
each Illinois general acute care hospital and each Illinois
freestanding children's hospital that, as of February 1, 2008,
was recognized as a Magnet hospital by the American Nurses
Credentialing Center and that had a case mix index greater than
the 75th percentile of case mix indices for all Illinois
hospitals amounts as follows:
(1) For hospitals located in a county whose eligibility
growth factor is greater than the mean, $450 multiplied by
the eligibility growth factor for the county in which the
hospital is located for each Medicaid inpatient day of care
provided by the hospital during State fiscal year 2005.
(2) For hospitals located in a county whose eligibility
growth factor is less than or equal to the mean, $225
multiplied by the eligibility growth factor for the county

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in which the hospital is located for each Medicaid
inpatient day of care provided by the hospital during State
fiscal year 2005.
For purposes of this subsection, "eligibility growth
factor" means the percentage by which the number of Medicaid
recipients in the county increased from State fiscal year 1998
to State fiscal year 2005.
(k) For purposes of this Section, a hospital that is
enrolled to provide Medicaid services during State fiscal year
2005 shall have its utilization and associated reimbursements
annualized prior to the payment calculations being performed
under this Section.
(l) For purposes of this Section, the terms "Medicaid
days", "ambulatory procedure listing services", and
"ambulatory procedure listing payments" do not include any
days, charges, or services for which Medicare or a managed care
organization reimbursed on a capitated basis was liable for
payment, except where explicitly stated otherwise in this
Section.
(m) For purposes of this Section, in determining the
percentile ranking of an Illinois hospital's case mix index or
capital costs, hospitals described in subsection (b) of Section
5A-3 shall be excluded from the ranking.
(n) Definitions. Unless the context requires otherwise or
unless provided otherwise in this Section, the terms used in
this Section for qualifying criteria and payment calculations

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shall have the same meanings as those terms have been given in
the Illinois Department's administrative rules as in effect on
March 1, 2008. Other terms shall be defined by the Illinois
Department by rule.
As used in this Section, unless the context requires
otherwise:
"Base inpatient payments" means, for a given hospital, the
sum of base payments for inpatient services made on a per diem
or per admission (DRG) basis, excluding those portions of per
admission payments that are classified as capital payments.
Disproportionate share hospital adjustment payments, Medicaid
Percentage Adjustments, Medicaid High Volume Adjustments, and
outlier payments, as defined by rule by the Department as of
January 1, 2008, are not base payments.
"Capital costs" means, for a given hospital, the total
capital costs determined using the most recent 2005 Medicare
cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on December 31,
2006, divided by the total inpatient days from the same cost
report to calculate a capital cost per day. The resulting
capital cost per day is inflated to the midpoint of State
fiscal year 2009 utilizing the national hospital market price
proxies (DRI) hospital cost index. If a hospital's 2005
Medicare cost report is not contained in the Healthcare Cost
Report Information System, the Department may obtain the data
necessary to compute the hospital's capital costs from any

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source available, including, but not limited to, records
maintained by the hospital provider, which may be inspected at
all times during business hours of the day by the Illinois
Department or its duly authorized agents and employees.
"Case mix index" means, for a given hospital, the sum of
the DRG relative weighting factors in effect on January 1,
2005, for all general acute care admissions for State fiscal
year 2005, excluding Medicare crossover admissions and
transplant admissions reimbursed under 89 Ill. Adm. Code
148.82, divided by the total number of general acute care
admissions for State fiscal year 2005, excluding Medicare
crossover admissions and transplant admissions reimbursed
under 89 Ill. Adm. Code 148.82.
"Medicaid inpatient day" means, for a given hospital, the
sum of days of inpatient hospital days provided to recipients
of medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Medicaid obstetrical day" means, for a given hospital, the
sum of days of inpatient hospital days grouped by the
Department to DRGs of 370 through 375 provided to recipients of
medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for

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Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Outpatient ambulatory procedure listing payments" means,
for a given hospital, the sum of payments for ambulatory
procedure listing services, as described in 89 Ill. Adm. Code
148.140(b), provided to recipients of medical assistance under
Title XIX of the federal Social Security Act, excluding
payments for individuals eligible for Medicare under Title
XVIII of the Act (Medicaid/Medicare crossover days), as
tabulated from the Department's paid claims data for services
occurring in State fiscal year 2005 that were adjudicated by
the Department through March 23, 2007.
(o) The Department may adjust payments made under this
Section 5A-12.2 to comply with federal law or regulations
regarding hospital-specific payment limitations on
government-owned or government-operated hospitals.
(p) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules that
change the hospital access improvement payments specified in
this Section, but only to the extent necessary to conform to
any federally approved amendment to the Title XIX State plan.
Any such rules shall be adopted by the Department as authorized
by Section 5-50 of the Illinois Administrative Procedure Act.
Notwithstanding any other provision of law, any changes

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implemented as a result of this subsection (p) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this Section.
(q) For State fiscal year 2014, the Department may make
recommendations to the General Assembly regarding the use of
more recent data for purposes of calculating the assessment
authorized under Section 5A-2 and the payments authorized under
this Section 5A-12.2. (Blank).
(r) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 96-821, eff. 11-20-09; 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-14)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on July 1, 2014 January 1,
2015.
(b) Section 5A-12 is repealed on July 1, 2005.
(c) Section 5A-12.1 is repealed on July 1, 2008.
(d) Section 5A-12.2 and Section 5A-12.4 are repealed on
July 1, 2014 January 1, 2015.
(e) Section 5A-12.3 is repealed on July 1, 2011.
(Source: P.A. 96-821, eff. 11-20-09; 96-1530, eff. 2-16-11;
97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)

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(305 ILCS 5/6-1.2) (from Ch. 23, par. 6-1.2)
Sec. 6-1.2. Need. Income available to the person, when
added to contributions in money, substance, or services from
other sources, including contributions from legally
responsible relatives, must be insufficient to equal the grant
amount established by Department regulation (or by local
governmental unit in units which do not receive State funds)
for such a person.
In determining income to be taken into account:
(1) The first $75 of earned income in income assistance
units comprised exclusively of one adult person shall be
disregarded, and for not more than 3 months in any 12
consecutive months that portion of earned income beyond the
first $75 that is the difference between the standard of
assistance and the grant amount, shall be disregarded.
(2) For income assistance units not comprised
exclusively of one adult person, when authorized by rules
and regulations of the Illinois Department, a portion of
earned income, not to exceed the first $25 a month plus 50%
of the next $75, may be disregarded for the purpose of
stimulating and aiding rehabilitative effort and
self-support activity.
"Earned income" means money earned in self-employment or
wages, salary, or commission for personal services performed as
an employee. The eligibility of any applicant for or recipient

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of public aid under this Article is not affected by the payment
of any grant under the "Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act", any
refund or payment of the federal Earned Income Tax Credit, or
any distributions or items of income described under
subparagraph (X) of paragraph (2) of subsection (a) of Section
203 of the Illinois Income Tax Act.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/6-2) (from Ch. 23, par. 6-2)
Sec. 6-2. Amount of aid. The amount and nature of General
Assistance for basic maintenance requirements shall be
determined in accordance with local budget standards for local
governmental units which do not receive State funds. For local
governmental units which do receive State funds, the amount and
nature of General Assistance for basic maintenance
requirements shall be determined in accordance with the
standards, rules and regulations of the Illinois Department.
However, the amount and nature of any financial aid is not
affected by the payment of any grant under the Senior Citizens
and Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act or any distributions or items of income
described under subparagraph (X) of paragraph (2) of subsection
(a) of Section 203 of the Illinois Income Tax Act. Due regard
shall be given to the requirements and the conditions existing
in each case, and to the income, money contributions and other

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support and resources available, from whatever source. In local
governmental units which do not receive State funds, the grant
shall be sufficient when added to all other income, money
contributions and support in excess of any excluded income or
resources, to provide the person with a grant in the amount
established for such a person by the local governmental unit
based upon standards meeting basic maintenance requirements.
In local governmental units which do receive State funds, the
grant shall be sufficient when added to all other income, money
contributions and support in excess of any excluded income or
resources, to provide the person with a grant in the amount
established for such a person by Department regulation based
upon standards providing a livelihood compatible with health
and well-being, as directed by Section 12-4.11 of this Code.
The Illinois Department may conduct special projects,
which may be known as Grant Diversion Projects, under which
recipients of financial aid under this Article are placed in
jobs and their grants are diverted to the employer who in turn
makes payments to the recipients in the form of salary or other
employment benefits. The Illinois Department shall by rule
specify the terms and conditions of such Grant Diversion
Projects. Such projects shall take into consideration and be
coordinated with the programs administered under the Illinois
Emergency Employment Development Act.
The allowances provided under Article IX for recipients
participating in the training and rehabilitation programs

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shall be in addition to such maximum payment.
Payments may also be made to provide persons receiving
basic maintenance support with necessary treatment, care and
supplies required because of illness or disability or with
acute medical treatment, care, and supplies. Payments for
necessary or acute medical care under this paragraph may be
made to or in behalf of the person. Obligations incurred for
such services but not paid for at the time of a recipient's
death may be paid, subject to the rules and regulations of the
Illinois Department, after the death of the recipient.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/6-11) (from Ch. 23, par. 6-11)
Sec. 6-11. State funded General Assistance.
(a) Effective July 1, 1992, all State funded General
Assistance and related medical benefits shall be governed by
this Section, provided that, notwithstanding any other
provisions of this Code to the contrary, on and after July 1,
2012, the State shall not fund the programs outlined in this
Section. Other parts of this Code or other laws related to
General Assistance shall remain in effect to the extent they do
not conflict with the provisions of this Section. If any other
part of this Code or other laws of this State conflict with the
provisions of this Section, the provisions of this Section
shall control.
(b) State funded General Assistance shall may consist of 2

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separate programs. One program shall be for adults with no
children and shall be known as State Transitional Assistance.
The other program shall may be for families with children and
for pregnant women and shall be known as State Family and
Children Assistance.
(c) (1) To be eligible for State Transitional Assistance on
or after July 1, 1992, an individual must be ineligible for
assistance under any other Article of this Code, must be
determined chronically needy, and must be one of the following:
(A) age 18 or over or
(B) married and living with a spouse, regardless of
age.
(2) The Illinois Department or the local governmental unit
shall determine whether individuals are chronically needy as
follows:
(A) Individuals who have applied for Supplemental
Security Income (SSI) and are awaiting a decision on
eligibility for SSI who are determined disabled by the
Illinois Department using the SSI standard shall be
considered chronically needy, except that individuals
whose disability is based solely on substance addictions
(drug abuse and alcoholism) and whose disability would
cease were their addictions to end shall be eligible only
for medical assistance and shall not be eligible for cash
assistance under the State Transitional Assistance
program.

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(B) If an individual has been denied SSI due to a
finding of "not disabled" (either at the Administrative Law
Judge level or above, or at a lower level if that
determination was not appealed), the Illinois Department
shall adopt that finding and the individual shall not be
eligible for State Transitional Assistance or any related
medical benefits. Such an individual may not be determined
disabled by the Illinois Department for a period of 12
months, unless the individual shows that there has been a
substantial change in his or her medical condition or that
there has been a substantial change in other factors, such
as age or work experience, that might change the
determination of disability. (Blank).
(C) The Illinois Department, by rule, unit of local
government may specify other categories of individuals as
chronically needy; nothing in this Section, however, shall
be deemed to require the inclusion of any specific category
other than as specified in paragraphs paragraph (A) and
(B).
(3) For individuals in State Transitional Assistance,
medical assistance shall may be provided by the unit of local
government in an amount and nature determined by the Department
of Healthcare and Family Services by rule. The amount and
nature of medical assistance provided need not be the same as
that provided under paragraph (4) of subsection (d) of this
Section, and nothing unit of local government. Nothing in this

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paragraph (3) shall be construed to require the coverage of any
particular medical service. In addition, the amount and nature
of medical assistance provided may be different for different
categories of individuals determined chronically needy.
(4) The Illinois Department shall determine, by rule, those
assistance recipients under Article VI who shall be subject to
employment, training, or education programs including
Earnfare, the content of those programs, and the penalties for
failure to cooperate in those programs. (Blank).
(5) The Illinois Department shall, by rule, establish
further eligibility requirements, including but not limited to
residence, need, and the level of payments. (Blank).
(d) (1) To be eligible for State Family and Children
Assistance, a family unit must be ineligible for assistance
under any other Article of this Code and must contain a child
who is:
(A) under age 18 or
(B) age 18 and a full-time student in a secondary
school or the equivalent level of vocational or technical
training, and who may reasonably be expected to complete
the program before reaching age 19.
Those children shall be eligible for State Family and
Children Assistance.
(2) The natural or adoptive parents of the child living in
the same household may be eligible for State Family and
Children Assistance.

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(3) A pregnant woman whose pregnancy has been verified
shall be eligible for income maintenance assistance under the
State Family and Children Assistance program.
(4) The amount and nature of medical assistance provided
under the State Family and Children Assistance program shall be
determined by the Department of Healthcare and Family Services
by rule unit of local government. The amount and nature of
medical assistance provided need not be the same as that
provided under paragraph (3) of subsection (c) of this Section,
and nothing in this paragraph (4) shall be construed to require
the coverage of any particular medical service.
(5) The Illinois Department shall, by rule, establish
further eligibility requirements, including but not limited to
residence, need, and the level of payments. (Blank).
(e) A local governmental unit that chooses to participate
in a General Assistance program under this Section shall
provide funding in accordance with Section 12-21.13 of this
Act. Local governmental funds used to qualify for State funding
may only be expended for clients eligible for assistance under
this Section 6-11 and related administrative expenses.
(f) In order to qualify for State funding under this
Section, a local governmental unit shall be subject to the
supervision and the rules and regulations of the Illinois
Department. (Blank).
(g) Notwithstanding any other provision in this Code, the
Illinois Department is authorized to reduce payment levels used

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to determine cash grants provided to recipients of State
Transitional Assistance at any time within a Fiscal Year in
order to ensure that cash benefits for State Transitional
Assistance do not exceed the amounts appropriated for those
cash benefits. Changes in payment levels may be accomplished by
emergency rule under Section 5-45 of the Illinois
Administrative Procedure Act, except that the limitation on the
number of emergency rules that may be adopted in a 24-month
period shall not apply and the provisions of Sections 5-115 and
5-125 of the Illinois Administrative Procedure Act shall not
apply. This provision shall also be applicable to any reduction
in payment levels made upon implementation of this amendatory
Act of the 98th General Assembly. (Blank).
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/11-13) (from Ch. 23, par. 11-13)
Sec. 11-13. Conditions For Receipt of Vendor Payments -
Limitation Period For Vendor Action - Penalty For Violation. A
vendor payment, as defined in Section 2-5 of Article II, shall
constitute payment in full for the goods or services covered
thereby. Acceptance of the payment by or in behalf of the
vendor shall bar him from obtaining, or attempting to obtain,
additional payment therefor from the recipient or any other
person. A vendor payment shall not, however, bar recovery of
the value of goods and services the obligation for which, under
the rules and regulations of the Illinois Department, is to be

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met from the income and resources available to the recipient,
and in respect to which the vendor payment of the Illinois
Department or the local governmental unit represents
supplementation of such available income and resources.
Vendors seeking to enforce obligations of a governmental
unit or the Illinois Department for goods or services (1)
furnished to or in behalf of recipients and (2) subject to a
vendor payment as defined in Section 2-5, shall commence their
actions in the appropriate Circuit Court or the Court of
Claims, as the case may require, within one year next after the
cause of action accrued.
A cause of action accrues within the meaning of this
Section upon the following date:
(1) If the vendor can prove that he submitted a bill
for the service rendered to the Illinois Department or a
governmental unit within 12 months of 180 days after the
date the service was rendered, then (a) upon the date the
Illinois Department or a governmental unit mails to the
vendor information that it is paying a bill in part or is
refusing to pay a bill in whole or in part, or (b) upon the
date one year following the date the vendor submitted such
bill if the Illinois Department or a governmental unit
fails to mail to the vendor such payment information within
one year following the date the vendor submitted the bill;
or
(2) If the vendor cannot prove that he submitted a bill

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for the service rendered within 12 months of 180 days after
the date the service was rendered, then upon the date 12
months following the date the vendor rendered the service
to the recipient.
In the case of long term care facilities, where the
Illinois Department initiates the monthly billing process for
the vendor, the cause of action shall accrue 12 months after
the last day of the month the service was rendered.
This paragraph governs only vendor payments as defined in
this Code and as limited by regulations of the Illinois
Department; it does not apply to goods or services purchased or
contracted for by a recipient under circumstances in which the
payment is to be made directly by the recipient.
Any vendor who accepts a vendor payment and who knowingly
obtains or attempts to obtain additional payment for the goods
or services covered by the vendor payment from the recipient or
any other person shall be guilty of a Class B misdemeanor.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
Sec. 11-26. Recipient's abuse of medical care;
restrictions on access to medical care.
(a) When the Department determines, on the basis of
statistical norms and medical judgment, that a medical care
recipient has received medical services in excess of need and
with such frequency or in such a manner as to constitute an

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abuse of the recipient's medical care privileges, the
recipient's access to medical care may be restricted.
(b) When the Department has determined that a recipient is
abusing his or her medical care privileges as described in this
Section, it may require that the recipient designate a primary
provider type of the recipient's own choosing to assume
responsibility for the recipient's care. For the purposes of
this subsection, "primary provider type" means a primary care
provider, primary care pharmacy, primary dentist, primary
podiatrist, or primary durable medical equipment provider
provider type as determined by the Department. Instead of
requiring a recipient to make a designation as provided in this
subsection, the Department, pursuant to rules adopted by the
Department and without regard to any choice of an entity that
the recipient might otherwise make, may initially designate a
primary provider type provided that the primary provider type
is willing to provide that care.
(c) When the Department has requested that a recipient
designate a primary provider type and the recipient fails or
refuses to do so, the Department may, after a reasonable period
of time, assign the recipient to a primary provider type of its
own choice and determination, provided such primary provider
type is willing to provide such care.
(d) When a recipient has been restricted to a designated
primary provider type, the recipient may change the primary
provider type:

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(1) when the designated source becomes unavailable, as
the Department shall determine by rule; or
(2) when the designated primary provider type notifies
the Department that it wishes to withdraw from any
obligation as primary provider type; or
(3) in other situations, as the Department shall
provide by rule.
The Department shall, by rule, establish procedures for
providing medical or pharmaceutical services when the
designated source becomes unavailable or wishes to withdraw
from any obligation as primary provider type, shall, by rule,
take into consideration the need for emergency or temporary
medical assistance and shall ensure that the recipient has
continuous and unrestricted access to medical care from the
date on which such unavailability or withdrawal becomes
effective until such time as the recipient designates a primary
provider type or a primary provider type willing to provide
such care is designated by the Department consistent with
subsections (b) and (c) and such restriction becomes effective.
(e) Prior to initiating any action to restrict a
recipient's access to medical or pharmaceutical care, the
Department shall notify the recipient of its intended action.
Such notification shall be in writing and shall set forth the
reasons for and nature of the proposed action. In addition, the
notification shall:
(1) inform the recipient that (i) the recipient has a

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right to designate a primary provider type of the
recipient's own choosing willing to accept such
designation and that the recipient's failure to do so
within a reasonable time may result in such designation
being made by the Department or (ii) the Department has
designated a primary provider type to assume
responsibility for the recipient's care; and
(2) inform the recipient that the recipient has a right
to appeal the Department's determination to restrict the
recipient's access to medical care and provide the
recipient with an explanation of how such appeal is to be
made. The notification shall also inform the recipient of
the circumstances under which unrestricted medical
eligibility shall continue until a decision is made on
appeal and that if the recipient chooses to appeal, the
recipient will be able to review the medical payment data
that was utilized by the Department to decide that the
recipient's access to medical care should be restricted.
(f) The Department shall, by rule or regulation, establish
procedures for appealing a determination to restrict a
recipient's access to medical care, which procedures shall, at
a minimum, provide for a reasonable opportunity to be heard
and, where the appeal is denied, for a written statement of the
reason or reasons for such denial.
(g) Except as otherwise provided in this subsection, when a
recipient has had his or her medical card restricted for 4 full

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quarters (without regard to any period of ineligibility for
medical assistance under this Code, or any period for which the
recipient voluntarily terminates his or her receipt of medical
assistance, that may occur before the expiration of those 4
full quarters), the Department shall reevaluate the
recipient's medical usage to determine whether it is still in
excess of need and with such frequency or in such a manner as
to constitute an abuse of the receipt of medical assistance. If
it is still in excess of need, the restriction shall be
continued for another 4 full quarters. If it is no longer in
excess of need, the restriction shall be discontinued. If a
recipient's access to medical care has been restricted under
this Section and the Department then determines, either at
reevaluation or after the restriction has been discontinued, to
restrict the recipient's access to medical care a second or
subsequent time, the second or subsequent restriction may be
imposed for a period of more than 4 full quarters. If the
Department restricts a recipient's access to medical care for a
period of more than 4 full quarters, as determined by rule, the
Department shall reevaluate the recipient's medical usage
after the end of the restriction period rather than after the
end of 4 full quarters. The Department shall notify the
recipient, in writing, of any decision to continue the
restriction and the reason or reasons therefor. A "quarter",
for purposes of this Section, shall be defined as one of the
following 3-month periods of time: January-March, April-June,

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July-September or October-December.
(h) In addition to any other recipient whose acquisition of
medical care is determined to be in excess of need, the
Department may restrict the medical care privileges of the
following persons:
(1) recipients found to have loaned or altered their
cards or misused or falsely represented medical coverage;
(2) recipients found in possession of blank or forged
prescription pads;
(3) recipients who knowingly assist providers in
rendering excessive services or defrauding the medical
assistance program.
The procedural safeguards in this Section shall apply to
the above individuals.
(i) Restrictions under this Section shall be in addition to
and shall not in any way be limited by or limit any actions
taken under Article VIIIA VIII-A of this Code.
(Source: P.A. 96-1501, eff. 1-25-11; 97-689, eff. 6-14-12;
revised 8-3-12.)
(305 ILCS 5/12-4.25) (from Ch. 23, par. 12-4.25)
Sec. 12-4.25. Medical assistance program; vendor
participation.
(A) The Illinois Department may deny, suspend, or terminate
the eligibility of any person, firm, corporation, association,
agency, institution or other legal entity to participate as a

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vendor of goods or services to recipients under the medical
assistance program under Article V, or may exclude any such
person or entity from participation as such a vendor, and may
deny, suspend, or recover payments, if after reasonable notice
and opportunity for a hearing the Illinois Department finds:
(a) Such vendor is not complying with the Department's
policy or rules and regulations, or with the terms and
conditions prescribed by the Illinois Department in its
vendor agreement, which document shall be developed by the
Department as a result of negotiations with each vendor
category, including physicians, hospitals, long term care
facilities, pharmacists, optometrists, podiatrists and
dentists setting forth the terms and conditions applicable
to the participation of each vendor group in the program;
or
(b) Such vendor has failed to keep or make available
for inspection, audit or copying, after receiving a written
request from the Illinois Department, such records
regarding payments claimed for providing services. This
section does not require vendors to make available patient
records of patients for whom services are not reimbursed
under this Code; or
(c) Such vendor has failed to furnish any information
requested by the Department regarding payments for
providing goods or services; or
(d) Such vendor has knowingly made, or caused to be

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made, any false statement or representation of a material
fact in connection with the administration of the medical
assistance program; or
(e) Such vendor has furnished goods or services to a
recipient which are (1) in excess of his or her needs need,
(2) harmful to the recipient, or (3) of grossly inferior
quality, all of such determinations to be based upon
competent medical judgment and evaluations; or
(f) The vendor; a person with management
responsibility for a vendor; an officer or person owning,
either directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate
vendor; an owner of a sole proprietorship which is a
vendor; or a partner in a partnership which is a vendor,
either:
(1) was previously terminated, suspended, or
excluded from participation in the Illinois medical
assistance program, or was terminated, suspended, or
excluded from participation in a medical assistance
program in another state that is of the same kind as
the program of medical assistance provided under
Article V of this Code another state or federal medical
assistance or health care program; or
(2) was a person with management responsibility
for a vendor previously terminated, suspended, or
excluded from participation in the Illinois medical

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assistance program, or terminated, suspended, or
excluded from participation in a another state or
federal medical assistance program in another state
that is of the same kind as the program of medical
assistance provided under Article V of this Code, or
health care program during the time of conduct which
was the basis for that vendor's termination,
suspension, or exclusion; or
(3) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate or
limited liability company vendor previously
terminated, suspended, or excluded from participation
in the Illinois medical assistance program, or
terminated, suspended, or excluded from participation
in a state or federal medical assistance or health care
program in another state that is of the same kind as
the program of medical assistance provided under
Article V of this Code, during the time of conduct
which was the basis for that vendor's termination,
suspension, or exclusion; or
(4) was an owner of a sole proprietorship or
partner of a partnership previously terminated,
suspended, or excluded from participation in the
Illinois medical assistance program, or terminated,
suspended, or excluded from participation in a state or

