Bill Text: IL SB2913 | 2017-2018 | 100th General Assembly | Chaptered

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Bill Title: Amends the Illinois Public Aid Code. Requires long-term care providers to submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage to the Department of Healthcare and Family Services through the Medical Electronic Data Interchange System, the Recipient Eligibility Verification System, or the Electronic Data Interchange System under a specified schedule. Requires the Department and other agencies to establish an expedited long-term care eligibility determination and enrollment system. Requires the Director of Healthcare and Family Services, in coordination with the Secretary of Human Services and the Director of Aging, to hold meetings for provider associations representing facilities licensed under the Nursing Home Care Act and certified as supportive living programs. Provides that the meetings shall be held every 6 weeks until all backlogged cases have been adjudicated and the application process has been reduced to the federal timeframe. Contains provisions concerning a 45-day extension of the federal eligibility application processing deadline in suspected cases of fraud; the identification of applicants who had full Medicaid benefits in the community for 6 months or more immediately before entering the long-term care facility; reporting requirements; public-private partnerships aimed at redeploying caseworkers to targeted high-Medicaid facilities for the purpose of expediting initial Medicaid and long-term care benefits applications; the establishment of a Health Insurance Portability and Accountability Act compliant database; and other matters. Effective immediately.

Spectrum: Slight Partisan Bill (Democrat 46-18)

Status: (Passed) 2018-08-02 - Public Act . . . . . . . . . 100-0665 [SB2913 Detail]

Download: Illinois-2017-SB2913-Chaptered.html

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Public Act 100-0665
SB2913 Enrolled LRB100 18099 KTG 34358 b
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 Sections 11-5.4 and 11-6 and by adding Section 5-5g as
follows:
(305 ILCS 5/5-5g new)
Sec. 5-5g. Long-term care patient; resident status.
Long-term care providers shall submit all changes in resident
status, including, but not limited to, death, discharge,
changes in patient credit, third party liability, and Medicare
coverage, to the Department through the Medical Electronic Data
Interchange System, the Recipient Eligibility Verification
System, or the Electronic Data Interchange System established
under 89 Ill. Adm. Code 140.55(b) in compliance with the
schedule below:
(1) 15 calendar days after a resident's death;
(2) 15 calendar days after a resident's discharge;
(3) 45 calendar days after being informed of a change
in the resident's income;
(4) 45 calendar days after being informed of a change
in a resident's third party liability;
(5) 45 calendar days after a resident's move to

exceptional care services; and
(6) 45 calendar days after a resident's need for
services requiring reimbursement under the ventilator or
traumatic brain injury enhanced rate.
(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. An
expedited long-term care eligibility determination and
enrollment system shall be established to reduce long-term care
determinations to 90 days or fewer by July 1, 2014 and
streamline the long-term care enrollment process.
Establishment of the system shall be a joint venture of the
Department of Human Services and Healthcare and Family Services
and the Department on Aging. The Governor shall name a lead
agency no later than 30 days after the effective date of this
amendatory Act of the 98th General Assembly to assume
responsibility for the full implementation of the
establishment and maintenance of the system. Project outcomes
shall include an enhanced eligibility determination tracking
system accessible to providers and a centralized application
review and eligibility determination with all applicants

reviewed within 90 days of receipt by the State of a complete
application. If the Department of Healthcare and Family
Services' Office of the Inspector General determines that there
is a likelihood that a non-allowable transfer of assets has
occurred, and the facility in which the applicant resides is
notified, an extension of up to 90 days shall be permissible.
(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, December 31, 2015, a
streamlined application and enrollment process shall be
put in place which must include, but need not be limited
to, the following: based on the following principles:
(A) (1) 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) (2) 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) (3) 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.
(b) The Department shall, on or before July 1, 2014, assess
the feasibility of incorporating all information needed to
determine eligibility for long-term care services, including
asset transfer and spousal impoverishment financials, into the
State's integrated eligibility system identifying all
resources needed and reasonable timeframes for achieving the
specified integration.
(c) The lead agency shall file interim reports with the

