reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 126.40 - Enrollment Fee

Current through Register Vol. 48, No. 28, July 12, 2024
To participate in the program, an approved applicant must pay
				  an amount determined by the Director of HFS upon enrollment and annually
				  thereafter (Section 35(a) of the Act). The Director may, in his or her
				  discretion, reduce the annual enrollment fee of $10 based upon actual
				  administrative costs. The Department shall establish, maintain and account for
				  annual enrollment fees in the Illinois Prescription Drug Discount Program
				  Fund.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 126.50 - Other Administrative Responsibilities of the Department

Current through Register Vol. 48, No. 28, July 12, 2024
a) In discharging
				its administrative responsibilities pursuant to the Act, the Department will
				either act as the Program Administrator or enter into a contract with an
				outside vendor, pursuant to Section 25 of the Act, and/or agreements with State
				agencies under which those entities will serve as the Program Administrator
				and/or exercise various recordkeeping and other administrative functions. Any
				contract or agreement must provide for inspection of appropriate records and
				audits of participating pharmacies or other appropriate measures deemed
				sufficient by the Director, in his or her discretion, to ensure contract
				compliance and to determine any fraudulent transactions or practices under the
				Act. Any contract entered into with outside vendors must be in compliance with
				the procedures and requirements set forth in the Illinois Procurement
				Code.
b) The Department will
				reimburse the Program Administrator for the cost of cardholder enrollment,
				pursuant to the contract entered into by the Department and the Program
				Administrator. The amount of reimbursement will be at a rate to be agreed upon
				by the Department and the Program Administrator and will be set forth in
				specificity in the contract. Funds to pay the reimbursement shall come from the
				enrollment fee and can either be taken from the enrollment fee prior to deposit
				or deposited into the Fund and reimbursed back to the Program Administrator, at
				the discretion of the Director.
c)
				The Department will, in cooperation with the Program Administrator, establish
				procedures for properly contracting for pharmacy services and validating
				compliance of authorized pharmacies with the Act and this Part 126.
d) The Department shall report to the
				Governor and the General Assembly by March 1 of each year on the administration
				of the program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart C - RESPONSIBILITIES OF THE PROGRAM ADMINISTRATOR › Section 126.60 - Eligibility Determination

Current through Register Vol. 48, No. 28, July 12, 2024
The Program Administrator shall obtain the necessary
				  enrollment information from applicants and shall verify eligibility.
				  Eligibility shall be determined within 30 days after receipt of the
				  application.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart C - RESPONSIBILITIES OF THE PROGRAM ADMINISTRATOR › Section 126.70 - Enrollment

Current through Register Vol. 48, No. 28, July 12, 2024
The Program Administrator shall:
a) Enroll eligible applicants into the
				program.
1) Other eligible applicants may
				enroll by mail, facsimile or telephone process.
2) Eligible applicants who enroll by mail or
				facsimile shall apply on the enrollment form, the content of which shall be
				approved by the Director, or his or her designee, and may be amended from time
				to time. The enrollment form requires the applicant's name, address, telephone
				number and income information.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart C - RESPONSIBILITIES OF THE PROGRAM ADMINISTRATOR › Section 126.80 - Re-enrollment

Current through Register Vol. 48, No. 28, July 12, 2024
The period of enrollment in the program is one year.
				  Cardholders must re-enroll each year by their one-year anniversary date or
				  enrollment will be terminated.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart C - RESPONSIBILITIES OF THE PROGRAM ADMINISTRATOR › Section 126.90 - Other Administrative Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Program Administrator shall contract
				with pharmacies electing to participate in the Illinois Prescription Drug
				Discount Program.
b) The contract
				shall require that a participating pharmacy, at a minimum, in Illinois be
				licensed and in good standing. Participation of any pharmacy shall be
				terminated by the Department upon a pharmacy's breach of contract and/or
				violation of the terms of the Illinois Prescription Drug Discount Program
				Act.
c) Cardholders may purchase
				medications in amounts up to a 90-day supply, except as may be necessary for
				utilization control reasons.
d) The
				Department and/or Program Administrator may negotiate with one or more drug
				manufacturers for payment rebates. These rebate dollars are to be used to
				further reduce the prescription cost to the Illinois Prescription Drug Discount
				Program enrollees, consistent with the requirements of the Illinois
				Prescription Drug Discount Program.
e) The Program Administrator is responsible
				for providing reports to the Department regarding enrollment participation,
				prescription costs, savings, pharmacy participation, and any other reports
				deemed necessary by the Department.
f) The Program Administrator is responsible
				for providing customer service to cardholders and is responsible for
				developing, administering and promoting any clinical programs, such as disease
				management, implemented at the discretion of the Director.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart C - RESPONSIBILITIES OF THE PROGRAM ADMINISTRATOR › Section 126.100 - Termination of Program Administrator