HB0027 - 289 - LRB098 00027 KTG 30027 b
federal medical assistance program in another state
that is of the same kind as the program of medical
assistance provided under Article V of this Code, or
health care program during the time of conduct which
was the basis for that vendor's termination,
suspension, or exclusion; or
(f-1) (Blank); or Such vendor has a delinquent debt
owed to the Illinois Department; or
(g) The vendor; a person with management
responsibility for a vendor; an officer or person owning,
either directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate or
limited liability company vendor; an owner of a sole
proprietorship which is a vendor; or a partner in a
partnership which is a vendor, either:
(1) has engaged in practices prohibited by
applicable federal or State law or regulation relating
to the medical assistance program; or
(2) was a person with management responsibility
for a vendor at the time that such vendor engaged in
practices prohibited by applicable federal or State
law or regulation relating to the medical assistance
program; or
(3) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a vendor at

HB0027 - 290 - LRB098 00027 KTG 30027 b
the time such vendor engaged in practices prohibited by
applicable federal or State law or regulation relating
to the medical assistance program; or
(4) was an owner of a sole proprietorship or
partner of a partnership which was a vendor at the time
such vendor engaged in practices prohibited by
applicable federal or State law or regulation relating
to the medical assistance program; or
(h) The direct or indirect ownership of the vendor
(including the ownership of a vendor that is a sole
proprietorship, a partner's interest in a vendor that is a
partnership, or ownership of 5% or more of the shares of
stock or other evidences of ownership in a corporate
vendor) has been transferred by an individual who is
terminated, suspended, or excluded or barred from
participating as a vendor to the individual's spouse,
child, brother, sister, parent, grandparent, grandchild,
uncle, aunt, niece, nephew, cousin, or relative by
marriage.
(A-5) The Illinois Department may deny, suspend, or
terminate the eligibility of any person, firm, corporation,
association, agency, institution, or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable notice and opportunity for a

HB0027 - 291 - LRB098 00027 KTG 30027 b
hearing, the Illinois Department finds that the vendor; a
person with management responsibility for a vendor; an officer
or person owning, either directly or indirectly, 5% or more of
the shares of stock or other evidences of ownership in a
corporate vendor; an owner of a sole proprietorship that is a
vendor; or a partner in a partnership that is a vendor has been
convicted of a felony an offense based on fraud or willful
misrepresentation related to any of the following:
(1) The medical assistance program under Article V of
this Code.
(2) A medical assistance or health care program in
another state that is of the same kind as the program of
medical assistance provided under Article V of this Code.
(3) The Medicare program under Title XVIII of the
Social Security Act.
(4) The provision of health care services.
(5) (Blank). A violation of this Code, as provided in
Article VIIIA, or another state or federal medical
assistance program or health care program.
(A-10) The Illinois Department may deny, suspend, or
terminate the eligibility of any person, firm, corporation,
association, agency, institution, or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable notice and opportunity for a

HB0027 - 292 - LRB098 00027 KTG 30027 b
hearing, the Illinois Department finds that (i) the vendor,
(ii) a person with management responsibility for a vendor,
(iii) an officer or person owning, either directly or
indirectly, 5% or more of the shares of stock or other
evidences of ownership in a corporate vendor, (iv) an owner of
a sole proprietorship that is a vendor, or (v) a partner in a
partnership that is a vendor has been convicted of a felony an
offense related to any of the following:
(1) Murder.
(2) A Class X felony under the Criminal Code of 1961.
(3) (Blank). Sexual misconduct that may subject
recipients to an undue risk of harm.
(4) (Blank). A criminal offense that may subject
recipients to an undue risk of harm.
(5) (Blank). A crime of fraud or dishonesty.
(6) (Blank). A crime involving a controlled substance.
(7) (Blank). A misdemeanor relating to fraud, theft,
embezzlement, breach of fiduciary responsibility, or other
financial misconduct related to a health care program.
(A-15) (Blank). The Illinois Department may deny the
eligibility of any person, firm, corporation, association,
agency, institution, or other legal entity to participate as a
vendor of goods or services to recipients under the medical
assistance program under Article V if, after reasonable notice
and opportunity for a hearing, the Illinois Department finds:
(1) The applicant or any person with management

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responsibility for the applicant; an officer or member of
the board of directors of an applicant; an entity owning
(directly or indirectly) 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor
applicant; an owner of a sole proprietorship applicant; a
partner in a partnership applicant; or a technical or other
advisor to an applicant has a debt owed to the Illinois
Department, and no payment arrangements acceptable to the
Illinois Department have been made by the applicant.
(2) The applicant or any person with management
responsibility for the applicant; an officer or member of
the board of directors of an applicant; an entity owning
(directly or indirectly) 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor
applicant; an owner of a sole proprietorship applicant; a
partner in a partnership vendor applicant; or a technical
or other advisor to an applicant was (i) a person with
management responsibility, (ii) an officer or member of the
board of directors of an applicant, (iii) an entity owning
(directly or indirectly) 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor, (iv)
an owner of a sole proprietorship, (v) a partner in a
partnership vendor, (vi) a technical or other advisor to a
vendor, during a period of time where the conduct of that
vendor resulted in a debt owed to the Illinois Department,
and no payment arrangements acceptable to the Illinois

HB0027 - 294 - LRB098 00027 KTG 30027 b
Department have been made by that vendor.
(3) There is a credible allegation of the use,
transfer, or lease of assets of any kind to an applicant
from a current or prior vendor who has a debt owed to the
Illinois Department, no payment arrangements acceptable to
the Illinois Department have been made by that vendor or
the vendor's alternate payee, and the applicant knows or
should have known of such debt.
(4) There is a credible allegation of a transfer of
management responsibilities, or direct or indirect
ownership, to an applicant from a current or prior vendor
who has a debt owed to the Illinois Department, and no
payment arrangements acceptable to the Illinois Department
have been made by that vendor or the vendor's alternate
payee, and the applicant knows or should have known of such
debt.
(5) There is a credible allegation of the use,
transfer, or lease of assets of any kind to an applicant
who is a spouse, child, brother, sister, parent,
grandparent, grandchild, uncle, aunt, niece, relative by
marriage, nephew, cousin, or relative of a current or prior
vendor who has a debt owed to the Illinois Department and
no payment arrangements acceptable to the Illinois
Department have been made.
(6) There is a credible allegation that the applicant's
previous affiliations with a provider of medical services

HB0027 - 295 - LRB098 00027 KTG 30027 b
that has an uncollected debt, a provider that has been or
is subject to a payment suspension under a federal health
care program, or a provider that has been previously
excluded from participation in the medical assistance
program, poses a risk of fraud, waste, or abuse to the
Illinois Department.
As used in this subsection, "credible allegation" is
defined to include an allegation from any source, including,
but not limited to, fraud hotline complaints, claims data
mining, patterns identified through provider audits, civil
actions filed under the False Claims Act, and law enforcement
investigations. An allegation is considered to be credible when
it has indicia of reliability.
(B) The Illinois Department shall deny, suspend or
terminate the eligibility of any person, firm, corporation,
association, agency, institution or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor:
(1) immediately, if such vendor is not properly
licensed, certified, or authorized;
(2) within 30 days of the date when such vendor's
professional license, certification or other authorization
has been refused renewal or has been , restricted, revoked,
suspended, or otherwise terminated; or

HB0027 - 296 - LRB098 00027 KTG 30027 b
(3) if such vendor has been convicted of a violation of
this Code, as provided in Article VIIIA.
(C) Upon termination, suspension, or exclusion of a vendor
of goods or services from participation in the medical
assistance program authorized by this Article, a person with
management responsibility for such vendor during the time of
any conduct which served as the basis for that vendor's
termination, suspension, or exclusion is barred from
participation in the medical assistance program.
Upon termination, suspension, or exclusion of a corporate
vendor, the officers and persons owning, directly or
indirectly, 5% or more of the shares of stock or other
evidences of ownership in the vendor during the time of any
conduct which served as the basis for that vendor's
termination, suspension, or exclusion are barred from
participation in the medical assistance program. A person who
owns, directly or indirectly, 5% or more of the shares of stock
or other evidences of ownership in a terminated corporate ,
suspended, or excluded vendor may not transfer his or her
ownership interest in that vendor to his or her spouse, child,
brother, sister, parent, grandparent, grandchild, uncle, aunt,
niece, nephew, cousin, or relative by marriage.
Upon termination, suspension, or exclusion of a sole
proprietorship or partnership, the owner or partners during the
time of any conduct which served as the basis for that vendor's
termination, suspension, or exclusion are barred from

HB0027 - 297 - LRB098 00027 KTG 30027 b
participation in the medical assistance program. The owner of a
terminated, suspended, or excluded vendor that is a sole
proprietorship, and a partner in a terminated, suspended, or
excluded vendor that is a partnership, may not transfer his or
her ownership or partnership interest in that vendor to his or
her spouse, child, brother, sister, parent, grandparent,
grandchild, uncle, aunt, niece, nephew, cousin, or relative by
marriage.
A person who owns, directly or indirectly, 5% or more of
the shares of stock or other evidences of ownership in a
corporate or limited liability company vendor who owes a debt
to the Department, if that vendor has not made payment
arrangements acceptable to the Department, shall not transfer
his or her ownership interest in that vendor, or vendor assets
of any kind, to his or her spouse, child, brother, sister,
parent, grandparent, grandchild, uncle, aunt, niece, nephew,
cousin, or relative by marriage.
Rules adopted by the Illinois Department to implement these
provisions shall specifically include a definition of the term
"management responsibility" as used in this Section. Such
definition shall include, but not be limited to, typical job
titles, and duties and descriptions which will be considered as
within the definition of individuals with management
responsibility for a provider.
A vendor or a prior vendor who has been terminated,
excluded, or suspended from the medical assistance program, or

HB0027 - 298 - LRB098 00027 KTG 30027 b
from another state or federal medical assistance or health care
program, and any individual currently or previously barred from
the medical assistance program, or from another state or
federal medical assistance or health care program, as a result
of being an officer or a person owning, directly or indirectly,
5% or more of the shares of stock or other evidences of
ownership in a corporate or limited liability company vendor
during the time of any conduct which served as the basis for
that vendor's termination, suspension, or exclusion, may be
required to post a surety bond as part of a condition of
enrollment or participation in the medical assistance program.
The Illinois Department shall establish, by rule, the criteria
and requirements for determining when a surety bond must be
posted and the value of the bond.
A vendor or a prior vendor who has a debt owed to the
Illinois Department and any individual currently or previously
barred from the medical assistance program, or from another
state or federal medical assistance or health care program, as
a result of being an officer or a person owning, directly or
indirectly, 5% or more of the shares of stock or other
evidences of ownership in that corporate or limited liability
company vendor during the time of any conduct which served as
the basis for the debt, may be required to post a surety bond
as part of a condition of enrollment or participation in the
medical assistance program. The Illinois Department shall
establish, by rule, the criteria and requirements for

HB0027 - 299 - LRB098 00027 KTG 30027 b
determining when a surety bond must be posted and the value of
the bond.
(D) If a vendor has been suspended from the medical
assistance program under Article V of the Code, the Director
may require that such vendor correct any deficiencies which
served as the basis for the suspension. The Director shall
specify in the suspension order a specific period of time,
which shall not exceed one year from the date of the order,
during which a suspended vendor shall not be eligible to
participate. At the conclusion of the period of suspension the
Director shall reinstate such vendor, unless he finds that such
vendor has not corrected deficiencies upon which the suspension
was based.
If a vendor has been terminated, suspended, or excluded
from the medical assistance program under Article V, such
vendor shall be barred from participation for at least one
year, except that if a vendor has been terminated, suspended,
or excluded based on a conviction of a violation of Article
VIIIA or a conviction of a felony based on fraud or a willful
misrepresentation related to (i) the medical assistance
program under Article V, (ii) a federal or another state's
medical assistance or health care program in another state that
is of the kind provided under Article V, (iii) the Medicare
program under Title XVIII of the Social Security Act, or (iv)
(iii) the provision of health care services, then the vendor
shall be barred from participation for 5 years or for the

HB0027 - 300 - LRB098 00027 KTG 30027 b
length of the vendor's sentence for that conviction, whichever
is longer. At the end of one year a vendor who has been
terminated, suspended, or excluded may apply for reinstatement
to the program. Upon proper application to be reinstated such
vendor may be deemed eligible by the Director providing that
such vendor meets the requirements for eligibility under this
Code. If such vendor is deemed not eligible for reinstatement,
he shall be barred from again applying for reinstatement for
one year from the date his application for reinstatement is
denied.
A vendor whose termination, suspension, or exclusion from
participation in the Illinois medical assistance program under
Article V was based solely on an action by a governmental
entity other than the Illinois Department may, upon
reinstatement by that governmental entity or upon reversal of
the termination, suspension, or exclusion, apply for
rescission of the termination, suspension, or exclusion from
participation in the Illinois medical assistance program. Upon
proper application for rescission, the vendor may be deemed
eligible by the Director if the vendor meets the requirements
for eligibility under this Code.
If a vendor has been terminated, suspended, or excluded and
reinstated to the medical assistance program under Article V
and the vendor is terminated, suspended, or excluded a second
or subsequent time from the medical assistance program, the
vendor shall be barred from participation for at least 2 years,

HB0027 - 301 - LRB098 00027 KTG 30027 b
except that if a vendor has been terminated, suspended, or
excluded a second time based on a conviction of a violation of
Article VIIIA or a conviction of a felony based on fraud or a
willful misrepresentation related to (i) the medical
assistance program under Article V, (ii) a federal or another
state's medical assistance or health care program in another
state that is of the kind provided under Article V, (iii) the
Medicare program under Title XVIII of the Social Security Act,
or (iv) (iii) the provision of health care services, then the
vendor shall be barred from participation for life. At the end
of 2 years, a vendor who has been terminated, suspended, or
excluded may apply for reinstatement to the program. Upon
application to be reinstated, the vendor may be deemed eligible
if the vendor meets the requirements for eligibility under this
Code. If the vendor is deemed not eligible for reinstatement,
the vendor shall be barred from again applying for
reinstatement for 2 years from the date the vendor's
application for reinstatement is denied.
(E) The Illinois Department may recover money improperly or
erroneously paid, or overpayments, either by setoff, crediting
against future billings or by requiring direct repayment to the
Illinois Department. The Illinois Department may suspend or
deny payment, in whole or in part, if such payment would be
improper or erroneous or would otherwise result in overpayment.
(1) Payments may be suspended, denied, or recovered
from a vendor or alternate payee: (i) for services rendered

HB0027 - 302 - LRB098 00027 KTG 30027 b
in violation of the Illinois Department's provider
notices, statutes, rules, and regulations; (ii) for
services rendered in violation of the terms and conditions
prescribed by the Illinois Department in its vendor
agreement; (iii) for any vendor who fails to grant the
Office of Inspector General timely access to full and
complete records, including, but not limited to, records
relating to recipients under the medical assistance
program for the most recent 6 years, in accordance with
Section 140.28 of Title 89 of the Illinois Administrative
Code, and other information for the purpose of audits,
investigations, or other program integrity functions,
after reasonable written request by the Inspector General;
this subsection (E) does not require vendors to make
available the medical records of patients for whom services
are not reimbursed under this Code or to provide access to
medical records more than 6 years old; (iv) when the vendor
has knowingly made, or caused to be made, any false
statement or representation of a material fact in
connection with the administration of the medical
assistance program; or (v) when the vendor previously
rendered services while terminated, suspended, or excluded
from participation in the medical assistance program or
while terminated or excluded from participation in another
state or federal medical assistance or health care program.
(2) Notwithstanding any other provision of law, if a

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vendor has the same taxpayer identification number
(assigned under Section 6109 of the Internal Revenue Code
of 1986) as is assigned to a vendor with past-due financial
obligations to the Illinois Department, the Illinois
Department may make any necessary adjustments to payments
to that vendor in order to satisfy any past-due
obligations, regardless of whether the vendor is assigned a
different billing number under the medical assistance
program.
If the Illinois Department establishes through an
administrative hearing that the overpayments resulted from the
vendor or alternate payee willfully knowingly making, using, or
causing to be made or used, a false record or statement or
misrepresentation of a material fact in connection with
billings and payments under to obtain payment or other benefit
from the medical assistance program under Article V, the
Department may recover interest on the amount of the
overpayments payment or other benefit at the rate of 5% per
annum. In addition to any other penalties that may be
prescribed by law, such a vendor or alternate payee shall be
subject to civil penalties consisting of an amount not to
exceed 3 times the amount of payment or other benefit resulting
from each such false record or statement, and the sum of $2,000
for each such false record or statement for payment or other
benefit. For purposes of this paragraph, "willfully"
"knowingly" means that a person makes a statement or

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representation with vendor or alternate payee with respect to
information: (i) has actual knowledge that it was false, or
makes a statement or representation with knowledge of facts or
information that would cause one to be aware that the statement
or representation was false when made. of the information, (ii)
acts in deliberate ignorance of the truth or falsity of the
information, or (iii) acts in reckless disregard of the truth
or falsity of the information. No proof of specific intent to
defraud is required.
(F) The Illinois Department may withhold payments to any
vendor or alternate payee prior to or during the pendency of
any audit or proceeding under this Section, and through the
pendency of any administrative appeal or administrative review
by any court proceeding. The Illinois Department shall state by
rule with as much specificity as practicable the conditions
under which payments will not be withheld during the pendency
of any proceeding under this Section. Payments may be denied
for bills submitted with service dates occurring during the
pendency of a proceeding, after a final decision has been
rendered, or after the conclusion of any administrative appeal,
where the final administrative decision is to terminate,
exclude, or suspend eligibility to participate in the medical
assistance program. The Illinois Department shall state by rule
with as much specificity as practicable the conditions under
which payments will not be denied for such bills. The Illinois
Department shall state by rule a process and criteria by which

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a vendor or alternate payee may request full or partial release
of payments withheld under this subsection. The Department must
complete a proceeding under this Section in a timely manner.
Notwithstanding recovery allowed under subsection (E) or
this subsection (F), the Illinois Department may withhold
payments to any vendor or alternate payee who is not properly
licensed, certified, or in compliance with State or federal
agency regulations. Payments may be denied for bills submitted
with service dates occurring during the period of time that a
vendor is not properly licensed, certified, or in compliance
with State or federal regulations. Facilities licensed under
the Nursing Home Care Act shall have payments denied or
withheld pursuant to subsection (I) of this Section.
(F-5) The Illinois Department may temporarily withhold
payments to a vendor or alternate payee if any of the following
individuals have been indicted or otherwise charged under a law
of the United States or this or any other state with a felony
an offense that is based on alleged fraud or willful
misrepresentation on the part of the individual related to (i)
the medical assistance program under Article V of this Code,
(ii) a federal or another state's medical assistance or health
care program provided in another state which is of the kind
provided under Article V of this Code, (iii) the Medicare
program under Title XVIII of the Social Security Act, or (iv)
(iii) the provision of health care services:
(1) If the vendor or alternate payee is a corporation:

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an officer of the corporation or an individual who owns,
either directly or indirectly, 5% or more of the shares of
stock or other evidence of ownership of the corporation.
(2) If the vendor is a sole proprietorship: the owner
of the sole proprietorship.
(3) If the vendor or alternate payee is a partnership:
a partner in the partnership.
(4) If the vendor or alternate payee is any other
business entity authorized by law to transact business in
this State: an officer of the entity or an individual who
owns, either directly or indirectly, 5% or more of the
evidences of ownership of the entity.
If the Illinois Department withholds payments to a vendor
or alternate payee under this subsection, the Department shall
not release those payments to the vendor or alternate payee
while any criminal proceeding related to the indictment or
charge is pending unless the Department determines that there
is good cause to release the payments before completion of the
proceeding. If the indictment or charge results in the
individual's conviction, the Illinois Department shall retain
all withheld payments, which shall be considered forfeited to
the Department. If the indictment or charge does not result in
the individual's conviction, the Illinois Department shall
release to the vendor or alternate payee all withheld payments.
(F-10) (Blank). If the Illinois Department establishes
that the vendor or alternate payee owes a debt to the Illinois

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Department, and the vendor or alternate payee subsequently
fails to pay or make satisfactory payment arrangements with the
Illinois Department for the debt owed, the Illinois Department
may seek all remedies available under the law of this State to
recover the debt, including, but not limited to, wage
garnishment or the filing of claims or liens against the vendor
or alternate payee.
(F-15) (Blank). Enforcement of judgment.
(1) Any fine, recovery amount, other sanction, or costs
imposed, or part of any fine, recovery amount, other
sanction, or cost imposed, remaining unpaid after the
exhaustion of or the failure to exhaust judicial review
procedures under the Illinois Administrative Review Law is
a debt due and owing the State and may be collected using
all remedies available under the law.
(2) After expiration of the period in which judicial
review under the Illinois Administrative Review Law may be
sought for a final administrative decision, unless stayed
by a court of competent jurisdiction, the findings,
decision, and order of the Director may be enforced in the
same manner as a judgment entered by a court of competent
jurisdiction.
(3) In any case in which any person or entity has
failed to comply with a judgment ordering or imposing any
fine or other sanction, any expenses incurred by the
Illinois Department to enforce the judgment, including,

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but not limited to, attorney's fees, court costs, and costs
related to property demolition or foreclosure, after they
are fixed by a court of competent jurisdiction or the
Director, shall be a debt due and owing the State and may
be collected in accordance with applicable law. Prior to
any expenses being fixed by a final administrative decision
pursuant to this subsection (F-15), the Illinois
Department shall provide notice to the individual or entity
that states that the individual or entity shall appear at a
hearing before the administrative hearing officer to
determine whether the individual or entity has failed to
comply with the judgment. The notice shall set the date for
such a hearing, which shall not be less than 7 days from
the date that notice is served. If notice is served by
mail, the 7-day period shall begin to run on the date that
the notice was deposited in the mail.
(4) Upon being recorded in the manner required by
Article XII of the Code of Civil Procedure or by the
Uniform Commercial Code, a lien shall be imposed on the
real estate or personal estate, or both, of the individual
or entity in the amount of any debt due and owing the State
under this Section. The lien may be enforced in the same
manner as a judgment of a court of competent jurisdiction.
A lien shall attach to all property and assets of such
person, firm, corporation, association, agency,
institution, or other legal entity until the judgment is

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satisfied.
(5) The Director may set aside any judgment entered by
default and set a new hearing date upon a petition filed at
any time (i) if the petitioner's failure to appear at the
hearing was for good cause, or (ii) if the petitioner
established that the Department did not provide proper
service of process. If any judgment is set aside pursuant
to this paragraph (5), the hearing officer shall have
authority to enter an order extinguishing any lien which
has been recorded for any debt due and owing the Illinois
Department as a result of the vacated default judgment.
(G) The provisions of the Administrative Review Law, as now
or hereafter amended, and the rules adopted pursuant thereto,
shall apply to and govern all proceedings for the judicial
review of final administrative decisions of the Illinois
Department under this Section. The term "administrative
decision" is defined as in Section 3-101 of the Code of Civil
Procedure.
(G-5) Non-emergency transportation Vendors who pose a risk
of fraud, waste, abuse, or harm.
(1) Notwithstanding any other provision in this
Section, for non-emergency transportation vendors, the
Department may terminate the vendor , suspend, or exclude
vendors who pose a risk of fraud, waste, abuse, or harm
from participation in the medical assistance program prior
to an evidentiary hearing but after reasonable notice and

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opportunity to respond as established by the Department by
rule.
(2) Vendors of non-emergency medical transportation
services, as defined by the Department by rule, who pose a
risk of fraud, waste, abuse, or harm shall submit to a
fingerprint-based criminal background check on current and
future information available in the State system and
current information available through the Federal Bureau
of Investigation's system by submitting all necessary fees
and information in the form and manner prescribed by the
Department of State Police. The following individuals
shall be subject to the check:
(A) In the case of a vendor that is a corporation,
every shareholder who owns, directly or indirectly, 5%
or more of the outstanding shares of the corporation.
(B) In the case of a vendor that is a partnership,
every partner.
(C) In the case of a vendor that is a sole
proprietorship, the sole proprietor.
(D) Each officer or manager of the vendor.
Each such vendor shall be responsible for payment of
the cost of the criminal background check.
(3) Vendors of non-emergency medical transportation
services who pose a risk of fraud, waste, abuse, or harm
may be required to post a surety bond. The Department shall
establish, by rule, the criteria and requirements for

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determining when a surety bond must be posted and the value
of the bond.
(4) The Department, or its agents, may refuse to accept
requests for non-emergency transportation authorizations
authorization from specific vendors who pose a risk of
fraud, waste, abuse, or harm, including prior-approval and
post-approval requests, if:
(A) the Department has initiated a notice of
termination, suspension, or exclusion of the vendor
from participation in the medical assistance program;
or
(B) the Department has issued notification of its
withholding of payments pursuant to subsection (F-5)
of this Section; or
(C) the Department has issued a notification of its
withholding of payments due to reliable evidence of
fraud or willful misrepresentation pending
investigation.
(5) (Blank). As used in this subsection, the following
terms are defined as follows:
(A) "Fraud" means an intentional deception or
misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized
benefit to himself or herself or some other person. It
includes any act that constitutes fraud under
applicable federal or State law.

