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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 Illinois Public Aid Code is amended by | ||||||
5 | changing Sections 5-2.05 and 12-4.36 as follows:
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6 | (305 ILCS 5/5-2.05)
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7 | Sec. 5-2.05. Children with disabilities
Disabled children .
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8 | (a) The Department of Healthcare and Family Services, in | ||||||
9 | conjunction with the Department of Human Services,
Public Aid
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10 | may offer, to children with developmental
disabilities or | ||||||
11 | children with severe mental illness or severe emotional | ||||||
12 | disorders
and severely mentally ill or emotionally disturbed | ||||||
13 | children who
otherwise would not qualify for medical assistance | ||||||
14 | under this Article due to
family income, home-based and | ||||||
15 | community-based services instead of institutional
placement, | ||||||
16 | as allowed under paragraph 7 of Section 5-2.
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17 | (b) The Department of Healthcare and Family Services
Public | ||||||
18 | Aid , in conjunction with the Department of
Human Services and | ||||||
19 | the Division of Specialized Care for Children, University of
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20 | Illinois-Chicago, shall submit a bi-annual
also
report to the | ||||||
21 | Governor and the General Assembly no
later than January 1 of | ||||||
22 | every even-numbered year beginning in 2008 , 2004 regarding the | ||||||
23 | status of existing services offered
under paragraph 7
of |
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1 | Section 5-2. This report shall include, but not be limited to, | ||||||
2 | the following
information:
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3 | (1) The number of persons eligible for these services.
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4 | (2) The number of persons who applied for these | ||||||
5 | services.
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6 | (1)
(3) The number of persons who currently receive | ||||||
7 | these services.
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8 | (2)
(4) The nature, scope, and cost of services | ||||||
9 | provided under paragraph 7 of
Section 5-2 .
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10 | (3)
(5) The comparative cost of providing those | ||||||
11 | services in a hospital,
skilled nursing facility, or | ||||||
12 | intermediate care facility.
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13 | (4)
(6) The funding sources for the provision of | ||||||
14 | services, including federal
financial participation.
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15 | (5)
(7) The qualifications, skills, and availability | ||||||
16 | of caregivers for
children receiving services. | ||||||
17 | (6) The number of children who have aged out of the | ||||||
18 | services offered under paragraph 7 of Section 5-2 during | ||||||
19 | the 2 years immediately preceding the report.
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20 | The report shall also include information regarding the | ||||||
21 | extent to which the
existing programs could provide coverage | ||||||
22 | for children with developmental disabilities or children with | ||||||
23 | severe mental illness or severe emotional disorders
mentally | ||||||
24 | disabled children who are
currently being provided services in | ||||||
25 | an institution who could otherwise be
served in a | ||||||
26 | less-restrictive, community-based setting for the same or a |
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1 | lower
cost. The report may be submitted as part of the report | ||||||
2 | required by subsection (e) of Section 12-4.36 of this Code | ||||||
3 | during the existence of the pilot program authorized by that | ||||||
4 | Section.
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5 | (Source: P.A. 93-599, eff. 8-26-03; revised 12-15-05.)
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6 | (305 ILCS 5/12-4.36) | ||||||
7 | Sec. 12-4.36. Pilot program for persons who are medically | ||||||
8 | fragile and technology-dependent. | ||||||
9 | (a) Subject to appropriations for the first fiscal year of | ||||||
10 | the pilot program beginning July 1, 2006, the Department of | ||||||
11 | Human Services, in cooperation with the Department of | ||||||
12 | Healthcare and Family Services, shall adopt rules to initiate a | ||||||
13 | 3-year pilot program to (i) test a standardized assessment tool | ||||||
14 | for persons who are medically fragile and technology-dependent | ||||||
15 | who may be provided home and community-based services to meet | ||||||
16 | their medical needs rather than be provided care in an | ||||||
17 | institution not solely because of a severe mental or | ||||||
18 | developmental impairment and (ii) provide appropriate home and | ||||||
19 | community-based medical services for such persons as provided | ||||||
20 | in subsection (c) of this Section. The Department of Human | ||||||
21 | Services may administer the pilot program until June 30, 2010
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22 | 2009 if the General Assembly annually appropriates funds for | ||||||
23 | this purpose. | ||||||
24 | (b) Notwithstanding any other provisions of this Code, the | ||||||
25 | rules implementing the pilot program shall provide for |
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1 | criteria, standards, procedures, and reimbursement for | ||||||
2 | services that are not otherwise being provided in scope, | ||||||
3 | duration, or amount through any other program administered by | ||||||
4 | any Department of Human Services or any other agency of the | ||||||
5 | State for these medically fragile, technology-dependent | ||||||
6 | persons. At a minimum, the rules shall include the following: | ||||||
7 | (1) A requirement that a pilot program participant be | ||||||
8 | eligible for medical assistance under this Code, a citizen | ||||||
9 | of the United States, or an individual who is lawfully | ||||||
10 | residing permanently in the United States, and a resident | ||||||
11 | of Illinois. | ||||||