Current through Register Vol. 48, No. 28, July 12, 2024
a) The contract with the Program
				Administrator may be terminated by the Director, with cause, upon 30 days
				written notice or, without cause, upon at least 120 days written
				notice.
b) Upon written notice,
				determined by the Director to be reasonable under the circumstances requiring
				modification, the Director may require the Program Administrator to modify the
				conduct of the program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart D - FUNDING › Section 126.110 - The Illinois Prescription Drug Discount Program Fund

Current through Register Vol. 48, No. 28, July 12, 2024
The Program Administrator shall collect and deposit
				  enrollment fees into the Illinois Prescription Drug Discount Program
				  Fund.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 126 - THE ILLINOIS PRESCRIPTION DRUG DISCOUNT PROGRAM › Subpart E - DISCOUNTS › Section 126.120 - Discounts

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Program
				Administrator shall electronically communicate prescription drug discount
				information to the participating pharmacy.
b) The Program Administrator shall ensure and
				guarantee that a cardholder will be charged no more than the rate agreed to in
				the contract.
c) Any manufacturer
				or group purchasing organization rebate used to provide a discount greater than
				the agreed to pharmacy rate to the cardholder shall be reimbursed to the
				participating pharmacy subject to the availability of funds.
d) The cardholder shall receive the greatest
				discount through the participating pharmacy (at the point of sale). The total
				amount paid by the available cardholder for any prescription drug under this
				program shall not exceed the usual and customary charge for the
				prescription.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 127 - STATE RESPONSIBILITY FOR MEDICARE PART D LOW-INCOME SUBSIDY › Section 127.10 - Federal Legislative Base

Current through Register Vol. 48, No. 28, July 12, 2024
The Medicare Prescription Drug, Improvement, and Modernization
				Act (MMA) of 2003 ( PL
				108-173 ) establishes a voluntary prescription
				drug benefit for Medicare beneficiaries under a new Medicare Part D that begins
				January 1, 2006. Medicare Part D provides medical coverage of prescription
				drugs to Medicaid eligible individuals who are also eligible for Medicare Part
				A or enrolled in Medicare Part B. It also provides for extra help with
				premiums, deductibles and co-payments under a low-income subsidy (LIS) for
				individuals who meet an income and asset test as described at
				42 CFR
				423.773.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 127 - STATE RESPONSIBILITY FOR MEDICARE PART D LOW-INCOME SUBSIDY › Section 127.20 - Scope of Department Responsibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) The federal Centers for Medicare and
			 Medicaid Services (CMS) have overall responsibility for implementing Medicare
			 Part D. Under Medicare Part D, the federal Social Security Administration (SSA)
			 has responsibility for eligibility determinations and redeterminations for the
			 LIS, and for appeals of those eligibility determinations and
			 redeterminations.
b) As described
			 at 42 CFR 423, Subpart S, the State has certain responsibilities related to
			 Medicare Part D. As the agency responsible for administering Medicaid in
			 Illinois, the Department shall make eligibility determinations and
			 redeterminations for the LIS, and hear appeals of eligibility determinations
			 and redeterminations, only for individuals who specifically request a State
			 determination (see 89 Ill. Adm. Code
			 110.10 ). The
			 Department is also required to notify CMS of LIS eligibility
			 determinations.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 127 - STATE RESPONSIBILITY FOR MEDICARE PART D LOW-INCOME SUBSIDY › Section 127.100 - Eligibility for Low-Income Subsidy