Chairs and Minority Spokespersons of the House and Senate Human
Services Committees no later than September 1, 2013 and on
February 1, 2014. The Department of Healthcare and Family
Services shall include in the annual Medicaid report for State
Fiscal Year 2014 and every fiscal year thereafter information
concerning implementation of the provisions of this Section.
(d) No later than August 1, 2014, the Auditor General shall
report to the General Assembly concerning the extent to which
the timeframes specified in this Section have been met and the
extent to which State staffing levels are adequate to meet the
requirements of this Section.
(e) The Department of Healthcare and Family Services, the
Department of Human Services, and the Department on Aging shall
take the following steps to achieve federally established
timeframes for eligibility determinations for Medicaid and
long-term care benefits and shall work toward the federal goal
of real time determinations:
(1) The Departments shall review, in collaboration
with representatives of affected providers, all forms and
procedures currently in use, federal guidelines either
suggested or mandated, and staff deployment by September
30, 2014 to identify additional measures that can improve
long-term care eligibility processing and make adjustments
where possible.
(2) No later than June 30, 2014, the Department of
Healthcare and Family Services shall issue vouchers for

advance payments not to exceed $50,000,000 to nursing
facilities with significant outstanding Medicaid liability
associated with services provided to residents with
Medicaid applications pending and residents facing the
greatest delays. Each facility with an advance payment
shall state in writing whether its own recoupment schedule
will be in 3 or 6 equal monthly installments, as long as
all advances are recouped by June 30, 2015.
(3) The Department of Healthcare and Family Services'
Office of Inspector General and the Department of Human
Services shall immediately forgo resource review and
review of transfers during the relevant look-back period
for applications that were submitted prior to September 1,
2013. An applicant who applied prior to September 1, 2013,
who was denied for failure to cooperate in providing
required information, and whose application was
incorrectly reviewed under the wrong look-back period
rules may request review and correction of the denial based
on this subsection. If found eligible upon review, such
applicants shall be retroactively enrolled.
(4) As soon as practicable, the Department of
Healthcare and Family Services shall implement policies
and promulgate rules to simplify financial eligibility
verification in the following instances: (A) for
applicants or recipients who are receiving Supplemental
Security Income payments or who had been receiving such

payments at the time they were admitted to a nursing
facility and (B) 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.
(5) As soon as practicable, but not later than July 1,
2014, the Department of Healthcare and Family Services and
the Department of Human Services shall jointly begin a
special enrollment project by using simplified eligibility
verification policies and by redeploying caseworkers
trained to handle long-term care cases to prioritize those
cases, until the backlog is eliminated and processing time
is within 90 days. This project shall apply to applications
for long-term care received by the State on or before May
15, 2014.
(6) As soon as practicable, but not later than
September 1, 2014, the Department on Aging shall make
available to long-term care facilities and community
providers upon request, through an electronic method, the
information contained within the Interagency Certification
of Screening Results completed by the pre-screener, in a
form and manner acceptable to the Department of Human

Services.
(d) (7) 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) (8) 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) (9) 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) (f) 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.

(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
(305 ILCS 5/11-6) (from Ch. 23, par. 11-6)
Sec. 11-6. Decisions on applications. Within 10 days after
a decision is reached on an application, the applicant shall be
notified in writing of the decision. If the applicant resides
in a facility licensed under the Nursing Home Care Act or a
supportive living facility authorized under Section 5-5.01a,
the facility shall also receive written notice of the decision,
provided that the notification is related to a Department
payment for services received by the applicant in the facility.
Only facilities enrolled in and subject to a provider agreement
under the medical assistance program under Article V may
receive such notices of decisions. The Department shall
consider eligibility for, and the notice shall contain a
decision on, each of the following assistance programs for
which the client may be eligible based on the information
contained in the application: Temporary Assistance for to Needy
Families, Medical Assistance, Aid to the Aged, Blind and
Disabled, General Assistance (in the City of Chicago), and food
stamps. No decision shall be required for any assistance
program for which the applicant has expressly declined in
writing to apply. If the applicant is determined to be
eligible, the notice shall include a statement of the amount of
financial aid to be provided and a statement of the reasons for
any partial grant amounts. If the applicant is determined

ineligible for any public assistance the notice shall include
the reason why the applicant is ineligible. If the application
for any public assistance is denied, the notice shall include a
statement defining the applicant's right to appeal the
decision. The Illinois Department, by rule, shall determine the
date on which assistance shall begin for applicants determined
eligible. That date may be no later than 30 days after the date
of the application.
Under no circumstances may any application be denied solely
to meet an application-processing deadline. As used in this
Section, "application" also refers to requests for admission
approval to facilities licensed under the Nursing Home Care Act
or to supportive living facilities authorized under Section
5-5.01a.
(Source: P.A. 96-206, eff. 1-1-10; revised 10-4-17.)
Section 99. Effective date. This Act takes effect upon
becoming law.