reglab/housing_qa huggingface dataset:
305 ILCS 5/5-30.10
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30.10. Electronic report submission. To preserve the quality of data and ensure productive oversight of Medicaid managed care organizations, all regular reports required, either by contract or statute, to be collected by the Department from managed care organizations shall be collected through a secure electronic format and medium as designated by the Department. The Department shall consider concerns raised by the contractor about potential burdens associated with producing the report. Ad hoc reports may be collected in alternative manners.  (Source: P.A. 100-1105, eff. 8-27-18; 101-81, eff. 7-12-19.)
305 ILCS 5/5-30.11
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30.11. Treatment of autism spectrum disorder. Treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program under this Article for children with a diagnosis of autism spectrum disorder when ordered by a physician licensed to practice medicine in all its branches and rendered by a licensed or certified health care professional with expertise in applied behavior analysis. Such coverage may be limited to age ranges based on evidence-based best practices. Appropriate State plan amendments as well as rules regarding provision of services and providers will be submitted by September 1, 2019.  (Source: P.A. 101-10, eff. 6-5-19; 102-558, eff. 8-20-21.)
305 ILCS 5/5-30.12
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30.12. Managed care claim rejection and denial management.(a) In order to provide greater transparency to managed care organizations (MCOs) and providers, the Department shall explore the availability of and, if reasonably available, procure technology that, for all electronic claims, with the exception of direct data entry claims, meets the following needs:(1) The technology shall allow the Department to     fully analyze the root cause of claims denials in the Medicaid managed care programs operated by the Department and expedite solutions that reduce the number of denials to the extent possible.(2) The technology shall create a single electronic     pipeline through which all claims from all providers submitted for adjudication by the Department or a managed care organization under contract with the Department shall be directed by clearing houses and providers or other claims submitting entities not using clearing houses prior to forwarding to the Department or the appropriate managed care organization.(3) The technology shall cause all HIPAA-compliant     responses to submitted claims, including rejections, denials, and payments, returned to the submitting provider to pass through the established single pipeline.(4) The technology shall give the Department the     ability to create edits to be placed at the front end of the pipeline that will reject claims back to the submitting provider with an explanation of why the claim cannot be properly adjudicated by the payer.(5) The technology shall allow the Department to     customize the language used to explain why a claim is being rejected and how the claim can be corrected for adjudication.(6) The technology shall send copies of all claims     and claim responses that pass through the pipeline, regardless of the payer to whom they are directed, to the Department's Enterprise Data Warehouse.(b) If the Department chooses to implement front end edits or customized responses to claims submissions, the MCOs and other stakeholders shall be consulted prior to implementation and providers shall be notified of edits at least 30 days prior to their effective date.(c) Neither the technology nor MCO policy shall require providers to submit claims through a process other than the pipeline.  MCOs may request supplemental information needed for adjudication which cannot be contained in the claim file to be submitted separately to the MCOs.(d) The technology shall allow the Department to fully analyze and report on MCO claims processing and payment performance by provider type.   (Source: P.A. 101-209, eff. 8-5-19.)
305 ILCS 5/5-30.13
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30.13. Managed care reports; minority-owned and women-owned businesses. Each Medicaid managed care health plan shall submit a report to the Department by March 1, 2020, and every March 1 thereafter, that includes the following information:(1) The administrative expenses paid to the Medicaid     managed care health plan.(2) The amount of  money the Medicaid managed care     health plan has spent with Business Enterprise Program certified businesses.(3) The amount of  money the Medicaid managed care     health plan has spent with minority-owned and women-owned businesses that are certified by other agencies or private organizations.(4) The amount of  money the Medicaid managed care     health plan has spent with not-for-profit community-based organizations serving predominantly minority communities, as defined by the Department.(5) The proportion of minorities, people with     disabilities, and women that make up the staff of the Medicaid managed care health plan.(6) Recommendations for increasing expenditures with     minority-owned and women-owned businesses.(7) A list of the types of services to which the     Medicaid managed care health plan is contemplating adding new vendors.(8) The certifications the Medicaid managed care     health plan accepts for minority-owned and women-owned businesses.(9) The point of contact for potential vendors     seeking to do business with the Medicaid managed care health plan.The Department shall publish the reports on its website and shall maintain each report on its website for 5 years. In May of 2020 and every May thereafter, the Department shall hold 2 annual public workshops, one in Chicago and one in Springfield. The workshops shall include each Medicaid managed care health plan and shall be open to vendor communities to discuss the submitted plans and to seek to connect vendors with the Medicaid managed care health plans.  (Source: P.A. 101-209, eff. 8-5-19; 102-558, eff. 8-20-21.)
