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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The State Finance Act is amended by adding | ||||||||||||||||||||||||||||||||||
5 | Section 5.625 as follows: | ||||||||||||||||||||||||||||||||||
6 | (30 ILCS 105/5.625 new)
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7 | Sec. 5.625. The Long-Term Care Special Administration | ||||||||||||||||||||||||||||||||||
8 | Fund. | ||||||||||||||||||||||||||||||||||
9 | Section 10. The Illinois Public Aid Code is amended by | ||||||||||||||||||||||||||||||||||
10 | adding the heading of Article V-F and Sections 5F-5, 5F-10, | ||||||||||||||||||||||||||||||||||
11 | 5F-15, and 5F-20 as follows: | ||||||||||||||||||||||||||||||||||
12 | (305 ILCS 5/Art. V-F heading new) | ||||||||||||||||||||||||||||||||||
13 | ARTICLE V-F. FINANCING OF LONG-TERM | ||||||||||||||||||||||||||||||||||
14 | CARE SERVICES
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15 | (305 ILCS 5/5F-5 new) | ||||||||||||||||||||||||||||||||||
16 | Sec. 5F-5. Definitions. In this Article: | ||||||||||||||||||||||||||||||||||
17 | "Long-term care services" means the range of services, | ||||||||||||||||||||||||||||||||||
18 | other than acute care services that provide time-limited | ||||||||||||||||||||||||||||||||||
19 | curative or restorative treatment, that are delivered in the | ||||||||||||||||||||||||||||||||||
20 | home, the community, or an institution to persons with | ||||||||||||||||||||||||||||||||||
21 | functional or cognitive limitations who require assistance | ||||||||||||||||||||||||||||||||||
22 | with performing activities of daily living. The term includes | ||||||||||||||||||||||||||||||||||
23 | services provided in a nursing home or in an individual's home | ||||||||||||||||||||||||||||||||||
24 | by a nurse, health aide, or personal attendant.
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25 | "Home and community-based services" means long-term care | ||||||||||||||||||||||||||||||||||
26 | services that are designed to assist older Illinoisans and | ||||||||||||||||||||||||||||||||||
27 | people with disabilities to remain independent and avoid | ||||||||||||||||||||||||||||||||||
28 | inappropriate institutionalization. Home and community-based | ||||||||||||||||||||||||||||||||||
29 | services include, but are not limited to, the following:
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1 | (1) Home and community-based waiver.
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2 | (2) Traumatic brain injury waiver.
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3 | (3) Residential care homes.
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4 | (4) Personal care attendant services.
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5 | (5) Chore and homemaker services.
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6 | (6) Older Americans Act-funded services.
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7 | (7) Adult day services and home health services.
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8 | (8) Respite care to provide support to family | ||||||
9 | caregivers.
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10 | (9) Any other long-term care support services.
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11 | (305 ILCS 5/5F-10 new) | ||||||
12 | Sec. 5F-10. Redistribution of long-term care expenditures. | ||||||
13 | (a) By the end of fiscal year 2005, the Department of | ||||||
14 | Public Aid shall estimate a reduction in Medicaid nursing home | ||||||
15 | expenditures based on the average annual expenditure for | ||||||
16 | nursing home beds and estimated reductions in occupancy from | ||||||
17 | State fiscal years 2000 through 2004. For fiscal years 2006 | ||||||
18 | through 2010, the Department, in cooperation with the nursing | ||||||
19 | home industry and other affected parties, may reduce Medicaid | ||||||
20 | nursing home expenditures in each fiscal year based on that | ||||||
21 | estimate. | ||||||
22 | (b) If the agency determines that it is necessary to reduce | ||||||
23 | the number of nursing home beds in each fiscal year in order to | ||||||
24 | reduce nursing home expenditures pursuant to the estimate | ||||||
25 | prepared under subsection (a), the Department shall develop a | ||||||
26 | plan that reduces the number of beds certified for | ||||||
27 | participation in the medical assistance program under Article V | ||||||
28 | while ensuring that the supply and distribution of long-term | ||||||
29 | care services are not diminished in any community in which one | ||||||
30 | or more nursing home beds may be eliminated, to the extent that | ||||||
31 | the need for such services cannot be met. No nursing home beds | ||||||
32 | may be decertified for participation under the medical | ||||||
33 | assistance program under this Section by the Department until | ||||||
34 | February 1, 2006. The requirements of this subsection shall not | ||||||
35 | impede the Department's authority to reduce nursing home |
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1 | expenditures effective July 1, 2005 pursuant to subsection (a) | ||||||
2 | and to redirect those expenditures to fund home and | ||||||
3 | community-based services pursuant to subsection (d).
