Chapter 305, PUBLIC AID

(305 ILCS 5/5B-6) (from Ch. 23, par. 5B-6) Sec. 5B-6. Disposition of proceeds. The Illinois Department shall pay all moneys received from long-term care providers under this Article into the Long-Term Care Provider Fund. Upon certification by the Illinois Department to the State …

(305 ILCS 5/5B-7) (from Ch. 23, par. 5B-7) Sec. 5B-7. 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 5/5B-8) (from Ch. 23, par. 5B-8) Sec. 5B-8. Long-Term Care Provider Fund. (a) There is created in the State Treasury the Long-Term Care Provider Fund. Interest earned by the Fund shall be credited to the Fund. The Fund shall not be used to replace any moneys appropriate…

(305 ILCS 5/5B-9) (from Ch. 23, par. 5B-9) Sec. 5B-9. Applicability. The assessment imposed by Section 5B-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-1) (from Ch. 23, par. 5C-1) Sec. 5C-1. Definitions. As used in this Article, unless the context requires otherwise: "Fund" means the Care Provider Fund for Persons with a Developmental Disability. "Care facility for persons with a developmental disability" means an…

(305 ILCS 5/5C-10) Sec. 5C-10. Adjustments. For long-term care facilities for persons under 22 years of age serving clinically complex residents previously classified as care facilities for persons with a developmental disability under this Article, the Department shall refund an…

(305 ILCS 5/5C-2) (from Ch. 23, par. 5C-2) Sec. 5C-2. Assessment; no local authorization to tax. (a) For the privilege of engaging in the occupation of care provider for persons with a developmental disability, an assessment is imposed upon each care provider for persons with a d…

(305 ILCS 5/5C-3) (from Ch. 23, par. 5C-3) Sec. 5C-3. Payment of assessment; penalty. (a) The assessment imposed by Section 5C-2 for a State fiscal year shall be due and payable in quarterly installments, each equalling one-fourth of the assessment for the year, on September 30, …

(305 ILCS 5/5C-4) (from Ch. 23, par. 5C-4) Sec. 5C-4. Reporting; penalty; maintenance of records. (a) After June 30 of each State fiscal year, and on or before September 30 of the succeeding State fiscal year, every care provider for persons with a developmental disability subjec…

(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 5/5F-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 nursing component per diem along with any add-ons for enhanced care services, support component per diem, and capital component per diem …

(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 5/5J-1) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-1. References to Article. This Article may be referred to as the Distressed Hospital Loan Program Law. (Source: P.A. 104-4…

(305 ILCS 5/5J-10) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-10. Definitions. As used in this Article: "Closed hospital" means a hospital that closed after January 1, 2019. "Departme…

(305 ILCS 5/5J-15) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-15. Administration. The Department shall administer the Distressed Hospital Loan Program in coordination with the Departm…

(305 ILCS 5/5J-18) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-18. Application requirements. A hospital applying for aid under this Program shall provide the Department with financial …

(305 ILCS 5/5J-20) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-20. Application evaluation. (a) In collaboration with the Governor's Office of Management and Budget and the Department o…

(305 ILCS 5/5J-25) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-25. Repayment agreement. (a) A hospital shall be required to enter into a repayment agreement with the Department to exec…

(305 ILCS 5/5J-30) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-30. Distressed Hospital Loan Program Fund. (a) The Distressed Hospital Loan Program Fund is created as a special fund in …

(305 ILCS 5/5J-35) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-35. Implementation. The Program described in this Article shall be operative on and after January 1, 2027 and shall be im…

(305 ILCS 5/5J-40) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-40. Repealer. This Article is repealed on June 30, 2033. (Source: P.A. 104-470, eff. 1-1-27.)

(305 ILCS 5/5J-5) (This Section may contain text from a Public Act with a delayed effective date) (Section scheduled to be repealed on June 30, 2033) Sec. 5J-5. Distressed Hospital Loan Program. The Distressed Hospital Loan Program is created. The purpose of the Program is to pro…

(305 ILCS 20/6) (from Ch. 111 2/3, par. 1406) Sec. 6. Eligibility, conditions of participation, and energy assistance. (a) Any person who is a resident of the State of Illinois and whose household income is not greater than an amount determined annually by the Department, in cons…

(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 5/6-1.2) (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…