305 ILCS 5/5-30a
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30a. Exemptions from managed care enrollment; children. Notwithstanding any other provision of law, the Department shall not require any of the following children to enroll in or transition to the State's managed care medical assistance program:(1) Children who are authorized by the Department to     receive in-home shift nursing services as required by the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions under 42 CFR 441.50 et seq.(2) Children made eligible for medical assistance     through any home and community-based services waiver program for medically fragile and technology dependent children authorized under Section 1915(c) of the Social Security Act.Any children who meet the criteria under paragraph (1) or (2) and who are enrolled in the State's managed care medical assistance program on or before the effective date of this amendatory Act of the 100th General Assembly shall be given the option to disenroll from the State's managed care medical assistance program and receive medical assistance coverage under the State's traditional fee-for-service program.   (Source: P.A. 100-990, eff. 1-1-19.)
305 ILCS 5/5-30b
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-30b. Exemptions from managed care; ground ambulance services.  Notwithstanding any other provision of law, beginning on the effective date of this amendatory Act of the 102nd General Assembly, the Department shall exempt ground ambulance services as described in subsections (c-1) and (c-2) of Section 5-4.2. These services shall continue to be paid under the State's traditional fee-for-service program.  (Source: P.A. 102-661, eff. 1-1-22.)
305 ILCS 5/5-31
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-31. Medicaid Research and Education Support Fund.(a) There is created in the State treasury the Medicaid Research and Education Support Fund. Interest earned by the Fund shall be credited to the Fund. The Fund shall not be used to replace any moneys appropriated to the Medicaid program by the General Assembly.(b) The Fund is created for the purpose of receiving moneys, donations, and grants from private and public colleges and universities and disbursing moneys only for the following purposes, notwithstanding any other provision of law, for making payments to hospitals as required under Section 5-32  of this Code and any amounts which are reimbursable to the federal government for payments from this Fund which are required to be paid by State warrant.Disbursements from the Fund shall be by warrants drawn by the State Comptroller upon receipt of vouchers duly executed and certified by the Illinois Department.(c) The Fund shall consist of the following:(1) All moneys collected or received by the Illinois      Department from donations and grants from private and public colleges and universities.(2) All federal matching funds received by the     Illinois Department as a result of expenditures made by the Illinois Department that are attributable to moneys deposited in the Fund.(3) Any interest or penalty levied in conjunction     with the administration of this Section.(4) Moneys transferred from another fund in the State     treasury.(5) All other moneys received for the Fund from any     other source, including interest earned thereon.(d) Interfund transfers from the Medicaid Research and Education Support Fund are prohibited.   (Source: P.A. 98-104, eff. 7-22-13.)
305 ILCS 5/5-32
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-32. Medicaid research and education enhancement payments.(a) The Department shall make Medicaid enhancement payments to Tier I and Tier II academic medical centers as defined in Section 5-5e.2 of this Code identified as primary affiliates by any university or college that makes a donation to the Medicaid Research and Education Support Fund.(b) By April 30 of each year, a university or college that intends to make a donation to the Medicaid Research and Education Support Fund for the upcoming State fiscal year must notify the Department of this intent and identify a primary Tier I or Tier II academic medical center as defined in Section 5-5e.2 of this Code.(c) Only Tier I and Tier II academic medical centers as defined in Section 5-5e.2 of this Code identified by a university or college as required under subsection (b) of this Section are eligible to receive payments under this Section.(d) Reimbursement methodology. The Department shall develop a reimbursement methodology consistent with this Section for distribution of moneys from the funds in a manner that would allow distributions from these funds to be matchable under Title XIX of the Social Security Act. The Department may enhance payment rates to any combination of Medicaid inpatient or outpatient Medicaid services. The Department may enhance Medicaid physician services for physicians employed by Tier I or Tier II academic medical centers as defined in Section 5-5e.2 of this Code qualified to receive payment under this Section if the Department and the Tier I or Tier II academic medical centers as defined in Section 5-5e.2 of this Code agree prior to the start of the State fiscal year for which payments are made. The Department shall promulgate rules necessary to make these distributions matchable.(e) The Department of Healthcare and Family Services must submit a State Medicaid Plan Amendment to the Centers for Medicare and Medicaid Services to implement the payments under this Section within 60 days of the effective date of this amendatory Act of the 98th General Assembly.(f) Reimbursements or payments by the State. Nothing in this Section may be used to reduce reimbursements or payments by the State to a hospital under any other Act.   (Source: P.A. 98-104, eff. 7-22-13.)
