HB 5364

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Full Text of HB5364
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	HB5364 - 104th General Assembly
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			Senate Amendment 001
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		HB5364 Enrolled		LRB104 19659 KTG 33108 b
1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 12-13.1 as follows:
6    (305 ILCS 5/12-13.1)
7    Sec. 12-13.1. Inspector General.
8    (a) The Governor shall appoint, and the Senate shall
9confirm, an Inspector General who shall function within the
10Illinois Department of Public Aid (now Healthcare and Family
11Services) and report to the Governor. The term of the
12Inspector General shall expire on the third Monday of January,
131997 and every 4 years thereafter.
14    (b) In order to prevent, detect, and eliminate fraud,
15waste, abuse, mismanagement, and misconduct, the Inspector
16General shall oversee the Department of Healthcare and Family
17Services' and the Department on Aging's integrity functions,
18which include, but are not limited to, the following:
19        (1) Investigation of misconduct by employees, vendors,
20    contractors and medical providers, except for allegations
21    of violations of the State Officials and Employees Ethics
22    Act which shall be referred to the Office of the
23    Governor's Executive Inspector General for investigation.
		HB5364 Enrolled	- 2 -	LRB104 19659 KTG 33108 b
1        (2) Prepayment and post-payment audits of medical
2    providers related to ensuring that appropriate payments
3    are made for services rendered and to the prevention and
4    recovery of overpayments.
5        (3) Monitoring of quality assurance programs
6    administered by the Department of Healthcare and Family
7    Services and the Community Care Program administered by
8    the Department on Aging.
9        (4) Quality control measurements of the programs
10    administered by the Department of Healthcare and Family
11    Services and the Community Care Program administered by
12    the Department on Aging.
13        (5) Investigations of fraud or intentional program
14    violations committed by clients of the Department of
15    Healthcare and Family Services and the Community Care
16    Program administered by the Department on Aging.
17        (6) Actions initiated against contractors, vendors, or
18    medical providers for any of the following reasons:
19            (A) Violations of the medical assistance program
20        and the Community Care Program administered by the
21        Department on Aging.
22            (B) Sanctions against providers brought in
23        conjunction with the Department of Public Health or
24        the Department of Human Services (as successor to the
25        Department of Mental Health and Developmental
26        Disabilities).
		HB5364 Enrolled	- 3 -	LRB104 19659 KTG 33108 b
1            (C) Recoveries of assessments against hospitals
2        and long-term care facilities.
3            (D) Sanctions mandated by the United States
4        Department of Health and Human Services against
5        medical providers.
6            (E) Violations of contracts related to any
7        programs administered by the Department of Healthcare
8        and Family Services and the Community Care Program
9        administered by the Department on Aging.
10        (7) Representation of the Department of Healthcare and
11    Family Services at hearings with the Illinois Department
12    of Financial and Professional Regulation in actions taken
13    against professional licenses held by persons who are in
14    violation of orders for child support payments.
15    (b-5) At the request of the Secretary of Human Services or 
16the Secretary of Early Childhood, the Inspector General shall,
17in relation to any function performed by the Department of
18Human Services as successor to the Department of Public Aid,
19exercise one or more of the powers provided under this Section
20as if those powers related to the Department of Human Services
21or the Department of Early Childhood; in such matters, the
22Inspector General shall report his or her findings to the
23Secretary of Human Services or the Secretary of Early 
24Childhood, respectively.
25    (c) Notwithstanding, and in addition to, any other
26provision of law, the Inspector General shall have access to
		HB5364 Enrolled	- 4 -	LRB104 19659 KTG 33108 b
1all information, personnel and facilities of the Department of
2Healthcare and Family Services and the Department of Human
3Services (as successor to the Department of Public Aid), their
4employees, vendors, contractors and medical providers and any
5federal, State or local governmental agency that are necessary
6to perform the duties of the Office as directly related to
7public assistance programs administered by those departments.
8No medical provider shall be compelled, however, to provide
9individual medical records of patients who are not clients of
10the programs administered by the Department of Healthcare and
11Family Services. State and local governmental agencies are
12authorized and directed to provide the requested information,
13assistance or cooperation.
14    For purposes of enhanced program integrity functions and
15oversight, and to the extent consistent with applicable
16information and privacy, security, and disclosure laws, State
17agencies and departments shall provide the Office of Inspector
18General access to confidential and other information and data,
19and the Inspector General is authorized to enter into
20agreements with appropriate federal agencies and departments
21to secure similar data. This includes, but is not limited to,
22information pertaining to: licensure; certification; earnings;
23immigration status; citizenship; wage reporting; unearned and
24earned income; pension income; employment; supplemental
25security income; social security numbers; National Provider
26Identifier (NPI) numbers; the National Practitioner Data Bank
		HB5364 Enrolled	- 5 -	LRB104 19659 KTG 33108 b
1(NPDB); program and agency exclusions; taxpayer identification
2numbers; tax delinquency; corporate information; and death
3records.
4    The Inspector General shall enter into agreements with
5State agencies and departments, and is authorized to enter
6into agreements with federal agencies and departments, under
7which such agencies and departments shall share data necessary
8for medical assistance program integrity functions and
9oversight. The Inspector General shall enter into agreements
10with State agencies and departments, and is authorized to
11enter into agreements with federal agencies and departments,
12under which such agencies shall share data necessary for
13recipient and vendor screening, review, and investigation,
14including but not limited to vendor payment and recipient
15eligibility verification. The Inspector General shall develop,
16in cooperation with other State and federal agencies and
17departments, and in compliance with applicable federal laws
18and regulations, appropriate and effective methods to share
19such data. The Inspector General shall enter into agreements
20with State agencies and departments, and is authorized to
21enter into agreements with federal agencies and departments,
22including, but not limited to: the Secretary of State; the
23Department of Revenue; the Department of Public Health; the
24Department of Human Services; and the Department of Financial
25and Professional Regulation.
