Bill Text: IL SB1573 | 2019-2020 | 101st General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Public Aid Code. Makes technical changes to specify in provisions concerning provisional eligibility for long-term care services that: (i) the Department of Healthcare and Family Services must maintain the applicant's provisional Medicaid enrollment status until a final eligibility determination is approved or the applicant's appeal has been adjudicated and eligibility is denied; (ii) the Department of Healthcare and Family Services or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period; (iii) the Department of Healthcare and Family Services must submit payment vouchers for all retroactive reimbursement due to the Office of the Comptroller within 10 business days of issuing provisional eligibility to an applicant; and (iv) the Department of Healthcare and Family Services must adopt rules.

Spectrum: Moderate Partisan Bill (Democrat 23-3)

Status: (Passed) 2019-08-23 - Public Act . . . . . . . . . 101-0559 [SB1573 Detail]

Download: Illinois-2019-SB1573-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB1573 Introduced 2/15/2019, by Sen. John G. Mulroe SYNOPSIS AS INTRODUCED:
305 ILCS 5/11-5.4
Amends the Illinois Public Aid Code. Makes technical changes to specify in provisions concerning provisional eligibility for long-term care services that: (i) the Department of Healthcare and Family Services must maintain the applicant's provisional Medicaid enrollment status until a final eligibility determination is approved or the applicant's appeal has been adjudicated and eligibility is denied; (ii) the Department of Healthcare and Family Services or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period; (iii) the Department of Healthcare and Family Services must submit payment vouchers for all retroactive reimbursement due to the Office of the Comptroller within 10 business days of issuing provisional eligibility to an applicant; and (iv) the Department of Healthcare and Family Services must adopt rules.
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A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 11-5.4 as follows:
(305 ILCS 5/11-5.4)
Sec. 11-5.4. Expedited long-term care eligibility
determination and enrollment.
(a) Establishment of the expedited long-term care
eligibility determination and enrollment system shall be a
joint venture of the Departments of Human Services and
Healthcare and Family Services and the Department on Aging.
(b) Streamlined application enrollment process; expedited
eligibility process. The streamlined application and
enrollment process must include, but need not be limited to,
the following:
(1) On or before July 1, 2019, a streamlined
application and enrollment process shall be put in place
which must include, but need not be limited to, the
following:
(A) Minimize the burden on applicants by
collecting only the data necessary to determine
eligibility for medical services, long-term care

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

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no greater than the allowable amounts pursuant to
Section 5-2 of this Code for classes of eligible
persons for whom a resource limit applies. Such
simplified verification policies shall apply to
community cases as well as long-term care cases.
(3) Subject to federal approval, the Department of
Healthcare and Family Services must implement an ex parte
renewal process for Medicaid-eligible individuals residing
in long-term care facilities. "Renewal" has the same
meaning as "redetermination" in State policies,
administrative rule, and federal Medicaid law. The ex parte
renewal process must be fully operational on or before
January 1, 2019.
(4) The Department of Human Services must use the
standards and distribution requirements described in this
subsection and in Section 11-6 for notification of missing
supporting documents and information during all phases of
the application process: initial, renewal, and appeal.
(c) The Department of Human Services must adopt policies
and procedures to improve communication between long-term care
benefits central office personnel, applicants and their
representatives, and facilities in which the applicants
reside. Such policies and procedures must at a minimum permit
applicants and their representatives and the facility in which
the applicants reside to speak directly to an individual
trained to take telephone inquiries and provide appropriate

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responses.
(d) Effective 30 days after the completion of 3 regionally
based trainings, nursing facilities shall submit all
applications for medical assistance online via the Application
for Benefits Eligibility (ABE) website. This requirement shall
extend to scanning and uploading with the online application
any required additional forms such as the Long Term Care
Facility Notification and the Additional Financial Information
for Long Term Care Applicants as well as scanned copies of any
supporting documentation. Long-term care facility admission
documents must be submitted as required in Section 5-5 of this
Code. No local Department of Human Services office shall refuse
to accept an electronically filed application. No Department of
Human Services office shall request submission of any document
in hard copy.
(e) Notwithstanding any other provision of this Code, the
Department of Human Services and the Department of Healthcare
and Family Services' Office of the Inspector General shall,
upon request, allow an applicant additional time to submit
information and documents needed as part of a review of
available resources or resources transferred during the
look-back period. The initial extension shall not exceed 30
days. A second extension of 30 days may be granted upon
request. Any request for information issued by the State to an
applicant shall include the following: an explanation of the
information required and the date by which the information must