305 ILCS 5/5-33
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-33. (Repealed).   (Source: P.A. 98-674, eff. 6-30-14. Repealed internally, eff. 1-1-16.)
305 ILCS 5/5-34
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-34. (Repealed).   (Source: P.A. 98-674, eff. 6-30-14. Repealed internally, eff. 1-1-16.)
305 ILCS 5/5-35
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec.  5-35. Personal needs allowance.  For a  person who is a resident in a facility licensed under the ID/DD Community Care Act, the Community-Integrated Living Arrangements Licensure  and Certification Act, the Specialized Mental Health Rehabilitation Act of 2013, or the MC/DD Act for whom payments are made under this Article throughout a month and who is determined to be eligible for medical assistance under this Article, the State shall pay an amount in addition to the minimum monthly personal needs allowance authorized under Section 1902(q) of Title XIX of the Social Security Act (42 U.S.C. 1396(q)) so that the person's total monthly personal needs allowance from both State and federal sources equals $60.  (Source: P.A. 100-23, eff. 7-6-17.)
305 ILCS 5/5-36.1
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-36.1. Earned income for residents of community-integrated living arrangements.(a) Beginning no later than July 1, 2021, residents of facilities licensed under the Community-Integrated Living Arrangements Licensure and Certification Act who are determined to be eligible for medical assistance under this Code and who are enrolled in the State's home and community-based services waiver program for adults with developmental disabilities shall retain all earned income from employment or community day services activities.(b)   No portion of earned income shall be applied toward the facilities rate reimbursement methodology. The Department of Human Services shall ensure the rates of payments paid to facilities under the Code are held harmless.  (Source: P.A. 102-343, eff. 8-13-21.)
305 ILCS 5/5-36.5
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-36.5. Education on mental health and substance use treatment services for children and young adults.  The Department of Healthcare and Family Services shall develop a layman's guide to the mental health and substance use treatment services available in Illinois through the Medical Assistance Program and through the Family Support Program, or other publicly funded programs, similar to what Massachusetts developed, to help families understand what services are available to them when they have a child in need of treatment or support.  The guide shall be in easy-to-understand language, be prominently available on the Department of Healthcare and Family Services' website, and be part of a statewide communications campaign to ensure families are aware of  Family Support Program services.  It shall briefly explain the service and whether it is covered by the Medical Assistance Program, the Family Support Program, or any other public funding source.  Within one year after January 1, 2020 (the effective date of Public Act 101-461), the Department of Healthcare and Family Services shall complete this guide, have it available on its website, and launch the communications campaign.  (Source: P.A. 101-461, eff. 1-1-20; 102-558, eff. 8-20-21.)
305 ILCS 5/5-38
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-38. Alignment of children's mental health treatment systems.  The Governor's Office shall establish, convene, and lead a working group that includes the Director of Healthcare and Family Services, the Secretary of Human Services, the Director of Public Health, the Director of  Children and Family Services, the Director of Juvenile Justice, the State Superintendent of Education, and the appropriate agency staff who will be responsible for implementation or oversight of reforms to children's behavioral health services. The  working group shall meet at least quarterly to foster interagency collaboration and work toward the goal of aligning services and programs to begin to create a coordinated children's behavioral health system consistent with system of care principles that spans across State agencies, rather than  separate siloed systems with different requirements, rates, and administrative processes and standards.   (Source: P.A. 101-461, eff. 1-1-20.)