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department will encourage individuals
			 to apply for the LIS under Medicare Part D with the Social Security
			 Administration.
b) The Department
			 shall make eligibility determinations and redeterminations, and hear appeals of
			 eligibility determinations and redeterminations, only for individuals who
			 specifically request a State determination of eligibility for the
			 LIS.
c) The determination and
			 redetermination of eligibility for the LIS will be made in accordance with the
			 financial and non-financial criteria established at 42 CFR 423, Subpart P
			 (2005, no further editions or amendments included).
d) Individuals who are eligible for the LIS
			 will not be required to report changes in circumstances, as described at 89
			 Ill. Adm. Code
			 102.50,
			 until redetermination of eligibility for the LIS.
e) Unless otherwise specified in federal law
			 or this Section, the Department will be governed by 89 Ill. Adm. Code 101, 102,
			 104, 110 and 120 in processing applications for the LIS and for hearing appeals
			 of determinations and redeterminations of eligibility for the LIS.
f) No State benefit shall accrue under this
			 Section to individuals for whom the Department makes a determination of
			 eligibility for the LIS, and nothing in this Section shall be construed to
			 confer a State benefit on any individual.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart A - GENERAL PROVISIONS › Section 128.100 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
This Part implements the Veterans' Health Insurance Program
				  Act of 2008 [330 ILCS 126 ] that authorizes the Department to administer a
				  program to offer uninsured veterans and their spouses in Illinois access to
				  health benefits. The Department coordinates with the Illinois Department of
				  Veterans' Affairs to assist veterans to apply for the program. Eligible
				  veterans are not eligible for Veterans Administration Healthcare or other
				  State-administered health benefits. The Department shall provide health
				  benefits coverage to eligible veterans and their spouses through purchasing or
				  providing health care benefits. When cost-effective, the Department may offer
				  veterans and spouses subsidies toward the cost of privately sponsored health
				  insurance, including employer-sponsored health insurance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart A - GENERAL PROVISIONS › Section 128.110 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purpose of this Part, the terms shall be defined as
				  follows:
"Act" means the Veterans' Health Insurance Program Act of
				  2008 [330 ILCS 126 ].
"Department" means the Department of Healthcare and Family
				  Services and any successor agencies.
"DVA" means the Illinois Department of Veterans
				  Affairs.
"Family" means the veteran applying for the program and the
				  following individuals living with the veteran who are counted in determining
				  eligibility:
The spouse of the veteran;
Children under 19 years of age of the veteran or the
				  veteran's spouse;
If the veteran or the spouse is pregnant, the unborn
				  children.
"Federal Poverty Level" means the federal poverty income
				  guidelines as established by the federal Department of Health and Human
				  Services and published in the Federal Register.
"Health Insurance" means health insurance coverage as defined
				  in
				  215 ILCS
				  105/2.
"Practitioner" means a physician (including a hospital
				  billing a physician office visit), osteopath, podiatrist, optometrist,
				  chiropractor, advanced practice nurse, Federally Qualified Health Center, Rural
				  Health Clinic or Encounter Rate Clinic.
"Program" means the program created under the Veterans'
				  Health Insurance Program Act and this Part, commonly called Veterans
				  Care.
"Resident" means an individual who has an Illinois residence,
				  as provided in Section 5-3 of the Illinois Public Aid Code.
"Spouse" means the person who, under the laws of the State of
				  Illinois, is married to an eligible veteran at the time of application and
				  subsequent redetermination for the program and includes enrolled spouses
				  surviving the death of the eligible veteran.
"Uninsured" means the person is not covered by group or
				  individual health insurance that provides coverage for hospitalization and
				  physician visits.
"Veteran" means an individual who served for at least 180
				  days after initial training in any branch of the U.S. military including the
				  Reserves and National Guard. The veteran must not be currently on active duty
				  in the U.S. military.
"Veterans Administration Geographic Means Test" means the
				  U.S. Department of Veterans Affairs Healthcare Program Enhancement Act of 2009
				  (
				  38 USC
				  1705(a)(7) ) income
				  guidelines established annually by county and published in the Federal Register
				  for determining eligibility for Veterans Administration healthcare. The income
				  guidelines can also be found at:
http://www.va.gov/healtheligibility/Library/pubs/
GMTIncomeThresholds.
"Veterans Administration Healthcare" means any of the health
				  programs or services provided or administered by the U.S. Department of
				  Veterans Affairs.
"Veterans Care" means the common name for this program under
				  the Act.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.200 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
A veteran may be eligible for Veterans Care provided that all
				  of the following eligibility criteria are met:
a) The veteran is not eligible for Veterans
				Administration healthcare, medical assistance under the Public Aid Code or
				benefits, including rebates, under the Children's Health Insurance Program
				Act;
b) The veteran was not
				dishonorably discharged;
c) The
				veteran is a resident of the State of Illinois;
d) The veteran is at least 19 and is no more
				than 64 years of age; and
e) The
				veteran meets one of the following:
1) The
				veteran has been uninsured for at least three months;
2) The veteran lost health insurance when the
				veteran's or the veteran's spouse's job ended within six months prior to
				applying under this Part;
3) The
				veteran has exhausted the life-time benefit limit of his or her health
				insurance within six months prior to applying under this Part;
4) The veteran's health insurance is
				purchased under the provisions of the Consolidated Omnibus Budget
				Reconciliation Act (COBRA);
5) The
				veteran was disenrolled for medical assistance under the Public Aid Code or
				benefits, including rebates under the Children's Health Insurance Program Act,
				within six months prior to applying under this Part;
6) The veteran has health insurance provided
				by the veteran's spouse but the veteran is unable to access such health
				insurance benefits;
7) The veteran
				has post-active duty related TRICARE healthcare coverage.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.210 - Eligibility Exclusions and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
a) A veteran or spouse shall not be
				determined eligible for Veterans Care if:
1)
				The veteran or spouse is an inmate of a public institution.
2) The veteran or spouse is a resident of a
				nursing facility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.220 - Application Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) Veterans
				apply for the program by submitting the Veterans Care application to the
				Department, or through one of the DVA's Veterans Service Offices, through the
				Veterans Assistance Commission serving the veteran's community, or through a
				U.S. Veterans Administration facility in Illinois. The Department may designate
				additional entities that may assist veterans to submit applications.
b) The application must meet all requirements
				found at 89 Ill. Adm. Code
				110.10, including
				provisions regarding who may apply on behalf of the veteran.
c) Applicants are obligated to provide
				truthful and accurate information for determining eligibility and to promptly
				report any change in information provided on the application.
d) The Department may stop taking
				applications if that is necessary to maintain the cost of the program within
				the available funding.
e) An
				eligible veteran may choose to apply to add the spouse to his or her existing
				case.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.230 - Determination of Monthly Countable Income