12 | (2) A requirement that a standardized assessment for | ||||||
13 | medically fragile, technology-dependent persons will | ||||||
14 | establish the level of care and the service-cost maximums. | ||||||
15 | (3) A requirement for a determination by a physician | ||||||
16 | licensed to practice medicine in all its branches (i) that, | ||||||
17 | except for the provision of home and community-based care, | ||||||
18 | these individuals would require the level of care provided | ||||||
19 | in an institutional setting and (ii) that the necessary | ||||||
20 | level of care can be provided safely in the home and | ||||||
21 | community through the provision of medical support | ||||||
22 | services. | ||||||
23 | (4) A requirement that the services provided be | ||||||
24 | medically necessary and appropriate for the level of | ||||||
25 | functioning of the persons who are participating in the | ||||||
26 | pilot program. |
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1 | (5) Provisions for care coordination and family | ||||||
2 | support services that will enable the person to receive | ||||||
3 | services in the most integrated setting possible | ||||||
4 | appropriate to his or her medical condition and level of | ||||||
5 | functioning. | ||||||
6 | (6) The frequency of assessment and plan-of-care | ||||||
7 | reviews. | ||||||
8 | (7) The family or guardian's active participation as | ||||||
9 | care givers in meeting the individual's medical needs. | ||||||
10 | (8) The estimated cost to the State for in-home care, | ||||||
11 | as compared to the institutional level of care appropriate | ||||||
12 | to the individual's medical needs, may not exceed 100% of | ||||||
13 | the institutional care as indicated by the standardized | ||||||
14 | assessment tool. | ||||||
15 | (9) When determining the hours of medically necessary | ||||||
16 | support services needed to maintain the individual at home, | ||||||
17 | consideration shall be given to the availability of other | ||||||
18 | services, including direct care provided by the | ||||||
19 | individual's family or guardian that can reasonably be | ||||||
20 | expected to meet the medical needs of the individual. | ||||||
21 | (c) During the pilot program, an individual who has | ||||||
22 | received services pursuant to paragraph 7 of Section 5-2 of | ||||||
23 | this Code, but who no longer receives
receive such services | ||||||
24 | because he or she has reached the age of 21, may be provided | ||||||
25 | additional services pursuant to rule if the Department of Human | ||||||
26 | Services, Division of Rehabilitation Services, determines from |
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1 | completion of the assessment tool for that individual that the | ||||||
2 | exceptional care rate established by the Department of | ||||||
3 | Healthcare and Family Services under Section 5-5.8a of this | ||||||
4 | Code is not sufficient to cover the medical needs of the | ||||||
5 | individual under the home and community-based services (HCBS) | ||||||
6 | waivers for persons with disabilities. | ||||||
7 | (d) The Department of Human Services is authorized to lower | ||||||
8 | the payment levels established under this Section or take such | ||||||
9 | other actions, including, without limitation, cessation of | ||||||
10 | enrollment, reduction of available medical services, and | ||||||
11 | changing standards for eligibility, that are deemed necessary | ||||||
12 | by the Department during a State fiscal year to ensure that | ||||||
13 | payments under this Section do not exceed available funds. | ||||||
14 | These changes may be accomplished by emergency rulemaking under | ||||||
15 | Section 5-45 of the Illinois Administrative Procedure Act, | ||||||
16 | except that the limitation on the number of emergency rules | ||||||
17 | that may be adopted in a 24-month period shall not apply. | ||||||
18 | (e) The Department of Human Services must make an annual | ||||||
19 | report to the Governor and the General Assembly with respect to | ||||||
20 | the persons eligible for medical assistance under this pilot | ||||||
21 | program. The report must cover the State fiscal year ending on | ||||||
22 | June 30 of the preceding year. The first report is due by | ||||||
23 | January 1, 2008.
The report must include the following | ||||||
24 | information for the fiscal year covered by the report: | ||||||
25 | (1) The number of persons who were evaluated through | ||||||
26 | the assessment tool under this pilot program. |
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1 | (2) The number of persons who received services not | ||||||
2 | available under the home and community-based services | ||||||
3 | (HCBS) waivers for persons with disabilities under this | ||||||
4 | pilot program. | ||||||
5 | (3) The number of persons whose services were reduced | ||||||
6 | under this pilot program. | ||||||
7 | (4) The nature, scope, and cost of services provided | ||||||
8 | under this pilot program. | ||||||
9 | (5) The comparative costs of providing those services | ||||||
10 | in other institutions. | ||||||
11 | (6) The Department's progress in establishing an | ||||||
12 | objective, standardized assessment tool for the HCBS | ||||||
13 | waiver that assesses the medical needs of medically | ||||||
14 | fragile, technology-dependent adults. | ||||||
15 | (7) Recommendations for the funding needed to expand | ||||||
16 | this pilot program to all medically fragile, | ||||||
17 | technology-dependent individuals in HCBS waivers.
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18 | (8) Participant experience survey information for | ||||||
19 | persons with disabilities who are participating in this | ||||||
20 | pilot program and for persons with disabilities who are not | ||||||
21 | participating in this pilot program but who are currently | ||||||
22 | receiving services under the home and community-based | ||||||
23 | services (HCBS) waiver and who have received services under | ||||||
24 | paragraph 7 of Section 5-2 of this Code.
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25 | (Source: P.A. 94-838, eff. 6-6-06.)
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26 | Section 99. Effective date. This Act takes effect upon |
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1 | becoming law.
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