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(B) "Abuse" means provider practices that are
inconsistent with sound fiscal, business, or medical
practices and that result in an unnecessary cost to the
medical assistance program or in reimbursement for
services that are not medically necessary or that fail
to meet professionally recognized standards for health
care. It also includes recipient practices that result
in unnecessary cost to the medical assistance program.
Abuse does not include diagnostic or therapeutic
measures conducted primarily as a safeguard against
possible vendor liability.
(C) "Waste" means the unintentional misuse of
medical assistance resources, resulting in unnecessary
cost to the medical assistance program. Waste does not
include diagnostic or therapeutic measures conducted
primarily as a safeguard against possible vendor
liability.
(D) "Harm" means physical, mental, or monetary
damage to recipients or to the medical assistance
program.
(G-6) (Blank). The Illinois Department, upon making a
determination based upon information in the possession of the
Illinois Department that continuation of participation in the
medical assistance program by a vendor would constitute an
immediate danger to the public, may immediately suspend such
vendor's participation in the medical assistance program

HB0027 - 313 - LRB098 00027 KTG 30027 b
without a hearing. In instances in which the Illinois
Department immediately suspends the medical assistance program
participation of a vendor under this Section, a hearing upon
the vendor's participation must be convened by the Illinois
Department within 15 days after such suspension and completed
without appreciable delay. Such hearing shall be held to
determine whether to recommend to the Director that the
vendor's medical assistance program participation be denied,
terminated, suspended, placed on provisional status, or
reinstated. In the hearing, any evidence relevant to the vendor
constituting an immediate danger to the public may be
introduced against such vendor; provided, however, that the
vendor, or his or her counsel, shall have the opportunity to
discredit, impeach, and submit evidence rebutting such
evidence.
(H) Nothing contained in this Code shall in any way limit
or otherwise impair the authority or power of any State agency
responsible for licensing of vendors.
(I) Based on a finding of noncompliance on the part of a
nursing home with any requirement for certification under Title
XVIII or XIX of the Social Security Act (42 U.S.C. Sec. 1395 et
seq. or 42 U.S.C. Sec. 1396 et seq.), the Illinois Department
may impose one or more of the following remedies after notice
to the facility:
(1) Termination of the provider agreement.
(2) Temporary management.

HB0027 - 314 - LRB098 00027 KTG 30027 b
(3) Denial of payment for new admissions.
(4) Civil money penalties.
(5) Closure of the facility in emergency situations or
transfer of residents, or both.
(6) State monitoring.
(7) Denial of all payments when the Health Care Finance
Administration U.S. Department of Health and Human
Services has imposed this sanction.
The Illinois Department shall by rule establish criteria
governing continued payments to a nursing facility subsequent
to termination of the facility's provider agreement if, in the
sole discretion of the Illinois Department, circumstances
affecting the health, safety, and welfare of the facility's
residents require those continued payments. The Illinois
Department may condition those continued payments on the
appointment of temporary management, sale of the facility to
new owners or operators, or other arrangements that the
Illinois Department determines best serve the needs of the
facility's residents.
Except in the case of a facility that has a right to a
hearing on the finding of noncompliance before an agency of the
federal government, a facility may request a hearing before a
State agency on any finding of noncompliance within 60 days
after the notice of the intent to impose a remedy. Except in
the case of civil money penalties, a request for a hearing
shall not delay imposition of the penalty. The choice of

HB0027 - 315 - LRB098 00027 KTG 30027 b
remedies is not appealable at a hearing. The level of
noncompliance may be challenged only in the case of a civil
money penalty. The Illinois Department shall provide by rule
for the State agency that will conduct the evidentiary
hearings.
The Illinois Department may collect interest on unpaid
civil money penalties.
The Illinois Department may adopt all rules necessary to
implement this subsection (I).
(J) The Illinois Department, by rule, may permit individual
practitioners to designate that Department payments that may be
due the practitioner be made to an alternate payee or alternate
payees.
(a) Such alternate payee or alternate payees shall be
required to register as an alternate payee in the Medical
Assistance Program with the Illinois Department.
(b) If a practitioner designates an alternate payee,
the alternate payee and practitioner shall be jointly and
severally liable to the Department for payments made to the
alternate payee. Pursuant to subsection (E) of this
Section, any Department action to suspend or deny payment
or recover money or overpayments from an alternate payee
shall be subject to an administrative hearing.
(c) Registration as an alternate payee or alternate
payees in the Illinois Medical Assistance Program shall be
conditional. At any time, the Illinois Department may deny

HB0027 - 316 - LRB098 00027 KTG 30027 b
or cancel any alternate payee's registration in the
Illinois Medical Assistance Program without cause. Any
such denial or cancellation is not subject to an
administrative hearing.
(d) The Illinois Department may seek a revocation of
any alternate payee, and all owners, officers, and
individuals with management responsibility for such
alternate payee shall be permanently prohibited from
participating as an owner, an officer, or an individual
with management responsibility with an alternate payee in
the Illinois Medical Assistance Program, if after
reasonable notice and opportunity for a hearing the
Illinois Department finds that:
(1) the alternate payee is not complying with the
Department's policy or rules and regulations, or with
the terms and conditions prescribed by the Illinois
Department in its alternate payee registration
agreement; or
(2) the alternate payee has failed to keep or make
available for inspection, audit, or copying, after
receiving a written request from the Illinois
Department, such records regarding payments claimed as
an alternate payee; or
(3) the alternate payee has failed to furnish any
information requested by the Illinois Department
regarding payments claimed as an alternate payee; or

HB0027 - 317 - LRB098 00027 KTG 30027 b
(4) the alternate payee has knowingly made, or
caused to be made, any false statement or
representation of a material fact in connection with
the administration of the Illinois Medical Assistance
Program; or
(5) the alternate payee, a person with management
responsibility for an alternate payee, an officer or
person owning, either directly or indirectly, 5% or
more of the shares of stock or other evidences of
ownership in a corporate alternate payee, or a partner
in a partnership which is an alternate payee:
(a) was previously terminated, suspended, or
excluded from participation as a vendor in the
Illinois Medical Assistance Program, or was
previously revoked as an alternate payee in the
Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code; or
(b) was a person with management
responsibility for a vendor previously terminated,
suspended, or excluded from participation as a
vendor in the Illinois Medical Assistance Program,
or was previously revoked as an alternate payee in

HB0027 - 318 - LRB098 00027 KTG 30027 b
the Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion or alternate
payee's revocation; or
(c) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a
corporate vendor previously terminated, suspended,
or excluded from participation as a vendor in the
Illinois Medical Assistance Program, or was
previously revoked as an alternate payee in the
Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion; or
(d) was an owner of a sole proprietorship or
partner in a partnership previously terminated,

HB0027 - 319 - LRB098 00027 KTG 30027 b
suspended, or excluded from participation as a
vendor in the Illinois Medical Assistance Program,
or was previously revoked as an alternate payee in
the Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion or alternate
payee's revocation; or
(6) the alternate payee, a person with management
responsibility for an alternate payee, an officer or
person owning, either directly or indirectly, 5% or
more of the shares of stock or other evidences of
ownership in a corporate alternate payee, or a partner
in a partnership which is an alternate payee:
(a) has engaged in conduct prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or
(b) was a person with management
responsibility for a vendor or alternate payee at
the time that the vendor or alternate payee engaged
in practices prohibited by applicable federal or

HB0027 - 320 - LRB098 00027 KTG 30027 b
State law or regulation relating to the Illinois
Medical Assistance Program; or
(c) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a vendor
or alternate payee at the time such vendor or
alternate payee engaged in practices prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or
(d) was an owner of a sole proprietorship or
partner in a partnership which was a vendor or
alternate payee at the time such vendor or
alternate payee engaged in practices prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or
(7) the direct or indirect ownership of the vendor
or alternate payee (including the ownership of a vendor
or alternate payee that is a partner's interest in a
vendor or alternate payee, or ownership of 5% or more
of the shares of stock or other evidences of ownership
in a corporate vendor or alternate payee) has been
transferred by an individual who is terminated,
suspended, or excluded or barred from participating as
a vendor or is prohibited or revoked as an alternate

HB0027 - 321 - LRB098 00027 KTG 30027 b
payee to the individual's spouse, child, brother,
sister, parent, grandparent, grandchild, uncle, aunt,
niece, nephew, cousin, or relative by marriage.
(K) The Illinois Department of Healthcare and Family
Services may withhold payments, in whole or in part, to a
provider or alternate payee upon receipt of where there is
credible evidence, received from State or federal law
enforcement or federal oversight agencies or from the results
of a preliminary Department audit and determined by the
Department to be credible, that the circumstances giving rise
to the need for a withholding of payments may involve fraud or
willful misrepresentation under the Illinois Medical
Assistance program. The Department shall by rule define what
constitutes "credible" evidence for purposes of this
subsection. The Department may withhold payments without first
notifying the provider or alternate payee of its intention to
withhold such payments. A provider or alternate payee may
request a reconsideration of payment withholding, and the
Department must grant such a request. The Department shall
state by rule a process and criteria by which a provider or
alternate payee may request full or partial release of payments
withheld under this subsection. This request may be made at any
time after the Department first withholds such payments.
(a) The Illinois Department must send notice of its
withholding of program payments within 5 days of taking
such action. The notice must set forth the general

HB0027 - 322 - LRB098 00027 KTG 30027 b
allegations as to the nature of the withholding action, but
need not disclose any specific information concerning its
ongoing investigation. The notice must do all of the
following:
(1) State that payments are being withheld in
accordance with this subsection.
(2) State that the withholding is for a temporary
period, as stated in paragraph (b) of this subsection,
and cite the circumstances under which withholding
will be terminated.
(3) Specify, when appropriate, which type or types
of Medicaid claims withholding is effective.
(4) Inform the provider or alternate payee of the
right to submit written evidence for reconsideration
of the withholding by the Illinois Department.
(5) Inform the provider or alternate payee that a
written request may be made to the Illinois Department
for full or partial release of withheld payments and
that such requests may be made at any time after the
Department first withholds such payments.
(b) All withholding-of-payment actions under this
subsection shall be temporary and shall not continue after
any of the following:
(1) The Illinois Department or the prosecuting
authorities determine that there is insufficient
evidence of fraud or willful misrepresentation by the

HB0027 - 323 - LRB098 00027 KTG 30027 b
provider or alternate payee.
(2) Legal proceedings related to the provider's or
alternate payee's alleged fraud, willful
misrepresentation, violations of this Act, or
violations of the Illinois Department's administrative
rules are completed.
(3) The withholding of payments for a period of 3
years.
(c) The Illinois Department may adopt all rules
necessary to implement this subsection (K).
(K-5) (Blank). The Illinois Department may withhold
payments, in whole or in part, to a provider or alternate payee
upon initiation of an audit, quality of care review,
investigation when there is a credible allegation of fraud, or
the provider or alternate payee demonstrating a clear failure
to cooperate with the Illinois Department such that the
circumstances give rise to the need for a withholding of
payments. As used in this subsection, "credible allegation" is
defined to include an allegation from any source, including,
but not limited to, fraud hotline complaints, claims data
mining, patterns identified through provider audits, civil
actions filed under the False Claims Act, and law enforcement
investigations. An allegation is considered to be credible when
it has indicia of reliability. The Illinois Department may
withhold payments without first notifying the provider or
alternate payee of its intention to withhold such payments. A

HB0027 - 324 - LRB098 00027 KTG 30027 b
provider or alternate payee may request a hearing or a
reconsideration of payment withholding, and the Illinois
Department must grant such a request. The Illinois Department
shall state by rule a process and criteria by which a provider
or alternate payee may request a hearing or a reconsideration
for the full or partial release of payments withheld under this
subsection. This request may be made at any time after the
Illinois Department first withholds such payments.
(a) The Illinois Department must send notice of its
withholding of program payments within 5 days of taking
such action. The notice must set forth the general
allegations as to the nature of the withholding action but
need not disclose any specific information concerning its
ongoing investigation. The notice must do all of the
following:
(1) State that payments are being withheld in
accordance with this subsection.
(2) State that the withholding is for a temporary
period, as stated in paragraph (b) of this subsection,
and cite the circumstances under which withholding
will be terminated.
(3) Specify, when appropriate, which type or types
of claims are withheld.
(4) Inform the provider or alternate payee of the
right to request a hearing or a reconsideration of the
withholding by the Illinois Department, including the

HB0027 - 325 - LRB098 00027 KTG 30027 b
ability to submit written evidence.
(5) Inform the provider or alternate payee that a
written request may be made to the Illinois Department
for a hearing or a reconsideration for the full or
partial release of withheld payments and that such
requests may be made at any time after the Illinois
Department first withholds such payments.
(b) All withholding of payment actions under this
subsection shall be temporary and shall not continue after
any of the following:
(1) The Illinois Department determines that there
is insufficient evidence of fraud, or the provider or
alternate payee demonstrates clear cooperation with
the Illinois Department, as determined by the Illinois
Department, such that the circumstances do not give
rise to the need for withholding of payments; or
(2) The withholding of payments has lasted for a
period in excess of 3 years.
(c) The Illinois Department may adopt all rules
necessary to implement this subsection (K-5).
(L) (Blank). The Illinois Department shall establish a
protocol to enable health care providers to disclose an actual
or potential violation of this Section pursuant to a
self-referral disclosure protocol, referred to in this
subsection as "the protocol". The protocol shall include
direction for health care providers on a specific person,

HB0027 - 326 - LRB098 00027 KTG 30027 b
official, or office to whom such disclosures shall be made. The
Illinois Department shall post information on the protocol on
the Illinois Department's public website. The Illinois
Department may adopt rules necessary to implement this
subsection (L). In addition to other factors that the Illinois
Department finds appropriate, the Illinois Department may
consider a health care provider's timely use or failure to use
the protocol in considering the provider's failure to comply
with this Code.
(M) (Blank). Notwithstanding any other provision of this
Code, the Illinois Department, at its discretion, may exempt an
entity licensed under the Nursing Home Care Act and the ID/DD
Community Care Act from the provisions of subsections (A-15),
(B), and (C) of this Section if the licensed entity is in
receivership.
(Source: P.A. 97-689, eff. 6-14-12; revised 8-3-12.)
(305 ILCS 5/12-4.38)
Sec. 12-4.38. Special FamilyCare provisions.
(a) The Department of Healthcare and Family Services may
submit to the Comptroller, and the Comptroller is authorized to
pay, on behalf of persons enrolled in the FamilyCare Program,
claims for services rendered to an enrollee during the period
beginning October 1, 2007, and ending on the effective date of
any rules adopted to implement the provisions of this
amendatory Act of the 96th General Assembly. The authorization

HB0027 - 327 - LRB098 00027 KTG 30027 b
for payment of claims applies only to bona fide claims for
payment for services rendered. Any claim for payment which is
authorized pursuant to the provisions of this amendatory Act of
the 96th General Assembly must adhere to all other applicable
rules, regulations, and requirements.
(b) Each person enrolled in the FamilyCare Program as of
the effective date of this amendatory Act of the 98th General
Assembly whose income exceeds 185% of the Federal Poverty
Level, but is not more than 400% of the Federal Poverty Level,
may remain enrolled in the FamilyCare Program pursuant to this
subsection so long as that person continues to meet the
eligibility criteria established under the emergency rule at 89
Ill. Adm. Code 120 (Illinois Register Volume 31, page 15854)
filed November 7, 2007. In no case may a person continue to be
enrolled in the FamilyCare Program pursuant to this subsection
if the person's income rises above 400% of the Federal Poverty
Level or falls below 185% of the Federal Poverty Level at any
subsequent time. Nothing contained in this subsection shall
prevent an individual from enrolling in the FamilyCare Program
as authorized by paragraph 15 of Section 5-2 of this Code if he
or she otherwise qualifies under that Section.
(c) In implementing the provisions of this amendatory Act
of the 98th General Assembly, the Department of Healthcare and
Family Services is authorized to adopt only those rules
necessary, including emergency rules. Nothing in this
amendatory Act of the 98th General Assembly permits the

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Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.
(Source: P.A. 96-20, eff. 6-30-09; 97-689, eff. 6-14-12.)
(305 ILCS 5/12-4.39)
Sec. 12-4.39. Dental clinic grant program.
(a) Grant program. Subject On and after July 1, 2012, and
subject to funding availability, the Department of Healthcare
and Family Services shall may administer a grant program. The
purpose of this grant program shall be to build the public
infrastructure for dental care and to make grants to local
health departments, federally qualified health clinics
(FQHCs), and rural health clinics (RHCs) for development of
comprehensive dental clinics for dental care services. The
primary purpose of these new dental clinics will be to increase
dental access for low-income and Department of Healthcare and
Family Services clients who have no dental arrangements with a
dental provider in a project's service area. The dental clinic
must be willing to accept out-of-area clients who need dental
services, including emergency services for adults and Early and
Periodic Screening, Diagnosis and Treatment (EPSDT)-referral
children. Medically Underserved Areas (MUAs) and Health

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Professional Shortage Areas (HPSAs) shall receive special
priority for grants under this program.
(b) Eligible applicants. The following entities are
eligible to apply for grants:
(1) Local health departments.
(2) Federally Qualified Health Centers (FQHCs).
(3) Rural health clinics (RHCs).
(c) Use of grant moneys. Grant moneys must be used to
support projects that develop dental services to meet the
dental health care needs of Department of Healthcare and Family
Services Dental Program clients. Grant moneys must be used for
operating expenses, including, but not limited to: insurance;
dental supplies and equipment; dental support services; and
renovation expenses. Grant moneys may not be used to offset
existing indebtedness, supplant existing funds, purchase real
property, or pay for personnel service salaries for dental
employees.
(d) Application process. The Department shall establish
procedures for applying for dental clinic grants.
(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10;
97-689, eff. 6-14-12.)
(305 ILCS 5/12-9) (from Ch. 23, par. 12-9)
Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The
Public Aid Recoveries Trust Fund shall consist of (1)
recoveries by the Department of Healthcare and Family Services

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(formerly Illinois Department of Public Aid) authorized by this
Code in respect to applicants or recipients under Articles III,
IV, V, and VI, including recoveries made by the Department of
Healthcare and Family Services (formerly Illinois Department
of Public Aid) from the estates of deceased recipients, (2)
recoveries made by the Department of Healthcare and Family
Services (formerly Illinois Department of Public Aid) in
respect to applicants and recipients under the Children's
Health Insurance Program Act, and the Covering ALL KIDS Health
Insurance Act, and the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act, (3)
federal funds received on behalf of and earned by State
universities and local governmental entities for services
provided to applicants or recipients covered under this Code,
the Children's Health Insurance Program Act, and the Covering
ALL KIDS Health Insurance Act, and the Senior Citizens and
Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act, (3.5) federal financial participation revenue
related to eligible disbursements made by the Department of
Healthcare and Family Services from appropriations required by
this Section, and (4) all other moneys received to the Fund,
including interest thereon. The Fund shall be held as a special
fund in the State Treasury.
Disbursements from this Fund shall be only (1) for the
reimbursement of claims collected by the Department of
Healthcare and Family Services (formerly Illinois Department

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of Public Aid) through error or mistake, (2) for payment to
persons or agencies designated as payees or co-payees on any
instrument, whether or not negotiable, delivered to the
Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) as a recovery under this
Section, such payment to be in proportion to the respective
interests of the payees in the amount so collected, (3) for
payments to the Department of Human Services for collections
made by the Department of Healthcare and Family Services
(formerly Illinois Department of Public Aid) on behalf of the
Department of Human Services under this Code, the Children's
Health Insurance Program Act, and the Covering ALL KIDS Health
Insurance Act, (4) for payment of administrative expenses
incurred in performing the activities authorized under this
Code, the Children's Health Insurance Program Act, and the
Covering ALL KIDS Health Insurance Act, and the Senior Citizens
and Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act, (5) for payment of fees to persons or agencies
in the performance of activities pursuant to the collection of
monies owed the State that are collected under this Code, the
Children's Health Insurance Program Act, and the Covering ALL
KIDS Health Insurance Act, (6) for payments of any amounts
which are reimbursable to the federal government which are
required to be paid by State warrant by either the State or
federal government, and (7) for payments to State universities
and local governmental entities of federal funds for services

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provided to applicants or recipients covered under this Code,
the Children's Health Insurance Program Act, and the Covering
ALL KIDS Health Insurance Act, and the Senior Citizens and
Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act. Disbursements from this Fund for purposes of
items (4) and (5) of this paragraph shall be subject to
appropriations from the Fund to the Department of Healthcare
and Family Services (formerly Illinois Department of Public
Aid).
The balance in this Fund on the first day of each calendar
quarter, after payment therefrom of any amounts reimbursable to
the federal government, and minus the amount reasonably
anticipated to be needed to make the disbursements during that
quarter authorized by this Section, shall be certified by the
Director of Healthcare and Family Services and transferred by
the State Comptroller to the Drug Rebate Fund or the Healthcare
Provider Relief Fund in the State Treasury, as appropriate,
within 30 days of the first day of each calendar quarter. The
Director of Healthcare and Family Services may certify and the
State Comptroller shall transfer to the Drug Rebate Fund
amounts on a more frequent basis.
On July 1, 1999, the State Comptroller shall transfer the
sum of $5,000,000 from the Public Aid Recoveries Trust Fund
(formerly the Public Assistance Recoveries Trust Fund) into the
DHS Recoveries Trust Fund.
(Source: P.A. 96-1100, eff. 1-1-11; 97-647, eff. 1-1-12;

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97-689, eff. 6-14-12.)
(305 ILCS 5/12-10.5)
Sec. 12-10.5. Medical Special Purposes Trust Fund.
(a) The Medical Special Purposes Trust Fund ("the Fund") is
created. Any grant, gift, donation, or legacy of money or
securities that the Department of Healthcare and Family
Services is authorized to receive under Section 12-4.18 or
Section 12-4.19 or any monies from any other source, and that
is are dedicated for functions connected with the
administration of any medical program administered by the
Department, shall be deposited into the Fund. All federal
moneys received by the Department as reimbursement for
disbursements authorized to be made from the Fund shall also be
deposited into the Fund. In addition, federal moneys received
on account of State expenditures made in connection with
obtaining compliance with the federal Health Insurance
Portability and Accountability Act (HIPAA) shall be deposited
into the Fund.
(b) No moneys received from a service provider or a
governmental or private entity that is enrolled with the
Department as a provider of medical services shall be deposited
into the Fund.
(c) Disbursements may be made from the Fund for the
purposes connected with the grants, gifts, donations, or
legacies, or other monies deposited into the Fund, including,

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but not limited to, medical quality assessment projects,
eligibility population studies, medical information systems
evaluations, and other administrative functions that assist
the Department in fulfilling its health care mission under any
medical program administered by the Department.
(Source: P.A. 97-48, eff. 6-28-11; 97-689, eff. 6-14-12.)
(305 ILCS 5/12-13.1)
Sec. 12-13.1. Inspector General.
(a) The Governor shall appoint, and the Senate shall
confirm, an Inspector General who shall function within the
Illinois Department of Public Aid (now Healthcare and Family
Services) and report to the Governor. The term of the Inspector
General shall expire on the third Monday of January, 1997 and
every 4 years thereafter.
(b) In order to prevent, detect, and eliminate fraud,
waste, abuse, mismanagement, and misconduct, the Inspector
General shall oversee the Department of Healthcare and Family
Services' integrity functions, which include, but are not
limited to, the following:
(1) Investigation of misconduct by employees, vendors,
contractors and medical providers, except for allegations
of violations of the State Officials and Employees Ethics
Act which shall be referred to the Office of the Governor's
Executive Inspector General for investigation.
(2) Audits Prepayment and post-payment audits of

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medical providers related to ensuring that appropriate
payments are made for services rendered and to the
prevention and recovery of overpayments.
(3) Monitoring of quality assurance programs generally
related to the medical assistance program and specifically
related to any managed care program administered by the
Department of Healthcare and Family Services.
(4) Quality control measurements of the programs
administered by the Department of Healthcare and Family
Services.
(5) Investigations of fraud or intentional program
violations committed by clients of the Department of
Healthcare and Family Services.
(6) Actions initiated against contractors, vendors, or
medical providers for any of the following reasons:
(A) Violations of the medical assistance program.
(B) Sanctions against providers brought in
conjunction with the Department of Public Health or the
Department of Human Services (as successor to the
Department of Mental Health and Developmental
Disabilities).
(C) Recoveries of assessments against hospitals
and long-term care facilities.
(D) Sanctions mandated by the United States
Department of Health and Human Services against
medical providers.

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(E) Violations of contracts related to any managed
care programs programs administered by the Department
of Healthcare and Family Services.
(7) Representation of the Department of Healthcare and
Family Services at hearings with the Illinois Department of
Financial and Professional Regulation in actions taken
against professional licenses held by persons who are in
violation of orders for child support payments.
(b-5) At the request of the Secretary of Human Services,
the Inspector General shall, in relation to any function
performed by the Department of Human Services as successor to
the Department of Public Aid, exercise one or more of the
powers provided under this Section as if those powers related
to the Department of Human Services; in such matters, the
Inspector General shall report his or her findings to the
Secretary of Human Services.
(c) The Notwithstanding, and in addition to, any other
provision of law, the Inspector General shall have access to
all information, personnel and facilities of the Department of
Healthcare and Family Services and the Department of Human
Services (as successor to the Department of Public Aid), their
employees, vendors, contractors and medical providers and any
federal, State or local governmental agency that are necessary
to perform the duties of the Office as directly related to
public assistance programs administered by those departments.
No medical provider shall be compelled, however, to provide

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individual medical records of patients who are not clients of
the Medical Assistance Program programs administered by the
Department of Healthcare and Family Services. State and local
governmental agencies are authorized and directed to provide
the requested information, assistance or cooperation.
For purposes of enhanced program integrity functions and
oversight, and to the extent consistent with applicable
information and privacy, security, and disclosure laws, State
agencies and departments shall provide the Office of Inspector
General access to confidential and other information and data,
and the Inspector General is authorized to enter into
agreements with appropriate federal agencies and departments
to secure similar data. This includes, but is not limited to,
information pertaining to: licensure; certification; earnings;
immigration status; citizenship; wage reporting; unearned and
earned income; pension income; employment; supplemental
security income; social security numbers; National Provider
Identifier (NPI) numbers; the National Practitioner Data Bank
(NPDB); program and agency exclusions; taxpayer identification
numbers; tax delinquency; corporate information; and death
records.
The Inspector General shall enter into agreements with
State agencies and departments, and is authorized to enter into
agreements with federal agencies and departments, under which
such agencies and departments shall share data necessary for
medical assistance program integrity functions and oversight.

