HB2765 98TH GENERAL ASSEMBLY

LRB098 03998 KTG 34931 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB2765

Introduced 2/21/2013, by Rep. Jerry F. Costello, II

SYNOPSIS AS INTRODUCED:

20 ILCS 105/4.03	from Ch. 23, par. 6104.03
305 ILCS 5/5-4	from Ch. 23, par. 5-4

Amends the Illinois Act on the Aging. In regard to a nursing home prescreening program administered by the Department on Aging for individuals with Alzheimer's Disease and related disorders, provides that case coordination units shall employ pre-screeners to perform all functions assigned to case coordination units under the Act and that in addition to information needed to properly assess an individual's need for services, the pre-screener shall be responsible for soliciting asset, income, and resource information needed to comply with federal spousal impoverishment requirements. Requires the pre-screener to (i) inform the individual and the individual's spouse, if any, of the consequences of failing to comply with full disclosure and (ii) enter asset, income, and resource information into the same database used to enter the Determination of Need score to ensure that the Department of Human Services and the Department of Healthcare and Family Services have open access to such information. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that subject to federal approval, the community spouse resource allowance shall be established and maintained, based on asset, income, and resource information collected by a pre-screener, at the higher of $109,560 or the minimum level permitted pursuant to certain federal guidelines, as now or hereafter amended, or an amount set after a fair hearing, whichever is greater (rather than the community spouse resource allowance shall be established and maintained at the higher of $109,560 or the minimum level permitted pursuant to certain federal guidelines, as now or hereafter amended, or an amount set after a fair hearing, whichever is greater). 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 Act on the Aging is amended by changing Section 4.03 as follows:

(20 ILCS 105/4.03) (from Ch. 23, par. 6104.03)

Sec. 4.03. The Department on Aging, in cooperation with the Department of Human Services and any other appropriate State, local or federal agency, shall, without regard to income guidelines, establish a nursing home prescreening program to determine whether Alzheimer's Disease and related disorders victims, and persons who are deemed as blind or disabled as defined by the Social Security Act and who are in need of long term care, may be satisfactorily cared for in their homes through the use of home and community based services. Responsibility for prescreening shall be vested with case coordination units which shall employ pre-screeners to perform all functions assigned to case coordination units under this Act. Prescreening shall occur: (i) when hospital discharge planners have advised the case coordination unit of the imminent risk of nursing home placement of a patient who meets the above criteria and in advance of discharge of the patient; or (ii) when a case coordination unit has been advised of the imminent risk of nursing home placement of an individual in the community. The individual who is prescreened shall be informed of all appropriate options, including placement in a nursing home and the availability of in-home and community-based services and shall be advised of her or his right to refuse nursing home, in-home, community-based, or all services. Case coordination units under contract with the Department may charge a fee for the prescreening provided under this Section and the fee shall be no greater than the cost of such services to the case coordination unit. At the time of each prescreening, case coordination units shall provide information regarding the Office of State Long Term Care Ombudsman's Residents Right to Know database as authorized in subsection (c-5) of Section 4.04. In addition to information needed to properly assess an individual's need for services, the pre-screener shall be responsible for soliciting asset, income, and resource information needed to comply with the spousal impoverishment requirements of Title XIX of the federal Social Security Act and the regulations duly promulgated thereunder. The pre-screener shall inform the individual and the individual's spouse, if any, of the consequences of failing to comply with full disclosure. The pre-screener shall enter asset, income, and resource information into the same database used to enter the Determination of Need score to ensure that the Department of Human Services and the Department of Healthcare and Family Services have open access to such information.

(Source: P.A. 95-80, eff. 8-13-07; 95-823, eff. 1-1-09; 96-328, eff. 8-11-09.)

Section 10. The Illinois Public Aid Code is amended by changing Section 5-4 as follows:

(305 ILCS 5/5-4) (from Ch. 23, par. 5-4)

Sec. 5-4. Amount and nature of medical assistance.

(a) The amount and nature of medical assistance shall be determined in accordance with the standards, rules, and regulations of the Department of Healthcare and Family Services, with due regard to the requirements and conditions in each case, including contributions available from legally responsible relatives. However, the amount and nature of such medical assistance shall not be affected by the payment of any grant under the Senior Citizens and Disabled Persons Property Tax Relief Act or any distributions or items of income described under subparagraph (X) of paragraph (2) of subsection (a) of Section 203 of the Illinois Income Tax Act. The amount and nature of medical assistance shall not be affected by the receipt of donations or benefits from fundraisers in cases of serious illness, as long as neither the person nor members of the person's family have actual control over the donations or benefits or the disbursement of the donations or benefits.

In determining the income and resources available to the institutionalized spouse and to the community spouse, the Department of Healthcare and Family Services shall follow the procedures established by federal law. If an institutionalized spouse or community spouse refuses to comply with the requirements of Title XIX of the federal Social Security Act and the regulations duly promulgated thereunder by failing to provide the total value of assets, including income and resources, to the extent either the institutionalized spouse or community spouse has an ownership interest in them pursuant to 42 U.S.C. 1396r-5, after being advised of the consequences of refusal pursuant to Section 4.03 of the Illinois Act on the Aging, such refusal may result in the institutionalized spouse being denied eligibility and continuing to remain ineligible for the medical assistance program based on failure to cooperate.

Subject to federal approval, the community spouse resource allowance shall be established and maintained, based on asset, income, and resource information collected by a pre-screener authorized by Section 4.03 of the Illinois Act on the Aging, at the higher of $109,560 or the minimum level permitted pursuant to Section 1924(f)(2) of the Social Security Act, as now or hereafter amended, or an amount set after a fair hearing, whichever is greater. The monthly maintenance allowance for the community spouse shall be established and maintained at the higher of $2,739 per month or the minimum level permitted pursuant to Section 1924(d)(3)(C) of the Social Security Act, as now or hereafter amended, or an amount set after a fair hearing, whichever is greater. Subject to the approval of the Secretary of the United States Department of Health and Human Services, the provisions of this Section shall be extended to persons who but for the provision of home or community-based services under Section 4.02 of the Illinois Act on the Aging, would require the level of care provided in an institution, as is provided for in federal law.

(b) Spousal support for institutionalized spouses receiving medical assistance.

(i) The Department may seek support for an institutionalized spouse, who has assigned his or her right of support from his or her spouse to the State, from the resources and income available to the community spouse.

(ii) The Department may bring an action in the circuit court to establish support orders or itself establish administrative support orders by any means and procedures authorized in this Code, as applicable, except that the standard and regulations for determining ability to support in Section 10-3 shall not limit the amount of support that may be ordered.

(iii) Proceedings may be initiated to obtain support, or for the recovery of aid granted during the period such support was not provided, or both, for the obtainment of support and the recovery of the aid provided. Proceedings for the recovery of aid may be taken separately or they may be consolidated with actions to obtain support. Such proceedings may be brought in the name of the person or persons requiring support or may be brought in the name of the Department, as the case requires.

(iv) The orders for the payment of moneys for the support of the person shall be just and equitable and may direct payment thereof for such period or periods of time as the circumstances require, including support for a period before the date the order for support is entered. In no event shall the orders reduce the community spouse resource allowance below the level established in subsection (a) of this Section or an amount set after a fair hearing, whichever is greater, or reduce the monthly maintenance allowance for the community spouse below the level permitted pursuant to subsection (a) of this Section.

(Source: P.A. 97-689, eff. 6-14-12.)

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