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4 | (c) The reductions required in subsection (a) shall not | ||||||
5 | have the effect of doing any of the following:
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6 | (1) Diminishing or reducing the quality of services | ||||||
7 | available to nursing home residents.
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8 | (2) Forcing any nursing home resident to involuntarily | ||||||
9 | accept home and community-based services instead of | ||||||
10 | nursing home services.
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11 | (3) Causing any nursing home resident to be | ||||||
12 | involuntarily transferred or discharged as the result of a | ||||||
13 | change in the resident's method of payment for nursing home | ||||||
14 | services or exhaustion of the resident's personal | ||||||
15 | financial resources.
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16 | (d) The reductions required in subsection (a) shall be | ||||||
17 | redirected in fiscal year 2006 to fund home and community-based | ||||||
18 | services. For fiscal year 2006 and thereafter, the reductions | ||||||
19 | estimated under subsection (a) shall be redirected in that | ||||||
20 | fiscal year to fund both home and community-based services and | ||||||
21 | any programs designed to reduce the number of nursing home | ||||||
22 | beds. Any general funds that are redirected but not spent | ||||||
23 | during any fiscal year shall be transferred to the Long-Term | ||||||
24 | Care Special Administration Fund, which is hereby created as a | ||||||
25 | special fund in the State treasury. Interest earned on moneys | ||||||
26 | in the fund shall be retained in the fund. All moneys received | ||||||
27 | from or generated to the fund shall be spent only for home and | ||||||
28 | community-based services or for mechanisms that reduce the | ||||||
29 | number of nursing home beds.
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30 | (e) The long-term care funds generated by the reductions in | ||||||
31 | nursing home expenditures required in subsection (a) shall be | ||||||
32 | distributed among the following categories of consumers:
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33 | (1) Nursing home residents who desire transfer to a | ||||||
34 | home and community-based setting and for whom such a | ||||||
35 | transfer is medically appropriate and cost effective.
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36 | (2) People on waiting lists for publicly funded |
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1 | programs as of July 1, 2005 and at the highest risk of | ||||||
2 | nursing home placement.
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3 | (3) People at the highest risk of nursing home | ||||||
4 | admission.
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5 | (4) People with the greatest social and economic need.
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6 | (305 ILCS 5/5F-15 new) | ||||||
7 | Sec. 5F-15. Implementation. | ||||||
8 | (a) The Department shall document and verify the amount of | ||||||
9 | funding transferred from nursing home services to home and | ||||||
10 | community-based services and any additional home and | ||||||
11 | community-based services that are provided or enhanced from | ||||||
12 | this transfer of funds. This documentation shall be submitted | ||||||
13 | to the General Assembly no later than January 1, 2006, and on | ||||||
14 | each January 1 thereafter until January 1, 2010. | ||||||
15 | (b) By July 1, 2005, the Department shall complete the | ||||||
16 | following:
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17 | (1) Implementation of the initial phase of a | ||||||
18 | comprehensive data system that tracks long-term care | ||||||
19 | expenditures, services, consumer profiles, and consumer | ||||||
20 | preferences.
