Illinois 2023-2024 Regular Session

Illinois House Bill HB4076 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4076 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED: 305 ILCS 5/11-5.3a new Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application. LRB103 32309 KTG 61622 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4076 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED: 305 ILCS 5/11-5.3a new 305 ILCS 5/11-5.3a new Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application. LRB103 32309 KTG 61622 b LRB103 32309 KTG 61622 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4076 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/11-5.3a new 305 ILCS 5/11-5.3a new
4	4	305 ILCS 5/11-5.3a new
5	5	Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.
6	6	LRB103 32309 KTG 61622 b LRB103 32309 KTG 61622 b
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8	8	A BILL FOR
9	9	HB4076LRB103 32309 KTG 61622 b HB4076 LRB103 32309 KTG 61622 b
10	10	HB4076 LRB103 32309 KTG 61622 b
11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 adding Section 11-5.3a as follows:
16	16	6 (305 ILCS 5/11-5.3a new)
17	17	7 Sec. 11-5.3a. Business Enterprise Program certified vendor
18	18	8 for redetermination system.
19	19	9 (a) The General Assembly finds that there is a real and
20	20	10 current need for automation of the process of determination,
21	21	11 redetermination (generally "determination"), certification,
22	22	12 or recertification of entry into any type of regulated program
23	23	13 while also providing for an automatic system of facilitating
24	24	14 the determination process where recalcitrance or reticence is
25	25	15 detected. Further, there is a need for a system that includes
26	26	16 finding, informing, recruiting, and securing an individual's
27	27	17 participation in programs such as the medical assistance
28	28	18 program under Article V to the benefit of the individual.
29	29	19 (b) The Department of Innovation and Technology, in
30	30	20 conjunction with the Department of Healthcare and Family
31	31	21 Services, shall select a State vendor to redetermine the
32	32	22 eligibility of medical assistance enrollees not covered by the
33	33	23 federal waivers provided under Section 1902(e)(14)(A) of the
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4076 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/11-5.3a new 305 ILCS 5/11-5.3a new
39	39	305 ILCS 5/11-5.3a new
40	40	Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.
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43	43	A BILL FOR
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68	68	1 Social Security Act. The selected vendor must be certified by
69	69	2 the Business Enterprise Program and have no less than 60% of
70	70	3 its owners with established residency in Illinois as of the
71	71	4 effective date of this amendatory Act of the 103rd General
72	72	5 Assembly. The selected vendor shall conduct redeterminations
73	73	6 utilizing a system that meets the following requirements:
74	74	7 (1) The redetermination system must be hosted on a
75	75	8 cloud-based platform that is secure and compliant with
76	76	9 standards under the federal Health Insurance Portability
77	77	10 and Accountability Act of 1996.
78	78	11 (2) The redetermination system must also use a cloud
79	79	12 communication platform to programmatically perform calls,
80	80	13 text messages, and other communication functions using web
81	81	14 services or application programming interface services.
82	82	15 (3) The redetermination system must be able to make
83	83	16 contact with a medical assistance enrollee in an automated
84	84	17 fashion, using the last known contact information to
85	85	18 contact the medical assistance enrollee, and if the
86	86	19 redetermination contact process is advised that contact
87	87	20 was not made, the process must use public and private
88	88	21 databases to find and test newly found contact information
89	89	22 until the medical assistance enrollee is reached and
90	90	23 redetermination is started, or the medical assistance
91	91	24 enrollee opts out of the redetermination contact process.
92	92	25 The redetermination system must be designed to continue
93	93	26 until contact is made and confirmed and contact
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104	104	1 information is updated to facilitate the following year's
105	105	2 redetermination contact process. A relentless search to
106	106	3 find medical assistance enrollees and complete the
107	107	4 redetermination process must be made, such that no
108	108	5 eligible medical assistance enrollee or applicant is left
109	109	6 behind.
110	110	7 (4) The redetermination system must also have the
111	111	8 ability to reward a medical assistance enrollee who
112	112	9 successfully completes the redetermination process, such
113	113	10 as with a gift card or other rewards that can be provided
114	114	11 to the medical assistance enrollee when the process is
115	115	12 completed. The amount of the gift card may be conditioned
116	116	13 on the responsiveness of the medical assistance enrollee
117	117	14 or dependent on other factors such as age, living
118	118	15 conditions, or abode as well as other factors or criteria.