26    The Inspector General shall have the authority to deny
		HB5364 Enrolled	- 6 -	LRB104 19659 KTG 33108 b
1payment, prevent overpayments, and recover overpayments.
2    The Inspector General shall have the authority to deny or
3suspend payment to, and deny, terminate, or suspend the
4eligibility of, any vendor who fails to grant the Inspector
5General timely access to full and complete records, including
6records of recipients under the medical assistance program for
7the most recent 6 years, in accordance with Section 140.28 of
8Title 89 of the Illinois Administrative Code, and other
9information for the purpose of audits, investigations, or
10other program integrity functions, after reasonable written
11request by the Inspector General.
12    (d) The Inspector General shall serve as the Department of
13Healthcare and Family Services' primary liaison with law
14enforcement, investigatory and prosecutorial agencies,
15including but not limited to the following:
16        (1) The Department of State Police.
17        (2) The Federal Bureau of Investigation and other
18    federal law enforcement agencies.
19        (3) The various Inspectors General of federal agencies
20    overseeing the programs administered by the Department of
21    Healthcare and Family Services.
22        (4) The various Inspectors General of any other State
23    agencies with responsibilities for portions of programs
24    primarily administered by the Department of Healthcare and
25    Family Services.
26        (5) The Offices of the several United States Attorneys
		HB5364 Enrolled	- 7 -	LRB104 19659 KTG 33108 b
1    in Illinois.
2        (6) The several State's Attorneys.
3        (7) The offices of the Centers for Medicare and
4    Medicaid Services that administer the Medicare and
5    Medicaid integrity programs.
6    The Inspector General shall meet on a regular basis with
7these entities to share information regarding possible
8misconduct by any persons or entities involved with the public
9aid programs administered by the Department of Healthcare and
10Family Services.
11    (e) All investigations conducted by the Inspector General
12shall be conducted in a manner that ensures the preservation
13of evidence for use in criminal prosecutions. If the Inspector
14General determines that a possible criminal act relating to
15fraud in the provision or administration of the medical
16assistance program has been committed, the Inspector General
17shall immediately notify the Medicaid Fraud Control Unit. If
18the Inspector General determines that a possible criminal act
19has been committed within the jurisdiction of the Office, the
20Inspector General may request the special expertise of the
21Department of State Police. The Inspector General may present
22for prosecution the findings of any criminal investigation to
23the Office of the Attorney General, the Offices of the several
24United States Attorneys in Illinois or the several State's
25Attorneys.
26    (f) To carry out his or her duties as described in this
		HB5364 Enrolled	- 8 -	LRB104 19659 KTG 33108 b
1Section, the Inspector General and his or her designees shall
2have the power to compel by subpoena the attendance and
3testimony of witnesses and the production of books, electronic
4records and papers as directly related to public assistance
5programs administered by the Department of Healthcare and
6Family Services or the Department of Human Services (as
7successor to the Department of Public Aid). No medical
8provider shall be compelled, however, to provide individual
9medical records of patients who are not clients of the Medical
10Assistance Program.
11    (g) The Inspector General shall report all convictions,
12terminations, and suspensions taken against vendors,
13contractors and medical providers to the Department of
14Healthcare and Family Services and to any agency responsible
15for licensing or regulating those persons or entities.
16    (h) The Inspector General shall make annual reports,
17findings, and recommendations regarding the Office's
18investigations into reports of fraud, waste, abuse,
19mismanagement, or misconduct relating to any programs
20administered by the Department of Healthcare and Family
21Services or the Department of Human Services (as successor to
22the Department of Public Aid) to the General Assembly and the
23Governor. These reports shall include, but not be limited to,
24the following information:
25        (1) Aggregate provider billing and payment
26    information, including the number of providers at various
		HB5364 Enrolled	- 9 -	LRB104 19659 KTG 33108 b
1    Medicaid earning levels.
2        (2) The number of audits of the medical assistance
3    program and the dollar savings resulting from those
4    audits.
5        (3) The number of prescriptions rejected annually
6    under the Department of Healthcare and Family Services'
7    Refill Too Soon program and the dollar savings resulting
8    from that program.
9        (4) Provider sanctions, in the aggregate, including
10    terminations and suspensions.
11        (5) A detailed summary of the investigations
12    undertaken in the previous fiscal year. These summaries
13    shall comply with all laws and rules regarding maintaining
14    confidentiality in the public aid programs.
15    (i) Nothing in this Section shall limit investigations by
16the Department of Healthcare and Family Services or the
17Department of Human Services that may otherwise be required by
18law or that may be necessary in their capacity as the central
19administrative authorities responsible for administration of
20their agency's programs in this State.
21    (j) The Inspector General may issue shields or other
22distinctive identification to his or her employees not
23exercising the powers of a peace officer if the Inspector
24General determines that a shield or distinctive identification
25is needed by an employee to carry out his or her
26responsibilities.
		HB5364 Enrolled	- 10 -	LRB104 19659 KTG 33108 b
1(Source: P.A. 97-689, eff. 6-14-12; 98-8, eff. 5-3-13.)
2    Section 99. Effective date. This Act takes effect upon
3becoming law.