Sen. Donne E. Trotter

Filed: 5/30/2005

 

 


 

 


 
09400HB1197sam001 LRB094 06321 WGH 47439 a

1
AMENDMENT TO HOUSE BILL 1197

2     AMENDMENT NO. ______. Amend House Bill 1197 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 1. Short title. This Act may be cited as the
5 FY2006 Budget Implementation (Human Services) Act.
 
6     Section 5. Purpose. It is the purpose of this Act to
7 implement the Governor's FY2006 budget recommendations
8 concerning human services.
 
9     Section 10. The Illinois Administrative Procedure Act is
10 amended by changing Section 5-45 as follows:
 
11     (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
12     Sec. 5-45. Emergency rulemaking.
13     (a) "Emergency" means the existence of any situation that
14 any agency finds reasonably constitutes a threat to the public
15 interest, safety, or welfare.
16     (b) If any agency finds that an emergency exists that
17 requires adoption of a rule upon fewer days than is required by
18 Section 5-40 and states in writing its reasons for that
19 finding, the agency may adopt an emergency rule without prior
20 notice or hearing upon filing a notice of emergency rulemaking
21 with the Secretary of State under Section 5-70. The notice
22 shall include the text of the emergency rule and shall be

 

 

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1 published in the Illinois Register. Consent orders or other
2 court orders adopting settlements negotiated by an agency may
3 be adopted under this Section. Subject to applicable
4 constitutional or statutory provisions, an emergency rule
5 becomes effective immediately upon filing under Section 5-65 or
6 at a stated date less than 10 days thereafter. The agency's
7 finding and a statement of the specific reasons for the finding
8 shall be filed with the rule. The agency shall take reasonable
9 and appropriate measures to make emergency rules known to the
10 persons who may be affected by them.
11     (c) An emergency rule may be effective for a period of not
12 longer than 150 days, but the agency's authority to adopt an
13 identical rule under Section 5-40 is not precluded. No
14 emergency rule may be adopted more than once in any 24 month
15 period, except that this limitation on the number of emergency
16 rules that may be adopted in a 24 month period does not apply
17 to (i) emergency rules that make additions to and deletions
18 from the Drug Manual under Section 5-5.16 of the Illinois
19 Public Aid Code or the generic drug formulary under Section
20 3.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
21 emergency rules adopted by the Pollution Control Board before
22 July 1, 1997 to implement portions of the Livestock Management
23 Facilities Act, ; or (iii) emergency rules adopted by the
24 Illinois Department of Public Health under subsections (a)
25 through (i) of Section 2 of the Department of Public Health Act
26 when necessary to protect the public's health. Two or more
27 emergency rules having substantially the same purpose and
28 effect shall be deemed to be a single rule for purposes of this
29 Section.
30     (d) In order to provide for the expeditious and timely
31 implementation of the State's fiscal year 1999 budget,
32 emergency rules to implement any provision of Public Act 90-587
33 or 90-588 or any other budget initiative for fiscal year 1999
34 may be adopted in accordance with this Section by the agency

 

 

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1 charged with administering that provision or initiative,
2 except that the 24-month limitation on the adoption of
3 emergency rules and the provisions of Sections 5-115 and 5-125
4 do not apply to rules adopted under this subsection (d). The
5 adoption of emergency rules authorized by this subsection (d)
6 shall be deemed to be necessary for the public interest,
7 safety, and welfare.
8     (e) In order to provide for the expeditious and timely
9 implementation of the State's fiscal year 2000 budget,
10 emergency rules to implement any provision of this amendatory
11 Act of the 91st General Assembly or any other budget initiative
12 for fiscal year 2000 may be adopted in accordance with this
13 Section by the agency charged with administering that provision
14 or initiative, except that the 24-month limitation on the
15 adoption of emergency rules and the provisions of Sections
16 5-115 and 5-125 do not apply to rules adopted under this
17 subsection (e). The adoption of emergency rules authorized by
18 this subsection (e) shall be deemed to be necessary for the
19 public interest, safety, and welfare.
20     (f) In order to provide for the expeditious and timely
21 implementation of the State's fiscal year 2001 budget,
22 emergency rules to implement any provision of this amendatory
23 Act of the 91st General Assembly or any other budget initiative
24 for fiscal year 2001 may be adopted in accordance with this
25 Section by the agency charged with administering that provision
26 or initiative, except that the 24-month limitation on the
27 adoption of emergency rules and the provisions of Sections
28 5-115 and 5-125 do not apply to rules adopted under this
29 subsection (f). The adoption of emergency rules authorized by
30 this subsection (f) shall be deemed to be necessary for the
31 public interest, safety, and welfare.
32     (g) In order to provide for the expeditious and timely
33 implementation of the State's fiscal year 2002 budget,
34 emergency rules to implement any provision of this amendatory

