Chapter 305 — PUBLIC AID

(305 ILCS 5/5-18.6) Sec. 5-18.6. Doula policies; hospitals and birthing centers. (a) Recognizing the importance that doulas provide in the support and advocacy for pregnant persons, within 6 months after this amendatory Act of the 104th General Assembly, all hospitals with licens…

(305 ILCS 5/5-18.7) Sec. 5-18.7. Standing recommendations. The Department of Healthcare and Family Services and the Department of Public Health may establish standing recommendations to meet Centers for Medicare and Medicaid Services requirements and ensure access to preventive s…

(305 ILCS 5/5-19) (from Ch. 23, par. 5-19) Sec. 5-19. Healthy Kids Program. (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 Treatme…

(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…

(305 ILCS 5/5-2.01) Sec. 5-2.01. Medicaid accountability through transparency program. (a) Internet-based transparency program. The Director of the Department of Healthcare and Family Services shall be authorized to implement a program under which the Director shall make availabl…

(305 ILCS 5/5-2.03) Sec. 5-2.03. Presumptive eligibility. Beginning on the effective date of this amendatory Act of the 96th General Assembly and except where federal law requires presumptive eligibility, no adult may be presumed eligible for medical assistance under this Code an…

(305 ILCS 5/5-2.05) Sec. 5-2.05. Children with disabilities. (a) The Department of Healthcare and Family Services, in conjunction with the Department of Human Services, may offer, to children with developmental disabilities or children with severe mental illness or severe emotion…

(305 ILCS 5/5-2.06) Sec. 5-2.06. Payment rates; Children's Community-Based Health Care Centers. Beginning January 1, 2025 and subject to federal approval, the Department shall, for eligible individuals, reimburse Children's Community-Based Health Care Centers established in the A…

(305 ILCS 5/5-2.06a) Sec. 5-2.06a. Medically fragile children; reimbursement for legally responsible family caregivers. By January 1, 2025, the Department of Healthcare and Family Services shall apply for a Home and Community-Based Services State Plan amendment and any federal wa…

(305 ILCS 5/5-2.06b) Sec. 5-2.06b. Certified family health aide program for children and adults. (a) The Department of Healthcare and Family Services may seek any federal approval from the Centers for Medicare and Medicaid Services necessary to reimburse a legally responsible car…

(305 ILCS 5/5-2.07) Sec. 5-2.07. Use of Medicaid spend-down. No later than July 1, 2007, subject to federal approval of a State Medicaid Plan amendment, which shall be sought by the Department of Healthcare and Family Services or its successor agency, persons described in item 2(…

(305 ILCS 5/5-2.08) Sec. 5-2.08. Spousal caregiver demonstration. (a) The Department of Human Services, in consultation with the Department of Healthcare and Family Services, shall develop a demonstration project within the Home Services Program under which a spouse may be reimbu…

(305 ILCS 5/5-2.09) Sec. 5-2.09. Enhanced federal medical assistance percentage. In accordance with Section 9817 of the American Rescue Plan Act of 2021 (Pub. L. 117-2) and corresponding federal guidance, the Department of Healthcare and Family Services shall take appropriate act…

(305 ILCS 5/5-2.1) (from Ch. 23, par. 5-2.1) Sec. 5-2.1. Property transfers. (a) To the extent required under federal law, a person shall not make or have made a voluntary or involuntary assignment or transfer of any legal or equitable interests in real property or in personal pr…

(305 ILCS 5/5-2.10) Sec. 5-2.10. Increased accountability for nursing facilities. The Department shall develop a plan for the revitalization of nursing homes licensed under the Nursing Home Care Act and shall report to the Governor and the General Assembly on a recommended course…

(305 ILCS 5/5-2.1a) Sec. 5-2.1a. Treatment of trust amounts. To the extent required by federal law, the Department of Healthcare and Family Services shall provide by rule for the consideration of trusts and similar legal instruments or devices established by a person in the Illin…

(305 ILCS 5/5-2.1d) Sec. 5-2.1d. Retroactive eligibility. An applicant for medical assistance may be eligible for up to 3 months prior to the date of application if the person would have been eligible for medical assistance at the time he or she received the services if he or she…