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The Inspector General shall enter into agreements with State
agencies and departments, and is authorized to enter into
agreements with federal agencies and departments, under which
such agencies shall share data necessary for recipient and
vendor screening, review, and investigation, including but not
limited to vendor payment and recipient eligibility
verification. The Inspector General shall develop, in
cooperation with other State and federal agencies and
departments, and in compliance with applicable federal laws and
regulations, appropriate and effective methods to share such
data. The Inspector General shall enter into agreements with
State agencies and departments, and is authorized to enter into
agreements with federal agencies and departments, including,
but not limited to: the Secretary of State; the Department of
Revenue; the Department of Public Health; the Department of
Human Services; and the Department of Financial and
Professional Regulation.
The Inspector General shall have the authority to deny
payment, prevent overpayments, and recover overpayments.
The Inspector General shall have the authority to deny or
suspend payment to, and deny, terminate, or suspend the
eligibility of, any vendor who fails to grant the Inspector
General timely access to full and complete records, including
records of recipients under the medical assistance program for
the most recent 6 years, in accordance with Section 140.28 of
Title 89 of the Illinois Administrative Code, and other

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information for the purpose of audits, investigations, or other
program integrity functions, after reasonable written request
by the Inspector General.
(d) The Inspector General shall serve as the Department of
Healthcare and Family Services' primary liaison with law
enforcement, investigatory and prosecutorial agencies,
including but not limited to the following:
(1) The Department of State Police.
(2) The Federal Bureau of Investigation and other
federal law enforcement agencies.
(3) The various Inspectors General of federal agencies
overseeing the programs administered by the Department of
Healthcare and Family Services.
(4) The various Inspectors General of any other State
agencies with responsibilities for portions of programs
primarily administered by the Department of Healthcare and
Family Services.
(5) The Offices of the several United States Attorneys
in Illinois.
(6) The several State's Attorneys.
(7) (Blank). The offices of the Centers for Medicare
and Medicaid Services that administer the Medicare and
Medicaid integrity programs.
The Inspector General shall meet on a regular basis with
these entities to share information regarding possible
misconduct by any persons or entities involved with the public

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aid programs administered by the Department of Healthcare and
Family Services.
(e) All investigations conducted by the Inspector General
shall be conducted in a manner that ensures the preservation of
evidence for use in criminal prosecutions. If the Inspector
General determines that a possible criminal act relating to
fraud in the provision or administration of the medical
assistance program has been committed, the Inspector General
shall immediately notify the Medicaid Fraud Control Unit. If
the Inspector General determines that a possible criminal act
has been committed within the jurisdiction of the Office, the
Inspector General may request the special expertise of the
Department of State Police. The Inspector General may present
for prosecution the findings of any criminal investigation to
the Office of the Attorney General, the Offices of the several
United States Attorneys in Illinois or the several State's
Attorneys.
(f) To carry out his or her duties as described in this
Section, the Inspector General and his or her designees shall
have the power to compel by subpoena the attendance and
testimony of witnesses and the production of books, electronic
records and papers as directly related to public assistance
programs administered by the Department of Healthcare and
Family Services or the Department of Human Services (as
successor to the Department of Public Aid). No medical provider
shall be compelled, however, to provide individual medical

HB0027 - 341 - LRB098 00027 KTG 30027 b
records of patients who are not clients of the Medical
Assistance Program.
(g) The Inspector General shall report all convictions,
terminations, and suspensions taken against vendors,
contractors and medical providers to the Department of
Healthcare and Family Services and to any agency responsible
for licensing or regulating those persons or entities.
(h) The Inspector General shall make annual reports,
findings, and recommendations regarding the Office's
investigations into reports of fraud, waste, abuse,
mismanagement, or misconduct relating to any public aid
programs administered by the Department of Healthcare and
Family Services or the Department of Human Services (as
successor to the Department of Public Aid) to the General
Assembly and the Governor. These reports shall include, but not
be limited to, the following information:
(1) Aggregate provider billing and payment
information, including the number of providers at various
Medicaid earning levels.
(2) The number of audits of the medical assistance
program and the dollar savings resulting from those audits.
(3) The number of prescriptions rejected annually
under the Department of Healthcare and Family Services'
Refill Too Soon program and the dollar savings resulting
from that program.
(4) Provider sanctions, in the aggregate, including

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terminations and suspensions.
(5) A detailed summary of the investigations
undertaken in the previous fiscal year. These summaries
shall comply with all laws and rules regarding maintaining
confidentiality in the public aid programs.
(i) Nothing in this Section shall limit investigations by
the Department of Healthcare and Family Services or the
Department of Human Services that may otherwise be required by
law or that may be necessary in their capacity as the central
administrative authorities responsible for administration of
public aid their agency's programs in this State.
(j) The Inspector General may issue shields or other
distinctive identification to his or her employees not
exercising the powers of a peace officer if the Inspector
General determines that a shield or distinctive identification
is needed by an employee to carry out his or her
responsibilities.
(Source: P.A. 96-555, eff. 8-18-09; 96-1316, eff. 1-1-11;
97-689, eff. 6-14-12.)
(305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
Sec. 14-8. Disbursements to Hospitals.
(a) For inpatient hospital services rendered on and after
September 1, 1991, the Illinois Department shall reimburse
hospitals for inpatient services at an inpatient payment rate
calculated for each hospital based upon the Medicare

HB0027 - 343 - LRB098 00027 KTG 30027 b
Prospective Payment System as set forth in Sections 1886(b),
(d), (g), and (h) of the federal Social Security Act, and the
regulations, policies, and procedures promulgated thereunder,
except as modified by this Section. Payment rates for inpatient
hospital services rendered on or after September 1, 1991 and on
or before September 30, 1992 shall be calculated using the
Medicare Prospective Payment rates in effect on September 1,
1991. Payment rates for inpatient hospital services rendered on
or after October 1, 1992 and on or before March 31, 1994 shall
be calculated using the Medicare Prospective Payment rates in
effect on September 1, 1992. Payment rates for inpatient
hospital services rendered on or after April 1, 1994 shall be
calculated using the Medicare Prospective Payment rates
(including the Medicare grouping methodology and weighting
factors as adjusted pursuant to paragraph (1) of this
subsection) in effect 90 days prior to the date of admission.
For services rendered on or after July 1, 1995, the
reimbursement methodology implemented under this subsection
shall not include those costs referred to in Sections
1886(d)(5)(B) and 1886(h) of the Social Security Act. The
additional payment amounts required under Section
1886(d)(5)(F) of the Social Security Act, for hospitals serving
a disproportionate share of low-income or indigent patients,
are not required under this Section. For hospital inpatient
services rendered on or after July 1, 1995, the Illinois
Department shall reimburse hospitals using the relative

HB0027 - 344 - LRB098 00027 KTG 30027 b
weighting factors and the base payment rates calculated for
each hospital that were in effect on June 30, 1995, less the
portion of such rates attributed by the Illinois Department to
the cost of medical education.
(1) The weighting factors established under Section
1886(d)(4) of the Social Security Act shall not be used in
the reimbursement system established under this Section.
Rather, the Illinois Department shall establish by rule
Medicaid weighting factors to be used in the reimbursement
system established under this Section.
(2) The Illinois Department shall define by rule those
hospitals or distinct parts of hospitals that shall be
exempt from the reimbursement system established under
this Section. In defining such hospitals, the Illinois
Department shall take into consideration those hospitals
exempt from the Medicare Prospective Payment System as of
September 1, 1991. For hospitals defined as exempt under
this subsection, the Illinois Department shall by rule
establish a reimbursement system for payment of inpatient
hospital services rendered on and after September 1, 1991.
For all hospitals that are children's hospitals as defined
in Section 5-5.02 of this Code, the reimbursement
methodology shall, through June 30, 1992, net of all
applicable fees, at least equal each children's hospital
1990 ICARE payment rates, indexed to the current year by
application of the DRI hospital cost index from 1989 to the

HB0027 - 345 - LRB098 00027 KTG 30027 b
year in which payments are made. Excepting county providers
as defined in Article XV of this Code, hospitals licensed
under the University of Illinois Hospital Act, and
facilities operated by the Department of Mental Health and
Developmental Disabilities (or its successor, the
Department of Human Services) for hospital inpatient
services rendered on or after July 1, 1995, the Illinois
Department shall reimburse children's hospitals, as
defined in 89 Illinois Administrative Code Section
149.50(c)(3), at the rates in effect on June 30, 1995, and
shall reimburse all other hospitals at the rates in effect
on June 30, 1995, less the portion of such rates attributed
by the Illinois Department to the cost of medical
education. For inpatient hospital services provided on or
after August 1, 1998, the Illinois Department may establish
by rule a means of adjusting the rates of children's
hospitals, as defined in 89 Illinois Administrative Code
Section 149.50(c)(3), that did not meet that definition on
June 30, 1995, in order for the inpatient hospital rates of
such hospitals to take into account the average inpatient
hospital rates of those children's hospitals that did meet
the definition of children's hospitals on June 30, 1995.
(3) (Blank).
(4) Notwithstanding any other provision of this
Section, hospitals that on August 31, 1991, have a contract
with the Illinois Department under Section 3-4 of the

HB0027 - 346 - LRB098 00027 KTG 30027 b
Illinois Health Finance Reform Act may elect to continue to
be reimbursed at rates stated in such contracts for general
and specialty care.
(5) In addition to any payments made under this
subsection (a), the Illinois Department shall make the
adjustment payments required by Section 5-5.02 of this
Code; provided, that in the case of any hospital reimbursed
under a per case methodology, the Illinois Department shall
add an amount equal to the product of the hospital's
average length of stay, less one day, multiplied by 20, for
inpatient hospital services rendered on or after September
1, 1991 and on or before September 30, 1992.
(b) (Blank).
(b-5) Excepting county providers as defined in Article XV
of this Code, hospitals licensed under the University of
Illinois Hospital Act, and facilities operated by the Illinois
Department of Mental Health and Developmental Disabilities (or
its successor, the Department of Human Services), for
outpatient services rendered on or after July 1, 1995 and
before July 1, 1998 the Illinois Department shall reimburse
children's hospitals, as defined in the Illinois
Administrative Code Section 149.50(c)(3), at the rates in
effect on June 30, 1995, less that portion of such rates
attributed by the Illinois Department to the outpatient
indigent volume adjustment and shall reimburse all other
hospitals at the rates in effect on June 30, 1995, less the

HB0027 - 347 - LRB098 00027 KTG 30027 b
portions of such rates attributed by the Illinois Department to
the cost of medical education and attributed by the Illinois
Department to the outpatient indigent volume adjustment. For
outpatient services provided on or after July 1, 1998,
reimbursement rates shall be established by rule.
(c) In addition to any other payments under this Code, the
Illinois Department shall develop a hospital disproportionate
share reimbursement methodology that, effective July 1, 1991,
through September 30, 1992, shall reimburse hospitals
sufficiently to expend the fee monies described in subsection
(b) of Section 14-3 of this Code and the federal matching funds
received by the Illinois Department as a result of expenditures
made by the Illinois Department as required by this subsection
(c) and Section 14-2 that are attributable to fee monies
deposited in the Fund, less amounts applied to adjustment
payments under Section 5-5.02.
(d) Critical Care Access Payments.
(1) In addition to any other payments made under this
Code, the Illinois Department shall develop a
reimbursement methodology that shall reimburse Critical
Care Access Hospitals for the specialized services that
qualify them as Critical Care Access Hospitals. No
adjustment payments shall be made under this subsection on
or after July 1, 1995.
(2) "Critical Care Access Hospitals" includes, but is
not limited to, hospitals that meet at least one of the

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following criteria:
(A) Hospitals located outside of a metropolitan
statistical area that are designated as Level II
Perinatal Centers and that provide a disproportionate
share of perinatal services to recipients; or
(B) Hospitals that are designated as Level I Trauma
Centers (adult or pediatric) and certain Level II
Trauma Centers as determined by the Illinois
Department; or
(C) Hospitals located outside of a metropolitan
statistical area and that provide a disproportionate
share of obstetrical services to recipients.
(e) Inpatient high volume adjustment. For hospital
inpatient services, effective with rate periods beginning on or
after October 1, 1993, in addition to rates paid for inpatient
services by the Illinois Department, the Illinois Department
shall make adjustment payments for inpatient services
furnished by Medicaid high volume hospitals. The Illinois
Department shall establish by rule criteria for qualifying as a
Medicaid high volume hospital and shall establish by rule a
reimbursement methodology for calculating these adjustment
payments to Medicaid high volume hospitals. No adjustment
payment shall be made under this subsection for services
rendered on or after July 1, 1995.
(f) The Illinois Department shall modify its current rules
governing adjustment payments for targeted access, critical

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care access, and uncompensated care to classify those
adjustment payments as not being payments to disproportionate
share hospitals under Title XIX of the federal Social Security
Act. Rules adopted under this subsection shall not be effective
with respect to services rendered on or after July 1, 1995. The
Illinois Department has no obligation to adopt or implement any
rules or make any payments under this subsection for services
rendered on or after July 1, 1995.
(f-5) The State recognizes that adjustment payments to
hospitals providing certain services or incurring certain
costs may be necessary to assure that recipients of medical
assistance have adequate access to necessary medical services.
These adjustments include payments for teaching costs and
uncompensated care, trauma center payments, rehabilitation
hospital payments, perinatal center payments, obstetrical care
payments, targeted access payments, Medicaid high volume
payments, and outpatient indigent volume payments. On or before
April 1, 1995, the Illinois Department shall issue
recommendations regarding (i) reimbursement mechanisms or
adjustment payments to reflect these costs and services,
including methods by which the payments may be calculated and
the method by which the payments may be financed, and (ii)
reimbursement mechanisms or adjustment payments to reflect
costs and services of federally qualified health centers with
respect to recipients of medical assistance.
(g) If one or more hospitals file suit in any court

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challenging any part of this Article XIV, payments to hospitals
under this Article XIV shall be made only to the extent that
sufficient monies are available in the Fund and only to the
extent that any monies in the Fund are not prohibited from
disbursement under any order of the court.
(h) Payments under the disbursement methodology described
in this Section are subject to approval by the federal
government in an appropriate State plan amendment.
(i) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
(j) Hospital Residing Long Term Care Services. In addition
to any other payments made under this Code, the Illinois
Department may by rule establish criteria and develop
methodologies for payments to hospitals for Hospital Residing
Long Term Care Services.
(k) Critical Access Hospital outpatient payments. In
addition to any other payments authorized under this Code, the
Illinois Department shall reimburse critical access hospitals,
as designated by the Illinois Department of Public Health in
accordance with 42 CFR 485, Subpart F, for outpatient services
at an amount that is no less than the cost of providing such
services, based on Medicare cost principles. Payments under
this subsection shall be subject to appropriation.
(l) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other

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payments or alter any methodologies authorized by this Code to
reduce any rate of reimbursement for services or other payments
in accordance with Section 5-5e.
(Source: P.A. 96-1382, eff. 1-1-11; 97-689, eff. 6-14-12;
revised 8-3-12.)
(305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
Sec. 15-1. Definitions. As used in this Article, unless the
context requires otherwise:
(a) "Base amount" means $108,800,000 multiplied by a
fraction, the numerator of which is the number of days
represented by the payments in question and the denominator of
which is 365. (Blank).
(a-5) "County provider" means a health care provider that
is, or is operated by, a county with a population greater than
3,000,000.
(b) "Fund" means the County Provider Trust Fund.
(c) "Hospital" or "County hospital" means a hospital, as
defined in Section 14-1 of this Code, which is a county
hospital located in a county of over 3,000,000 population.
(Source: P.A. 97-687, eff. 6-14-12; 97-689, eff. 6-14-12.)
(305 ILCS 5/5-2b rep.)
(305 ILCS 5/5-2.1d rep.)
(305 ILCS 5/5-5e rep.)
305 ILCS 5/5-5e.1 rep.)

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(305 ILCS 5/5-5f rep.)
(305 ILCS 5/5A-15 rep.)
(305 ILCS 5/11-5.2 rep.)
(305 ILCS 5/11-5.3 rep.)
(305 ILCS 5/14-11 rep.)
Section 2-76. The Illinois Public Aid Code is amended by
repealing Sections 5-2b, 5-2.1d, 5-5e, 5-5e.1, 5-5f, 5A-15,
11-5.2, 11-5.3, and 14-11.
(305 ILCS 60/3 rep.)
Section 2-85.The Pediatric Palliative Care Act is amended
by repealing Section 3.
Section 2-90. The Senior Citizens and Disabled Persons
Property Tax Relief Act is amended by changing the title of the
Act and Sections 1, 1.5, 2, 3.05a, 3.10, 4, 4.05, 5, 6, 7, 8, 9,
12, and 13 and by adding Section 4.2 as follows:
(320 ILCS 25/Act title)
An Act in relation to the payment of grants to enable the
elderly and the disabled to acquire or retain private housing
and to acquire prescription drugs.
(320 ILCS 25/1) (from Ch. 67 1/2, par. 401)
Sec. 1. Short title; common name. This Article shall be
known and may be cited as the Senior Citizens and Disabled

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Persons Property Tax Relief and Pharmaceutical Assistance Act.
Common references to the "Circuit Breaker Act" mean this
Article. As used in this Article, "this Act" means this
Article.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/1.5)
Sec. 1.5. Implementation of Executive Order No. 3 of 2004;
termination of the Illinois Senior Citizens and Disabled
Persons Pharmaceutical Assistance Program. Executive Order No.
3 of 2004, in part, provided for the transfer of the programs
under this Act from the Department of Revenue to the Department
on Aging and the Department of Healthcare and Family Services.
It is the purpose of this amendatory Act of the 96th General
Assembly to conform this Act and certain related provisions of
other statutes to that Executive Order. This amendatory Act of
the 96th General Assembly also makes other substantive changes
to this Act.
It is the purpose of this amendatory Act of the 97th
General Assembly to terminate the Illinois Senior Citizens and
Disabled Persons Pharmaceutical Assistance Program on July 1,
2012.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/2) (from Ch. 67 1/2, par. 402)
Sec. 2. Purpose. The purpose of this Act is to provide

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incentives to the senior citizens and disabled persons of this
State to acquire and retain private housing of their choice and
at the same time to relieve those citizens from the burdens of
extraordinary property taxes and rising drug costs against
their increasingly restricted earning power, and thereby to
reduce the requirements for public housing in this State.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/3.05a)
Sec. 3.05a. Additional resident. "Additional resident"
means a person who (i) is living in the same residence with a
claimant for the claim year and at the time of filing the
claim, (ii) is not the spouse of the claimant, (iii) does not
file a separate claim under this Act for the same period, and
(iv) receives more than half of his or her total financial
support for that claim year from the household. An Prior to
July 1, 2012, an additional resident who meets qualifications
may receive pharmaceutical assistance based on a claimant's
application.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/3.10) (from Ch. 67 1/2, par. 403.10)
Sec. 3.10. Regulations. "Regulations" includes both rules
promulgated and forms prescribed by the applicable Department.
In this Act, references to the rules of the Department on Aging
or the Department of Healthcare and Family Services, in effect

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prior to July 1, 2012, shall be deemed to include, in
appropriate cases, the corresponding rules adopted by the
Department of Revenue, to the extent that those rules continue
in force under Executive Order No. 3 of 2004.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/4) (from Ch. 67 1/2, par. 404)
Sec. 4. Amount of Grant.
(a) In general. Any individual 65 years or older or any
individual who will become 65 years old during the calendar
year in which a claim is filed, and any surviving spouse of
such a claimant, who at the time of death received or was
entitled to receive a grant pursuant to this Section, which
surviving spouse will become 65 years of age within the 24
months immediately following the death of such claimant and
which surviving spouse but for his or her age is otherwise
qualified to receive a grant pursuant to this Section, and any
disabled person whose annual household income is less than the
income eligibility limitation, as defined in subsection (a-5)
and whose household is liable for payment of property taxes
accrued or has paid rent constituting property taxes accrued
and is domiciled in this State at the time he or she files his
or her claim is entitled to claim a grant under this Act. With
respect to claims filed by individuals who will become 65 years
old during the calendar year in which a claim is filed, the
amount of any grant to which that household is entitled shall

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be an amount equal to 1/12 of the amount to which the claimant
would otherwise be entitled as provided in this Section,
multiplied by the number of months in which the claimant was 65
in the calendar year in which the claim is filed.
(a-5) Income eligibility limitation. For purposes of this
Section, "income eligibility limitation" means an amount for
grant years 2008 and thereafter:
(1) less than $22,218 for a household containing one
person;
(2) less than $29,480 for a household containing 2
persons; or
(3) less than $36,740 for a household containing 3 or
more persons.
For 2009 claim year applications submitted during calendar
year 2010, a household must have annual household income of
less than $27,610 for a household containing one person; less
than $36,635 for a household containing 2 persons; or less than
$45,657 for a household containing 3 or more persons.
The Department on Aging may adopt rules such that on
January 1, 2011, and thereafter, the foregoing household income
eligibility limits may be changed to reflect the annual cost of
living adjustment in Social Security and Supplemental Security
Income benefits that are applicable to the year for which those
benefits are being reported as income on an application.
If a person files as a surviving spouse, then only his or
her income shall be counted in determining his or her household

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income.
(b) Limitation. Except as otherwise provided in
subsections (a) and (f) of this Section, the maximum amount of
grant which a claimant is entitled to claim is the amount by
which the property taxes accrued which were paid or payable
during the last preceding tax year or rent constituting
property taxes accrued upon the claimant's residence for the
last preceding taxable year exceeds 3 1/2% of the claimant's
household income for that year but in no event is the grant to
exceed (i) $700 less 4.5% of household income for that year for
those with a household income of $14,000 or less or (ii) $70 if
household income for that year is more than $14,000.
(c) Public aid recipients. If household income in one or
more months during a year includes cash assistance in excess of
$55 per month from the Department of Healthcare and Family
Services or the Department of Human Services (acting as
successor to the Department of Public Aid under the Department
of Human Services Act) which was determined under regulations
of that Department on a measure of need that included an
allowance for actual rent or property taxes paid by the
recipient of that assistance, the amount of grant to which that
household is entitled, except as otherwise provided in
subsection (a), shall be the product of (1) the maximum amount
computed as specified in subsection (b) of this Section and (2)
the ratio of the number of months in which household income did
not include such cash assistance over $55 to the number twelve.