 

 

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1 Act of the 92nd General Assembly or any other budget initiative
2 for fiscal year 2002 may be adopted in accordance with this
3 Section by the agency charged with administering that provision
4 or initiative, except that the 24-month limitation on the
5 adoption of emergency rules and the provisions of Sections
6 5-115 and 5-125 do not apply to rules adopted under this
7 subsection (g). The adoption of emergency rules authorized by
8 this subsection (g) shall be deemed to be necessary for the
9 public interest, safety, and welfare.
10     (h) In order to provide for the expeditious and timely
11 implementation of the State's fiscal year 2003 budget,
12 emergency rules to implement any provision of this amendatory
13 Act of the 92nd General Assembly or any other budget initiative
14 for fiscal year 2003 may be adopted in accordance with this
15 Section by the agency charged with administering that provision
16 or initiative, except that the 24-month limitation on the
17 adoption of emergency rules and the provisions of Sections
18 5-115 and 5-125 do not apply to rules adopted under this
19 subsection (h). The adoption of emergency rules authorized by
20 this subsection (h) shall be deemed to be necessary for the
21 public interest, safety, and welfare.
22     (i) In order to provide for the expeditious and timely
23 implementation of the State's fiscal year 2004 budget,
24 emergency rules to implement any provision of this amendatory
25 Act of the 93rd General Assembly or any other budget initiative
26 for fiscal year 2004 may be adopted in accordance with this
27 Section by the agency charged with administering that provision
28 or initiative, except that the 24-month limitation on the
29 adoption of emergency rules and the provisions of Sections
30 5-115 and 5-125 do not apply to rules adopted under this
31 subsection (i). The adoption of emergency rules authorized by
32 this subsection (i) shall be deemed to be necessary for the
33 public interest, safety, and welfare.
34     (j) In order to provide for the expeditious and timely

 

 

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1 implementation of the provisions of the State's fiscal year
2 2005 budget as provided under the Fiscal Year 2005 Budget
3 Implementation (Human Services) Act, emergency rules to
4 implement any provision of the Fiscal Year 2005 Budget
5 Implementation (Human Services) Act may be adopted in
6 accordance with this Section by the agency charged with
7 administering that provision, except that the 24-month
8 limitation on the adoption of emergency rules and the
9 provisions of Sections 5-115 and 5-125 do not apply to rules
10 adopted under this subsection (j). The Department of Public Aid
11 may also adopt rules under this subsection (j) necessary to
12 administer the Illinois Public Aid Code and the Children's
13 Health Insurance Program Act. The adoption of emergency rules
14 authorized by this subsection (j) shall be deemed to be
15 necessary for the public interest, safety, and welfare.
16     (k) In order to provide for the expeditious and timely
17 implementation of the provisions of the State's fiscal year
18 2006 budget, emergency rules to implement any provision of this
19 amendatory Act of the 94th General Assembly or any other budget
20 initiative for fiscal year 2006 may be adopted in accordance
21 with this Section by the agency charged with administering that
22 provision or initiative, except that the 24-month limitation on
23 the adoption of emergency rules and the provisions of Sections
24 5-115 and 5-125 do not apply to rules adopted under this
25 subsection (k). The Department of Public Aid may also adopt
26 rules under this subsection (k) necessary to administer the
27 Illinois Public Aid Code, the Senior Citizens and Disabled
28 Persons Property Tax Relief and Pharmaceutical Assistance Act,
29 the Senior Citizens and Disabled Persons Prescription Drug
30 Discount Program Act, and the Children's Health Insurance
31 Program Act. The adoption of emergency rules authorized by this
32 subsection (k) shall be deemed to be necessary for the public
33 interest, safety, and welfare.
34 (Source: P.A. 92-10, eff. 6-11-01; 92-597, eff. 6-28-02; 93-20,