119	119	16 (5) The redetermination system must have the ability
120	120	17 to simplify and greatly facilitate medical assistance
121	121	18 enrollees to engage in the redetermination process and
122	122	19 easily enter, update, and transmit their required
123	123	20 information and data by being able to go from using a voice
124	124	21 virtual agent or text virtual agent to an online web form
125	125	22 and back to a human assistant seamlessly and without
126	126	23 losing any data input.
127	127	24 (6) The redetermination system must allow the medical
128	128	25 assistance enrollee to start the process through one of
129	129	26 the means available, stop at some point, and then resume
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140	140	1 using the same means or transferring the process to
141	141	2 another means available through the system without missing
142	142	3 a beat.
143	143	4 (7) The redetermination system must allow the medical
144	144	5 assistance enrollee to switch between the voice virtual
145	145	6 agent (using artificial intelligence), the text virtual
146	146	7 agent, and an online web form.
147	147	8 (8) The redetermination system must also perform the
148	148	9 function of pre-populating forms with the information
149	149	10 confirmed by the medical assistance enrollee, which can be
150	150	11 uploaded during the redetermination process as the medical
151	151	12 assistance enrollee proceeds through the data fields so as
152	152	13 to confirm or update the medical assistance recipient's
153	153	14 information.
154	154	15 (9) The redetermination system must be designed to be
155	155	16 compliant with the Americans with Disabilities Act (ADA).
156	156	17 ADA compliance must be found regardless of which of the
157	157	18 different ways a medical assistance enrollee enters the
158	158	19 data, and then, any of the other means to which the medical
159	159	20 assistance enrollee can switch, continues to be ADA
160	160	21 compliant regardless of the stage of the redetermination
161	161	22 process that the enrollee is in and regardless of the
162	162	23 number of transitions from one data entry means to
163	163	24 another.
164	164	25 (10) The redetermination system must provide an
165	165	26 out-of-the-box analytics dashboard that is tethered to the
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176	176	1 cloud-based system with no additional software
177	177	2 installation on the user's computer or mobile devices.
178	178	3 (11) The redetermination system must allow for a
179	179	4 scouring of the laws, rules, and regulations to review any
180	180	5 changes to the medical assistance program and institute
181	181	6 those changes in the questionnaires and forms utilized to
182	182	7 assess the candidate and enroll the applicant.
183	183	8 (12) Using the redetermination system shall not be
184	184	9 considered "assistance" but rather a different modality of
185	185	10 applying for redetermination.
186	186	11 (13) The redetermination system must have a cloud data
187	187	12 processing platform to accumulate enrollee data to begin
188	188	13 the process in an automated fashion. This includes data
189	189	14 validation, rejection, and preparation for communication
190	190	15 such as call or text.
191	191	16 (14) The redetermination system must have a cloud data
192	192	17 processing platform to be able to provide data submitted
193	193	18 by medical assistance enrollees to managed care
194	194	19 organizations at a predefined frequency, such as daily,
195	195	20 weekly, or monthly.
196	196	21 (c) All vendors applying for consideration as the State
197	197	22 vendor to conduct medical assistance eligibility
198	198	23 redeterminations as provided in subsection (b) shall submit a
199	199	24 letter of intent to the Department of Innovation and
200	200	25 Technology in a form and manner required by the Department of
201	201	26 Innovation and Technology. The Department of Innovation and
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212	212	1 Technology shall allow 7 days for a letter of intent and shall
213	213	2 issue a grant award to the selected vendor within 2 weeks after
214	214	3 the end of the 7-day period. To qualify for a grant award under
215	215	4 this Section, the selected vendor must already have all
216	216	5 contracts in place with any relevant subvendors no later than
217	217	6 5 business days after the effective date of this amendatory
218	218	7 Act of the 103rd General Assembly.
219	219	8 (d) Nothing in this amendatory Act of the 103rd General
220	220	9 Assembly shall be construed to contravene any federal
221	221	10 regulation, policy, or requirement of the Centers for Medicare
222	222	11 and Medicaid Services. If any provision of this amendatory Act
223	223	12 of the 103rd General Assembly or its application is found to be
224	224	13 in violation of any federal regulation, policy, or requirement
225	225	14 of the Centers for Medicare and Medicaid Services, that
226	226	15 provision is declared invalid but does not affect any other
227	227	16 provision or application of this amendatory Act that can be
228	228	17 given effect without the invalid provision or application. The
229	229	18 provisions of this amendatory Act of the 103rd General
230	230	19 Assembly are declared to be severable.
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