October 14, 2026 · 3,266 words · 12 speakers · 86 segments
. Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . . Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . . Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . . Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. . . Thank you. Thank you. Good afternoon The Joint Committee on Administrative Rules shall come to order As a reminder it is JCAR policy to only allow representatives of state agencies to testify before this committee If members of the public wish to express their views with respect to rulemaking, they should submit written comments to the JCAR office at the following address. The Joint Committee on Administrative Rules, 700 Stratton Office Building, Springfield, Illinois, 62706, or via email at jcar at ilga.gov. The committee would also like to remind commenters to submit their public comment on rulemakings in a timely manner. And that submitting last-minute comments to the committee is discouraged and may not be considered. And with that said, staff, please call the attendance roll call.
Senator Bryant.
Senator Castro.
Senator Cunningham.
Senator DeWitt.
Senator Harris.
Senator Turner.
Representative Delgado.
Representative Haas.
Representative Reich.
Representative Spain.
Representative Tarver.
and Representative Vela.
President and Quorum established. Thank you. We'll move to approval of the minutes.
Representative Delgado
moves seconded by Senator DeWitt that the minutes of the September 15, 2026 committee meeting be approved. All those in favor say aye. Those opposed say nay. Independent of the chair, the ayes have it. And the minutes are approved. We'll move now to agency responses. First with the Department of Health Care and Family Services on tabs 59 and 60 regarding hospital services. Staff, please read the committee's response. To the appropriateness of the agency's response, no further action. Thank you. Now moving to a review of agency rulemakings, we begin with the State Board of Elections on tab 8 regarding the evaluation of educator licensed employees under Articles 24A and 34 of the school code. Staff, please read the motion. Jicar with the concurrence of the State Board of Education, extend the second notice period for the rulemaking titled evaluation of educator licensed employees under articles 24a and 34 the school code for an additional 45 days thank you representative vela moved seconded by senator turner that the motion just read be approved all those in favor say aye those opposed say nay in the opinion of the chair the ayes have it and the motion passes now moving to the department of financial and professional regulation several tabs tab 10 regarding minimum organizational capital requirements for banks and trust companies, tab 11, corporate applications for banks and corporate fiduciaries, tab 12, corporate fiduciary applications and notices, tab 13, corporate fiduciary receivership accounts, tab 14, pledging requirements for Illinois trust companies, tab 15, standards for operation and conduct of affairs of corporate fiduciaries, and tab 18, professional geologist licensing act. Staff, please read the motion. J. Carr with the concurrence of the Department of Financial Regulation, extend the second notice period for the rulemaking just read for an additional 45 days. Thank you, Kevin. Representative Reich moves seconded by Senator Castro that the motion just read be approved. All those in favor say aye. Those opposed say nay. And the motion passes. Now moving to the Department of Health Care and Family Services on tab 19 regarding the medical assistance programs and tab 21 for medical payments staff please read the motion. Jake Gard with the concurrence of the Department of Health Care and Family Services is setting the second notice period for the rulemakings titled medical assistance programs and medical payment for an additional 45 days. Senator Harris moved seconded by Representative Haas that the motion just read be approved. All those in favor say aye. Those opposed say nay. In the opinion of the chair, the ayes have it and the motion is adopted. Moving now to some additional items for discussion. Could we please have beginning with tab 22 the Department of Health Care and Family Services rulemaking regarding medical payment and C invoice payments And Mr. Shaker, if you'd introduce yourself for the record and your colleague, and then we'll begin with Senator DeWitt for questions.
Thank you, co-chairman. My name is Omar Shaker. I'm the chief of administrative rules for the Department of Health Care and Family Services. I'm Daniel Bishop, Assistant General Counsel at OGC for HFS.
Thank you. Senator DeWitt.
Thank you, Mr. Chairman. Good morning, gentlemen. Thanks for coming out this morning. I understand the amount of money we're talking about with regards to these rule changes. They're somewhere in the vicinity of $300 or $310 million split between nursing home indebtedness as well as hospital indebtedness. Are we in the same ballpark?
Yes.
Okay. I want to try to get a handle on the scope of this problem. Do you have any information that would give us some idea of the total amount of dollars that were granted in the scope of this program and what that number may look like as compared to the $300 million still outstanding?
Yes, I can speak to that. So for nursing homes, we gave out $112 million in advances. $17 million was repaid, leaving $95 million left unpaid for the nursing homes. And then for hospitals, this is just a rough estimate. I don't have the exact total in front of me, but I believe we have given out $277 million and $227 million is left unpaid there.
Okay. Sounds like we have a long way to go. So a small percentage of those dollars that were committed to be repaid have got to come back in. And yet you're talking about extending the amount of time these facilities are going to have to repay their outstanding balances. why are we not taking a more aggressive approach in recouping these dollars when most of these are defaults with regards to agreements they've signed and agreed to pay the state back for? You want to extend the payback to 36 months, I understand?