(305 ILCS 5/5-2.2) (from Ch. 23, par. 5-2.2) Sec. 5-2.2. Cooperation in establishing support obligation. A parent or other person having custody of the child or a spouse who fails or refuses to comply with the requirements of Title XIX of the federal Social Security Act, and the …

(305 ILCS 5/5-2.3) Sec. 5-2.3. Notice of rights concerning institutionalization. The Illinois Department shall prepare a notice to be given to every applicant for and recipient of medical assistance under this Article when the applicant or recipient, or the spouse of the applican…

(305 ILCS 5/5-2.4) Sec. 5-2.4. (Repealed). (Source: P.A. 95-248, eff. 8-17-07. Repealed by P.A. 97-48, eff. 6-28-11.)

(305 ILCS 5/5-20) Sec. 5-20. Electronic health care card. By December 31, 1994, the Illinois Department may develop and implement by rule an electronic health information system to process claims electronically and to electronically store Medicare and Medicaid patient records, me…

(305 ILCS 5/5-21) Sec. 5-21. Immunization. By July 1, 1994, the Illinois Department shall, in cooperation with the Department of Public Health, establish and implement a pilot program that will provide immunization services for children on a walk-in basis at local public aid offi…

(305 ILCS 5/5-22) Sec. 5-22. (Repealed). (Source: P.A. 90-655, eff. 7-30-98. Repealed by P.A. 96-1123, eff. 1-1-11.)

(305 ILCS 5/5-23) Sec. 5-23. (Repealed). (Source: P.A. 92-581, eff. 6-26-02. Repealed internally, eff. 7-1-03.)

(305 ILCS 5/5-24) Sec. 5-24. (Repealed). (Source: P.A. 97-689, eff. 6-14-12. Repealed internally, eff. 1-1-14.)

(305 ILCS 5/5-25) Sec. 5-25. Pediatric asthma initiative. (a) During fiscal year 2006, the Department of Public Aid shall evaluate current standards of treatment of asthma for its beneficiaries. The review may include state-of-the-art programs in asthma disease management as well…

(305 ILCS 5/5-26) Sec. 5-26. Federal Family Opportunity Act. (a) As used in this Section, "the federal Act" means the federal Family Opportunity Act, enacted as part of the Deficit Reduction Act of 2005. (b) Subject to appropriations for program administration and services, the D…

(305 ILCS 5/5-27) Sec. 5-27. (Repealed). (Source: P.A. 96-1372, eff. 7-29-10. Repealed internally, eff. 1-1-11.)

(305 ILCS 5/5-28) Sec. 5-28. Community transition resources. The Department of Healthcare and Family Services, in collaboration with all relevant agencies, shall develop a Community Transition Plan to allow nursing facility residents who are determined to be appropriate for trans…

(305 ILCS 5/5-29) Sec. 5-29. Income Limits and Parental Responsibility. In light of the unprecedented fiscal crisis confronting the State, it is the intent of the General Assembly to explore whether the income limits and income counting methods established for children under the …

(305 ILCS 5/5-2a) Sec. 5-2a. Medicaid State Plan; eligibility determination status. The Department shall conduct an analysis and deliver a report to the General Assembly by January 1, 2012 to evaluate the feasibility of changing Illinois' Medicaid State Plan from 209(b) status to…

(305 ILCS 5/5-2b) Sec. 5-2b. Medically fragile and technology dependent children eligibility and program; provider reimbursement rates. (a) Notwithstanding any other provision of law except as provided in Section 5-30a, on and after September 1, 2012, subject to federal approval,…

(305 ILCS 5/5-3) (from Ch. 23, par. 5-3) Sec. 5-3. Residence. Any person who has established his residence in this State and lives therein, including any person who is a migrant worker, may qualify for medical assistance. A person who, while temporarily in this State, suffers inj…

(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…

(305 ILCS 5/5-30.1) Sec. 5-30.1. Managed care protections. (a) As used in this Section: "Managed care organization" or "MCO" means any entity which contracts with the Department to provide services where payment for medical services is made on a capitated basis. "Emergency servic…

