Chapter 305 — PUBLIC AID

(305 ILCS 5/5C-5) (from Ch. 23, par. 5C-5) Sec. 5C-5. Disposition of proceeds. The Illinois Department shall pay all moneys received from care providers for persons with a developmental disability under this Article into the Care Provider Fund for Persons with a Developmental Dis…

(305 ILCS 5/5C-6) (from Ch. 23, par. 5C-6) Sec. 5C-6. Administration; enforcement provisions. (a) To the extent practicable, the Illinois Department shall administer and enforce this Article and collect the assessments, interest, and penalty assessments imposed under this Article…

(305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7) Sec. 5C-7. Care Provider Fund for Persons with a Developmental Disability. (a) There is created in the State Treasury the Care Provider Fund for Persons with a Developmental Disability. Interest earned by the Fund shall be credited to th…

(305 ILCS 5/5C-8) (from Ch. 23, par. 5C-8) Sec. 5C-8. Applicability. The assessment imposed by Section 5C-2 shall cease to be imposed if the amount of matching federal funds under Title XIX of the Social Security Act is eliminated or significantly reduced on account of the assess…

(305 ILCS 5/5C-9) (from Ch. 23, par. 5C-9) Sec. 5C-9. Severability. If any clause, sentence, Section, exemption, provision, or part of this Article or the application thereof to any person or circumstance shall be adjudged to be unconstitutional or otherwise invalid the remainder…

(305 ILCS 5/5D-1) (from Ch. 23, par. 5D-1) Sec. 5D-1. (Repealed). (Source: P.A. 89-21, eff. 7-1-95. Repealed by P.A. 93-659, eff. 2-3-04.)

(305 ILCS 5/5D-2) (from Ch. 23, par. 5D-2) Sec. 5D-2. (Repealed). (Source: P.A. 88-88. Repealed by P.A. 93-659, eff. 2-3-04.)

(305 ILCS 5/5F-1) Sec. 5F-1. Short title. This Article may be referred to as the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law. (Source: P.A. 98-651, eff. 6-16-14.)

(305 ILCS 5/5F-10) Sec. 5F-10. Scope. This Article applies to policies and contracts amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 98th General Assembly for the nursing home component of the Medicare-Medicaid Alignment Initiat…

(305 ILCS 5/5F-15) Sec. 5F-15. Definitions. As used in this Article: "Appeal" means any of the procedures that deal with the review of adverse organization determinations on the health care services the enrollee believes he or she is entitled to receive, including delay in provid…

(305 ILCS 5/5F-20) Sec. 5F-20. Network adequacy. (a) Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at the plan's standard terms, conditions, and rates. Either party may opt to limit the contra…

(305 ILCS 5/5F-25) Sec. 5F-25. Care coordination. Care coordination provided to all enrollees in the Demonstration Project shall conform to the following requirements: (1) care coordination services shall be enrollee-driven and person-centered; (2) all enrollees in the Demonstrat…

(305 ILCS 5/5F-30) Sec. 5F-30. Continuity of care. When a nursing home resident first transitions to a managed care organization from the fee-for-service system or from another managed care organization, the managed care organization shall honor the existing care plan and any nec…

(305 ILCS 5/5F-31) Sec. 5F-31. Patient credit files; denials of claims. To reduce the number of claim denials resulting from coverage plan errors, the Department shall provide each nursing home enrolled in one or more Medicaid managed care networks with the corresponding patient …

(305 ILCS 5/5F-32) Sec. 5F-32. Non-emergency prior approval and appeal. (a) MCOs must have a method of receiving prior approval requests 24 hours a day, 7 days a week, 365 days a year from nursing home residents, physicians, or providers. If a response is not provided within 24 h…

(305 ILCS 5/5F-33) Sec. 5F-33. Payment of claims. (a) Clean claims, as defined by the Department, submitted by a provider to a managed care organization in the form and manner requested by the managed care organization shall be reviewed and paid within 30 days of receipt. (b) A m…

(305 ILCS 5/5F-35) Sec. 5F-35. Reimbursement. The Department shall provide each managed care organization with the quarterly facility-specific RUG-IV nursing component per diem along with any add-ons for enhanced care services, support component per diem, and capital component pe…

(305 ILCS 5/5F-40) Sec. 5F-40. Contractual requirements. (a) Every contract shall contain a clause for termination consistent with the Managed Care Reform and Patient Rights Act providing nursing homes the ability to terminate the contract. (b) All changes to the contract by the …