Current through Register Vol. 48, No. 28, July 12, 2024
a) The earned and unearned income of the
				following persons shall be counted when determining eligibility, except as
				specified in subsections (b) and (c) of this Section.
1) Income of the veteran;
2) Income of the veteran's spouse;
3) Unearned income of a dependent child under
				the age of 18 years who is included in the income standard as set forth at 89
				Ill. Adm. Code
				120.20
				because it is to the advantage of the veteran.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.240 - Eligibility Determination and Enrollment Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) The applicant's military discharge status,
				time spent in active duty, health insurance status and eligibility for Veterans
				Administration healthcare will be reviewed first.
b) For the purpose of determining eligibility
				under this Part, applicants who are not found ineligible under subsection (a)
				of this Section will be screened for eligibility for medical assistance under
				the Public Aid Code or health benefits, including rebates, under the Children's
				Health Insurance Program Act. Veterans who are likely to be eligible for these
				other programs will be directed to apply for them. Veterans and their spouses
				may be enrolled under this Part while an application for coverage under another
				program is pending.
c) If the
				monthly countable income is equal to or less than the Veterans Care income
				standard, the application will be approved if all other factors of eligibility
				are met. The Veterans Care income standard is 50 percent of the Federal Poverty
				Level plus the Veterans Administration Geographic Means Test
				threshold.
d) Applicants will be
				notified, in writing, regarding the outcome of their eligibility
				determination.
e) Eligibility
				determinations for the program made by the 10th day
				of a month will be effective the first day of the following month. Eligibility
				determinations for the program made after the 10th
				day of a month will be effective no later than the first day of the second
				month following that determination.
f) The duration of eligibility for the
				program will be 12 months unless one of the events described in Section
				128.210(b)
				 occurs or the Department shortens the
				enrollment period to maintain program spending within available
				funding.
g) Veterans and their
				spouses may obtain backdated medical coverage for the month of application plus
				up to three months prior to the month of application, except as stated in
				Section
				128.330(a).
				Spouses are not eligible to be included for backdated months prior to December
				1, 2012. This coverage shall be subject to the veteran paying the premiums for
				the months of backdated coverage requested. The veteran and spouse may choose
				the month for which backdated coverage will begin. Backdated months of coverage
				shall be consecutive beginning with the initial month of backdated coverage
				requested.
h) At the sole
				discretion of the Department, the Department may reduce the income threshold
				established in subsection (c) of this Section if necessary to keep the cost of
				the program within available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.250 - Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person who
				applies for or receives benefits under the program shall have the right to
				appeal any of the following actions:
1)
				Refusal to accept an application.
2) Denial of an application or cancellation
				at the redetermination of eligibility, including denial based on failure to
				meet one or more of the eligibility requirements specified in this Part. No
				eligibility exists during the appeal process. If the appeal is upheld, the
				veteran or spouse will have the opportunity to receive coverage back to the
				original application date, including possible backdated months or the
				cancellation month. All premium and co-payment requirements shall apply to the
				retroactive period.
3) Termination
				of coverage based on failure to continue to meet one or more of the eligibility
				requirements specified in this Part. If the termination is not upheld on
				appeal, coverage under the Program shall be reinstated retroactive to the
				termination date. All premium and co-payment requirements shall apply to any
				retroactive period. The veteran or spouse may choose coverage for all or some
				of the months during the appeal process as long as the retroactive months are
				consecutive to the new initial month of regular eligibility.
4) Determination of the amount of the premium
				or co-payments required. Any premium or co-payment requirements shall remain in
				force during the appeal process.
5)
				Individuals or their representatives do not have the right to appeal
Department decisions necessary to keep the cost of the
				  program within the annual appropriations, such as a Department decision
				  to:
A) cease accepting applications
				pursuant to Section
				128.220(d).
B) increase premium levels for all
				individuals within an income range.
C) require more frequent redeterminations of
				eligibility.
D) increase the income
				standard.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.260 - Renewals of Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Eligibility shall be reviewed at least annually.
b) Prior to the eligibility period ending,
				and in sufficient time for the veteran and spouse to respond to the
				Department's request for information, the Department or its designee will send
				an annual renewal notice to the veteran.
c) Renewals shall be subject to all
				eligibility requirements and exclusions set forth in Sections
				128.200,
				128.210,
				128.230
				and
				128.240.
d) The Department may require renewal of
				eligibility more frequently than annually if necessary to keep spending within
				available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.300 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
Covered health care services shall be the same as covered
				  services for adults described in the State's approved plan under Title XIX of
				  the Social Security Act, except as provided in Section
				  128.310.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.310 - Service Exclusions