Yes, we have.
And it's currently 12?
It's currently 6, I believe. But we are extending that out. We have spoken to the providers and stakeholders throughout this whole process and issued a number of provider notices, and several of them have reached back out to the state, indicating that they're in financial distress and have some difficulties in terms of paying this back immediately, which we are giving them the benefit of the doubt there. And we are, for nursing homes in particular, we are allowing them to enter into renegotiated advanced payment agreements in which they pay over the course of 12 months. And we lay that out in the statute pretty specifically, and there would be equal monthly payments to repay those back. So for nursing homes in particular with the old advanced payments agreements, we're giving them a year to repay those. Now for other providers, hospitals, they have much more significant advances, sometimes in the range of $10 to $20 million, and we generally don expect to be able to recoup that immediately or in the near immediate future So we are providing them kind of a lifeline here and potentially extending that out to 36 months of repayments which would allow them more time to get their finances in order and get this money back to the state.
Okay. My last question, is it safe to assume that any of these facilities with this debt outstanding have been restricted from any additional advances or loans, however you want to describe it, moving forward?
Yes. Generally speaking, we have not given out any advances recently to any of these providers that have the old outstanding advances.
Okay. And your phrase, generally speaking, would suggest that there might be a couple of instances where there have been advances above and beyond their indebtedness?
Not recently.
Okay.
So I can think of just a couple of hospitals that asked for additional advances going back to like 2023, 2024, that received a second or third advance. But in the recent, in this year, 2026, I don't believe we've given out any advancements.
Okay. And I did forget one question. How far back did these go?
They go back to 2018, some of these unpaid advances.
Just prior to COVID?
Yes, prior to COVID.
Okay. All right. Thank you. Appreciate that.
Thank you.
Representative Reich is recognized.
Thank you, Chair. Thanks for showing up, guys. You gave us some numbers with regard to paid versus unpaid and all that kind of stuff. How much actual money is put forth to all providers with these advanced payments? What's the denominator of that fraction that you're talking about?
roughly it would be $277 million plus $112 million.
Yeah, but that is the full extent of the amount of money that's put forth in this program of advancements, or is that the amount that's subject to being that has not been repaid? I guess my question is, is this like a billion-dollar program? that, so are we dealing specifically with just certain facilities that are getting these advance payments?
It is just certain facilities, and it's not really a program per se. It's generally, we give out these advances in times of emergency. So let's say like a hospital is installing a new EMR system and it doesn't work for a couple months. We'll give out an advance as like a loan for that period of time so that they can keep their finances going and they're supposed to pay it back according to the terms of our advanced payment agreements. So what we have given out is roughly around a little under 400 million and roughly a hundred million of that has been paid back.
And this is going about a 25% reimbursement rate or whatever you want to call it.
Generally. Yes.
Is there, Are there any restrictions upon the resources that are available to the department for clawback, or are you specifically limited to maybe not giving a future one or giving it and clawing it back? I'm thinking in terms of not making a pension payment by a municipality, and they're subject to losing their local government distributed fund. Do you have other resources or other avenues for collecting this money for clawback other than just the actual grant money itself?
So that was... purposes of us implementing or drafting this rule was we were able to recoup from fee-for-service payments from the providers and we wanted to expand upon those methods and include MCO payments and state grants and be able to recoup from liens on real estate things like that is that no we have not included liens in this particular process as a method of recruitment what do you think
the likelihood of collecting that 75% is, and do I wonder what you're talking about here? I mean, it's rather generous as far as your willingness to extend this out. Are we just basically, you know, waving goodbye from a distance now rather than something we want to get right away?
That is one of the purposes of this rule is to recoup as much money as possible here. I couldn't put a percentage on it, but in the nursing home realm, a couple of the providers have declared for bankruptcy. but generally we are planning on recouping most of the money for the, almost all of the money for the providers that did not declare bankruptcy. In the hospital realm, we're still working on the terms of those renegotiated agreements.
Are these reimbursements, are they secured or unsecured in bankruptcy?
They're unsecured.
Unsecured?
Yes.
Okay, very good. Thank you.
Thank you.
The chair recognizes Senator Turner for questions.
I think he might have got all the answers that I needed, but thank you, gentlemen, for being here today. I just had a question more about the lien. So in your contractual agreement that you have, is that correct, you have a contractual agreement?
Yes, that is correct.
And within the body of that agreement, it doesn't say anything about a lien on the property or anything like that, right?
So in our currently executed agreements going back to 2018, we do not have any language regarding liens. However, going forward, we have begun to institute and put lien language into some of those contracts.
That's great. In the new contract.