(305 ILCS 5/5F-45) Sec. 5F-45. Prohibition. No managed care organization or contract shall contain any provision, policy, or procedure that limits, restricts, or waives any rights set forth in this Article or is expressly prohibited by this Article. Any such policy or procedure i…

(305 ILCS 5/5F-5) Sec. 5F-5. Findings. The General Assembly finds that elderly Illinoisans residing in a nursing home have the right to: (1) quality health care regardless of the payer; (2) receive medically necessary care prescribed by their doctors; (3) a simple appeal process …

(305 ILCS 5/5H-1) Sec. 5H-1. Definitions. As used in this Article: "Base year" means the 12-month period from January 1, 2023 to December 31, 2023. "Department" means the Department of Healthcare and Family Services. "Federal employee health benefit" means the program of health b…

(305 ILCS 5/5H-2) Sec. 5H-2. Federal waivers. The Department shall request a waiver from the federal Centers for Medicare and Medicaid Services of the broad-based and uniformity provisions of Section 1903(w)(3)(B) and (C) of Title XIX of the Social Security Act, 42 U.S.C. 1396b, …

(305 ILCS 5/5H-3) Sec. 5H-3. Managed care assessment. (a) There is imposed upon managed care organization member months an assessment, calculated on base year data, as set forth below for the appropriate tier: (1) Tier 1: $78.90 per member month. (2) Tier 2: $1.40 per member mont…

(305 ILCS 5/5H-4) Sec. 5H-4. Payment of assessment. (a) The assessment payable pursuant to Section 5H-3 shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the first State business day of each month. (b) If the approval o…

(305 ILCS 5/5H-5) Sec. 5H-5. Liability or resultant entities. In the event of a merger, acquisition, or any similar transaction involving entities subject to the assessment under this Article, the resultant entity shall be responsible for the full amount of the assessment for all…

(305 ILCS 5/5H-6) Sec. 5H-6. Recordkeeping; penalties. (a) A managed care organization that is liable for the assessment under this Article shall keep accurate and complete records and pertinent documents as may be required by the Department. Records required by the Department sh…

(305 ILCS 5/5H-7) Sec. 5H-7. Rulemaking. The Department may by rule modify or make adjustments to any methodology, assessment amount, assessment tier, or other similar provision specified in this Article, including broadening the tax base in subsection (a) of Section 5H-3, to the…

(305 ILCS 5/5H-8) Sec. 5H-8. Duties of the Department. (a) The Department shall ensure that rates to Medicaid managed care organizations are actuarially sound including appropriate incorporation of assessments under this Article, other taxes and administrative expenses, including…

(305 ILCS 5/6-1) (from Ch. 23, par. 6-1) Sec. 6-1. Eligibility requirements. Financial aid in meeting basic maintenance requirements shall be given under this Article to or in behalf of persons who meet the eligibility conditions of Sections 6-1.1 through 6-1.10. In addition, eac…

(305 ILCS 5/6-1.1) (from Ch. 23, par. 6-1.1) Sec. 6-1.1. Residence.) If it appears that an applicant is not a resident of this State but that he will suffer great hardship and privation unless general assistance is provided, general assistance may be given for such temporary peri…

(305 ILCS 5/6-1.10) (from Ch. 23, par. 6-1.10) Sec. 6-1.10. (Repealed). (Source: Repealed by P.A. 88-554, eff. 7-26-94.)

(305 ILCS 5/6-1.2) (from Ch. 23, par. 6-1.2) Sec. 6-1.2. Need. Income available to the person, when added to contributions in money, substance, or services from other sources, including contributions from legally responsible relatives, must be insufficient to equal the grant amou…

(305 ILCS 5/6-1.3) (from Ch. 23, par. 6-1.3) Sec. 6-1.3. Utilization of aid available under other provisions of Code. The person must have been determined ineligible for aid under the federally funded programs to aid refugees and Articles III, IV or V. Nothing in this Section sha…

(305 ILCS 5/6-1.3a) (from Ch. 23, par. 6-1.3a) Sec. 6-1.3a. Residents of public institutions. Residents of municipal, county, state or national institutions for persons with mental illness or persons with a developmental disability or for the tuberculous, or residents of a home o…