 

 

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1 eff. 6-20-03; 93-829, eff. 7-28-04; 93-841, eff. 7-30-04;
2 revised 10-25-04.)
 
3     Section 12. The Illinois Act on the Aging is amended by
4 changing Section 4.02 as follows:
 
5     (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
6     Sec. 4.02. The Department shall establish a program of
7 services to prevent unnecessary institutionalization of
8 persons age 60 and older in need of long term care or who are
9 established as persons who suffer from Alzheimer's disease or a
10 related disorder under the Alzheimer's Disease Assistance Act,
11 thereby enabling them to remain in their own homes or in other
12 living arrangements. Such preventive services, which may be
13 coordinated with other programs for the aged and monitored by
14 area agencies on aging in cooperation with the Department, may
15 include, but are not limited to, any or all of the following:
16         (a) home health services;
17         (b) home nursing services;
18         (c) homemaker services;
19         (d) chore and housekeeping services;
20         (e) day care services;
21         (f) home-delivered meals;
22         (g) education in self-care;
23         (h) personal care services;
24         (i) adult day health services;
25         (j) habilitation services;
26         (k) respite care;
27         (k-5) community reintegration services;
28         (l) other nonmedical social services that may enable
29     the person to become self-supporting; or
30         (m) clearinghouse for information provided by senior
31     citizen home owners who want to rent rooms to or share
32     living space with other senior citizens.

 

 

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1     The Department shall establish eligibility standards for
2 such services taking into consideration the unique economic and
3 social needs of the target population for whom they are to be
4 provided. Such eligibility standards shall be based on the
5 recipient's ability to pay for services; provided, however,
6 that in determining the amount and nature of services for which
7 a person may qualify, consideration shall not be given to the
8 value of cash, property or other assets held in the name of the
9 person's spouse pursuant to a written agreement dividing
10 marital property into equal but separate shares or pursuant to
11 a transfer of the person's interest in a home to his spouse,
12 provided that the spouse's share of the marital property is not
13 made available to the person seeking such services.
14     Beginning July 1, 2002, the Department shall require as a
15 condition of eligibility that all financially eligible
16 applicants and recipients apply for medical assistance under
17 Article V of the Illinois Public Aid Code in accordance with
18 rules promulgated by the Department.
19     The Department shall, in conjunction with the Department of
20 Public Aid, seek appropriate amendments under Sections 1915 and
21 1924 of the Social Security Act. The purpose of the amendments
22 shall be to extend eligibility for home and community based
23 services under Sections 1915 and 1924 of the Social Security
24 Act to persons who transfer to or for the benefit of a spouse
25 those amounts of income and resources allowed under Section
26 1924 of the Social Security Act. Subject to the approval of
27 such amendments, the Department shall extend the provisions of
28 Section 5-4 of the Illinois Public Aid Code to persons who, but
29 for the provision of home or community-based services, would
30 require the level of care provided in an institution, as is
31 provided for in federal law. Those persons no longer found to
32 be eligible for receiving noninstitutional services due to
33 changes in the eligibility criteria shall be given 60 days
34 notice prior to actual termination. Those persons receiving

 

 

