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1		AN ACT concerning public aid.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Public Aid Code is amended by
5		changing Section 11-5.4 as follows:
6		(305 ILCS 5/11-5.4)
7		Sec. 11-5.4. Expedited long-term care eligibility
8		determination and enrollment.
9		(a) Establishment of the expedited long-term care
10		eligibility determination and enrollment system shall be a
11		joint venture of the Departments of Human Services and
12		Healthcare and Family Services and the Department on Aging.
13		(b) Streamlined application enrollment process; expedited
14		eligibility process. The streamlined application and
15		enrollment process must include, but need not be limited to,
16		the following:
17		(1) On or before July 1, 2019, a streamlined
18		application and enrollment process shall be put in place
19		which must include, but need not be limited to, the
20		following:
21		(A) Minimize the burden on applicants by
22		collecting only the data necessary to determine
23		eligibility for medical services, long-term care

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1		services, and spousal impoverishment offset.
2		(B) Integrate online data sources to simplify the
3		application process by reducing the amount of
4		information needed to be entered and to expedite
5		eligibility verification.
6		(C) Provide online prompts to alert the applicant
7		that information is missing or not complete.
8		(D) Provide training and step-by-step written
9		instructions for caseworkers, applicants, and
10		providers.
11		(2) The State must expedite the eligibility process for
12		applicants meeting specified guidelines, regardless of the
13		age of the application. The guidelines, subject to federal
14		approval, must include, but need not be limited to, the
15		following individually or collectively:
16		(A) Full Medicaid benefits in the community for a
17		specified period of time.
18		(B) No transfer of assets or resources during the
19		federally prescribed look-back period, as specified in
20		federal law.
21		(C) Receives Supplemental Security Income payments
22		or was receiving such payments at the time of admission
23		to a nursing facility.
24		(D) For applicants or recipients with verified
25		income at or below 100% of the federal poverty level
26		when the declared value of their countable resources is

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1		no greater than the allowable amounts pursuant to
2		Section 5-2 of this Code for classes of eligible
3		persons for whom a resource limit applies. Such
4		simplified verification policies shall apply to
5		community cases as well as long-term care cases.
6		(3) Subject to federal approval, the Department of
7		Healthcare and Family Services must implement an ex parte
8		renewal process for Medicaid-eligible individuals residing
9		in long-term care facilities. "Renewal" has the same
10		meaning as "redetermination" in State policies,
11		administrative rule, and federal Medicaid law. The ex parte
12		renewal process must be fully operational on or before
13		January 1, 2019. If an individual has transferred to
14		another long-term care facility, any annual notice
15		concerning redetermination of eligibility must be sent to
16		the long-term care facility where the individual resides as
17		well as to the individual.
18		(4) The Department of Human Services must use the
19		standards and distribution requirements described in this
20		subsection and in Section 11-6 for notification of missing
21		supporting documents and information during all phases of
22		the application process: initial, renewal, and appeal.
23		(c) The Department of Human Services must adopt policies
24		and procedures to improve communication between long-term care
25		benefits central office personnel, applicants and their
26		representatives, and facilities in which the applicants

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1		reside. Such policies and procedures must at a minimum permit
2		applicants and their representatives and the facility in which
3		the applicants reside to speak directly to an individual
4		trained to take telephone inquiries and provide appropriate
5		responses.
6		(d) Effective 30 days after the completion of 3 regionally
7		based trainings, nursing facilities shall submit all
8		applications for medical assistance online via the Application
9		for Benefits Eligibility (ABE) website. This requirement shall
10		extend to scanning and uploading with the online application
11		any required additional forms such as the Long Term Care
12		Facility Notification and the Additional Financial Information
13		for Long Term Care Applicants as well as scanned copies of any
14		supporting documentation. Long-term care facility admission
15		documents must be submitted as required in Section 5-5 of this
16		Code. No local Department of Human Services office shall refuse
17		to accept an electronically filed application. No Department of
18		Human Services office shall request submission of any document
19		in hard copy.
20		(e) Notwithstanding any other provision of this Code, the
21		Department of Human Services and the Department of Healthcare
22		and Family Services' Office of the Inspector General shall,
23		upon request, allow an applicant additional time to submit
24		information and documents needed as part of a review of
25		available resources or resources transferred during the
26		look-back period. The initial extension shall not exceed 30