(305 ILCS 5/5-30.10) Sec. 5-30.10. Electronic report submission. To preserve the quality of data and ensure productive oversight of Medicaid managed care organizations, all regular reports required, either by contract or statute, to be collected by the Department from managed car…

(305 ILCS 5/5-30.11) Sec. 5-30.11. Treatment of autism spectrum disorder. Treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program under this Article for children with a diagnosis of autism spectrum disorder whe…

(305 ILCS 5/5-30.12) Sec. 5-30.12. Managed care claim rejection and denial management. (a) In order to provide greater transparency to managed care organizations (MCOs) and providers, the Department shall explore the availability of and, if reasonably available, procure technolog…

(305 ILCS 5/5-30.13) Sec. 5-30.13. Managed care reports; minority-owned and women-owned businesses. Each Medicaid managed care health plan shall submit a report to the Department by March 1, 2020, and every March 1 thereafter, that includes the following information: (1) The admi…

(305 ILCS 5/5-30.14) Sec. 5-30.14. Medicaid managed care organizations; preferred drug lists. (a) No later than January 1, 2020, the Illinois Department shall develop a standardized format for all Medicaid managed care organization preferred drug lists in collaboration with Medic…

(305 ILCS 5/5-30.16) Sec. 5-30.16. Medicaid Business Opportunity Commission. (a) The Medicaid Business Opportunity Commission is created within the Department of Healthcare and Family Services to develop a program to support and grow minority, women, and persons with disability o…

(305 ILCS 5/5-30.17) Sec. 5-30.17. Medicaid Managed Care Oversight Commission. (a) The Medicaid Managed Care Oversight Commission is created within the Department of Healthcare and Family Services to evaluate the effectiveness of Illinois' managed care program. (b) The Commission…

(305 ILCS 5/5-30.18) (Section scheduled to be repealed on December 31, 2030) Sec. 5-30.18. Service authorization program performance. (a) Definitions. As used in this Section: "Gold Card provider" means a provider identified by each Medicaid Managed Care Organization (MCO) as qua…

(305 ILCS 5/5-30.2) Sec. 5-30.2. Monthly reports; managed care enrollment. (a) As used in this Section, "Medicaid Managed Care Entity" means a Managed Care Organization (MCO), a Managed Care Community Network (MCCN), an Accountable Care Entity (ACE), or a Care Coordination Entity…

(305 ILCS 5/5-30.3) Sec. 5-30.3. Empowering meaningful patient choice in Medicaid Managed Care. (a) Definitions. As used in this Section: "Client enrollment services broker" means a vendor the Department contracts with to carry out activities related to Medicaid recipients' enrol…

(305 ILCS 5/5-30.4) Sec. 5-30.4. Provider inquiry portal. The Department shall establish, no later than January 1, 2018, a web-based portal to accept inquiries and requests for assistance from managed care organizations under contract with the State and providers under contract w…

(305 ILCS 5/5-30.5) Sec. 5-30.5. Managed care; automatic assignment. The Department shall, within a reasonable period of time after relevant data from managed care entities has been collected and analyzed, but no earlier than January 1, 2017, seek input from the managed care enti…

(305 ILCS 5/5-30.6) Sec. 5-30.6. Managed care organization contracts procurement requirement. Beginning on March 12, 2018 (the effective date of Public Act 100-580), any new contract between the Department and a managed care organization as defined in Section 5-30.1 shall be proc…

(305 ILCS 5/5-30.7) Sec. 5-30.7. Encounter data guidelines; provider fee schedule. (a) No later than 60 days after the effective date of this amendatory Act of the 100th General Assembly, the Department shall publish on its website comprehensive written guidance on the submission…

(305 ILCS 5/5-30.8) Sec. 5-30.8. Managed care organization rate transparency. (a) For the establishment of managed care organization (MCO) capitation base rate payments from the State, including, but not limited to: (i) hospital fee schedule reforms and updates, (ii) rates relate…