Public Act 101-0559

SB1573 Enrolled LRB101 07820 KTG 52871 b

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois,

represented in the General Assembly:

Section 1. The Equity in Long-term Care Quality Act is

amended by adding Section 25 as follows:

(30 ILCS 772/25 new)

Sec. 25. Nursing home labor force program.

(a) The Department of Public Health, contingent upon

approval by the Centers for Medicare and Medicaid Services,

shall establish a nursing home labor force promotion,

expansion, and retention program no later than January 1, 2020

using moneys appropriated from the Equity in Long-term Care

Quality Fund.

(b) Components of the program shall include, but are not

limited to: (1) a public relations campaign to encourage people

to become nursing home workers; (2) scholarships for certified

nursing assistants, licensed practical nurses, and registered

nurses; and (3) retention incentives for nursing home workers.

(c) The Department shall establish partnerships with one or

more community colleges or universities to execute the program.

Sixty percent of the scholarships provided by the program shall

be distributed to candidates living in counties with 3,000,000

or more residents. Preferential scholarship consideration

shall be given to certified nursing assistants, single parents,

and applicants from communities that are economically

depressed or that have high percentages of Medicaid

beneficiaries, immigrants, or racial or ethnic minorities.

(d) The Department shall report to the General Assembly no

later than January 30, 2020 on the status of the establishment

of the program. No later than January 1, 2021, and each January

1 thereafter, the Department shall report to the General

Assembly the number of scholarships awarded during the

preceding year and the demographics of the awardees.

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

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

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

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

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

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

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.

(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

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.)

Section 99. Effective date. This Act takes effect upon

becoming law.