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21 | (2) Implementation, in cooperation with the Department | ||||||
22 | on Aging, the Department of Human Services, and the | ||||||
23 | Department of Public Health, of a system of statewide | ||||||
24 | long-term care service coordination and case management to | ||||||
25 | minimize administrative costs, improve access to services, | ||||||
26 | and minimize obstacles to the delivery of long-term care | ||||||
27 | services to people in need. At a minimum, the system shall | ||||||
28 | include the following:
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29 | (A) A request for proposal process by which the | ||||||
30 | Department may authorize local entities to administer | ||||||
31 | long-term care services.
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32 | (B) A comprehensive assessment system by which all | ||||||
33 | individuals shall be evaluated before receiving | ||||||
34 | long-term care services and may be evaluated | ||||||
35 | periodically, as needed, while long-term care services |
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1 | are being provided to ensure that an individual | ||||||
2 | receives appropriate long-term care services.
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3 | (C) Coordination of all of the long-term care | ||||||
4 | services administered by the Department on Aging, the | ||||||
5 | Department of Public Aid, and the Department of Human | ||||||
6 | Services.
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7 | (D) Completion of consumer information about all | ||||||
8 | of the long-term care services that are available.
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9 | (E) Consumer participation and oversight at the | ||||||
10 | State and local levels in the planning and delivery of | ||||||
11 | long-term care services.
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12 | (F) Long-term care service models that are | ||||||
13 | alternatives to nursing home models, provided that the | ||||||
14 | alternative models are comparable in cost or are more | ||||||
15 | cost effective than the nursing home models that | ||||||
16 | provide equivalent services. Any such alternative | ||||||
17 | long-term care service models must be financially | ||||||
18 | viable, must be cost effective, and must promote | ||||||
19 | consumer independence, participation, and | ||||||
20 | noninstitutionalization and, when appropriate, | ||||||
21 | consumer direction; in addition, they may include a | ||||||
22 | service or a combination of services such as assisted | ||||||
23 | living, adult foster care, attendant care, and | ||||||
24 | modifications of the residential care home system.
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25 | (G) Proposals for legislation to create | ||||||
26 | alternative long-term care service models.
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27 | (3) In consultation with the nursing home industry, | ||||||
28 | consumer advocates, consumers, and other long-term service | ||||||
29 | providers, the proposal and implementation of methods to | ||||||
30 | contain costs and encourage the reduction of Medicaid | ||||||
31 | nursing home expenditures. These methods may include the | ||||||
32 | following:
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33 | (A) Maximizing Medicare billing to pay for nursing | ||||||
34 | home care.
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35 | (B) Mechanisms to reduce the number of nursing home | ||||||
36 | beds, including a schedule for those reductions and |
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1 | recommendations for various sources of funding for | ||||||
2 | payments to nursing homes to reduce the number of | ||||||
3 | licensed beds.
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4 | (C) Elimination or modification of State nursing | ||||||
5 | home rules that do not advance the quality of patient | ||||||
6 | care and are not cost effective.
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7 | (D) Applications for exemption from federal | ||||||
8 | nursing home regulations to improve the efficiency and | ||||||
9 | reduce the cost and paperwork required to regulate the | ||||||
10 | nursing home industry.
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11 | (E) Proposals for adoption of or changes in rules, | ||||||
12 | subject to the certificate of need review, that permit | ||||||
13 | the following:
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14 | (i) Greater cooperation among long-term care | ||||||
15 | providers in such areas as discharge planning and | ||||||
16 | staff sharing during periods of transition.
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17 | (ii) Greater cooperation between nursing homes | ||||||
18 | and providers of home care, respite care, adult day | ||||||
19 | care, and other long-term care services.
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20 | (iii) The use of vacant nursing home beds as | ||||||
21 | respite beds.
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22 | (F) Changes in the State Medicaid plan to permit | ||||||
23 | Medicaid billing for community residential care homes.
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24 | (G) Strategies to provide alternative financing of | ||||||
25 | long-term care services by shifting the balance of the | ||||||
26 | financial responsibility for payment for long-term | ||||||
27 | care services from public to private sources by | ||||||
28 | promoting public-private partnerships and personal | ||||||
29 | responsibility for long-term care. These strategies | ||||||
30 | may include the following:
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31 | (i) Flexible use of reverse mortgages.