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1 notice of termination may contact the Department and request
2 the determination be appealed at any time during the 60 day
3 notice period. With the exception of the lengthened notice and
4 time frame for the appeal request, the appeal process shall
5 follow the normal procedure. In addition, each person affected
6 regardless of the circumstances for discontinued eligibility
7 shall be given notice and the opportunity to purchase the
8 necessary services through the Community Care Program. If the
9 individual does not elect to purchase services, the Department
10 shall advise the individual of alternative services. The target
11 population identified for the purposes of this Section are
12 persons age 60 and older with an identified service need.
13 Priority shall be given to those who are at imminent risk of
14 institutionalization. The services shall be provided to
15 eligible persons age 60 and older to the extent that the cost
16 of the services together with the other personal maintenance
17 expenses of the persons are reasonably related to the standards
18 established for care in a group facility appropriate to the
19 person's condition. These non-institutional services, pilot
20 projects or experimental facilities may be provided as part of
21 or in addition to those authorized by federal law or those
22 funded and administered by the Department of Human Services.
23 The Departments of Human Services, Public Aid, Public Health,
24 Veterans' Affairs, and Commerce and Economic Opportunity and
25 other appropriate agencies of State, federal and local
26 governments shall cooperate with the Department on Aging in the
27 establishment and development of the non-institutional
28 services. The Department shall require an annual audit from all
29 chore/housekeeping and homemaker vendors contracting with the
30 Department under this Section. The annual audit shall assure
31 that each audited vendor's procedures are in compliance with
32 Department's financial reporting guidelines requiring an
33 administrative and employee wage and benefits cost split as
34 defined in administrative rules a 27% administrative cost split

 

 

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1 and a 73% employee wages and benefits cost split. The audit is
2 a public record under the Freedom of Information Act. The
3 Department shall execute, relative to the nursing home
4 prescreening project, written inter-agency agreements with the
5 Department of Human Services and the Department of Public Aid,
6 to effect the following: (1) intake procedures and common
7 eligibility criteria for those persons who are receiving
8 non-institutional services; and (2) the establishment and
9 development of non-institutional services in areas of the State
10 where they are not currently available or are undeveloped. On
11 and after July 1, 1996, all nursing home prescreenings for
12 individuals 60 years of age or older shall be conducted by the
13 Department.
14     The Department is authorized to establish a system of
15 recipient copayment for services provided under this Section,
16 such copayment to be based upon the recipient's ability to pay
17 but in no case to exceed the actual cost of the services
18 provided. Additionally, any portion of a person's income which
19 is equal to or less than the federal poverty standard shall not
20 be considered by the Department in determining the copayment.
21 The level of such copayment shall be adjusted whenever
22 necessary to reflect any change in the officially designated
23 federal poverty standard.
24     The Department, or the Department's authorized
25 representative, shall recover the amount of moneys expended for
26 services provided to or in behalf of a person under this
27 Section by a claim against the person's estate or against the
28 estate of the person's surviving spouse, but no recovery may be
29 had until after the death of the surviving spouse, if any, and
30 then only at such time when there is no surviving child who is
31 under age 21, blind, or permanently and totally disabled. This
32 paragraph, however, shall not bar recovery, at the death of the
33 person, of moneys for services provided to the person or in
34 behalf of the person under this Section to which the person was

 

 

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1 not entitled; provided that such recovery shall not be enforced
2 against any real estate while it is occupied as a homestead by
3 the surviving spouse or other dependent, if no claims by other
4 creditors have been filed against the estate, or, if such
5 claims have been filed, they remain dormant for failure of
6 prosecution or failure of the claimant to compel administration
7 of the estate for the purpose of payment. This paragraph shall
8 not bar recovery from the estate of a spouse, under Sections
9 1915 and 1924 of the Social Security Act and Section 5-4 of the
10 Illinois Public Aid Code, who precedes a person receiving
11 services under this Section in death. All moneys for services
12 paid to or in behalf of the person under this Section shall be
13 claimed for recovery from the deceased spouse's estate.
14 "Homestead", as used in this paragraph, means the dwelling
15 house and contiguous real estate occupied by a surviving spouse
16 or relative, as defined by the rules and regulations of the
17 Illinois Department of Public Aid, regardless of the value of
18 the property.
19     The Department shall develop procedures to enhance
20 availability of services on evenings, weekends, and on an
21 emergency basis to meet the respite needs of caregivers.
22 Procedures shall be developed to permit the utilization of
23 services in successive blocks of 24 hours up to the monthly
24 maximum established by the Department. Workers providing these
25 services shall be appropriately trained.
26     Beginning on the effective date of this Amendatory Act of
27 1991, no person may perform chore/housekeeping and homemaker
28 services under a program authorized by this Section unless that
29 person has been issued a certificate of pre-service to do so by
30 his or her employing agency. Information gathered to effect
31 such certification shall include (i) the person's name, (ii)
32 the date the person was hired by his or her current employer,
33 and (iii) the training, including dates and levels. Persons
34 engaged in the program authorized by this Section before the