305 ILCS 5/5-39
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-39. Behavioral health services for children; diagnostic assessment system. Beginning on July 1, 2022, if it is necessary to provide a diagnostic code for behavioral health services for children ages 5 and under, providers shall utilize a developmentally appropriate and age-appropriate diagnostic assessment system, such as the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised (DC:0-5), for diagnosis and treatment planning.  If necessary for billing purposes, the provider, managed care organization, or Department shall utilize the existing crosswalk tool to convert the developmentally appropriate and age-appropriate diagnosis code to the relevant code available in the State system.By no later than January 1, 2022, the Department shall make recommendations to the General Assembly  on the resources needed to integrate developmentally appropriate and age-appropriate diagnostic codes into the State system.   (Source: P.A. 101-654, eff. 3-8-21.)
305 ILCS 5/5-42
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-42. Tobacco cessation coverage; managed care. Notwithstanding any other provision of this Article, a managed care organization under contract with the Department to provide services to recipients of medical assistance shall provide coverage for all tobacco cessation medications approved by the United States Food and Drug Administration, all individual and group tobacco cessation counseling services, and all telephone-based counseling services and tobacco cessation medications provided through the Illinois Tobacco Quitline. The Department may adopt any rules necessary to implement this Section.  (Source: P.A. 102-43, eff. 7-6-21.)
305 ILCS 5/5-43
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

(305 ILCS 5/5-43)Sec. 5-43. Supports Waiver Program for Young Adults with Developmental Disabilities.(a) The Department of Human Services' Division of Developmental Disabilities, in partnership with the Department of Healthcare and Family Services and stakeholders, shall study the development and implementation of a supports waiver program for young adults with developmental disabilities.  The Division shall explore the following components of a supports waiver program to determine what is most appropriate:(1) The age of individuals to be provided services in     a waiver program.(2) The number of individuals to be provided services     in a waiver program.(3) The services to be provided in a waiver program.(4) The funding to be provided to individuals within     a waiver program.(5) The transition process to the Waiver for Adults     with Developmental Disabilities.(6) The type of home and community-based services     waiver to be utilized.(b) The Department of Human Services and the Department of Healthcare and Family Services are authorized to adopt and implement any rules necessary to study  the supports waiver program.(c) Subject to appropriation, no later than January 1, 2024, the Department of Healthcare and Family Services shall apply to the federal Centers for Medicare and Medicaid Services for a supports waiver for young adults with developmental disabilities utilizing the information learned from the study under subsection (a).  (Source: P.A. 102-43, eff. 7-6-21.)
305 ILCS 5/Art. V-A heading
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V-A - Hospital Provider Funding

 ARTICLE V-A.  HOSPITAL PROVIDER FUNDING
305 ILCS 5/5A-1
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V-A - Hospital Provider Funding

 (from Ch. 23, par. 5A-1)Sec. 5A-1. Definitions.  As used in this Article, unless the context requires  otherwise:"Fund" means the Hospital Provider Fund."Hospital" means an institution, place, building, or agency located in this  State that is subject to licensure by the Illinois Department of Public Health  under the Hospital Licensing Act, whether public or private and whether  organized for profit or not-for-profit."Hospital provider" means a person licensed by the Department of Public  Health to conduct, operate, or maintain a hospital, regardless of whether the  person is a Medicaid provider.  For purposes of this paragraph, "person" means  any political subdivision of the State, municipal corporation, individual,  firm, partnership, corporation, company, limited liability company,  association, joint stock association, or trust, or a receiver, executor,  trustee, guardian, or other representative appointed by order of any court."Medicare bed days" means, for each hospital, the sum of the number of days that each bed was occupied by a patient who was covered by Title XVIII of the Social Security Act, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services.  Medicare bed days shall be computed separately for each hospital operated or maintained by a hospital provider."Occupied bed days" means the sum of the number of days  that each bed was occupied by a patient for all beds, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services.  Occupied bed days shall be computed separately for each  hospital operated or maintained by a hospital provider."Outpatient gross revenue" means, for each hospital, its total gross charges attributed to outpatient services as reported on the Medicare cost report at Worksheet C, Part I, Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65, 66, 67, and 68 (and any subsets of those lines).   (Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)