HB5641 97TH GENERAL ASSEMBLY

LRB097 19117 KTG 64358 b

97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5641

Introduced 2/15/2012, by Rep. Patricia R. Bellock

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-1.2a new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish, within 6 months after the effective date of the amendatory Act, uniform procedures to identify, investigate, and resolve potential cases of fraud, misrepresentation, or inadequate documentation prior to determining an applicant's eligibility for medical assistance under the Code. Requires the Department to establish a computerized income eligibility verification system in order to verify eligibility, eliminate duplication of assistance, and deter fraud. Provides that prior to awarding medical assistance or continuing such assistance, the Department shall match the social security number of each applicant and recipient against unearned income information maintained by the Internal Revenue Service; employer quarterly reports of income and unemployment insurance payment information maintained by the Department of Employment Security; immigration status information maintained by the U.S. Citizenship and Immigration Services; and other State and federal informational databases. Contains provisions concerning the procedures the Department shall follow when discovering a discrepancy between an applicant's or recipient's social security number and information contained in specified databases. Contains provisions concerning reporting requirements and third-party entities contracted to review or to provide information to facilitate the review of eligibility criteria for individuals enrolled in the medical assistance program prior to the effective date of the amendatory Act. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

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 adding Section 5-1.2a as follows:

(305 ILCS 5/5-1.2a new)

Sec. 5-1.2a. Fraud detection system.

(a) Definitions. As used in this Section:

"Discrepancy" means information regarding the assets, income, resources, or status of an applicant or recipient of assistance under this Article, derived from one or more of the databases or information tools listed under paragraph (1) of subsection (c) of this Section, which gives the Department grounds to suspect that either:

(i) an applicant or recipient is ineligible to receive assistance under federal or State law; or

(ii) the assets, income, or resources of an applicant or recipient are at least, in terms of a dollar amount, 10% greater than the dollar amount reflected in the information the Department possesses about the applicant or recipient with respect to the applicant's or recipient's assets, income, or resources.

"Status" means the applicant or recipient is in the United States illegally, is no longer living, is an inmate in a prison or jail, or is a fleeing felon.

(b) Uniform procedures. Within 6 months after the effective date of this amendatory Act of the 97th General Assembly, the Department shall establish uniform procedures to identify, investigate, and resolve potential cases of fraud, misrepresentation, or inadequate documentation prior to determining an applicant's eligibility for assistance under this Article. The procedures shall ensure that every case is reviewed. Each review shall include utilization of the income eligibility verification system established in subsection (c).

(c) Income eligibility verification system.

(1) The Department shall establish a computerized income eligibility verification system in order to verify eligibility, eliminate duplication of assistance, and deter fraud. Prior to awarding assistance under this Article or continuing such assistance under this Article, the Department shall match the social security number of each applicant and recipient against the following:

(A) Unearned income information maintained by the Internal Revenue Service.

(B) Employer quarterly reports of income and unemployment insurance payment information maintained by the Department of Employment Security.

(C) Earned income information maintained by the Social Security Administration.

(D) Immigration status information maintained by the U.S. Citizenship and Immigration Services.

(E) Death register information maintained by the Social Security Administration.

(F) Prisoner information maintained by the Social Security Administration.

(G) Public housing and Section 8 Housing Assistance payment information maintained by the Department of Housing and Urban Development.

(H) National fleeing felon information maintained by the Federal Bureau of Investigation.

(I) Wage reporting and similar information maintained by states contiguous to this State.

(J) Beneficiary records and earnings information maintained by the Social Security Administration in its Beneficiary and Earnings Data Exchange (BENDEX) database.

(K) Earnings and pension information maintained by the Social Security Administration in its Beneficiary Earnings Exchange Record System (BEERS) database.

(L) Employment information maintained by the Department of Employment Security in its New Hire Directory database.

(M) Employment information maintained by the U.S. Department of Health and Human Services in its National Directory of New Hires database.

(N) Supplemental Security Income information maintained by the Social Security Administration in its SSI State Data Exchange (SDX) database.

(O) Veterans' benefits information maintained by the U.S. Department of Health and Human Services, in coordination with the Department of Human Services and the Department of Veterans' Affairs, in the federal Public Assistance Reporting Information System (PARIS) database.

(P) Child care services information maintained by the Department of Human Services under its Child Care Assistance Program.

(Q) Utility payments information maintained by the Department of Commerce and Economic Opportunity under the Low Income Home Energy Assistance Program.

(R) A database which is substantially similar to or a successor of a database established in this subsection.

(S) The database of all persons who currently hold a license, permit, or certificate from a State agency the cost of which exceeds $1,000.

(2) If a discrepancy results between an applicant's or recipient's social security number and one or more of the databases or information tools listed under paragraph (1), the Department shall review the applicant's or recipient's case using the following procedures:

(A) If the information discovered under paragraph (1) does not result in the Department finding the applicant or recipient ineligible for assistance under this Article, the Department shall take no further action.

(B) If the information discovered under paragraph (1) results in the Department finding the applicant or recipient ineligible for assistance under this Article, the applicant or recipient shall be given an opportunity to explain the discrepancy. The Department shall provide written notice to the applicant or recipient which shall describe in sufficient detail the circumstances of the discrepancy, the manner in which the applicant or recipient may respond, and the consequences of failing to take action. The applicant or recipient shall have 10 business days to respond in an attempt to resolve the discrepancy. The explanation provided by the recipient or applicant shall be given in writing. After receiving the explanation, the Department may request additional documentation if it determines that there is a substantial risk of fraud.

(C) If the applicant or recipient does not respond to the notice, the Department shall deny assistance for failure to cooperate, in which case the Department shall provide notice of intent to discontinue assistance. Eligibility for assistance shall not be reestablished until the significant discrepancy has been resolved.

(D) If an applicant or recipient responds to the notice and disagrees with the findings of the match between his or her social security number and one or more databases or information tools listed under paragraph (1), the Department shall reinvestigate the matter. If the Department finds that there has been an error, the Department shall take immediate action to correct it and no further action shall be taken. If, after an investigation, the Department determines that there is no error, the Department shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the Department's action shall be given to the applicant or recipient.

(E) If the applicant or recipient agrees with the findings of the match between the applicant's or recipient's social security number and one or more databases or information tools listed under paragraph (1), the Department shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the Department's action shall be given to the applicant or recipient.

(3) In no case shall the Department discontinue medical assistance coverage as a result of a match between the applicant's or recipient's social security number and one or more databases or information tools listed under paragraph (1) until the applicant or recipient has been given notice of the discrepancy and the opportunity to respond.

(4) No later than one year after the effective date of this amendatory Act of the 97th General Assembly, and every year thereafter, the Department shall provide a written report to the General Assembly detailing the results achieved under this Section and the number of case closures and the amount of savings that resulted.

(d) The Department shall be authorized to use the computerized income eligibility verification system established under subsection (c) to review eligibility criteria for individuals enrolled for coverage under the medical assistance program prior to the effective date of this amendatory Act of the 97th General Assembly. The Department may also contract with third-party entities to perform the review of such enrollees as authorized under this subsection or to provide information to facilitate such reviews.

(e) The Department shall promulgate any rules necessary to implement this Section.

Section 99. Effective date. This Act takes effect upon becoming law.