 

 

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1 effective date of this amendatory Act of 1991 shall be issued a
2 certificate of all pre- and in-service training from his or her
3 employer upon submitting the necessary information. The
4 employing agency shall be required to retain records of all
5 staff pre- and in-service training, and shall provide such
6 records to the Department upon request and upon termination of
7 the employer's contract with the Department. In addition, the
8 employing agency is responsible for the issuance of
9 certifications of in-service training completed to their
10 employees.
11     The Department is required to develop a system to ensure
12 that persons working as homemakers and chore housekeepers
13 receive increases in their wages when the federal minimum wage
14 is increased by requiring vendors to certify that they are
15 meeting the federal minimum wage statute for homemakers and
16 chore housekeepers. An employer that cannot ensure that the
17 minimum wage increase is being given to homemakers and chore
18 housekeepers shall be denied any increase in reimbursement
19 costs.
20     The Department on Aging and the Department of Human
21 Services shall cooperate in the development and submission of
22 an annual report on programs and services provided under this
23 Section. Such joint report shall be filed with the Governor and
24 the General Assembly on or before September 30 each year.
25     The requirement for reporting to the General Assembly shall
26 be satisfied by filing copies of the report with the Speaker,
27 the Minority Leader and the Clerk of the House of
28 Representatives and the President, the Minority Leader and the
29 Secretary of the Senate and the Legislative Research Unit, as
30 required by Section 3.1 of the General Assembly Organization
31 Act and filing such additional copies with the State Government
32 Report Distribution Center for the General Assembly as is
33 required under paragraph (t) of Section 7 of the State Library
34 Act.

 

 

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1     Those persons previously found eligible for receiving
2 non-institutional services whose services were discontinued
3 under the Emergency Budget Act of Fiscal Year 1992, and who do
4 not meet the eligibility standards in effect on or after July
5 1, 1992, shall remain ineligible on and after July 1, 1992.
6 Those persons previously not required to cost-share and who
7 were required to cost-share effective March 1, 1992, shall
8 continue to meet cost-share requirements on and after July 1,
9 1992. Beginning July 1, 1992, all clients will be required to
10 meet eligibility, cost-share, and other requirements and will
11 have services discontinued or altered when they fail to meet
12 these requirements.
13 (Source: P.A. 92-597, eff. 6-28-02; 93-85, eff. 1-1-04; 93-902,
14 eff. 8-10-04.)
 
15     Section 15. The Children's Health Insurance Program Act is
16 amended by changing Section 30 as follows:
 
17     (215 ILCS 106/30)
18     Sec. 30. Cost sharing.
19     (a) Children enrolled in a health benefits program pursuant
20 to subdivision (a)(2) of Section 25 and persons enrolled in a
21 health benefits waiver program pursuant to Section 40 shall be
22 subject to the following cost sharing requirements:
23         (1) There shall be no co-payment required for well-baby
24     or well-child care, including age-appropriate
25     immunizations as required under federal law.
26         (2) Health insurance premiums for family members,
27     either children or adults, in families whose household
28     income is above 150% of the federal poverty level shall be
29     payable monthly, subject to rules promulgated by the
30     Department for grace periods and advance payments, and
31     shall be as follows:
32             (A) $15 per month for one family member child.