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If household income did not include such cash assistance over
$55 for any months during the year, the amount of the grant to
which the household is entitled shall be the maximum amount
computed as specified in subsection (b) of this Section. For
purposes of this paragraph (c), "cash assistance" does not
include any amount received under the federal Supplemental
Security Income (SSI) program.
(d) Joint ownership. If title to the residence is held
jointly by the claimant with a person who is not a member of
his or her household, the amount of property taxes accrued used
in computing the amount of grant to which he or she is entitled
shall be the same percentage of property taxes accrued as is
the percentage of ownership held by the claimant in the
residence.
(e) More than one residence. If a claimant has occupied
more than one residence in the taxable year, he or she may
claim only one residence for any part of a month. In the case
of property taxes accrued, he or she shall prorate 1/12 of the
total property taxes accrued on his or her residence to each
month that he or she owned and occupied that residence; and, in
the case of rent constituting property taxes accrued, shall
prorate each month's rent payments to the residence actually
occupied during that month.
(f) (Blank).
(g) Effective January 1, 2006, there is hereby established
a program of pharmaceutical assistance to the aged and

HB0027 - 359 - LRB098 00027 KTG 30027 b
disabled, entitled the Illinois Seniors and Disabled Drug
Coverage Program, which shall be administered by the Department
of Healthcare and Family Services and the Department on Aging
in accordance with this subsection, to consist of coverage of
specified prescription drugs on behalf of beneficiaries of the
program as set forth in this subsection. Notwithstanding any
provisions of this Act to the contrary, on and after July 1,
2012, pharmaceutical assistance under this Act shall no longer
be provided, and on July 1, 2012 the Illinois Senior Citizens
and Disabled Persons Pharmaceutical Assistance Program shall
terminate. The following provisions that concern the Illinois
Senior Citizens and Disabled Persons Pharmaceutical Assistance
Program shall continue to apply on and after July 1, 2012 to
the extent necessary to pursue any actions authorized by
subsection (d) of Section 9 of this Act with respect to acts
which took place prior to July 1, 2012.
To become a beneficiary under the program established under
this subsection, a person must:
(1) be (i) 65 years of age or older or (ii) disabled;
and
(2) be domiciled in this State; and
(3) enroll with a qualified Medicare Part D
Prescription Drug Plan if eligible and apply for all
available subsidies under Medicare Part D; and
(4) for the 2006 and 2007 claim years, have a maximum
household income of (i) less than $21,218 for a household

HB0027 - 360 - LRB098 00027 KTG 30027 b
containing one person, (ii) less than $28,480 for a
household containing 2 persons, or (iii) less than $35,740
for a household containing 3 or more persons; and
(5) for the 2008 claim year, have a maximum household
income of (i) less than $22,218 for a household containing
one person, (ii) $29,480 for a household containing 2
persons, or (iii) $36,740 for a household containing 3 or
more persons; and
(6) for 2009 claim year applications submitted during
calendar year 2010, have annual household income of less
than (i) $27,610 for a household containing one person;
(ii) less than $36,635 for a household containing 2
persons; or (iii) less than $45,657 for a household
containing 3 or more persons; and
(7) as of September 1, 2011, have a maximum household
income at or below 200% of the federal poverty level.
All individuals enrolled as of December 31, 2005, in the
pharmaceutical assistance program operated pursuant to
subsection (f) of this Section and all individuals enrolled as
of December 31, 2005, in the SeniorCare Medicaid waiver program
operated pursuant to Section 5-5.12a of the Illinois Public Aid
Code shall be automatically enrolled in the program established
by this subsection for the first year of operation without the
need for further application, except that they must apply for
Medicare Part D and the Low Income Subsidy under Medicare Part
D. A person enrolled in the pharmaceutical assistance program

HB0027 - 361 - LRB098 00027 KTG 30027 b
operated pursuant to subsection (f) of this Section as of
December 31, 2005, shall not lose eligibility in future years
due only to the fact that they have not reached the age of 65.
To the extent permitted by federal law, the Department may
act as an authorized representative of a beneficiary in order
to enroll the beneficiary in a Medicare Part D Prescription
Drug Plan if the beneficiary has failed to choose a plan and,
where possible, to enroll beneficiaries in the low-income
subsidy program under Medicare Part D or assist them in
enrolling in that program.
Beneficiaries under the program established under this
subsection shall be divided into the following 4 eligibility
groups:
(A) Eligibility Group 1 shall consist of beneficiaries
who are not eligible for Medicare Part D coverage and who
are:
(i) disabled and under age 65; or
(ii) age 65 or older, with incomes over 200% of the
Federal Poverty Level; or
(iii) age 65 or older, with incomes at or below
200% of the Federal Poverty Level and not eligible for
federally funded means-tested benefits due to
immigration status.
(B) Eligibility Group 2 shall consist of beneficiaries
who are eligible for Medicare Part D coverage.
(C) Eligibility Group 3 shall consist of beneficiaries

HB0027 - 362 - LRB098 00027 KTG 30027 b
age 65 or older, with incomes at or below 200% of the
Federal Poverty Level, who are not barred from receiving
federally funded means-tested benefits due to immigration
status and are not eligible for Medicare Part D coverage.
If the State applies and receives federal approval for
a waiver under Title XIX of the Social Security Act,
persons in Eligibility Group 3 shall continue to receive
benefits through the approved waiver, and Eligibility
Group 3 may be expanded to include disabled persons under
age 65 with incomes under 200% of the Federal Poverty Level
who are not eligible for Medicare and who are not barred
from receiving federally funded means-tested benefits due
to immigration status.
(D) Eligibility Group 4 shall consist of beneficiaries
who are otherwise described in Eligibility Group 2 who have
a diagnosis of HIV or AIDS.
The program established under this subsection shall cover
the cost of covered prescription drugs in excess of the
beneficiary cost-sharing amounts set forth in this paragraph
that are not covered by Medicare. The Department of Healthcare
and Family Services may establish by emergency rule changes in
cost-sharing necessary to conform the cost of the program to
the amounts appropriated for State fiscal year 2012 and future
fiscal years except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 of the Illinois Administrative Procedure Act

HB0027 - 363 - LRB098 00027 KTG 30027 b
shall not apply to rules adopted under this subsection (g). The
adoption of emergency rules authorized by this subsection (g)
shall be deemed to be necessary for the public interest,
safety, and welfare.
For purposes of the program established under this
subsection, the term "covered prescription drug" has the
following meanings:
For Eligibility Group 1, "covered prescription drug"
means: (1) any cardiovascular agent or drug; (2) any
insulin or other prescription drug used in the treatment of
diabetes, including syringe and needles used to administer
the insulin; (3) any prescription drug used in the
treatment of arthritis; (4) any prescription drug used in
the treatment of cancer; (5) any prescription drug used in
the treatment of Alzheimer's disease; (6) any prescription
drug used in the treatment of Parkinson's disease; (7) any
prescription drug used in the treatment of glaucoma; (8)
any prescription drug used in the treatment of lung disease
and smoking-related illnesses; (9) any prescription drug
used in the treatment of osteoporosis; and (10) any
prescription drug used in the treatment of multiple
sclerosis. The Department may add additional therapeutic
classes by rule. The Department may adopt a preferred drug
list within any of the classes of drugs described in items
(1) through (10) of this paragraph. The specific drugs or
therapeutic classes of covered prescription drugs shall be

HB0027 - 364 - LRB098 00027 KTG 30027 b
indicated by rule.
For Eligibility Group 2, "covered prescription drug"
means those drugs covered by the Medicare Part D
Prescription Drug Plan in which the beneficiary is
enrolled.
For Eligibility Group 3, "covered prescription drug"
means those drugs covered by the Medical Assistance Program
under Article V of the Illinois Public Aid Code.
For Eligibility Group 4, "covered prescription drug"
means those drugs covered by the Medicare Part D
Prescription Drug Plan in which the beneficiary is
enrolled.
Any person otherwise eligible for pharmaceutical
assistance under this subsection whose covered drugs are
covered by any public program is ineligible for assistance
under this subsection to the extent that the cost of those
drugs is covered by the other program.
The Department of Healthcare and Family Services shall
establish by rule the methods by which it will provide for the
coverage called for in this subsection. Those methods may
include direct reimbursement to pharmacies or the payment of a
capitated amount to Medicare Part D Prescription Drug Plans.
For a pharmacy to be reimbursed under the program
established under this subsection, it must comply with rules
adopted by the Department of Healthcare and Family Services
regarding coordination of benefits with Medicare Part D

HB0027 - 365 - LRB098 00027 KTG 30027 b
Prescription Drug Plans. A pharmacy may not charge a
Medicare-enrolled beneficiary of the program established under
this subsection more for a covered prescription drug than the
appropriate Medicare cost-sharing less any payment from or on
behalf of the Department of Healthcare and Family Services.
The Department of Healthcare and Family Services or the
Department on Aging, as appropriate, may adopt rules regarding
applications, counting of income, proof of Medicare status,
mandatory generic policies, and pharmacy reimbursement rates
and any other rules necessary for the cost-efficient operation
of the program established under this subsection.
(h) A qualified individual is not entitled to duplicate
benefits in a coverage period as a result of the changes made
by this amendatory Act of the 96th General Assembly.
(Source: P.A. 96-804, eff. 1-1-10; 97-74, eff. 6-30-11; 97-333,
eff. 8-12-11; 97-689, eff. 6-14-12.)
(320 ILCS 25/4.05)
Sec. 4.05. Application.
(a) The Department on Aging shall establish the content,
required eligibility and identification information, use of
social security numbers, and manner of applying for benefits in
a simplified format under this Act, including claims filed for
new or renewed prescription drug benefits.
(b) An application may be filed on paper or over the
Internet to enable persons to apply separately or for both a

HB0027 - 366 - LRB098 00027 KTG 30027 b
property tax relief grant and pharmaceutical assistance on the
same application. An application may also enable persons to
apply for other State or federal programs that provide medical
or pharmaceutical assistance or other benefits, as determined
by the Department on Aging in conjunction with the Department
of Healthcare and Family Services.
(c) Applications must be filed during the time period
prescribed by the Department.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/4.2 new)
Sec. 4.2. Information to the Department. Notwithstanding
any other law to the contrary, entities subject to the Illinois
Insurance Code, Comprehensive Health Insurance Plan Act,
Dental Service Plan Act, Children's Health Insurance Program
Act, Health Care Purchasing Group Act, Health Maintenance
Organization Act, Limited Health Service Organization Act,
Voluntary Health Services Plans Act, and the Workers'
Compensation Act, including, but not limited to, insurers,
health maintenance organizations, pharmacy benefit managers,
third party administrators, fraternal benefit societies,
group-funded workers' compensation pools, municipal
group-funded pools, self-funded or self-insured welfare or
benefit plans or programs, and any other entities that provide
health coverage through an employer, union, trade association
or other organization or source, or any other entities, must

HB0027 - 367 - LRB098 00027 KTG 30027 b
provide information to the Department, or its designee, that is
necessary to carry out the purposes of this Act, including, but
not limited to, the name, social security number, address, date
of birth, and coverage of their policyholders, their
subscribers, or the beneficiaries of their plans, benefits, or
services who participate in the programs under this Act. The
provision of this information to the Department or its designee
is subject to the confidentiality provisions in Section 8a of
this Act.
(320 ILCS 25/5) (from Ch. 67 1/2, par. 405)
Sec. 5. Procedure.
(a) In general. Claims must be filed after January 1, on
forms prescribed by the Department. No claim may be filed more
than one year after December 31 of the year for which the claim
is filed. The pharmaceutical assistance identification card
provided for in subsection (f) of Section 4 shall be valid for
a period determined by the Department of Healthcare and Family
Services.
(b) Claim is Personal. The right to file a claim under this
Act shall be personal to the claimant and shall not survive his
death, but such right may be exercised on behalf of a claimant
by his legal guardian or attorney-in-fact. If a claimant dies
after having filed a timely claim, the amount thereof shall be
disbursed to his surviving spouse or, if no spouse survives, to
his surviving dependent minor children in equal parts, provided

HB0027 - 368 - LRB098 00027 KTG 30027 b
the spouse or child, as the case may be, resided with the
claimant at the time he filed his claim. If at the time of
disbursement neither the claimant nor his spouse is surviving,
and no dependent minor children of the claimant are surviving
the amount of the claim shall escheat to the State.
(c) One claim per household. Only one member of a household
may file a claim under this Act in any calendar year; where
both members of a household are otherwise entitled to claim a
grant under this Act, they must agree as to which of them will
file a claim for that year.
(d) (Blank).
(e) Pharmaceutical Assistance Procedures. The Prior to
July 1, 2012, the Department of Healthcare and Family Services
shall determine eligibility for pharmaceutical assistance
using the applicant's current income. The Department shall
determine a person's current income in the manner provided by
the Department by rule.
(f) A person may not under any circumstances charge a fee
to a claimant under this Act for assistance in completing an
application form for a property tax relief grant or
pharmaceutical assistance under this Act.
(Source: P.A. 96-491, eff. 8-14-09; 96-804, eff. 1-1-10;
96-1000, eff. 7-2-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/6) (from Ch. 67 1/2, par. 406)
Sec. 6. Administration.

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(a) In general. Upon receipt of a timely filed claim, the
Department shall determine whether the claimant is a person
entitled to a grant under this Act and the amount of grant to
which he is entitled under this Act. The Department may require
the claimant to furnish reasonable proof of the statements of
domicile, household income, rent paid, property taxes accrued
and other matters on which entitlement is based, and may
withhold payment of a grant until such additional proof is
furnished.
(b) Rental determination. If the Department finds that the
gross rent used in the computation by a claimant of rent
constituting property taxes accrued exceeds the fair rental
value for the right to occupy that residence, the Department
may determine the fair rental value for that residence and
recompute rent constituting property taxes accrued
accordingly.
(c) Fraudulent claims. The Department shall deny claims
which have been fraudulently prepared or when it finds that the
claimant has acquired title to his residence or has paid rent
for his residence primarily for the purpose of receiving a
grant under this Act.
(d) Pharmaceutical Assistance. The Department shall allow
all pharmacies licensed under the Pharmacy Practice Act to
participate as authorized pharmacies unless they have been
removed from that status for cause pursuant to the terms of
this Section. The Director of the Department may enter into a

HB0027 - 370 - LRB098 00027 KTG 30027 b
written contract with any State agency, instrumentality or
political subdivision, or a fiscal intermediary for the purpose
of making payments to authorized pharmacies for covered
prescription drugs and coordinating the program of
pharmaceutical assistance established by this Act with other
programs that provide payment for covered prescription drugs.
Such agreement shall establish procedures for properly
contracting for pharmacy services, validating reimbursement
claims, validating compliance of dispensing pharmacists with
the contracts for participation required under this Section,
validating the reasonable costs of covered prescription drugs,
and otherwise providing for the effective administration of
this Act. (Blank).
The Department shall promulgate rules and regulations to
implement and administer the program of pharmaceutical
assistance required by this Act, which shall include the
following:
(1) Execution of contracts with pharmacies to dispense
covered prescription drugs. Such contracts shall stipulate
terms and conditions for authorized pharmacies
participation and the rights of the State to terminate such
participation for breach of such contract or for violation
of this Act or related rules and regulations of the
Department;
(2) Establishment of maximum limits on the size of
prescriptions, new or refilled, which shall be in amounts

HB0027 - 371 - LRB098 00027 KTG 30027 b
sufficient for 34 days, except as otherwise specified by
rule for medical or utilization control reasons;
(3) Establishment of liens upon any and all causes of
action which accrue to a beneficiary as a result of
injuries for which covered prescription drugs are directly
or indirectly required and for which the Director made
payment or became liable for under this Act;
(4) Charge or collection of payments from third parties
or private plans of assistance, or from other programs of
public assistance for any claim that is properly chargeable
under the assignment of benefits executed by beneficiaries
as a requirement of eligibility for the pharmaceutical
assistance identification card under this Act;
(4.5) Provision for automatic enrollment of
beneficiaries into a Medicare Discount Card program
authorized under the federal Medicare Modernization Act of
2003 (P.L. 108-391) to coordinate coverage including
Medicare Transitional Assistance;
(5) Inspection of appropriate records and audit of
participating authorized pharmacies to ensure contract
compliance, and to determine any fraudulent transactions
or practices under this Act;
(6) Payment to pharmacies under this Act in accordance
with the State Prompt Payment Act.
The Department shall annually report to the Governor and
the General Assembly by March 1st of each year on the

HB0027 - 372 - LRB098 00027 KTG 30027 b
administration of pharmaceutical assistance under this Act.
(Source: P.A. 96-328, eff. 8-11-09; 97-333, eff. 8-12-11;
97-689, eff. 6-14-12.)
(320 ILCS 25/7) (from Ch. 67 1/2, par. 407)
Sec. 7. Payment and denial of claims.
(a) In general. The Director shall order the payment from
appropriations made for that purpose of grants to claimants
under this Act in the amounts to which the Department has
determined they are entitled, respectively. If a claim is
denied, the Director shall cause written notice of that denial
and the reasons for that denial to be sent to the claimant.
(b) Payment of claims one dollar and under. Where the
amount of the grant computed under Section 4 is less than one
dollar, the Department shall pay to the claimant one dollar.
(c) Right to appeal. Any person aggrieved by an action or
determination of the Department on Aging arising under any of
its powers or duties under this Act may request in writing that
the Department on Aging reconsider its action or determination,
setting out the facts upon which the request is based. The
Department on Aging shall consider the request and either
modify or affirm its prior action or determination. The
Department on Aging may adopt, by rule, procedures for
conducting its review under this Section.
Any person aggrieved by an action or determination of the
Department of Healthcare and Family Services arising under any

HB0027 - 373 - LRB098 00027 KTG 30027 b
of its powers or duties under this Act may request in writing
that the Department of Healthcare and Family Services
reconsider its action or determination, setting out the facts
upon which the request is based. The Department of Healthcare
and Family Services shall consider the request and either
modify or affirm its prior action or determination. The
Department of Healthcare and Family Services may adopt, by
rule, procedures for conducting its review under this Section.
(d) (Blank).
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/8) (from Ch. 67 1/2, par. 408)
Sec. 8. Records. Every claimant of a grant under this Act
and, prior to July 1, 2012, every applicant for pharmaceutical
assistance under this Act shall keep such records, render such
statements, file such forms and comply with such rules and
regulations as the Department on Aging may from time to time
prescribe. The Department on Aging may by regulations require
landlords to furnish to tenants statements as to gross rent or
rent constituting property taxes accrued.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/9) (from Ch. 67 1/2, par. 409)
Sec. 9. Fraud; error.
(a) Any person who files a fraudulent claim for a grant
under this Act, or who for compensation prepares a claim for a

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grant and knowingly enters false information on an application
for any claimant under this Act, or who fraudulently files
multiple applications, or who fraudulently states that a
nondisabled person is disabled, or who, prior to July 1, 2012,
fraudulently procures pharmaceutical assistance benefits, or
who fraudulently uses such assistance to procure covered
prescription drugs, or who, on behalf of an authorized
pharmacy, files a fraudulent request for payment, is guilty of
a Class 4 felony for the first offense and is guilty of a Class
3 felony for each subsequent offense.
(b) The Department on Aging and the Department of
Healthcare and Family Services shall immediately suspend the
pharmaceutical assistance benefits of any person suspected of
fraudulent procurement or fraudulent use of such assistance,
and shall revoke such assistance upon a conviction. A person
convicted of fraud under subsection (a) shall be permanently
barred from all of the programs established under this Act.
(Blank).
(c) The Department on Aging may recover from a claimant any
amount paid to that claimant under this Act on account of an
erroneous or fraudulent claim, together with 6% interest per
year. Amounts recoverable from a claimant by the Department on
Aging under this Act may, but need not, be recovered by
offsetting the amount owed against any future grant payable to
the person under this Act.
The Department of Healthcare and Family Services may

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recover for acts prior to July 1, 2012 from an authorized
pharmacy any amount paid to that pharmacy under the
pharmaceutical assistance program on account of an erroneous or
fraudulent request for payment under that program, together
with 6% interest per year. The Department of Healthcare and
Family Services may recover from a person who erroneously or
fraudulently obtains benefits under the pharmaceutical
assistance program the value of the benefits so obtained,
together with 6% interest per year.
(d) A prosecution for a violation of this Section may be
commenced at any time within 3 years of the commission of that
violation.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/12) (from Ch. 67 1/2, par. 412)
Sec. 12. Regulations - Department on Aging.
(a) Regulations. Notwithstanding any other provision to
the contrary, the Department on Aging may adopt rules regarding
applications, proof of eligibility, required identification
information, use of social security numbers, counting of
income, and a method of computing "gross rent" in the case of a
claimant living in a nursing or sheltered care home, and any
other rules necessary for the cost-efficient operation of the
program established under Section 4.
(b) The Department on Aging shall, to the extent of
appropriations made for that purpose:

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(1) attempt to secure the cooperation of appropriate
federal, State and local agencies in securing the names and
addresses of persons to whom this Act pertains;
(2) prepare a mailing list of persons eligible for
grants under this Act;
(3) secure the cooperation of the Department of
Revenue, the Department of Healthcare and Family Services,
other State agencies, and local business establishments to
facilitate distribution of applications under this Act to
those eligible to file claims; and
(4) through use of direct mail, newspaper
advertisements and radio and television advertisements,
and all other appropriate means of communication, conduct
an on-going public relations program to increase awareness
of eligible citizens of the benefits under this Act and the
procedures for applying for them.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
(320 ILCS 25/13) (from Ch. 67 1/2, par. 413)
Sec. 13. List of persons who have qualified. The Department
on Aging shall maintain a list of all persons who have
qualified under this Act and shall make the list available to
the Department of Healthcare and Family Services, the
Department of Public Health, the Secretary of State,
municipalities, and public transit authorities upon request.
All information received by a State agency, municipality,

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or public transit authority under this Section shall be
confidential, except for official purposes, and any person who
divulges or uses that information in any manner, except in
accordance with a proper judicial order, shall be guilty of a
Class B misdemeanor.
(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
Section 2-91. The Senior Citizens Real Estate Tax Deferral
Act is amended by changing Sections 2 and 8 as follows:
(320 ILCS 30/2) (from Ch. 67 1/2, par. 452)
Sec. 2. Definitions. As used in this Act:
(a) "Taxpayer" means an individual whose household income
for the year is no greater than: (i) $40,000 through tax year
2005; (ii) $50,000 for tax years 2006 through 2011; and (iii)
$55,000 for tax year 2012 and thereafter.
(b) "Tax deferred property" means the property upon which
real estate taxes are deferred under this Act.
(c) "Homestead" means the land and buildings thereon,
including a condominium or a dwelling unit in a multidwelling
building that is owned and operated as a cooperative, occupied
by the taxpayer as his residence or which are temporarily
unoccupied by the taxpayer because such taxpayer is temporarily
residing, for not more than 1 year, in a licensed facility as
defined in Section 1-113 of the Nursing Home Care Act.
(d) "Real estate taxes" or "taxes" means the taxes on real

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property for which the taxpayer would be liable under the
Property Tax Code, including special service area taxes, and
special assessments on benefited real property for which the
taxpayer would be liable to a unit of local government.
(e) "Department" means the Department of Revenue.
(f) "Qualifying property" means a homestead which (a) the
taxpayer or the taxpayer and his spouse own in fee simple or
are purchasing in fee simple under a recorded instrument of
sale, (b) is not income-producing property, (c) is not subject
to a lien for unpaid real estate taxes when a claim under this
Act is filed, and (d) is not held in trust, other than an
Illinois land trust with the taxpayer identified as the sole
beneficiary, if the taxpayer is filing for the program for the
first time effective as of the January 1, 2011 assessment year
or tax year 2012 and thereafter.
(g) "Equity interest" means the current assessed valuation
of the qualified property times the fraction necessary to
convert that figure to full market value minus any outstanding
debts or liens on that property. In the case of qualifying
property not having a separate assessed valuation, the
appraised value as determined by a qualified real estate
appraiser shall be used instead of the current assessed
valuation.
(h) "Household income" has the meaning ascribed to that
term in the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act.