Current through Register Vol. 48, No. 28, July 12, 2024
The following health care services shall not be covered under
				  this Part.
a) Non-emergency medical
				transportation.
b) Nursing facility
				services.
c) Funeral and burial
				expenses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.320 - Co-payments and Cost Sharing

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Co-payments or cost sharing may be charged for services provided to a veteran
				and spouse by a health care provider as described in subsection (b), except for
				practitioner visits scheduled for family planning services.
b) Co-payment and cost sharing requirements
				are as follows:
1) Practitioner office
				visits, $15;
2) Dental visits,
				$15;
3) Inpatient hospitalizations,
				$150 per hospital stay;
4) Hospital
				or Ambulatory Surgical Treatment Center outpatient services set forth at 89
				Ill. Adm. Code
				148.140(b),
				10 percent of the Department rate as set forth in Section
				128.350(c);
5) Hospital Emergency Visits, $50;
6) Prescription drugs, $6 for a 1- to 30-day
				supply of generic drugs or $14 for a 1- to 30-day supply of brand name
				drugs.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.330 - Premium Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Veterans
				enrolled in Veterans Care must pay a monthly premium of $20. The veteran may
				choose to enroll the eligible spouse for an additional $20 per month. For any
				backdated months prior to December 1, 2012, premiums shall be as follows:
1) If the Veteran's income is equal to or
				less than 25 percent of the Federal Poverty Level plus the Veterans
				Administration Geographic Means Test threshold, the premium is $40 per
				month.
2) If the Veteran's income
				is more than 25 percent of the Federal Poverty Level plus the Veterans
				Administration Geographic Means Test threshold and equal to or less than 50
				percent of the Federal Poverty Level plus the Veterans Administration
				Geographic Means Test threshold, the premium is $70 per month.
3) There are no backdated months for an
				eligible spouse prior to December 1, 2012. Premiums for any backdated months
				after December 1, 2012 for an eligible spouse are $20 per month.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.340 - Non-payment of Premium