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1		days. A second extension of 30 days may be granted upon
2		request. Any request for information issued by the State to an
3		applicant shall include the following: an explanation of the
4		information required and the date by which the information must
5		be submitted; a statement that failure to respond in a timely
6		manner can result in denial of the application; a statement
7		that the applicant or the facility in the name of the applicant
8		may seek an extension; and the name and contact information of
9		a caseworker in case of questions. Any such request for
10		information shall also be sent to the facility. In deciding
11		whether to grant an extension, the Department of Human Services
12		or the Department of Healthcare and Family Services' Office of
13		the Inspector General shall take into account what is in the
14		best interest of the applicant. The time limits for processing
15		an application shall be tolled during the period of any
16		extension granted under this subsection.
17		(f) The Department of Human Services and the Department of
18		Healthcare and Family Services must jointly compile data on
19		pending applications, denials, appeals, and redeterminations
20		into a monthly report, which shall be posted on each
21		Department's website for the purposes of monitoring long-term
22		care eligibility processing. The report must specify the number
23		of applications and redeterminations pending long-term care
24		eligibility determination and admission and the number of
25		appeals of denials in the following categories:
26		(A) Length of time applications, redeterminations, and

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1		appeals are pending - 0 to 45 days, 46 days to 90 days, 91
2		days to 180 days, 181 days to 12 months, over 12 months to
3		18 months, over 18 months to 24 months, and over 24 months.
4		(B) Percentage of applications and redeterminations
5		pending in the Department of Human Services' Family
6		Community Resource Centers, in the Department of Human
7		Services' long-term care hubs, with the Department of
8		Healthcare and Family Services' Office of Inspector
9		General, and those applications which are being tolled due
10		to requests for extension of time for additional
11		information.
12		(C) Status of pending applications, denials, appeals,
13		and redeterminations.
14		(g) Beginning on July 1, 2017, the Auditor General shall
15		report every 3 years to the General Assembly on the performance
16		and compliance of the Department of Healthcare and Family
17		Services, the Department of Human Services, and the Department
18		on Aging in meeting the requirements of this Section and the
19		federal requirements concerning eligibility determinations for
20		Medicaid long-term care services and supports, and shall report
21		any issues or deficiencies and make recommendations. The
22		Auditor General shall, at a minimum, review, consider, and
23		evaluate the following:
24		(1) compliance with federal regulations on furnishing
25		services as related to Medicaid long-term care services and
26		supports as provided under 42 CFR 435.930;

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1		(2) compliance with federal regulations on the timely
2		determination of eligibility as provided under 42 CFR
3		435.912;
4		(3) the accuracy and completeness of the report
5		required under paragraph (9) of subsection (e);
6		(4) the efficacy and efficiency of the task-based
7		process used for making eligibility determinations in the
8		centralized offices of the Department of Human Services for
9		long-term care services, including the role of the State's
10		integrated eligibility system, as opposed to the
11		traditional caseworker-specific process from which these
12		central offices have converted; and
13		(5) any issues affecting eligibility determinations
14		related to the Department of Human Services' staff
15		completing Medicaid eligibility determinations instead of
16		the designated single-state Medicaid agency in Illinois,
17		the Department of Healthcare and Family Services.
18		The Auditor General's report shall include any and all
19		other areas or issues which are identified through an annual
20		review. Paragraphs (1) through (5) of this subsection shall not
21		be construed to limit the scope of the annual review and the
22		Auditor General's authority to thoroughly and completely
23		evaluate any and all processes, policies, and procedures
24		concerning compliance with federal and State law requirements
25		on eligibility determinations for Medicaid long-term care
26		services and supports.

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1		(h) The Department of Healthcare and Family Services shall
2		adopt any rules necessary to administer and enforce any
3		provision of this Section. Rulemaking shall not delay the full
4		implementation of this Section.
5		(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17;
6		100-665, eff. 8-2-18.)