305 ILCS 5/5-1.2
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-1.2. Recipient eligibility verification.(a) The Illinois Department shall initiate a statewide system by which  providers and sites of medical care can electronically verify recipient  eligibility for aid under this Article.  High-volume providers and sites of medical care, as defined by the Illinois  Department by rule, shall be required to participate in the eligibility  verification system.  Every non-high-volume provider and site of medical  care shall be afforded the opportunity to participate in the eligibility  verification system.  The Illinois Department shall provide by rule for  implementation of the system, which may be accomplished in phases over time and  by geographic region, recipient classification, and provider type.  The system shall initially be implemented in, but not limited to, the  following zip codes in Cook County: 60601, 60602, 60603, 60604, 60605, 60606,  60607, 60608, 60609, 60612, and 60616.  The system shall be implemented within  6  months after approval by the federal government.  The Illinois Department shall  report to the General Assembly by December 31, 1994 on the status of the  Illinois Department's application to the federal government for approval of  this system.  The recipient eligibility verification system may be coordinated with the  Electronic Benefits Transfer system established by Section 11-3.1 of this Code  and compatible with any of the methods for the delivery of medical care and  services authorized by this Article.  The system shall make available to providers the history of claims for  medical services submitted to the Illinois Department for those services  provided to the recipient.  The Illinois Department shall develop safeguards to  protect each recipient's health information from misuse or unauthorized  disclosure.(b) The Illinois Department shall conduct a demonstration project in at  least 2 geographic locations for the purpose of assessing the effectiveness of  a recipient photo identification card in reducing abuses in the provision of  services under this Article.  In order to receive medical care, recipients  included in this demonstration project must present a Medicaid card and photo  identification card.  The Illinois Department shall apply for any federal  waivers or approvals necessary to conduct this demonstration project.  The  demonstration project shall become operational (i) 12 months after the  effective  date of this amendatory Act of 1994 or (ii) after the Illinois Department's  receipt  of all necessary federal waivers and approvals, whichever occurs later, and  shall operate for 12 months.(c)  Effective October 1, 2007, all changes in status of Medicaid recipients  residing in Illinois nursing facilities after initial eligibility for  Medicaid has been established shall be reported to the Department, using an  Internet-based electronic data interchange system, by the nursing facilities,  except for those changes made by personnel of the Department.  Changes reported  using the Internet-based electronic data interchange system shall be deemed  valid and shall be used as the basis for future Medicaid payments unless  Department approval of the transaction is required, or until such time as  any review or audit conducted by the State establishes that the  information is incorrect.       (Source: P.A. 95-458, eff. 8-27-07.)