Current through Register Vol. 48, No. 28, July 12, 2024
a) For initial
				coverage, the Veteran must pay the first monthly premium by the due date to
				begin coverage for the Veteran and spouse. For subsequent months, veterans will
				have a grace period of one month following the month in which the premium was
				due to pay the premium.
b) Failure
				to pay the full monthly premium by the last day of the grace period will result
				in termination of coverage.
c)
				Partial premium payments will not be refunded.
d) When termination of coverage is recorded
				by the 10th day of the month, it will be effective
				the first day of the following month. When termination of coverage is recorded
				after the 10th day of the month, it will be
				effective no later than the first day of the second month following.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 128 - VETERANS' HEALTH INSURANCE PROGRAM › Subpart B - GENERAL ELIGIBILITY AND ENROLLMENT › Section 128.350 - Provider Reimbursement

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Provider participation under this Part shall be subject to enrollment with and
				approval by the Department to provide health care under 89 Ill. Adm. Code
				140.11
				and
				140.12.
b) Provider participation under this Part
				shall be voluntary.
c) Providers
				under this Part shall be reimbursed in accordance with the established rates of
				the Department or other appropriate State agency (as set forth in 89 Ill. Adm.
				Code 140, 143, 144, 148, 149, 152 and 153; 52 Ill. Adm. Code 132; and 77 Ill.
				Adm. Code 2090) less co-payments or cost sharing as specified in Section
				128.320,
				regardless of whether the patient share is collected.
d) Providers under this Part shall be
				prohibited from billing veterans covered under Veterans Care for any difference
				between the charge amount and the amount paid by the Department other than the
				co-payment amounts specified in Section 128.320.
e) Providers shall be responsible for
				refunding to the veteran and spouse co-payments collected in excess of the
				amounts permitted by this Part.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.10 - Program Administration

Current through Register Vol. 48, No. 28, July 12, 2024
The Department provides services directly and contracts with
				  other State agencies and public and private agencies for the provision of
				  social services utilizing Title XX Social Service Block Grant Funds, as
				  provided in Title XX of the Social Security Act (
				  42 U.S.C.
				  1397 et seq.).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.15 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Community Services Agreement" means the agreement between
				  the Department and a provider of social services detailing the activities to be
				  performed by the provider and the manner and amount of payment a provider is to
				  receive.
"Donated Funds Initiative" means the funding mechanism
				  established by the State to make federal funds available to local service
				  providers on a cost sharing basis through the Local Initiative Fund or the
				  Special Purposes Trust Fund.
"In-kind Contributions" means property or services that
				  benefit a federally assisted project or program and that are contributed by
				  non-federal sources or allowable sources without charge to the grantee, or a
				  cost reimbursement type contractor under the Community Services
				  Agreement.
"Local Initiative Fund" means the State account, established
				  outside the treasury, used to receive and disburse federal funds to be utilized
				  to reimburse contract social service providers for services provided.
"Public" means local governmental units, i.e., cities,
				  counties, townships, villages, colleges/universities, and/or mental health
				  boards.
"Report on Projected Expenditures for the Title XX Social
				  Services Block Grant" means the report that describes the intended use of funds
				  made available through the Title XX Social Services Block Grant.
"Service Provider" means any entity that provides social
				  services either directly or through contract with the Department or through
				  subcontract.
"Social Services" means services included and defined in the
				  State of Illinois Report on Projected Expenditures for the Title XX Social
				  Services Block Grant.
"Sponsoring Agency" means any State department described in
				  the Report on Projected Expenditures for the Title XX Social Services Block
				  Grant as collaborating with the Department in planning for the provision of
				  social services under the auspices of the Title XX Social Services Block
				  Grant.
"Title V" means the Maternal and Child Health Services Block
				  Grant.
"Title XVIII" means the Health Insurance for the Aged and
				  Disabled.
"Title XIX" means Grants to States for Medical Assistance
				  programs.
"Title XX Social Services Block Grant" means the consolidated
				  federal assistance granted to states in a single grant, increasing state
				  flexibility in using social service grants, and encouraging each state, as far
				  as practicable, to furnish services directed at one or more of the five
				  national goals.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.20 - Goal of Services