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32 | (ii) Private insurance coverage for long-term | ||||||
33 | care.
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34 | (iii) Tax credits or employment programs, such | ||||||
35 | as medical savings accounts for long-term care.
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36 | (iv) Changes in Medicaid eligibility |
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1 | requirements that increase consumers' financial | ||||||
2 | responsibility for their long-term care, such as | ||||||
3 | revising the rules relating to the transfer of | ||||||
4 | assets.
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5 | (v) Social insurance models.
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6 | (vi) Estate recovery options.
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7 | (vii) Methods to supplement and support family | ||||||
8 | and community care giving.
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9 | (4) Designation and implementation of a voucher | ||||||
10 | program that permits appropriate consumers to direct, | ||||||
11 | manage, and pay for their home and community-based care | ||||||
12 | services. The Department shall apply for any federal | ||||||
13 | waivers required to implement this program. The cost of | ||||||
14 | providing those services pursuant to the voucher program | ||||||
15 | shall be limited to no more than 90% of the cost of | ||||||
16 | providing similar services under the Medicaid program and | ||||||
17 | shall be designed to provide the following:
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18 | (A) Program flexibility that permits consumers to | ||||||
19 | design, manage, and pay for their own long-term care | ||||||
20 | services, including hiring and firing their personal | ||||||
21 | care assistants. The Department shall apply for | ||||||
22 | available foundation grants to address barriers to | ||||||
23 | recruitment and retention of caregivers. Policy and | ||||||
24 | fiscal program design shall be based on input from | ||||||
25 | consumers and caregivers. Support services, such as | ||||||
26 | transportation, training, and personal assistance | ||||||
27 | reimbursement, shall be provided to ensure such | ||||||
28 | participation.
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29 | (B) Mechanisms to ensure quality of service.
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30 | (C) An eligibility determination procedure by | ||||||
31 | which appropriate long-term care service needs are | ||||||
32 | determined for each consumer by means of a | ||||||
33 | self-evaluation of needs and abilities in combination | ||||||
34 | with an objective evaluation of the consumer's ability | ||||||
35 | to direct, coordinate, and manage such services.
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36 | (D) The amount of any copayment to be made by the |
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1 | consumer, based on income criteria.
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2 | (E) A payment system by which a consumer receives a | ||||||
3 | voucher in the amount required to pay for his or her | ||||||
4 | long-term care services on a regular, determined | ||||||
5 | schedule. The amount of the voucher shall not be more | ||||||
6 | than 90% of the cost of providing the same or | ||||||
7 | comparable services under Medicaid, less the amount of | ||||||
8 | any copayment to be paid by the consumer.
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9 | (c) No later than January 1, 2007, the Department shall | ||||||
10 | report to the General Assembly regarding the progress made in | ||||||
11 | complying with the requirements of subsection (b).
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12 | (305 ILCS 5/5F-20 new) | ||||||
13 | Sec. 5F-20. Long-term care budget. By January 1, 2006, and | ||||||
14 | by January 1 of each year thereafter, the Department shall | ||||||
15 | submit to the General Assembly a budget and budget management | ||||||
16 | plan. The budget shall include all publicly financed long-term | ||||||
17 | care services available to older Illinoisans and people with | ||||||
18 | disabilities, including: | ||||||
19 | (1) Medicaid expenditures for nursing homes.
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20 | (2) Home and community-based waiver.
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21 | (3) Traumatic brain injury waiver.
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22 | (4) Residential care home waiver.
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23 | (5) Personal care attendant services.
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24 | (6) Chore and homemaker services.
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25 | (7) Older Americans Act-funded services.
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26 | (8) Adult day services and home health services.
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27 | (9) Respite care to provide support to family | ||||||
28 | caregivers.
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29 | (10) Any other long-term care support services.
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