ILCS » Chapter 210 · Act 45

210 ILCS 45/3-401.1

(a) A facility participating in the Medical Assistance Program is prohibited from failing or refusing to retain as a resident any person because he or she is a recipient of or an applicant for the Medical Assistance Program

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(210 ILCS 45/3-401.1) (from Ch. 111 1/2, par. 4153-401.1)
    Sec. 3-401.1. (a) A facility participating in the Medical Assistance Program is prohibited from failing or refusing to retain as a resident any person because he or she is a recipient of or an applicant for the Medical Assistance Program.
    (a-5) A facility of which only a distinct part is certified to participate in the Medical Assistance Program may refuse to retain as a resident any person who resides in a part of the facility that does not participate in the Medical Assistance Program and who is unable to pay for his or her care in the facility without Medical Assistance only if:
        (1) the facility, no later than at the time of
    
admission and at the time of the resident's contract renewal, explains to the resident (unless he or she is incompetent), and to the resident's representative, and to the person making payment on behalf of the resident for the resident's stay, in writing, that the facility may discharge the resident if the resident is no longer able to pay for his or her care in the facility without Medical Assistance;
        (2) the resident (unless he or she is incompetent),
    
the resident's representative, and the person making payment on behalf of the resident for the resident's stay, acknowledge in writing that they have received the written explanation;
        (3) in circumstances where the Medicare coverage is
    
ending prior to the full 100-day benefit period, the facility provides notice to the resident and to the resident's representative that the resident's Medicare coverage will likely end in 5 days. This notification shall specify that the resident shall not be required to move under this Section until these 5 days are up. In cases where the facility is notified in a shorter time frame than 5 days by a managed care organization or the time frame is shorter than 5 days due to inaccurate reporting by an outside entity, the facility must provide a minimum of 2 days' notification.
    (a-10) For the purposes of this Section, a recipient or applicant shall be considered a resident in the facility during any hospital stay totaling 10 days or less following a hospital admission. The Department of Healthcare and Family Services shall recoup funds from a facility when, as a result of the facility's refusal to readmit a recipient after hospitalization for 10 days or less, the recipient incurs hospital bills in an amount greater than the amount that would have been paid by that Department (formerly the Illinois Department of Public Aid) for care of the recipient in the facility. The amount of the recoupment shall be the difference between the Department of Healthcare and Family Services' (formerly the Illinois Department of Public Aid's) payment for hospital care and the amount that Department would have paid for care in the facility.
    (b) A facility which violates this Section shall be guilty of a business offense and fined not less than $500 nor more than $1,000 for the first offense and not less than $1,000 nor more than $5,000 for each subsequent offense.
(Source: P.A. 103-691, eff. 1-1-25.)

    
Notes of Decisions
Cited in 6 cases, 2015–2015 · leading case: Gruby v. The Department of Public Health
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Gruby v. The Department of Public Health (2015) illappct · cites it 2× “1 of the Act (210 ILCS 45/3-401.1 (West 2012)). Manorcare’s counsel responded that the facility administrator had “discussed the situation at length” with Manorcare’s corporate legal department and had “determined that the liability the facility face[d] for allowing [plaintiff]…”
Gruby v. The Department of Public Health (2015) illappct · cites it 2× “1 of the Act (210 ILCS 45/3-401.1 (West 2012)). Manorcare’s counsel responded that the facility administrator had “discussed the situation at length” with Manorcare’s corporate legal department and had “determined that the liability the -2- 2015 IL App (2d) 140790 facility…”
Slepicka v. State (2015) illappct “” See 210 ILCS 45/3-401.1(a-5) (West 2012). ¶ 83 In her brief, plaintiff disputes that, from June 2011 to March 2012, she had to be in a Medicaid bed, or in the “distinct part SNF,” as a condition of Medicaid’s covering that period.”
Gruby v. The Department of Public Health (2015) illappct · cites it 2× “1 of the Act (210 ILCS 45/3-401.1 (West 2012)). Manorcare’s counsel responded that the facility administrator had “discussed the situation at -2- 2015 IL App (2d) 140790 length” with Manorcare’s corporate legal department and had “determined that the liability the facility…”
Slepicka v. State (2015) illappct “" See 210 ILCS 45/3-401.1(a-5) (West 2012). ¶ 78 Plaintiff disputes that, from June 2011 to March 2012, she had to be in a Medicaid bed, or in the "distinct part SNF," as a condition of Medicaid's covering that period.”
Slepicka v. State (2015) illappct “" See 210 ILCS 45/3-401.1(a-5) (West 2012). - 26 - ¶ 83 In her brief, plaintiff disputes that, from June 2011 to March 2012, she had to be in a Medicaid bed, or in the "distinct part SNF," as a condition of Medicaid's covering that period.”
— 210 ILCS 45/3-401.1(a) — 1 case
Gruby v. The Department of Public Health (2015) illappct “1 of the Act (210 ILCS 45/3-401.1 (West 2012)). Manorcare’s counsel responded that the facility administrator had “discussed the situation at length” with Manorcare’s corporate legal department and had “determined that the liability the facility face[d] for allowing [plaintiff]…”
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