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall determine the services it intends to
				  provide with the Title XX Social Services Block Grant Funds. Services must be
				  directed at one or more of the following national goals:
a) achieving or maintaining economic
				self-support to prevent, reduce or eliminate dependency;
b) achieving or maintaining self-sufficiency,
				including reduction or prevention of dependency;
c) preventing or remedying neglect, abuse or
				exploitation of children and adults unable to protect their own interests, or
				preserving, rehabilitating or reuniting families;
d) preventing or reducing inappropriate
				institutional care by providing for community-based care, home-based care or
				other forms of less intensive care; and
e) securing referral or admission for
				institutional care when other forms of care are not appropriate or providing
				services to individuals in institutions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.25 - Service Activities

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall provide each sponsoring agency with a
				  description of all such service activities for inclusion in the Report on
				  Projected Expenditures for the Title XX Social Services Block Grant. Examples
				  of the service activities include, but are not limited to, counseling,
				  employment and training, transportation, health support, community maintenance,
				  child care, and rehabilitation and treatment for substance
				  abuse.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.30 - Expenditure of Block Grant Funds

Current through Register Vol. 48, No. 28, July 12, 2024
Expenditures for social services that are used as a basis for
				  claiming the annual federal allocation of the Title XX Social Services Block
				  Grant program funds may include expenditures for:
a) administration (including planning and
				evaluation);
b) personnel training
				and retraining directly related to the provision of services included in the
				Report on Projected Expenditures for the Title XX Social Services Block Grant;
				and
c) conferences or workshops and
				training or retraining through grants to non-profit organizations within the
				meaning of Section 501(c)(3) of the Internal Revenue Code or to individuals
				with social services expertise, or through financial assistance to individuals
				participating in such conferences, workshops, and training or
				retraining.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.35 - Limitations on Services and Expenditures

Current through Register Vol. 48, No. 28, July 12, 2024
Pursuant to
				  42 USC
				  1397 d, funds made available through the
				  Title XX Social Services Block Grant may not be used:
a) for the purchase or improvement of land,
				or the purchase, construction, or permanent improvement (other than minor
				remodeling) of any building or other facility;
b) for the provision of cash payments for
				costs of subsistence or for the provision of room and board (other than costs
				of subsistence during rehabilitation, room and board provided for a short term
				as an integral but subordinate part of a social service, or temporary emergency
				shelter provided as a protective service)
				45
				CFR 96.71(a)
				(2001);
c) for the provision of medical care (other
				than family planning services, rehabilitation services, or initial
				detoxification of an alcoholic or drug dependent individual) unless it is an
				integral but subordinate part of a social service for which grants may be used
				under Title XX;
d) for social
				services (except services to an alcoholic or drug dependent individual or
				rehabilitation services) provided in and by employees of any hospital, skilled
				nursing facility, intermediate care facility, or prison, to any individual
				living in such institutions;
e) for
				the payment of the wages of any individual as a social service (other than
				payments of the wages of welfare recipients employed in the provision of child
				day care services);
f) for the
				provision of any educational service the State makes generally available to
				residents without cost and without regard to income (the School Code [105 ILCS
				5 /Art. 14]);
g) for any child day
				care services unless such services meet applicable standards of State and local
				law (the Child Care Act of 1969 [225 ILCS 10 ]);
h) for the provision of cash payments as a
				service (except as otherwise provided in 42 USC 1937 );
i) for the payment for any item or service
				(other than an emergency item or service) furnished:
1) by an individual or entity during the
				period when the individual or entity is excluded under Title XX, Title V, Title
				XVIII, or Title XIX pursuant to
				42
				USC 1320a-7,
				1320a-7a,
				1320c-5
				or
				1395
				u(j)(2); or
2) at the medical
				direction or on the prescription of a physician during the period when the
				physician is excluded under Title XX, Title V, Title XVIIIa, or Title XIX
				pursuant to
				42
				USC 1320a-7,
				1320a-7a,
				1320c-5
				or
				1395
				u(j)(2) and when the person furnishing the item or service knew or had reason
				to know of the exclusion after a reasonable time period and after reasonable
				notice has been furnished to the person; or
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.40 - Eligibility For Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department, through the Report on Projected Expenditures for the Title XX
				Social Services Block Grant, shall define the criteria on which eligibility for
				services so provided will be based.
b) The service provider shall further define
				the characteristics for the population to be served in accordance with the
				mission or inherent responsibility of the sponsoring agency as promulgated in
				official policy and/or State administrative rule, as appropriate, for the
				sponsoring agency.
c) Standards for
				eligibility shall be based on:
1)
				characteristics of the individuals to be served that are verifiable (i.e., age,
				residence, handicap, or area of residence); and/or
2common characteristics of individuals that
				would document a need for the service to be provided, as directed by the
				sponsoring agency; and/or
3)
				eligibility for child care for children may be based on family income. Fees may
				be assessed for this service in accordance with State law and administrative
				policies of the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.45 - Opportunity to Apply For and Receive Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Service providers shall provide each
				individual wishing to do so an opportunity to apply for services offered
				through the Title XX Social Services Block Grant.
b) To the extent that financial and program
				resources are available, all service providers shall provide services to
				clients determined eligible in accordance with established criteria.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.46 - Client Case Records