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be submitted; a statement that failure to respond in a timely
manner can result in denial of the application; a statement
that the applicant or the facility in the name of the applicant
may seek an extension; and the name and contact information of
a caseworker in case of questions. Any such request for
information shall also be sent to the facility. In deciding
whether to grant an extension, the Department of Human Services
or the Department of Healthcare and Family Services' Office of
the Inspector General shall take into account what is in the
best interest of the applicant. The time limits for processing
an application shall be tolled during the period of any
extension granted under this subsection.
(f) The Department of Human Services and the Department of
Healthcare and Family Services must jointly compile data on
pending applications, denials, appeals, and redeterminations
into a monthly report, which shall be posted on each
Department's website for the purposes of monitoring long-term
care eligibility processing. The report must specify the number
of applications and redeterminations pending long-term care
eligibility determination and admission and the number of
appeals of denials in the following categories:
(A) Length of time applications, redeterminations, and
appeals are pending - 0 to 45 days, 46 days to 90 days, 91
days to 180 days, 181 days to 12 months, over 12 months to
18 months, over 18 months to 24 months, and over 24 months.
(B) Percentage of applications and redeterminations

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pending in the Department of Human Services' Family
Community Resource Centers, in the Department of Human
Services' long-term care hubs, with the Department of
Healthcare and Family Services' Office of Inspector
General, and those applications which are being tolled due
to requests for extension of time for additional
information.
(C) Status of pending applications, denials, appeals,
and redeterminations.
(g) Beginning on July 1, 2017, the Auditor General shall
report every 3 years to the General Assembly on the performance
and compliance of the Department of Healthcare and Family
Services, the Department of Human Services, and the Department
on Aging in meeting the requirements of this Section and the
federal requirements concerning eligibility determinations for
Medicaid long-term care services and supports, and shall report
any issues or deficiencies and make recommendations. The
Auditor General shall, at a minimum, review, consider, and
evaluate the following:
(1) compliance with federal regulations on furnishing
services as related to Medicaid long-term care services and
supports as provided under 42 CFR 435.930;
(2) compliance with federal regulations on the timely
determination of eligibility as provided under 42 CFR
435.912;
(3) the accuracy and completeness of the report

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required under paragraph (9) of subsection (e);
(4) the efficacy and efficiency of the task-based
process used for making eligibility determinations in the
centralized offices of the Department of Human Services for
long-term care services, including the role of the State's
integrated eligibility system, as opposed to the
traditional caseworker-specific process from which these
central offices have converted; and
(5) any issues affecting eligibility determinations
related to the Department of Human Services' staff
completing Medicaid eligibility determinations instead of
the designated single-state Medicaid agency in Illinois,
the Department of Healthcare and Family Services.
The Auditor General's report shall include any and all
other areas or issues which are identified through an annual
review. Paragraphs (1) through (5) of this subsection shall not
be construed to limit the scope of the annual review and the
Auditor General's authority to thoroughly and completely
evaluate any and all processes, policies, and procedures
concerning compliance with federal and State law requirements
on eligibility determinations for Medicaid long-term care
services and supports.
(h) The Department of Healthcare and Family Services shall
adopt any rules necessary to administer and enforce any
provision of this Section. Rulemaking shall not delay the full
implementation of this Section.

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(g) The Department shall adopt rules necessary to
administer and enforce any provision of this Section.
Rulemaking shall not delay the full implementation of this
Section.
(i) (h) Beginning on June 29, 2018, provisional
eligibility, in the form of a recipient identification number
and any other necessary credentials to permit an applicant to
receive benefits, must be issued to any applicant who has not
received a final eligibility determination on his or her
application for Medicaid or Medicaid long-term care benefits or
a notice of an opportunity for a hearing within the federally
prescribed deadlines for the processing of such applications.
The Department of Healthcare and Family Services must maintain
the applicant's provisional Medicaid enrollment status until a
final eligibility determination is approved or the applicant's
appeal has been adjudicated and eligibility is denied. The
Department of Healthcare and Family Services or the managed
care organization, if applicable, must reimburse providers for
services rendered during an applicant's provisional
eligibility period.
(1) Claims for services rendered to an applicant with
provisional eligibility status must be submitted and
processed in the same manner as those submitted on behalf
of beneficiaries determined to qualify for benefits.
(2) An applicant with provisional enrollment status
must have his or her benefits paid for under the State's

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fee-for-service system until the State makes a final
determination on the applicant's Medicaid or Medicaid
long-term care application. If an individual is enrolled
with a managed care organization for community benefits at
the time the individual's provisional status is issued, the
managed care organization is only responsible for paying
benefits covered under the capitation payment received by
the managed care organization for the individual.
(3) The Department of Healthcare and Family Services,
within 10 business days of issuing provisional eligibility
to an applicant, must submit to the Office of the
Comptroller for payment a voucher for all retroactive
reimbursement due. The Department of Healthcare and Family
Services must clearly identify such vouchers as
provisional eligibility vouchers.
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17;
100-665, eff. 8-2-18; 100-1141, eff. 11-28-18.)