In the new contracts. Yeah, the renegotiated contract.
All right. Thank you.
Thank you.
Any further discussion? One question that I have you have focused on the nearly million in advance payments but we know that this problem is compounded by unpaid provider taxes What is the magnitude of that liability for long-term care and hospitals?
I don't have an exact number in front of me for both of those. There are significant unpaid provider taxes. You are correct in that statement. but we are currently working on repayment agreements in that realm, too. We executed quite a few assessment repayment agreements back in 2025 with a new statute that we passed in June of 2025. So we are currently in the process of collecting on those unpaid assessment taxes as well.
Is that a 36-month collection period as well?
I think the agreements vary in terms of how quickly we are recouping from the various hospitals.
Could you provide an update to us regarding those unpaid provider taxes? And then one further question, and this you can answer now or it could be included in your update to us. what advanced payments and unpaid provider assessments are lost and will never be recovered from providers who have declared bankruptcy and ceased operations?
The only number that I know offhand is for the nursing home realm. It's about $43 million for a provider that declared bankruptcy, but those aren't necessarily lost. we could still file a claim within those bankruptcy proceedings, and we're working on that right now, and we may be able to recover some of that money as well.
Okay. Yeah, if you would get us an update on, I hear you on the long-term care, and then we know there's some hospitals that have closed that have received a lot of attention as well.
Yes.
I imagine those would be on the list.
Yes, those are on the list as well, and we're currently in the process of figuring out how we can recoup those unpaid advances for those particular hospitals. And we're working with third party counsel and bankruptcy attorneys as well in those in those regards. Okay, thank you
Seeing no further discussion Thank you both for being here and answering our questions Look forward to more information Thank you Thank you We move now to tab 58 the Department of Public Health Emergency Rules titled Skilled Nursing and Intermediate Care Facilities Code Welcome, Ms. Neckert. And we'll begin with questions from Senator Bryant.
Thank you. Thanks for being here. So we've had some issues in a lot of places where nursing homes do all kinds of advertisements. They've covered every base they can possibly cover to try to get the staffing. and you guys have been really good about kind of putting this off and putting it off. I am concerned that once this, I mean the statute is the statute, I get that. Once this goes into effect, is there still a mechanism by which a facility can show that they've done everything in the world to meet the staffing ratios but they just haven't been able to? Do they get a waiver? Could you just explain how that would work? And also I'll ask the second question. I was going to do them both at the same time, is it looks like you're going to use data that is from the quarter that just passed. So in a sense, the fines are kind of retroactive. So what happens in that case if the first question I asked you, it was impossible for them to hire? Sure.
So Allison Eckern, Deputy Chief of Staff at IDPH. So the statute and then, of course, the rules based on the statute do contemplate that issue. There is what's called an RN waiver process. And so it's not going to be in the emergency rules that you all reviewed because we didn't open that section in the emergency rules. I think it's Section 1232 details the process by which facilities can apply, saying, here's all the things we did to try to bring in nursing staff. And then it does give IDPH the ability to give a waiver for that quarter. I know we're supposed to review those on a quarterly basis. I would have to check on the status of the review for the past quarter that we just had So I can look into that information but the statute does address that possibility
So what is the criteria then so that it's not like a waiver being granted is not arbitrary. There's rules in place that that facility knows they have to do this, this, and this to show that they're making every effort, right?
Correct.
Then that's available to them.
So if they get the fine, it is because they didn't try all of those avenues.
Correct. And I'm happy to send you that section of the rule so you can review it.
Oh, thank you so much.
Thank you. Any further discussion? Seeing none, thank you very much.
Thank you.
We'll move now to the certification of no objection. Please note that no action will be taken on the State Board of Elections rulemaking titled Constitutional Amendments and Statewide Advisory Questions found at Tab 9 and the Department of Health Care and Family Services rulemaking titled Medical Payments found on Tab 20. Staff, please read the certification motion. The committee shall inform the agencies to whose rulemakings the committee has not voted an objection or extension, or did not remove from the no-objection list, that the committee consider their respective rulemakings at the monthly meeting, and based upon the agreements for modification of the rulemaking made by the agency, no objections will be issued. Senator Bryant moves seconded by Senator Castro that the certification motion just read be approved. All those in favor say yes, or say aye. Those opposed say nay. In the opinion of the chair, hearing all the ayes, the ayes have it, and the certification motion passes. Our next JCAR meeting will be held on Tuesday, November 17, 2026, at 1030 in room C1 of the Stratton office building in Springfield. And now with no further business to come before the committee, co-chair Cunningham moves, seconded by Representative Reich, that this meeting of the Joint Committee on Administrative Rules stands adjourned. All those in favor say aye. Those opposed say nay. In the opinion of the chair, the ayes have it. And this meeting is adjourned. Thank you.