Current through Register Vol. 48, No. 28, July 12, 2024
Service providers participating in the Title XX Social
				  Services Block Grant must maintain client case record information set forth in
				  the contractual agreements. Examples of the case record documentation include,
				  but are not limited to, intake, assessment of service needs, reassessment of
				  service needs, and service plans.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.50 - Purchase of Services

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may purchase social services for eligible
				  clients through the Title XX Social Services Block Grant under the following
				  conditions:
a) A written contractual
				agreement must be executed between the Department and the service provider that
				meets all requirements of the Illinois Procurement Code [30 ILCS 500 ] and
				federal regulations ( 45 CFR 96, 2001 ) established for the administration of
				the Title XX Social Services Block Grant program.
b) The service provider is subject to audit
				under terms of the contractual agreement in accordance with
				42 USC
				1397(e) and Section
				130.85
				of this Part.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.60 - Record Retention

Current through Register Vol. 48, No. 28, July 12, 2024
a) Service
				providers must assure the maintenance of records as enumerated in the
				contractual agreement, necessary for the proper and efficient administration of
				services provided with Title XX Social Services Block Grant funds.
b) In accordance with the contractual
				agreement, all records shall be maintained for a period of five years beyond
				the close of the fiscal year in which the expenditures occurred, unless there
				is an audit in which case the records shall be maintained until the audit is
				concluded.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.80 - Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Annually service providers shall provide the Department, in a
				  manner set forth in the contractual agreements, with reports pertaining to
				  activities carried out with Title XX Social Services Block Grant funds. The
				  Department reserves the right to require additional reporting based on data
				  collection needs.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 130 - ADMINISTRATION OF SOCIAL SERVICE PROGRAMS › Subpart A - TITLE XX BLOCK GRANT PROGRAM › Section 130.85 - Reporting and Audit Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				The Department shall, not less frequently than every two years, cause the
				records of expenditures and services delivered by service providers receiving
				Title XX Social Services Block Grant funds to be audited in a manner set forth
				in the contractual agreements.
b)
				Such audits shall be conducted by an independent entity in accordance with
				generally accepted auditing standards, Government Auditing Standards (1988) and
				OMB Circular A-133 "Audits of States, Local Governments, and Non-Profit
				Organizations".
c) A representative
				sample of service providers' client case records shall be tested for compliance
				with reporting requirements established in Section
				130.46 of
				this Part and reconciled to monthly service reports forwarded to the
				Department.
d) For those contracts
				requiring the service provider to obtain/provide matching funds, a
				representative sample of the service providers' matching fund
				receipts/transfers shall be tested for compliance with the requirements
				established in Subpart B, Sections
				130.150 through
				130.160
				of this Part.