(305 ILCS 5/6-1.4) (from Ch. 23, par. 6-1.4) Sec. 6-1.4. Registration for and Acceptance of Employment. A person who is able to engage in employment, including dependent members of his family age 16 or over not in regular attendance in school as defined in Section 4-1.1, who is u…

(305 ILCS 5/6-1.5) (from Ch. 23, par. 6-1.5) Sec. 6-1.5. Participation in educational and vocational training programs. A person for whom education and training is suitable must participate in the educational and vocational training programs established under Section 9-5 of Artic…

(305 ILCS 5/6-1.6) (from Ch. 23, par. 6-1.6) Sec. 6-1.6. Acceptance of Assignment to Job Search, Training and Work Programs. A person for whom the job search, training and work programs established under Section 9-6 of Article IX are applicable must accept assignment to such prog…

(305 ILCS 5/6-1.7) (from Ch. 23, par. 6-1.7) Sec. 6-1.7. A recipient of financial aid under this Article, which money or vendor payment is made by a local governmental unit which administers aid under this Article and is not a County Department, who is required under Section 6-1.…

(305 ILCS 5/6-1.8) (from Ch. 23, par. 6-1.8) Sec. 6-1.8. Multiple convictions for violations of this Code. Any person found guilty of a second violation of Article VIIIA shall be ineligible for financial aid under this Article, as provided in Section 8A-8. (Source: P.A. 82-440.)…

(305 ILCS 5/6-1.9) (from Ch. 23, par. 6-1.9) Sec. 6-1.9. An adult is eligible for aid under this Article if he is (1) age 21 or over, (2) married and living with a spouse, regardless of age, even if living in the residence of a natural or adoptive parent or (3) age 18, 19, or 20 …

(305 ILCS 5/6-10) (from Ch. 23, par. 6-10) Sec. 6-10. Emergency financial assistance. Except in a city, village or incorporated town of more than 500,000 population, when an applicant resides in the local governmental unit in which he makes application, emergency financial assist…

(305 ILCS 5/6-11) (from Ch. 23, par. 6-11) Sec. 6-11. General Assistance. (a) Effective July 1, 1992, all State funded General Assistance and related medical benefits shall be governed by this Section, provided that, notwithstanding any other provisions of this Code to the contra…

(305 ILCS 5/6-11a) Sec. 6-11a. Townships. A local governmental unit may provide assistance under its General Assistance program under a service that complies with Section 85-13 of the Township Code. Before a local governmental unit provides assistance under this Section, the boar…

(305 ILCS 5/6-12) (from Ch. 23, par. 6-12) Sec. 6-12. General Assistance not funded by State. General Assistance programs in local governments that do not receive State funds shall continue to be governed by Sections 6-1 through 6-10, as applicable, as well as other relevant part…

(305 ILCS 5/6-2) (from Ch. 23, par. 6-2) Sec. 6-2. Amount of aid. The amount and nature of General Assistance for basic maintenance requirements shall be determined in accordance with local budget standards for local governmental units which do not receive State funds. For local …

(305 ILCS 5/6-2.1) (from Ch. 23, par. 6-2.1) Sec. 6-2.1. Assets of homeless persons. (a) For the purpose of assisting homeless persons in securing housing, all assistance units that include a homeless person shall have an asset disregard no less than that applicable to recipients…

(305 ILCS 5/6-3) (from Ch. 23, par. 6-3) Sec. 6-3. Entitlement to social services. Persons qualified for aid hereunder shall be entitled to receive, under Article IX, such rehabilitative, training or other social services as are appropriate to their condition. (Source: Laws 1967,…

(305 ILCS 5/6-4) (from Ch. 23, par. 6-4) Sec. 6-4. (Repealed). (Source: P.A. 85-1209. Repealed by P.A. 92-111, eff. 1-1-02.)

(305 ILCS 5/6-5) (from Ch. 23, par. 6-5) Sec. 6-5. Medical practitioners. In supplying persons receiving basic maintenance support with necessary treatment, care, and supplies required because of illness or disability or with acute medical treatment, care, and supplies a local go…

(305 ILCS 5/6-6) (from Ch. 23, par. 6-6) Sec. 6-6. Funeral and Burial. If the estate of a deceased recipient is insufficient to pay for funeral and burial expenses and if no other resources including assistance from legally responsible relatives or the United States Veterans Admi…