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(i) "Collector" means the county collector or, if the taxes
to be deferred are special assessments, an official designated
by a unit of local government to collect special assessments.
(Source: P.A. 97-481, eff. 8-22-11; 97-689, eff. 6-14-12.)
(320 ILCS 30/8) (from Ch. 67 1/2, par. 458)
Sec. 8. Nothing in this Act (a) affects any provision of
any mortgage or other instrument relating to land requiring a
person to pay real estate taxes or (b) affects the eligibility
of any person to receive any grant pursuant to the "Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act".
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-92. The Senior Pharmaceutical Assistance Act is
amended by changing Section 5 as follows:
(320 ILCS 50/5)
Sec. 5. Findings. The General Assembly finds:
(1) Senior citizens identify pharmaceutical assistance as
the single most critical factor to their health, well-being,
and continued independence.
(2) The State of Illinois currently operates 2
pharmaceutical assistance programs that benefit seniors: (i)
the program of pharmaceutical assistance under the Senior
Citizens and Disabled Persons Property Tax Relief and

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Pharmaceutical Assistance Act and (ii) the Aid to the Aged,
Blind, or Disabled program under the Illinois Public Aid Code.
The State has been given authority to establish a third
program, SeniorRx Care, through a federal Medicaid waiver.
(3) Each year, numerous pieces of legislation are filed
seeking to establish additional pharmaceutical assistance
benefits for seniors or to make changes to the existing
programs.
(4) Establishment of a pharmaceutical assistance review
committee will ensure proper coordination of benefits,
diminish the likelihood of duplicative benefits, and ensure
that the best interests of seniors are served.
(5) In addition to the State pharmaceutical assistance
programs, several private entities, such as drug manufacturers
and pharmacies, also offer prescription drug discount or
coverage programs.
(6) Many seniors are unaware of the myriad of public and
private programs available to them.
(7) Establishing a pharmaceutical clearinghouse with a
toll-free hot-line and local outreach workers will educate
seniors about the vast array of options available to them and
enable seniors to make an educated and informed choice that is
best for them.
(8) Estimates indicate that almost one-third of senior
citizens lack prescription drug coverage. The federal
government, states, and the pharmaceutical industry each have a

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role in helping these uninsured seniors gain access to
life-saving medications.
(9) The State of Illinois has recognized its obligation to
assist Illinois' neediest seniors in purchasing prescription
medications, and it is now time for pharmaceutical
manufacturers to recognize their obligation to make their
medications affordable to seniors.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-100. The Sexual Assault Survivors Emergency
Treatment Act is amended by changing Section 7 as follows:
(410 ILCS 70/7) (from Ch. 111 1/2, par. 87-7)
Sec. 7. Charges and reimbursement Reimbursement.
(a) When any ambulance provider furnishes transportation,
hospital provides hospital emergency services and forensic
services, hospital or health care professional or laboratory
provides follow-up healthcare, or pharmacy dispenses
prescribed medications to any sexual assault survivor, as
defined by the Department of Healthcare and Family Services,
who is neither eligible to receive such services under the
Illinois Public Aid Code nor covered as to such services by a
policy of insurance, the ambulance provider, hospital, health
care professional, pharmacy, or laboratory shall furnish such
services to that person without charge and shall be entitled to
be reimbursed for its billed charges in providing such services

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by the Illinois Sexual Assault Emergency Treatment Program
under the Department of Healthcare and Family Services.
Pharmacies shall dispense prescribed medications without
charge to the survivor and shall be reimbursed and at the
Department of Healthcare and Family Services' Medicaid
allowable rates under the Illinois Public Aid Code.
(b) The hospital is responsible for submitting the request
for reimbursement for ambulance services, hospital emergency
services, and forensic services to the Illinois Sexual Assault
Emergency Treatment Program. Nothing in this Section precludes
hospitals from providing follow-up healthcare and receiving
reimbursement under this Section.
(c) The health care professional who provides follow-up
healthcare and the pharmacy that dispenses prescribed
medications to a sexual assault survivor are responsible for
submitting the request for reimbursement for follow-up
healthcare or pharmacy services to the Illinois Sexual Assault
Emergency Treatment Program.
(d) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or other
payments or alter any methodologies authorized by this Act or
the Illinois Public Aid Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code.
(e) (d) The Department of Healthcare and Family Services
shall establish standards, rules, and regulations to implement

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this Section.
(Source: P.A. 97-689, eff. 6-14-12; revised 8-3-12.)
Section 2-102. The Hemophilia Care Act is amended by
changing Section 3 as follows:
(410 ILCS 420/3) (from Ch. 111 1/2, par. 2903)
Sec. 3. The powers and duties of the Department shall
include the following:
(1) With the advice and counsel of the Committee,
develop standards for determining eligibility for care and
treatment under this program. Among other standards
developed under this Section, persons suffering from
hemophilia must be evaluated in a center properly staffed
and equipped for such evaluation, but not operated by the
Department.
(2) (Blank).
(3) Extend financial assistance to eligible persons in
order that they may obtain blood and blood derivatives for
use in hospitals, in medical and dental facilities, or at
home. The Department shall extend financial assistance in
each fiscal year to each family containing one or more
eligible persons in the amount of (a) the family's eligible
cost of hemophilia services for that fiscal year, minus (b)
one fifth of its available family income for its next
preceding taxable year. The Director may extend financial

HB0027 - 384 - LRB098 00027 KTG 30027 b
assistance in the case of unusual hardships, according to
specific procedures and conditions adopted for this
purpose in the rules and regulations promulgated by the
Department to implement and administer this Act.
(4) (Blank).
(5) Promulgate rules and regulations with the advice
and counsel of the Committee for the implementation and
administration of this Act.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Act or the Illinois Public
Aid Code to reduce any rate of reimbursement for services or
other payments in accordance with Section 5-5e of the Illinois
Public Aid Code.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-103. The Renal Disease Treatment Act is amended
by changing Section 3 as follows:
(410 ILCS 430/3) (from Ch. 111 1/2, par. 22.33)
Sec. 3. Duties of Departments of Healthcare and Family
Services and Public Health.
(A) The Department of Healthcare and Family Services shall:
(a) With the advice of the Renal Disease Advisory
Committee, develop standards for determining eligibility
for care and treatment under this program. Among other

HB0027 - 385 - LRB098 00027 KTG 30027 b
standards so developed under this paragraph, candidates,
to be eligible for care and treatment, must be evaluated in
a center properly staffed and equipped for such evaluation.
(b) (Blank).
(c) (Blank).
(d) Extend financial assistance to persons suffering
from chronic renal diseases in obtaining the medical,
surgical, nursing, pharmaceutical, and technical services
necessary in caring for such diseases, including the
renting of home dialysis equipment. The Renal Disease
Advisory Committee shall recommend to the Department the
extent of financial assistance, including the reasonable
charges and fees, for:
(1) Treatment in a dialysis facility;
(2) Hospital treatment for dialysis and transplant
surgery;
(3) Treatment in a limited care facility;
(4) Home dialysis training; and
(5) Home dialysis.
(e) Assist in equipping dialysis centers.
(f) (Blank). On and after July 1, 2012, the Department
shall reduce any rate of reimbursement for services or
other payments or alter any methodologies authorized by
this Act or the Illinois Public Aid Code to reduce any rate
of reimbursement for services or other payments in
accordance with Section 5-5e of the Illinois Public Aid

HB0027 - 386 - LRB098 00027 KTG 30027 b
Code.
(B) The Department of Public Health shall:
(a) Assist in the development and expansion of programs
for the care and treatment of persons suffering from
chronic renal diseases, including dialysis and other
medical or surgical procedures and techniques that will
have a lifesaving effect in the care and treatment of
persons suffering from these diseases.
(b) Assist in the development of programs for the
prevention of chronic renal diseases.
(c) Institute and carry on an educational program among
physicians, hospitals, public health departments, and the
public concerning chronic renal diseases, including the
dissemination of information and the conducting of
educational programs concerning the prevention of chronic
renal diseases and the methods for the care and treatment
of persons suffering from these diseases.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 2-104. The Illinois Vehicle Code is amended by
changing Sections 3-609, 3-623, 3-626, 3-667, 3-683, 3-806.3,
and 11-1301.2 as follows:
(625 ILCS 5/3-609) (from Ch. 95 1/2, par. 3-609)
Sec. 3-609. Disabled Veterans' Plates.
(a) Any veteran who holds proof of a service-connected

HB0027 - 387 - LRB098 00027 KTG 30027 b
disability from the United States Department of Veterans
Affairs, and who has obtained certification from a licensed
physician, physician assistant, or advanced practice nurse
that the service-connected disability qualifies the veteran
for issuance of registration plates or decals to a person with
disabilities in accordance with Section 3-616, may, without the
payment of any registration fee, make application to the
Secretary of State for disabled veterans license plates
displaying the international symbol of access, for the
registration of one motor vehicle of the first division or one
motor vehicle of the second division weighing not more than
8,000 pounds.
(b) Any veteran who holds proof of a service-connected
disability from the United States Department of Veterans
Affairs, and whose degree of disability has been declared to be
50% or more, but whose disability does not qualify the veteran
for a plate or decal for persons with disabilities under
Section 3-616, may, without the payment of any registration
fee, make application to the Secretary for a special
registration plate without the international symbol of access
for the registration of one motor vehicle of the first division
or one motor vehicle of the second division weighing not more
than 8,000 pounds.
(c) Renewal of such registration must be accompanied with
documentation for eligibility of registration without fee
unless the applicant has a permanent qualifying disability, and

HB0027 - 388 - LRB098 00027 KTG 30027 b
such registration plates may not be issued to any person not
eligible therefor. The Illinois Department of Veterans'
Affairs may assist in providing the documentation of
disability.
(d) The design and color of the plates shall be within the
discretion of the Secretary, except that the plates issued
under subsection (b) of this Section shall not contain the
international symbol of access. The Secretary may, in his or
her discretion, allow the plates to be issued as vanity or
personalized plates in accordance with Section 3-405.1 of this
Code. Registration shall be for a multi-year period and may be
issued staggered registration.
(e) Any person eligible to receive license plates under
this Section who has been approved for benefits under the
Senior Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act, or who has claimed and received
a grant under that Act, shall pay a fee of $24 instead of the
fee otherwise provided in this Code for passenger cars
displaying standard multi-year registration plates issued
under Section 3-414.1, for motor vehicles registered at 8,000
pounds or less under Section 3-815(a), or for recreational
vehicles registered at 8,000 pounds or less under Section
3-815(b), for a second set of plates under this Section.
(Source: P.A. 96-79, eff. 1-1-10; 97-689, eff. 6-14-12; 97-918,
eff. 1-1-13; revised 8-23-12.)

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(625 ILCS 5/3-623) (from Ch. 95 1/2, par. 3-623)
Sec. 3-623. Purple Heart Plates. The Secretary, upon
receipt of an application made in the form prescribed by the
Secretary of State, may issue to recipients awarded the Purple
Heart by a branch of the armed forces of the United States who
reside in Illinois, special registration plates. The
Secretary, upon receipt of the proper application, may also
issue these special registration plates to an Illinois resident
who is the surviving spouse of a person who was awarded the
Purple Heart by a branch of the armed forces of the United
States. The special plates issued pursuant to this Section
should be affixed only to passenger vehicles of the 1st
division, including motorcycles, or motor vehicles of the 2nd
division weighing not more than 8,000 pounds. The Secretary
may, in his or her discretion, allow the plates to be issued as
vanity or personalized plates in accordance with Section
3-405.1 of this Code. The Secretary of State must make a
version of the special registration plates authorized under
this Section in a form appropriate for motorcycles.
The design and color of such plates shall be wholly within
the discretion of the Secretary of State. Appropriate
documentation, as determined by the Secretary, and the
appropriate registration fee shall accompany the application.
However, for an individual who has been issued Purple Heart
plates for a vehicle and who has been approved for benefits
under the Senior Citizens and Disabled Persons Property Tax

HB0027 - 390 - LRB098 00027 KTG 30027 b
Relief and Pharmaceutical Assistance Act, the annual fee for
the registration of the vehicle shall be as provided in Section
3-806.3 of this Code.
(Source: P.A. 96-1101, eff. 1-1-11; 97-689, eff. 6-14-12.)
(625 ILCS 5/3-626)
Sec. 3-626. Korean War Veteran license plates.
(a) In addition to any other special license plate, the
Secretary, upon receipt of all applicable fees and applications
made in the form prescribed by the Secretary of State, may
issue special registration plates designated as Korean War
Veteran license plates to residents of Illinois who
participated in the United States Armed Forces during the
Korean War. The special plate issued under this Section shall
be affixed only to passenger vehicles of the first division,
motorcycles, motor vehicles of the second division weighing not
more than 8,000 pounds, and recreational vehicles as defined by
Section 1-169 of this Code. Plates issued under this Section
shall expire according to the staggered multi-year procedure
established by Section 3-414.1 of this Code.
(b) The design, color, and format of the plates shall be
wholly within the discretion of the Secretary of State. The
Secretary may, in his or her discretion, allow the plates to be
issued as vanity plates or personalized in accordance with
Section 3-405.1 of this Code. The plates are not required to
designate "Land Of Lincoln", as prescribed in subsection (b) of

HB0027 - 391 - LRB098 00027 KTG 30027 b
Section 3-412 of this Code. The Secretary shall prescribe the
eligibility requirements and, in his or her discretion, shall
approve and prescribe stickers or decals as provided under
Section 3-412.
(c) (Blank).
(d) The Korean War Memorial Construction Fund is created as
a special fund in the State treasury. All moneys in the Korean
War Memorial Construction Fund shall, subject to
appropriation, be used by the Department of Veteran Affairs to
provide grants for construction of the Korean War Memorial to
be located at Oak Ridge Cemetery in Springfield, Illinois. Upon
the completion of the Memorial, the Department of Veteran
Affairs shall certify to the State Treasurer that the
construction of the Memorial has been completed. Upon the
certification by the Department of Veteran Affairs, the State
Treasurer shall transfer all moneys in the Fund and any future
deposits into the Fund into the Secretary of State Special
License Plate Fund.
(e) An individual who has been issued Korean War Veteran
license plates for a vehicle and who has been approved for
benefits under the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act shall pay
the original issuance and the regular annual fee for the
registration of the vehicle as provided in Section 3-806.3 of
this Code in addition to the fees specified in subsection (c)
of this Section.

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(Source: P.A. 96-1409, eff. 1-1-11; 97-689, eff. 6-14-12.)
(625 ILCS 5/3-667)
Sec. 3-667. Korean Service license plates.
(a) In addition to any other special license plate, the
Secretary, upon receipt of all applicable fees and applications
made in the form prescribed by the Secretary of State, may
issue special registration plates designated as Korean Service
license plates to residents of Illinois who, on or after July
27, 1954, participated in the United States Armed Forces in
Korea. The special plate issued under this Section shall be
affixed only to passenger vehicles of the first division,
motorcycles, motor vehicles of the second division weighing not
more than 8,000 pounds, and recreational vehicles as defined by
Section 1-169 of this Code. Plates issued under this Section
shall expire according to the staggered multi-year procedure
established by Section 3-414.1 of this Code.
(b) The design, color, and format of the plates shall be
wholly within the discretion of the Secretary of State. The
Secretary may, in his or her discretion, allow the plates to be
issued as vanity or personalized plates in accordance with
Section 3-405.1 of this Code. The plates are not required to
designate "Land of Lincoln", as prescribed in subsection (b) of
Section 3-412 of this Code. The Secretary shall prescribe the
eligibility requirements and, in his or her discretion, shall
approve and prescribe stickers or decals as provided under

HB0027 - 393 - LRB098 00027 KTG 30027 b
Section 3-412.
(c) An applicant shall be charged a $2 fee for original
issuance in addition to the applicable registration fee. This
additional fee shall be deposited into the Korean War Memorial
Construction Fund a special fund in the State treasury.
(d) An individual who has been issued Korean Service
license plates for a vehicle and who has been approved for
benefits under the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act shall pay
the original issuance and the regular annual fee for the
registration of the vehicle as provided in Section 3-806.3 of
this Code in addition to the fees specified in subsection (c)
of this Section.
(Source: P.A. 97-306, eff. 1-1-12; 97-689, eff. 6-14-12.)
(625 ILCS 5/3-683)
Sec. 3-683. Distinguished Service Cross license plates.
The Secretary, upon receipt of an application made in the form
prescribed by the Secretary of State, shall issue special
registration plates to any Illinois resident who has been
awarded the Distinguished Service Cross by a branch of the
armed forces of the United States. The Secretary, upon receipt
of the proper application, shall also issue these special
registration plates to an Illinois resident who is the
surviving spouse of a person who was awarded the Distinguished
Service Cross by a branch of the armed forces of the United

HB0027 - 394 - LRB098 00027 KTG 30027 b
States. The special plates issued under this Section should be
affixed only to passenger vehicles of the first division,
including motorcycles, or motor vehicles of the second division
weighing not more than 8,000 pounds.
The design and color of the plates shall be wholly within
the discretion of the Secretary of State. Appropriate
documentation, as determined by the Secretary, and the
appropriate registration fee shall accompany the application.
However, for an individual who has been issued Distinguished
Service Cross plates for a vehicle and who has been approved
for benefits under the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act, the
annual fee for the registration of the vehicle shall be as
provided in Section 3-806.3 of this Code.
(Source: P.A. 96-328, eff. 8-11-09; 97-689, eff. 6-14-12.)
(625 ILCS 5/3-806.3) (from Ch. 95 1/2, par. 3-806.3)
Sec. 3-806.3. Senior Citizens. Commencing with the 2009
registration year, the registration fee paid by any vehicle
owner who has been approved for benefits under the Senior
Citizens and Disabled Persons Property Tax Relief and
Pharmaceutical Assistance Act or who is the spouse of such a
person shall be $24 instead of the fee otherwise provided in
this Code for passenger cars displaying standard multi-year
registration plates issued under Section 3-414.1, motor
vehicles displaying special registration plates issued under

HB0027 - 395 - LRB098 00027 KTG 30027 b
Section 3-609, 3-616, 3-621, 3-622, 3-623, 3-624, 3-625, 3-626,
3-628, 3-638, 3-642, 3-645, 3-647, 3-650, 3-651, or 3-663,
motor vehicles registered at 8,000 pounds or less under Section
3-815(a), and recreational vehicles registered at 8,000 pounds
or less under Section 3-815(b). Widows and widowers of
claimants shall also be entitled to this reduced registration
fee for the registration year in which the claimant was
eligible.
Commencing with the 2009 registration year, the
registration fee paid by any vehicle owner who has claimed and
received a grant under the Senior Citizens and Disabled Persons
Property Tax Relief and Pharmaceutical Assistance Act or who is
the spouse of such a person shall be $24 instead of the fee
otherwise provided in this Code for passenger cars displaying
standard multi-year registration plates issued under Section
3-414.1, motor vehicles displaying special registration plates
issued under Section 3-607, 3-609, 3-616, 3-621, 3-622, 3-623,
3-624, 3-625, 3-626, 3-628, 3-638, 3-642, 3-645, 3-647, 3-650,
3-651, 3-663, or 3-664, motor vehicles registered at 8,000
pounds or less under Section 3-815(a), and recreational
vehicles registered at 8,000 pounds or less under Section
3-815(b). Widows and widowers of claimants shall also be
entitled to this reduced registration fee for the registration
year in which the claimant was eligible.
No more than one reduced registration fee under this
Section shall be allowed during any 12 month period based on

HB0027 - 396 - LRB098 00027 KTG 30027 b
the primary eligibility of any individual, whether such reduced
registration fee is allowed to the individual or to the spouse,
widow or widower of such individual. This Section does not
apply to the fee paid in addition to the registration fee for
motor vehicles displaying vanity or special license plates.
(Source: P.A. 96-554, eff. 1-1-10; 97-689, eff. 6-14-12.)
(625 ILCS 5/11-1301.2) (from Ch. 95 1/2, par. 11-1301.2)
Sec. 11-1301.2. Special decals for parking; persons with
disabilities.
(a) The Secretary of State shall provide for, by
administrative rules, the design, size, color, and placement of
a person with disabilities motorist decal or device and shall
provide for, by administrative rules, the content and form of
an application for a person with disabilities motorist decal or
device, which shall be used by local authorities in the
issuance thereof to a person with temporary disabilities,
provided that the decal or device is valid for no more than 90
days, subject to renewal for like periods based upon continued
disability, and further provided that the decal or device
clearly sets forth the date that the decal or device expires.
The application shall include the requirement of an Illinois
Identification Card number or a State of Illinois driver's
license number. This decal or device may be used by the
authorized holder to designate and identify a vehicle not owned
or displaying a registration plate as provided in Sections

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3-609 and 3-616 of this Act to designate when the vehicle is
being used to transport said person or persons with
disabilities, and thus is entitled to enjoy all the privileges
that would be afforded a person with disabilities licensed
vehicle. Person with disabilities decals or devices issued and
displayed pursuant to this Section shall be recognized and
honored by all local authorities regardless of which local
authority issued such decal or device.
The decal or device shall be issued only upon a showing by
adequate documentation that the person for whose benefit the
decal or device is to be used has a temporary disability as
defined in Section 1-159.1 of this Code.
(b) The local governing authorities shall be responsible
for the provision of such decal or device, its issuance and
designated placement within the vehicle. The cost of such decal
or device shall be at the discretion of such local governing
authority.
(c) The Secretary of State may, pursuant to Section
3-616(c), issue a person with disabilities parking decal or
device to a person with disabilities as defined by Section
1-159.1. Any person with disabilities parking decal or device
issued by the Secretary of State shall be registered to that
person with disabilities in the form to be prescribed by the
Secretary of State. The person with disabilities parking decal
or device shall not display that person's address. One
additional decal or device may be issued to an applicant upon

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his or her written request and with the approval of the
Secretary of State. The written request must include a
justification of the need for the additional decal or device.
(c-5) Beginning January 1, 2014, the Secretary shall
provide by administrative rule for the issuance of a separate
and distinct parking decal or device for persons with
disabilities as defined by Section 1-159.1 of this Code. The
authorized holder of a decal or device issued under this
subsection (c-5) shall be exempt from the payment of fees
generated by parking in a metered space, a parking area subject
to paragraph (10) of subsection (a) of Section 11-209 of this
Code, or a publicly owned parking structure or area.
The Secretary shall issue a meter-exempt decal or device to
a person with disabilities who: (i) has been issued
registration plates under Section 3-609 or 3-616 of this Code
or a special decal or device under this Section, (ii) holds a
valid Illinois driver's license, ; and (iii) is unable to do one
or more of the following:
(1) manage, manipulate, or insert coins, or obtain
tickets or tokens in parking meters or ticket machines in
parking lots or parking structures, due to the lack of fine
motor control of both hands;
(2) reach above his or her head to a height of 42
inches from the ground, due to a lack of finger, hand, or
upper extremity strength or mobility;
(3) approach a parking meter due to his or her use of a

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wheelchair or other device for mobility; or
(4) walk more than 20 feet due to an orthopedic,
neurological, cardiovascular, or lung condition in which
the degree of debilitation is so severe that it almost
completely impedes the ability to walk.
The application for a meter-exempt parking decal or device
shall contain a statement certified by a licensed physician,
physician assistant, or advanced practice nurse attesting to
the nature and estimated duration of the applicant's condition
and verifying that the applicant meets the physical
qualifications specified in this subsection (c-5).
Notwithstanding the requirements of this subsection (c-5),
the Secretary shall issue a meter-exempt decal or device to a
person who has been issued registration plates under Section
3-616 of this Code or a special decal or device under this
Section, if the applicant is the parent or guardian of a person
with disabilities who is under 18 years of age and incapable of
driving.
(d) Replacement decals or devices may be issued for lost,
stolen, or destroyed decals upon application and payment of a
$10 fee. The replacement fee may be waived for individuals that
have claimed and received a grant under the Senior Citizens and
Disabled Persons Property Tax Relief and Pharmaceutical
Assistance Act.
(Source: P.A. 96-72, eff. 1-1-10; 96-79, eff. 1-1-10; 96-1000,
eff. 7-2-10; 97-689, eff. 6-14-12; 97-845, eff. 1-1-13; revised

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8-3-12.)
Section 2-105. The Criminal Code of 2012 is amended by
changing Section 17-6.5 as follows:
(720 ILCS 5/17-6.5)
Sec. 17-6.5. Persons under deportation order;
ineligibility for benefits.
(a) An individual against whom a United States Immigration
Judge has issued an order of deportation which has been
affirmed by the Board of Immigration Review, as well as an
individual who appeals such an order pending appeal, under
paragraph 19 of Section 241(a) of the Immigration and
Nationality Act relating to persecution of others on account of
race, religion, national origin or political opinion under the
direction of or in association with the Nazi government of
Germany or its allies, shall be ineligible for the following
benefits authorized by State law:
(1) The homestead exemptions and homestead improvement
exemption under Sections 15-170, 15-175, 15-176, and
15-180 of the Property Tax Code.
(2) Grants under the Senior Citizens and Disabled
Persons Property Tax Relief and Pharmaceutical Assistance
Act.
(3) The double income tax exemption conferred upon
persons 65 years of age or older by Section 204 of the

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Illinois Income Tax Act.
(4) Grants provided by the Department on Aging.
(5) Reductions in vehicle registration fees under
Section 3-806.3 of the Illinois Vehicle Code.
(6) Free fishing and reduced fishing license fees under
Sections 20-5 and 20-40 of the Fish and Aquatic Life Code.
(7) Tuition free courses for senior citizens under the
Senior Citizen Courses Act.
(8) Any benefits under the Illinois Public Aid Code.
(b) If a person has been found by a court to have knowingly
received benefits in violation of subsection (a) and:
(1) the total monetary value of the benefits received
is less than $150, the person is guilty of a Class A
misdemeanor; a second or subsequent violation is a Class 4
felony;
(2) the total monetary value of the benefits received
is $150 or more but less than $1,000, the person is guilty
of a Class 4 felony; a second or subsequent violation is a
Class 3 felony;
(3) the total monetary value of the benefits received
is $1,000 or more but less than $5,000, the person is
guilty of a Class 3 felony; a second or subsequent
violation is a Class 2 felony;
(4) the total monetary value of the benefits received
is $5,000 or more but less than $10,000, the person is
guilty of a Class 2 felony; a second or subsequent

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violation is a Class 1 felony; or
(5) the total monetary value of the benefits received
is $10,000 or more, the person is guilty of a Class 1
felony.
(c) For purposes of determining the classification of an
offense under this Section, all of the monetary value of the
benefits received as a result of the unlawful act, practice, or
course of conduct may be accumulated.
(d) Any grants awarded to persons described in subsection
(a) may be recovered by the State of Illinois in a civil action
commenced by the Attorney General in the circuit court of
Sangamon County or the State's Attorney of the county of
residence of the person described in subsection (a).
(e) An individual described in subsection (a) who has been
deported shall be restored to any benefits which that
individual has been denied under State law pursuant to
subsection (a) if (i) the Attorney General of the United States
has issued an order cancelling deportation and has adjusted the
status of the individual to that of an alien lawfully admitted
for permanent residence in the United States or (ii) the
country to which the individual has been deported adjudicates
or exonerates the individual in a judicial or administrative
proceeding as not being guilty of the persecution of others on
account of race, religion, national origin, or political
opinion under the direction of or in association with the Nazi
government of Germany or its allies.

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(Source: P.A. 96-1551, eff. 7-1-11; 97-689, eff. 6-14-12.)
Section 2-106. The Code of Civil Procedure is amended by
changing Section 5-105 as follows:
(735 ILCS 5/5-105) (from Ch. 110, par. 5-105)
Sec. 5-105. Leave to sue or defend as an indigent person.
(a) As used in this Section:
(1) "Fees, costs, and charges" means payments imposed
on a party in connection with the prosecution or defense of
a civil action, including, but not limited to: filing fees;
appearance fees; fees for service of process and other
papers served either within or outside this State,
including service by publication pursuant to Section 2-206
of this Code and publication of necessary legal notices;
motion fees; jury demand fees; charges for participation
in, or attendance at, any mandatory process or procedure
including, but not limited to, conciliation, mediation,
arbitration, counseling, evaluation, "Children First",
"Focus on Children" or similar programs; fees for
supplementary proceedings; charges for translation
services; guardian ad litem fees; charges for certified
copies of court documents; and all other processes and
procedures deemed by the court to be necessary to commence,
prosecute, defend, or enforce relief in a civil action.
(2) "Indigent person" means any person who meets one or

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more of the following criteria:
(i) He or she is receiving assistance under one or
more of the following public benefits programs:
Supplemental Security Income (SSI), Aid to the Aged,
Blind and Disabled (AABD), Temporary Assistance for
Needy Families (TANF), Food Stamps, General
Assistance, State Transitional Assistance, or State
Children and Family Assistance.
(ii) His or her available income is 125% or less of
the current poverty level as established by the United
States Department of Health and Human Services, unless
the applicant's assets that are not exempt under Part 9
or 10 of Article XII of this Code are of a nature and
value that the court determines that the applicant is
able to pay the fees, costs, and charges.
(iii) He or she is, in the discretion of the court,
unable to proceed in an action without payment of fees,
costs, and charges and whose payment of those fees,
costs, and charges would result in substantial
hardship to the person or his or her family.
(iv) He or she is an indigent person pursuant to
Section 5-105.5 of this Code.
(b) On the application of any person, before, or after the
commencement of an action, a court, on finding that the
applicant is an indigent person, shall grant the applicant
leave to sue or defend the action without payment of the fees,

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costs, and charges of the action.
(c) An application for leave to sue or defend an action as
an indigent person shall be in writing and supported by the
affidavit of the applicant or, if the applicant is a minor or
an incompetent adult, by the affidavit of another person having
knowledge of the facts. The contents of the affidavit shall be
established by Supreme Court Rule. The court shall provide,
through the office of the clerk of the court, simplified forms
consistent with the requirements of this Section and applicable
Supreme Court Rules to any person seeking to sue or defend an
action who indicates an inability to pay the fees, costs, and
charges of the action. The application and supporting affidavit
may be incorporated into one simplified form. The clerk of the
court shall post in a conspicuous place in the courthouse a
notice no smaller than 8.5 x 11 inches, using no smaller than
30-point typeface printed in English and in Spanish, advising
the public that they may ask the court for permission to sue or
defend a civil action without payment of fees, costs, and
charges. The notice shall be substantially as follows:
"If you are unable to pay the fees, costs, and charges
of an action you may ask the court to allow you to proceed
without paying them. Ask the clerk of the court for forms."
(d) The court shall rule on applications under this Section
in a timely manner based on information contained in the
application unless the court, in its discretion, requires the
applicant to personally appear to explain or clarify

HB0027 - 406 - LRB098 00027 KTG 30027 b
information contained in the application. If the court finds
that the applicant is an indigent person, the court shall enter
an order permitting the applicant to sue or defend without
payment of fees, costs, or charges. If the application is
denied, the court shall enter an order to that effect stating
the specific reasons for the denial. The clerk of the court
shall promptly mail or deliver a copy of the order to the
applicant.
(e) The clerk of the court shall not refuse to accept and
file any complaint, appearance, or other paper presented by the
applicant if accompanied by an application to sue or defend in
forma pauperis, and those papers shall be considered filed on
the date the application is presented. If the application is
denied, the order shall state a date certain by which the
necessary fees, costs, and charges must be paid. The court, for
good cause shown, may allow an applicant whose application is
denied to defer payment of fees, costs, and charges, make
installment payments, or make payment upon reasonable terms and
conditions stated in the order. The court may dismiss the
claims or defenses of any party failing to pay the fees, costs,
or charges within the time and in the manner ordered by the
court. A determination concerning an application to sue or
defend in forma pauperis shall not be construed as a ruling on
the merits.
(f) The court may order an indigent person to pay all or a
portion of the fees, costs, or charges waived pursuant to this

HB0027 - 407 - LRB098 00027 KTG 30027 b
Section out of moneys recovered by the indigent person pursuant
to a judgment or settlement resulting from the civil action.
However, nothing in this Section shall be construed to limit
the authority of a court to order another party to the action
to pay the fees, costs, or charges of the action.
(g) A court, in its discretion, may appoint counsel to
represent an indigent person, and that counsel shall perform
his or her duties without fees, charges, or reward.
(h) Nothing in this Section shall be construed to affect
the right of a party to sue or defend an action in forma
pauperis without the payment of fees, costs, or charges, or the
right of a party to court-appointed counsel, as authorized by
any other provision of law or by the rules of the Illinois
Supreme Court.
(i) The provisions of this Section are severable under
Section 1.31 of the Statute on Statutes.
(Source: P.A. 97-689, eff. 6-14-12; 97-813, eff. 7-13-12.)
Section 2-107. The Unemployment Insurance Act is amended by
changing Sections 1400.2, 1402, 1404, 1405, 1801.1, and 1900 as
follows:
(820 ILCS 405/1400.2)
Sec. 1400.2. Annual reporting and paying; household
workers. This Section applies to an employer who solely employs
one or more household workers with respect to whom the employer

HB0027 - 408 - LRB098 00027 KTG 30027 b
files federal unemployment taxes as part of his or her federal
income tax return, or could file federal unemployment taxes as
part of his or her federal income tax return if the worker or
workers were providing services in employment for purposes of
the federal unemployment tax. For purposes of this Section,
"household worker" has the meaning ascribed to it for purposes
of Section 3510 of the federal Internal Revenue Code. If an
employer to whom this Section applies notifies the Director, in
writing, that he or she wishes to pay his or her contributions
for each quarter and submit his or her wage and contribution
reports for each month or quarter, as the case may be, on an
annual basis, then the due date for filing the reports and
paying the contributions shall be April 15 of the calendar year
immediately following the close of the months or quarters to
which the reports and quarters to which the contributions
apply, except that the Director may, by rule, establish a
different due date for good cause.
(Source: P.A. 97-689, eff. 6-14-12.)
(820 ILCS 405/1402) (from Ch. 48, par. 552)
Sec. 1402. Penalties.
A. If any employer fails, within the time prescribed in
this Act as amended and in effect on October 5, 1980, and the
regulations of the Director, to file a report of wages paid to
each of his workers, or to file a sufficient report of such
wages after having been notified by the Director to do so, for

HB0027 - 409 - LRB098 00027 KTG 30027 b
any period which begins prior to January 1, 1982, he shall pay
to the Department as a penalty a sum determined in accordance
with the provisions of this Act as amended and in effect on
October 5, 1980.
B. Except as otherwise provided in this Section, any
employer who fails to file a report of wages paid to each of
his workers for any period which begins on or after January 1,
1982, within the time prescribed by the provisions of this Act
and the regulations of the Director, or, if the Director
pursuant to such regulations extends the time for filing the
report, fails to file it within the extended time, shall, in
addition to any sum otherwise payable by him under the
provisions of this Act, pay to the Department as a penalty a
sum equal to the lesser of (1) $5 for each $10,000 or fraction
thereof of the total wages for insured work paid by him during
the period or (2) $2,500, for each month or part thereof of
such failure to file the report. With respect to an employer
who has elected to file reports of wages on an annual basis
pursuant to Section 1400.2, in assessing penalties for the
failure to submit all reports by the due date established
pursuant to that Section, the 30-day period immediately
following the due date shall be considered as one month.
If the Director deems an employer's report of wages paid to
each of his workers for any period which begins on or after
January 1, 1982, insufficient, he shall notify the employer to
file a sufficient report. If the employer fails to file such

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sufficient report within 30 days after the mailing of the
notice to him, he shall, in addition to any sum otherwise
payable by him under the provisions of this Act, pay to the
Department as a penalty a sum determined in accordance with the
provisions of the first paragraph of this subsection, for each
month or part thereof of such failure to file such sufficient
report after the date of the notice.
For wages paid in calendar years prior to 1988, the penalty
or penalties which accrue under the two foregoing paragraphs
with respect to a report for any period shall not be less than
$100, and shall not exceed the lesser of (1) $10 for each
$10,000 or fraction thereof of the total wages for insured work
paid during the period or (2) $5,000. For wages paid in
calendar years after 1987, the penalty or penalties which
accrue under the 2 foregoing paragraphs with respect to a
report for any period shall not be less than $50, and shall not
exceed the lesser of (1) $10 for each $10,000 or fraction of
the total wages for insured work paid during the period or (2)
$5,000. With respect to an employer who has elected to file
reports of wages on an annual basis pursuant to Section 1400.2,
for purposes of calculating the minimum penalty prescribed by
this Section for failure to file the reports on a timely basis,
a calendar year shall constitute a single period. For reports
of wages paid after 1986, the Director shall not, however,
impose a penalty pursuant to either of the two foregoing
paragraphs on any employer who can prove within 30 working days

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after the mailing of a notice of his failure to file such a
report, that (1) the failure to file the report is his first
such failure during the previous 20 consecutive calendar
quarters, and (2) the amount of the total contributions due for
the calendar quarter of such report (or, in the case of an
employer who is required to file the reports on a monthly
basis, the amount of the total contributions due for the
calendar quarter that includes the month of such report) is
less than $500.
For any month which begins on or after January 1, 2013, a
report of the wages paid to each of an employer's workers shall
be due on or before the last day of the month next following
the calendar month in which the wages were paid if the employer
is required to report such wages electronically pursuant to the
regulations of the Director; otherwise a report of the wages
paid to each of the employer's workers shall be due on or
before the last day of the month next following the calendar
quarter in which the wages were paid.
Any employer who wilfully fails to pay any contribution or
part thereof, based upon wages paid prior to 1987, when
required by the provisions of this Act and the regulations of
the Director, with intent to defraud the Director, shall in
addition to such contribution or part thereof pay to the
Department a penalty equal to 50 percent of the amount of such
contribution or part thereof, as the case may be, provided that
the penalty shall not be less than $200.

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Any employer who willfully fails to pay any contribution or
part thereof, based upon wages paid in 1987 and in each
calendar year thereafter, when required by the provisions of
this Act and the regulations of the Director, with intent to
defraud the Director, shall in addition to such contribution or
part thereof pay to the Department a penalty equal to 60% of
the amount of such contribution or part thereof, as the case
may be, provided that the penalty shall not be less than $400.
However, all or part of any penalty may be waived by the
Director for good cause shown.
(Source: P.A. 97-689, eff. 6-14-12; 97-791, eff. 1-1-13;
revised 7-23-12.)
(820 ILCS 405/1404) (from Ch. 48, par. 554)
Sec. 1404. Payments in lieu of contributions by nonprofit
organizations.
A. For the year 1972 and for each calendar year thereafter,
contributions shall accrue and become payable, pursuant to
Section 1400, by each nonprofit organization (defined in
Section 211.2) upon the wages paid by it with respect to
employment after 1971, unless the nonprofit organization
elects, in accordance with the provisions of this Section, to
pay, in lieu of contributions, an amount equal to the amount of
regular benefits and one-half the amount of extended benefits
(defined in Section 409) paid to individuals, for any weeks
which begin on or after the effective date of the election, on

HB0027 - 413 - LRB098 00027 KTG 30027 b
the basis of wages for insured work paid to them by such
nonprofit organization during the effective period of such
election. Notwithstanding the preceding provisions of this
subsection and the provisions of subsection D, with respect to
benefit years beginning prior to July 1, 1989, any adjustment
after September 30, 1989 to the base period wages paid to the
individual by any employer shall not affect the ratio for
determining the payments in lieu of contributions of a
nonprofit organization which has elected to make payments in
lieu of contributions. Provided, however, that with respect to
benefit years beginning on or after July 1, 1989, the nonprofit
organization shall be required to make payments equal to 100%
of regular benefits, including dependents' allowances, and 50%
of extended benefits, including dependents' allowances, paid
to an individual with respect to benefit years beginning during
the effective period of the election, but only if the nonprofit
organization: (a) is the last employer as provided in Section
1502.1 and (b) paid to the individual receiving benefits, wages
for insured work during his base period. If the nonprofit
organization described in this paragraph meets the
requirements of (a) but not (b), with respect to benefit years
beginning on or after July 1, 1989, it shall be required to
make payments in an amount equal to 50% of regular benefits,
including dependents' allowances, and 25% of extended
benefits, including dependents' allowances, paid to an
individual with respect to benefit years beginning during the

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effective period of the election.
1. Any employing unit which becomes a nonprofit
organization on January 1, 1972, may elect to make payments
in lieu of contributions for not less than one calendar
year beginning with January 1, 1972, provided that it files
its written election with the Director not later than
January 31, 1972.
2. Any employing unit which becomes a nonprofit
organization after January 1, 1972, may elect to make
payments in lieu of contributions for a period of not less
than one calendar year beginning as of the first day with
respect to which it would, in the absence of its election,
incur liability for the payment of contributions, provided
that it files its written election with the Director not
later than 30 days immediately following the end of the
calendar quarter in which it becomes a nonprofit
organization.
3. A nonprofit organization which has incurred
liability for the payment of contributions for at least 2
calendar years and is not delinquent in such payment and in
the payment of any interest or penalties which may have
accrued, may elect to make payments in lieu of
contributions beginning January 1 of any calendar year,
provided that it files its written election with the
Director prior to such January 1, and provided, further,
that such election shall be for a period of not less than 2

HB0027 - 415 - LRB098 00027 KTG 30027 b
calendar years.
4. An election to make payments in lieu of
contributions shall not terminate any liability incurred
by an employer for the payment of contributions, interest
or penalties with respect to any calendar quarter (or
month, as the case may be) which ends prior to the
effective period of the election.
5. A nonprofit organization which has elected,
pursuant to paragraph 1, 2, or 3, to make payments in lieu
of contributions may terminate the effective period of the
election as of January 1 of any calendar year subsequent to
the required minimum period of the election only if, prior
to such January 1, it files with the Director a written
notice to that effect. Upon such termination, the
organization shall become liable for the payment of
contributions upon wages for insured work paid by it on and
after such January 1 and, notwithstanding such
termination, it shall continue to be liable for payments in
lieu of contributions with respect to benefits paid to
individuals on and after such January 1, with respect to
benefit years beginning prior to July 1, 1989, on the basis
of wages for insured work paid to them by the nonprofit
organization prior to such January 1, and, with respect to
benefit years beginning after June 30, 1989, if such
employer was the last employer as provided in Section
1502.1 during a benefit year beginning prior to such

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January 1.
6. Written elections to make payments in lieu of
contributions and written notices of termination of
election shall be filed in such form and shall contain such
information as the Director may prescribe. Upon the filing
of such election or notice, the Director shall either order
it approved, or, if it appears to the Director that the
nonprofit organization has not filed such election or
notice within the time prescribed, he shall order it
disapproved. The Director shall serve notice of his order
upon the nonprofit organization. The Director's order
shall be final and conclusive upon the nonprofit
organization unless, within 15 days after the date of
mailing of notice thereof, the nonprofit organization
files with the Director an application for its review,
setting forth its reasons in support thereof. Upon receipt
of an application for review within the time prescribed,
the Director shall order it allowed, or shall order that it
be denied, and shall serve notice upon the nonprofit
organization of his order. All of the provisions of Section
1509, applicable to orders denying applications for review
of determinations of employers' rates of contribution and
not inconsistent with the provisions of this subsection,
shall be applicable to an order denying an application for
review filed pursuant to this subsection.
B. As soon as practicable following the close of each

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calendar quarter, the Director shall mail to each nonprofit
organization which has elected to make payments in lieu of
contributions a Statement of the amount due from it for the
regular and one-half the extended benefits paid (or the amounts
otherwise provided for in subsection A) during the calendar
quarter, together with the names of its workers or former
workers and the amounts of benefits paid to each of them during
the calendar quarter, with respect to benefit years beginning
prior to July 1, 1989, on the basis of wages for insured work
paid to them by the nonprofit organization; or, with respect to
benefit years beginning after June 30, 1989, if such nonprofit
organization was the last employer as provided in Section
1502.1 with respect to a benefit year beginning during the
effective period of the election. The amount due shall be
payable, and the nonprofit organization shall make payment of
such amount not later than 30 days after the date of mailing of
the Statement. The Statement shall be final and conclusive upon
the nonprofit organization unless, within 20 days after the
date of mailing of the Statement, the nonprofit organization
files with the Director an application for revision thereof.
Such application shall specify wherein the nonprofit
organization believes the Statement to be incorrect, and shall
set forth its reasons for such belief. All of the provisions of
Section 1508, applicable to applications for revision of
Statements of Benefit Wages and Statements of Benefit Charges
and not inconsistent with the provisions of this subsection,

HB0027 - 418 - LRB098 00027 KTG 30027 b
shall be applicable to an application for revision of a
Statement filed pursuant to this subsection.
1. Payments in lieu of contributions made by any
nonprofit organization shall not be deducted or
deductible, in whole or in part, from the remuneration of
individuals in the employ of the organization, nor shall
any nonprofit organization require or accept any waiver of
any right under this Act by an individual in its employ.
The making of any such deduction or the requirement or
acceptance of any such waiver is a Class A misdemeanor. Any
agreement by an individual in the employ of any person or
concern to pay all or any portion of a payment in lieu of
contributions, required under this Act from a nonprofit
organization, is void.
2. A nonprofit organization which fails to make any
payment in lieu of contributions when due under the
provisions of this subsection shall pay interest thereon at
the rates specified in Section 1401. A nonprofit
organization which has elected to make payments in lieu of
contributions shall be subject to the penalty provisions of
Section 1402. In the making of any payment in lieu of
contributions or in the payment of any interest or
penalties, a fractional part of a cent shall be disregarded
unless it amounts to one-half cent or more, in which case
it shall be increased to one cent.
3. All of the remedies available to the Director under

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the provisions of this Act or of any other law to enforce
the payment of contributions, interest, or penalties under
this Act, including the making of determinations and
assessments pursuant to Section 2200, are applicable to the
enforcement of payments in lieu of contributions and of
interest and penalties, due under the provisions of this
Section. For the purposes of this paragraph, the term
"contribution" or "contributions" which appears in any
such provision means "payment in lieu of contributions" or
"payments in lieu of contributions." The term
"contribution" which appears in Section 2800 also means
"payment in lieu of contributions."
4. All of the provisions of Sections 2201 and 2201.1,
applicable to adjustment or refund of contributions,
interest and penalties erroneously paid and not
inconsistent with the provisions of this Section, shall be
applicable to payments in lieu of contributions
erroneously made or interest or penalties erroneously paid
by a nonprofit organization.
5. Payment in lieu of contributions shall be due with
respect to any sum erroneously paid as benefits to an
individual unless such sum has been recouped pursuant to
Section 900 or has otherwise been recovered. If such
payment in lieu of contributions has been made, the amount
thereof shall be adjusted or refunded in accordance with
the provisions of paragraph 4 and Section 2201 if

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recoupment or other recovery has been made.
6. A nonprofit organization which has elected to make
payments in lieu of contributions and thereafter ceases to
be an employer shall continue to be liable for payments in
lieu of contributions with respect to benefits paid to
individuals on and after the date it has ceased to be an
employer, with respect to benefit years beginning prior to
July 1, 1989, on the basis of wages for insured work paid
to them by it prior to the date it ceased to be an
employer, and, with respect to benefit years beginning
after June 30, 1989, if such employer was the last employer
as provided in Section 1502.1 prior to the date that it
ceased to be an employer.
7. With respect to benefit years beginning prior to
July 1, 1989, wages paid to an individual during his base
period, by a nonprofit organization which elects to make
payments in lieu of contributions, for less than full time
work, performed during the same weeks in the base period
during which the individual had other insured work, shall
not be subject to payments in lieu of contributions (upon
such employer's request pursuant to the regulation of the
Director) so long as the employer continued after the end
of the base period, and continues during the applicable
benefit year, to furnish such less than full time work to
the individual on the same basis and in substantially the
same amount as during the base period. If the individual is

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paid benefits with respect to a week (in the applicable
benefit year) after the employer has ceased to furnish the
work hereinabove described, the nonprofit organization
shall be liable for payments in lieu of contributions with
respect to the benefits paid to the individual after the
date on which the nonprofit organization ceases to furnish
the work.
C. With respect to benefit years beginning prior to July 1,
1989, whenever benefits have been paid to an individual on the
basis of wages for insured work paid to him by a nonprofit
organization, and the organization incurred liability for the
payment of contributions on some of the wages because only a
part of the individual's base period was within the effective
period of the organization's written election to make payments
in lieu of contributions, the organization shall pay an amount
in lieu of contributions which bears the same ratio to the
total benefits paid to the individual as the total wages for
insured work paid to him during the base period by the
organization upon which it did not incur liability for the
payment of contributions (for the aforesaid reason) bear to the
total wages for insured work paid to the individual during the
base period by the organization.
D. With respect to benefit years beginning prior to July 1,
1989, whenever benefits have been paid to an individual on the
basis of wages for insured work paid to him by a nonprofit
organization which has elected to make payments in lieu of

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contributions, and by one or more other employers, the
nonprofit organization shall pay an amount in lieu of
contributions which bears the same ratio to the total benefits
paid to the individual as the wages for insured work paid to
the individual during his base period by the nonprofit
organization bear to the total wages for insured work paid to
the individual during the base period by all of the employers.
If the nonprofit organization incurred liability for the
payment of contributions on some of the wages for insured work
paid to the individual, it shall be treated, with respect to
such wages, as one of the other employers for the purposes of
this paragraph.
E. Two or more nonprofit organizations which have elected
to make payments in lieu of contributions may file a joint
application with the Director for the establishment of a group
account, effective January 1 of any calendar year, for the
purpose of sharing the cost of benefits paid on the basis of
the wages for insured work paid by such nonprofit
organizations, provided that such joint application is filed
with the Director prior to such January 1. The application
shall identify and authorize a group representative to act as
the group's agent for the purposes of this paragraph, and shall
be filed in such form and shall contain such information as the
Director may prescribe. Upon his approval of a joint
application, the Director shall, by order, establish a group
account for the applicants and shall serve notice upon the

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group's representative of such order. Such account shall remain
in effect for not less than 2 calendar years and thereafter
until terminated by the Director for good cause or, as of the
close of any calendar quarter, upon application by the group.
Upon establishment of the account, the group shall be liable to
the Director for payments in lieu of contributions in an amount
equal to the total amount for which, in the absence of the
group account, liability would have been incurred by all of its
members; provided, with respect to benefit years beginning
prior to July 1, 1989, that the liability of any member to the
Director with respect to any payment in lieu of contributions,
interest or penalties not paid by the group when due with
respect to any calendar quarter shall be in an amount which
bears the same ratio to the total benefits paid during such
quarter on the basis of the wages for insured work paid by all
members of the group as the total wages for insured work paid
by such member during such quarter bear to the total wages for
insured work paid during the quarter by all members of the
group, and, with respect to benefit years beginning on or after
July 1, 1989, that the liability of any member to the Director
with respect to any payment in lieu of contributions, interest
or penalties not paid by the group when due with respect to any
calendar quarter shall be in an amount which bears the same
ratio to the total benefits paid during such quarter to
individuals with respect to whom any member of the group was
the last employer as provided in Section 1502.1 as the total

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wages for insured work paid by such member during such quarter
bear to the total wages for insured work paid during the
quarter by all members of the group. With respect to calendar
months and quarters beginning on or after January 1, 2013, the
liability of any member to the Director with respect to any
penalties that are assessed for failure to file a timely and
sufficient report of wages and which are not paid by the group
when due with respect to the calendar month or quarter, as the
case may be, shall be in an amount which bears the same ratio
to the total penalties due with respect to such month or
quarter as the total wages for insured work paid by such member
during such month or quarter bear to the total wages for
insured work paid during the month or quarter by all members of
the group. All of the provisions of this Section applicable to
nonprofit organizations which have elected to make payments in
lieu of contributions, and not inconsistent with the provisions
of this paragraph, shall apply to a group account and, upon its
termination, to each former member thereof. The Director shall
by regulation prescribe the conditions for establishment,
maintenance and termination of group accounts, and for addition
of new members to and withdrawal of active members from such
accounts.
F. Whenever service of notice is required by this Section,
such notice may be given and be complete by depositing it with
the United States Mail, addressed to the nonprofit organization
(or, in the case of a group account, to its representative) at

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its last known address. If such organization is represented by
counsel in proceedings before the Director, service of notice
may be made upon the nonprofit organization by mailing the
notice to such counsel.
(Source: P.A. 97-689, eff. 6-14-12.)
(820 ILCS 405/1405) (from Ch. 48, par. 555)
Sec. 1405. Financing Benefits for Employees of Local
Governments.
A. 1. For the year 1978 and for each calendar year
thereafter, contributions shall accrue and become payable,
pursuant to Section 1400, by each governmental entity (other
than the State of Illinois and its wholly owned
instrumentalities) referred to in clause (B) of Section 211.1,
upon the wages paid by such entity with respect to employment
after 1977, unless the entity elects to make payments in lieu
of contributions pursuant to the provisions of subsection B.
Notwithstanding the provisions of Sections 1500 to 1510,
inclusive, a governmental entity which has not made such
election shall, for liability for contributions incurred prior
to January 1, 1984, pay contributions equal to 1 percent with
respect to wages for insured work paid during each such
calendar year or portion of such year as may be applicable. As
used in this subsection, the word "wages", defined in Section
234, is subject to all of the provisions of Section 235.
2. An Indian tribe for which service is exempted from the

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federal unemployment tax under Section 3306(c)(7) of the
Federal Unemployment Tax Act may elect to make payments in lieu
of contributions in the same manner and subject to the same
conditions as provided in this Section with regard to
governmental entities, except as otherwise provided in
paragraphs 7, 8, and 9 of subsection B.
B. Any governmental entity subject to subsection A may
elect to make payments in lieu of contributions, in amounts
equal to the amounts of regular and extended benefits paid to
individuals, for any weeks which begin on or after the
effective date of the election, on the basis of wages for
insured work paid to them by the entity during the effective
period of such election. Notwithstanding the preceding
provisions of this subsection and the provisions of subsection
D of Section 1404, with respect to benefit years beginning
prior to July 1, 1989, any adjustment after September 30, 1989
to the base period wages paid to the individual by any employer
shall not affect the ratio for determining payments in lieu of
contributions of a governmental entity which has elected to
make payments in lieu of contributions. Provided, however, that
with respect to benefit years beginning on or after July 1,
1989, the governmental entity shall be required to make
payments equal to 100% of regular benefits, including
dependents' allowances, and 100% of extended benefits,
including dependents' allowances, paid to an individual with
respect to benefit years beginning during the effective period

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of the election, but only if the governmental entity: (a) is
the last employer as provided in Section 1502.1 and (b) paid to
the individual receiving benefits, wages for insured work
during his base period. If the governmental entity described in
this paragraph meets the requirements of (a) but not (b), with
respect to benefit years beginning on or after July 1, 1989, it
shall be required to make payments in an amount equal to 50% of
regular benefits, including dependents' allowances, and 50% of
extended benefits, including dependents' allowances, paid to
an individual with respect to benefit years beginning during
the effective period of the election.
1. Any such governmental entity which becomes an employer
on January 1, 1978 pursuant to Section 205 may elect to make
payments in lieu of contributions for not less than one
calendar year beginning with January 1, 1978, provided that it
files its written election with the Director not later than
January 31, 1978.
2. A governmental entity newly created after January 1,
1978, may elect to make payments in lieu of contributions for a
period of not less than one calendar year beginning as of the
first day with respect to which it would, in the absence of its
election, incur liability for the payment of contributions,
provided that it files its written election with the Director
not later than 30 days immediately following the end of the
calendar quarter in which it has been created.
3. A governmental entity which has incurred liability for

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the payment of contributions for at least 2 calendar years, and
is not delinquent in such payment and in the payment of any
interest or penalties which may have accrued, may elect to make
payments in lieu of contributions beginning January 1 of any
calendar year, provided that it files its written election with
the Director prior to such January 1, and provided, further,
that such election shall be for a period of not less than 2
calendar years.
4. An election to make payments in lieu of contributions
shall not terminate any liability incurred by a governmental
entity for the payment of contributions, interest or penalties
with respect to any calendar quarter (or month, as the case may
be) which ends prior to the effective period of the election.
5. The termination by a governmental entity of the
effective period of its election to make payments in lieu of
contributions, and the filing of and subsequent action upon
written notices of termination of election, shall be governed
by the provisions of paragraphs 5 and 6 of Section 1404A,
pertaining to nonprofit organizations.
6. With respect to benefit years beginning prior to July 1,
1989, wages paid to an individual during his base period by a
governmental entity which elects to make payments in lieu of
contributions for less than full time work, performed during
the same weeks in the base period during which the individual
had other insured work, shall not be subject to payments in
lieu of contribution (upon such employer's request pursuant to

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the regulation of the Director) so long as the employer
continued after the end of the base period, and continues
during the applicable benefit year, to furnish such less than
full time work to the individual on the same basis and in
substantially the same amount as during the base period. If the
individual is paid benefits with respect to a week (in the
applicable benefit year) after the employer has ceased to
furnish the work hereinabove described, the governmental
entity shall be liable for payments in lieu of contributions
with respect to the benefits paid to the individual after the
date on which the governmental entity ceases to furnish the
work.
7. An Indian tribe may elect to make payments in lieu of
contributions for calendar year 2003, provided that it files
its written election with the Director not later than January
31, 2003, and provided further that it is not delinquent in the
payment of any contributions, interest, or penalties.
8. Failure of an Indian tribe to make a payment in lieu of
contributions, or a payment of interest or penalties due under
this Act, within 90 days after the Department serves notice of
the finality of a determination and assessment shall cause the
Indian tribe to lose the option of making payments in lieu of
contributions, effective as of the calendar year immediately
following the date on which the Department serves the notice.
Notice of the loss of the option to make payments in lieu of
contributions may be protested in the same manner as a

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determination and assessment under Section 2200 of this Act.
9. An Indian tribe that, pursuant to paragraph 8, loses the
option of making payments in lieu of contributions may again
elect to make payments in lieu of contributions for a calendar
year if: (a) the Indian tribe has incurred liability for the
payment of contributions for at least one calendar year since
losing the option pursuant to paragraph 8, (b) the Indian tribe
is not delinquent in the payment of any liabilities under the
Act, including interest or penalties, and (c) the Indian tribe
files its written election with the Director not later than
January 31 of the year with respect to which it is making the
election.
C. As soon as practicable following the close of each
calendar quarter, the Director shall mail to each governmental
entity which has elected to make payments in lieu of
contributions a Statement of the amount due from it for all the
regular and extended benefits paid during the calendar quarter,
together with the names of its workers or former workers and
the amounts of benefits paid to each of them during the
calendar quarter with respect to benefit years beginning prior
to July 1, 1989, on the basis of wages for insured work paid to
them by the governmental entity; or, with respect to benefit
years beginning after June 30, 1989, if such governmental
entity was the last employer as provided in Section 1502.1 with
respect to a benefit year beginning during the effective period
of the election. All of the provisions of subsection B of

HB0027 - 431 - LRB098 00027 KTG 30027 b
Section 1404 pertaining to nonprofit organizations, not
inconsistent with the preceding sentence, shall be applicable
to payments in lieu of contributions by a governmental entity.
D. The provisions of subsections C through F, inclusive, of
Section 1404, pertaining to nonprofit organizations, shall be
applicable to each governmental entity which has elected to
make payments in lieu of contributions.
E. 1. If an Indian tribe fails to pay any liability under
this Act (including assessments of interest or penalty) within
90 days after the Department issues a notice of the finality of
a determination and assessment, the Director shall immediately
notify the United States Internal Revenue Service and the
United States Department of Labor.
2. Notices of payment and reporting delinquencies to Indian
tribes shall include information that failure to make full
payment within the prescribed time frame:
a. will cause the Indian tribe to lose the exemption
provided by Section 3306(c)(7) of the Federal Unemployment
Tax Act with respect to the federal unemployment tax;
b. will cause the Indian tribe to lose the option to
make payments in lieu of contributions.
(Source: P.A. 97-689, eff. 6-14-12.)
(820 ILCS 405/1801.1)
Sec. 1801.1. Directory of New Hires.
A. The Director shall establish and operate an automated

HB0027 - 432 - LRB098 00027 KTG 30027 b
directory of newly hired employees which shall be known as the
"Illinois Directory of New Hires" which shall contain the
information required to be reported by employers to the
Department under subsection B. In the administration of the
Directory, the Director shall comply with any requirements
concerning the Employer New Hire Reporting Program established
by the federal Personal Responsibility and Work Opportunity
Reconciliation Act of 1996. The Director is authorized to use
the information contained in the Directory of New Hires to
administer any of the provisions of this Act.
B. Each employer in Illinois, except a department, agency,
or instrumentality of the United States, shall file with the
Department a report in accordance with rules adopted by the
Department (but in any event not later than 20 days after the
date the employer hires the employee or, in the case of an
employer transmitting reports magnetically or electronically,
by 2 monthly transmissions, if necessary, not less than 12 days
nor more than 16 days apart) providing the following
information concerning each newly hired employee: the
employee's name, address, and social security number, the date
services for remuneration were first performed by the employee,
the employee's projected monthly wages, and the employer's
name, address, Federal Employer Identification Number assigned
under Section 6109 of the Internal Revenue Code of 1986, and
such other information as may be required by federal law or
regulation, provided that each employer may voluntarily file

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the address to which the employer wants income withholding
orders to be mailed, if it is different from the address given
on the Federal Employer Identification Number. An employer in
Illinois which transmits its reports electronically or
magnetically and which also has employees in another state may
report all newly hired employees to a single designated state
in which the employer has employees if it has so notified the
Secretary of the United States Department of Health and Human
Services in writing. An employer may, at its option, submit
information regarding any rehired employee in the same manner
as information is submitted regarding a newly hired employee.
Each report required under this subsection shall, to the extent
practicable, be made on an Internal Revenue Service Form W-4
or, at the option of the employer, an equivalent form, and may
be transmitted by first class mail, by telefax, magnetically,
or electronically.
C. An employer which knowingly fails to comply with the
reporting requirements established by this Section shall be
subject to a civil penalty of $15 for each individual whom it
fails to report. An employer shall be considered to have
knowingly failed to comply with the reporting requirements
established by this Section with respect to an individual if
the employer has been notified by the Department that it has
failed to report an individual, and it fails, without
reasonable cause, to supply the required information to the
Department within 21 days after the date of mailing of the

HB0027 - 434 - LRB098 00027 KTG 30027 b
notice. Any individual who knowingly conspires with the newly
hired employee to cause the employer to fail to report the
information required by this Section or who knowingly conspires
with the newly hired employee to cause the employer to file a
false or incomplete report shall be guilty of a Class B
misdemeanor with a fine not to exceed $500 with respect to each
employee with whom the individual so conspires.
D. As used in this Section, "newly hired employee" means an
individual who (i) is an employee within the meaning of Chapter
24 of the Internal Revenue Code of 1986 and (ii) either has not
previously been employed by the employer or was previously
employed by the employer but has been separated from that prior
employment for at least 60 consecutive days; however, "newly
hired employee" does not include an employee of a federal or
State agency performing intelligence or counterintelligence
functions, if the head of that agency has determined that the
filing of the report required by this Section with respect to
the employee could endanger the safety of the employee or
compromise an ongoing investigation or intelligence mission.
Notwithstanding Section 205, and for the purposes of this
Section only, the term "employer" has the meaning given by
Section 3401(d) of the Internal Revenue Code of 1986 and
includes any governmental entity and labor organization as
defined by Section 2(5) of the National Labor Relations Act,
and includes any entity (also known as a hiring hall) which is
used by the organization and an employer to carry out the

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requirements described in Section 8(f)(3) of that Act of an
agreement between the organization and the employer.
(Source: P.A. 97-621, eff. 11-18-11; 97-689, eff. 6-14-12;
97-791, eff. 1-1-13; revised 7-23-12.)
(820 ILCS 405/1900) (from Ch. 48, par. 640)
Sec. 1900. Disclosure of information.
A. Except as provided in this Section, information obtained
from any individual or employing unit during the administration
of this Act shall:
1. be confidential,
2. not be published or open to public inspection,
3. not be used in any court in any pending action or
proceeding,
4. not be admissible in evidence in any action or
proceeding other than one arising out of this Act.
B. No finding, determination, decision, ruling or order
(including any finding of fact, statement or conclusion made
therein) issued pursuant to this Act shall be admissible or
used in evidence in any action other than one arising out of
this Act, nor shall it be binding or conclusive except as
provided in this Act, nor shall it constitute res judicata,
regardless of whether the actions were between the same or
related parties or involved the same facts.
C. Any officer or employee of this State, any officer or
employee of any entity authorized to obtain information

HB0027 - 436 - LRB098 00027 KTG 30027 b
pursuant to this Section, and any agent of this State or of
such entity who, except with authority of the Director under
this Section, shall disclose information shall be guilty of a
Class B misdemeanor and shall be disqualified from holding any
appointment or employment by the State.
D. An individual or his duly authorized agent may be
supplied with information from records only to the extent
necessary for the proper presentation of his claim for benefits
or with his existing or prospective rights to benefits.
Discretion to disclose this information belongs solely to the
Director and is not subject to a release or waiver by the
individual. Notwithstanding any other provision to the
contrary, an individual or his or her duly authorized agent may
be supplied with a statement of the amount of benefits paid to
the individual during the 18 months preceding the date of his
or her request.
E. An employing unit may be furnished with information,
only if deemed by the Director as necessary to enable it to
fully discharge its obligations or safeguard its rights under
the Act. Discretion to disclose this information belongs solely
to the Director and is not subject to a release or waiver by
the employing unit.
F. The Director may furnish any information that he may
deem proper to any public officer or public agency of this or
any other State or of the federal government dealing with:
1. the administration of relief,

HB0027 - 437 - LRB098 00027 KTG 30027 b
2. public assistance,
3. unemployment compensation,
4. a system of public employment offices,
5. wages and hours of employment, or
6. a public works program.
The Director may make available to the Illinois Workers'
Compensation Commission information regarding employers for
the purpose of verifying the insurance coverage required under
the Workers' Compensation Act and Workers' Occupational
Diseases Act.
G. The Director may disclose information submitted by the
State or any of its political subdivisions, municipal
corporations, instrumentalities, or school or community
college districts, except for information which specifically
identifies an individual claimant.
H. The Director shall disclose only that information
required to be disclosed under Section 303 of the Social
Security Act, as amended, including:
1. any information required to be given the United
States Department of Labor under Section 303(a)(6); and
2. the making available upon request to any agency of
the United States charged with the administration of public
works or assistance through public employment, the name,
address, ordinary occupation and employment status of each
recipient of unemployment compensation, and a statement of
such recipient's right to further compensation under such

HB0027 - 438 - LRB098 00027 KTG 30027 b
law as required by Section 303(a)(7); and
3. records to make available to the Railroad Retirement
Board as required by Section 303(c)(1); and
4. information that will assure reasonable cooperation
with every agency of the United States charged with the
administration of any unemployment compensation law as
required by Section 303(c)(2); and
5. information upon request and on a reimbursable basis
to the United States Department of Agriculture and to any
State food stamp agency concerning any information
required to be furnished by Section 303(d); and
6. any wage information upon request and on a
reimbursable basis to any State or local child support
enforcement agency required by Section 303(e); and
7. any information required under the income
eligibility and verification system as required by Section
303(f); and
8. information that might be useful in locating an
absent parent or that parent's employer, establishing
paternity or establishing, modifying, or enforcing child
support orders for the purpose of a child support
enforcement program under Title IV of the Social Security
Act upon the request of and on a reimbursable basis to the
public agency administering the Federal Parent Locator
Service as required by Section 303(h); and
9. information, upon request, to representatives of

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any federal, State or local governmental public housing
agency with respect to individuals who have signed the
appropriate consent form approved by the Secretary of
Housing and Urban Development and who are applying for or
participating in any housing assistance program
administered by the United States Department of Housing and
Urban Development as required by Section 303(i).
I. The Director, upon the request of a public agency of
Illinois, of the federal government or of any other state
charged with the investigation or enforcement of Section 10-5
of the Criminal Code of 1961 (or a similar federal law or
similar law of another State), may furnish the public agency
information regarding the individual specified in the request
as to:
1. the current or most recent home address of the
individual, and
2. the names and addresses of the individual's
employers.
J. Nothing in this Section shall be deemed to interfere
with the disclosure of certain records as provided for in
Section 1706 or with the right to make available to the
Internal Revenue Service of the United States Department of the
Treasury, or the Department of Revenue of the State of
Illinois, information obtained under this Act.
K. The Department shall make available to the Illinois
Student Assistance Commission, upon request, information in

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the possession of the Department that may be necessary or
useful to the Commission in the collection of defaulted or
delinquent student loans which the Commission administers.
L. The Department shall make available to the State
Employees' Retirement System, the State Universities
Retirement System, the Teachers' Retirement System of the State
of Illinois, and the Department of Central Management Services,
Risk Management Division, upon request, information in the
possession of the Department that may be necessary or useful to
the System or the Risk Management Division for the purpose of
determining whether any recipient of a disability benefit from
the System or a workers' compensation benefit from the Risk
Management Division is gainfully employed.
M. This Section shall be applicable to the information
obtained in the administration of the State employment service,
except that the Director may publish or release general labor
market information and may furnish information that he may deem
proper to an individual, public officer or public agency of
this or any other State or the federal government (in addition
to those public officers or public agencies specified in this
Section) as he prescribes by Rule.
N. The Director may require such safeguards as he deems
proper to insure that information disclosed pursuant to this
Section is used only for the purposes set forth in this
Section.
O. Nothing in this Section prohibits communication with an

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individual or entity through unencrypted e-mail or other
unencrypted electronic means as long as the communication does
not contain the individual's or entity's name in combination
with any one or more of the individual's or entity's social
security number; driver's license or State identification
number; account number or credit or debit card number; or any
required security code, access code, or password that would
permit access to further information pertaining to the
individual or entity.
P. Within 30 days after the effective date of this
amendatory Act of 1993 and annually thereafter, the Department
shall provide to the Department of Financial Institutions a
list of individuals or entities that, for the most recently
completed calendar year, report to the Department as paying
wages to workers. The lists shall be deemed confidential and
may not be disclosed to any other person.
Q. The Director shall make available to an elected federal
official the name and address of an individual or entity that
is located within the jurisdiction from which the official was
elected and that, for the most recently completed calendar
year, has reported to the Department as paying wages to
workers, where the information will be used in connection with
the official duties of the official and the official requests
the information in writing, specifying the purposes for which
it will be used. For purposes of this subsection, the use of
information in connection with the official duties of an

HB0027 - 442 - LRB098 00027 KTG 30027 b
official does not include use of the information in connection
with the solicitation of contributions or expenditures, in
money or in kind, to or on behalf of a candidate for public or
political office or a political party or with respect to a
public question, as defined in Section 1-3 of the Election
Code, or in connection with any commercial solicitation. Any
elected federal official who, in submitting a request for
information covered by this subsection, knowingly makes a false
statement or fails to disclose a material fact, with the intent
to obtain the information for a purpose not authorized by this
subsection, shall be guilty of a Class B misdemeanor.
R. The Director may provide to any State or local child
support agency, upon request and on a reimbursable basis,
information that might be useful in locating an absent parent
or that parent's employer, establishing paternity, or
establishing, modifying, or enforcing child support orders.
S. The Department shall make available to a State's
Attorney of this State or a State's Attorney's investigator,
upon request, the current address or, if the current address is
unavailable, current employer information, if available, of a
victim of a felony or a witness to a felony or a person against
whom an arrest warrant is outstanding.
T. The Director shall make available to the Department of
State Police, a county sheriff's office, or a municipal police
department, upon request, any information concerning the
current address and place of employment or former places of

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employment of a person who is required to register as a sex
offender under the Sex Offender Registration Act that may be
useful in enforcing the registration provisions of that Act.
U. (Blank). The Director shall make information available
to the Department of Healthcare and Family Services and the
Department of Human Services for the purpose of determining
eligibility for public benefit programs authorized under the
Illinois Public Aid Code and related statutes administered by
those departments, for verifying sources and amounts of income,
and for other purposes directly connected with the
administration of those programs.
(Source: P.A. 96-420, eff. 8-13-09; 97-621, eff. 11-18-11;
97-689, eff. 6-14-12.)
ARTICLE 99.
Section 99-95. Severability. If any provision of this Act
or application thereof to any person or circumstance is held
invalid, such invalidity does not affect other provisions or
applications of this Act which can be given effect without the
invalid application or provision, and to this end the
provisions of this Act are declared to be severable.
Section 99-99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance
New Act
5 ILCS 100/5-45 from Ch. 127, par. 1005-45
15 ILCS 405/10.05 from Ch. 15, par. 210.05
20 ILCS 415/4d from Ch. 127, par. 63b104d
30 ILCS 5/2-20 rep.
30 ILCS 105/5.826 new
30 ILCS 105/5.827 new
30 ILCS 105/5.828 new
30 ILCS 105/6z-52
30 ILCS 105/6z-81
30 ILCS 500/1-10
30 ILCS 740/2-15.2
30 ILCS 740/2-15.3
35 ILCS 200/15-172
35 ILCS 200/15-175
35 ILCS 200/20-15
35 ILCS 200/21-27
35 ILCS 515/7 from Ch. 120, par. 1207
70 ILCS 3605/51
70 ILCS 3605/52
70 ILCS 3610/8.6
70 ILCS 3610/8.7
70 ILCS 3615/3A.15
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70 ILCS 3615/3A.16
70 ILCS 3615/3B.14
70 ILCS 3615/3B.15
110 ILCS 990/1 from Ch. 144, par. 1801
210 ILCS 45/3-202.05
210 ILCS 50/3.86
210 ILCS 155/35
210 ILCS 155/40
210 ILCS 155/45
210 ILCS 155/55 rep.
215 ILCS 106/25
215 ILCS 106/40
215 ILCS 170/30
215 ILCS 170/35
220 ILCS 10/9 from Ch. 111 2/3, par. 909
305 ILCS 5/3-1.2 from Ch. 23, par. 3-1.2
305 ILCS 5/3-5 from Ch. 23, par. 3-5
305 ILCS 5/4-1.6 from Ch. 23, par. 4-1.6
305 ILCS 5/4-2 from Ch. 23, par. 4-2
305 ILCS 5/5-2 from Ch. 23, par. 5-2
305 ILCS 5/5-4 from Ch. 23, par. 5-4
305 ILCS 5/5-4.1 from Ch. 23, par. 5-4.1
305 ILCS 5/5-4.2 from Ch. 23, par. 5-4.2
305 ILCS 5/5-5 from Ch. 23, par. 5-5
305 ILCS 5/5-5.02 from Ch. 23, par. 5-5.02
305 ILCS 5/5-5.05
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305 ILCS 5/5-5.2 from Ch. 23, par. 5-5.2
305 ILCS 5/5-5.3 from Ch. 23, par. 5-5.3
305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
305 ILCS 5/5-5.4e
305 ILCS 5/5-5.4h new
305 ILCS 5/5-5.4i new
305 ILCS 5/5-5.5 from Ch. 23, par. 5-5.5
305 ILCS 5/5-5.8b from Ch. 23, par. 5-5.8b
305 ILCS 5/5-5.12 from Ch. 23, par. 5-5.12
305 ILCS 5/5-5.17 from Ch. 23, par. 5-5.17
305 ILCS 5/5-5.20
305 ILCS 5/5-5.23
305 ILCS 5/5-5.24
305 ILCS 5/5-5.25
305 ILCS 5/5-16.7
305 ILCS 5/5-16.7a
305 ILCS 5/5-16.8
305 ILCS 5/5-16.9
305 ILCS 5/5-17 from Ch. 23, par. 5-17
305 ILCS 5/5-19 from Ch. 23, par. 5-19
305 ILCS 5/5-24
305 ILCS 5/5-30
305 ILCS 5/5A-1 from Ch. 23, par. 5A-1
305 ILCS 5/5A-2 from Ch. 23, par. 5A-2
305 ILCS 5/5A-3 from Ch. 23, par. 5A-3
305 ILCS 5/5A-4 from Ch. 23, par. 5A-4
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305 ILCS 5/5A-5 from Ch. 23, par. 5A-5
305 ILCS 5/5A-6 from Ch. 23, par. 5A-6
305 ILCS 5/5A-8 from Ch. 23, par. 5A-8
305 ILCS 5/5A-10 from Ch. 23, par. 5A-10
305 ILCS 5/5A-12.2
305 ILCS 5/5A-14
305 ILCS 5/6-1.2 from Ch. 23, par. 6-1.2
305 ILCS 5/6-2 from Ch. 23, par. 6-2
305 ILCS 5/6-11 from Ch. 23, par. 6-11
305 ILCS 5/11-13 from Ch. 23, par. 11-13
305 ILCS 5/11-26 from Ch. 23, par. 11-26
305 ILCS 5/12-4.25 from Ch. 23, par. 12-4.25
305 ILCS 5/12-4.38
305 ILCS 5/12-4.39
305 ILCS 5/12-9 from Ch. 23, par. 12-9
305 ILCS 5/12-10.5
305 ILCS 5/12-13.1
305 ILCS 5/14-8 from Ch. 23, par. 14-8
305 ILCS 5/15-1 from Ch. 23, par. 15-1
305 ILCS 5/5-2b rep.
305 ILCS 5/5-2.1d rep.
305 ILCS 5/5-5e rep.
305 ILCS 5/5-5e.1 rep.
305 ILCS 5/5-5f rep.
305 ILCS 5/5A-15 rep.
305 ILCS 5/11-5.2 rep.
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305 ILCS 5/11-5.3 rep.
305 ILCS 5/14-11 rep.
305 ILCS 60/3 rep.
320 ILCS 25/Act title
320 ILCS 25/1 from Ch. 67 1/2, par. 401
320 ILCS 25/1.5
320 ILCS 25/2 from Ch. 67 1/2, par. 402
320 ILCS 25/3.05a
320 ILCS 25/3.10 from Ch. 67 1/2, par. 403.10
320 ILCS 25/4 from Ch. 67 1/2, par. 404
320 ILCS 25/4.05
320 ILCS 25/4.2 new
320 ILCS 25/5 from Ch. 67 1/2, par. 405
320 ILCS 25/6 from Ch. 67 1/2, par. 406
320 ILCS 25/7 from Ch. 67 1/2, par. 407
320 ILCS 25/8 from Ch. 67 1/2, par. 408
320 ILCS 25/9 from Ch. 67 1/2, par. 409
320 ILCS 25/12 from Ch. 67 1/2, par. 412
320 ILCS 25/13 from Ch. 67 1/2, par. 413
320 ILCS 30/2 from Ch. 67 1/2, par. 452
320 ILCS 30/8 from Ch. 67 1/2, par. 458
320 ILCS 50/5
410 ILCS 70/7 from Ch. 111 1/2, par. 87-7
410 ILCS 420/3 from Ch. 111 1/2, par. 2903
410 ILCS 430/3 from Ch. 111 1/2, par. 22.33
625 ILCS 5/3-609 from Ch. 95 1/2, par. 3-609
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