 

 

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1             (B) $25 per month for 2 family members children.
2             (C) $30 per month for 3 family members or more
3         children.
4             (D) $35 per month for 4 family members.
5             (E) $40 per month for 5 or more family members.
6         (3) Co-payments for children or adults in families
7     whose income is at or below 150% of the federal poverty
8     level, at a minimum and to the extent permitted under
9     federal law, shall be $2 for all medical visits and
10     prescriptions provided under this Act.
11         (4) Co-payments for children or adults in families
12     whose income is above 150% of the federal poverty level, at
13     a minimum and to the extent permitted under federal law
14     shall be as follows:
15             (A) $5 for medical visits.
16             (B) $3 for generic prescriptions and $5 for brand
17         name prescriptions.
18             (C) $25 for emergency room use for a non-emergency
19         situation as defined by the Department by rule.
20         (5) The maximum amount of out-of-pocket expenses for
21     co-payments shall be $100 per family per year.
22     (b) Individuals enrolled in a privately sponsored health
23 insurance plan pursuant to subdivision (a)(1) of Section 25
24 shall be subject to the cost sharing provisions as stated in
25 the privately sponsored health insurance plan.
26 (Source: P.A. 90-736, eff. 8-12-98; 91-266, eff. 7-23-99.)
 
27     Section 20. The Illinois Public Aid Code is amended by
28 changing Sections 5-5.4, 5-5.12, 5-11, and 12-4.35 as follows:
 
29     (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
30     Sec. 5-5.4. Standards of Payment - Department of Public
31 Aid. The Department of Public Aid shall develop standards of
32 payment of skilled nursing and intermediate care services in

 

 

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1 facilities providing such services under this Article which:
2     (1) Provide for the determination of a facility's payment
3 for skilled nursing and intermediate care services on a
4 prospective basis. The amount of the payment rate for all
5 nursing facilities certified by the Department of Public Health
6 under the Nursing Home Care Act as Intermediate Care for the
7 Developmentally Disabled facilities, Long Term Care for Under
8 Age 22 facilities, Skilled Nursing facilities, or Intermediate
9 Care facilities under the medical assistance program shall be
10 prospectively established annually on the basis of historical,
11 financial, and statistical data reflecting actual costs from
12 prior years, which shall be applied to the current rate year
13 and updated for inflation, except that the capital cost element
14 for newly constructed facilities shall be based upon projected
15 budgets. The annually established payment rate shall take
16 effect on July 1 in 1984 and subsequent years. No rate increase
17 and no update for inflation shall be provided on or after July
18 1, 1994 and before July 1, 2006 2005, unless specifically
19 provided for in this Section. The changes made by this
20 amendatory Act of the 93rd General Assembly extending the
21 duration of the prohibition against a rate increase or update
22 for inflation are effective retroactive to July 1, 2004.
23     For facilities licensed by the Department of Public Health
24 under the Nursing Home Care Act as Intermediate Care for the
25 Developmentally Disabled facilities or Long Term Care for Under
26 Age 22 facilities, the rates taking effect on July 1, 1998
27 shall include an increase of 3%. For facilities licensed by the
28 Department of Public Health under the Nursing Home Care Act as
29 Skilled Nursing facilities or Intermediate Care facilities,
30 the rates taking effect on July 1, 1998 shall include an
31 increase of 3% plus $1.10 per resident-day, as defined by the
32 Department.
33     For facilities licensed by the Department of Public Health
34 under the Nursing Home Care Act as Intermediate Care for the

 

 

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1 Developmentally Disabled facilities or Long Term Care for Under
2 Age 22 facilities, the rates taking effect on July 1, 1999
3 shall include an increase of 1.6% plus $3.00 per resident-day,
4 as defined by the Department. For facilities licensed by the
5 Department of Public Health under the Nursing Home Care Act as
6 Skilled Nursing facilities or Intermediate Care facilities,
7 the rates taking effect on July 1, 1999 shall include an
8 increase of 1.6% and, for services provided on or after October
9 1, 1999, shall be increased by $4.00 per resident-day, as
10 defined by the Department.
11     For facilities licensed by the Department of Public Health
12 under the Nursing Home Care Act as Intermediate Care for the
13 Developmentally Disabled facilities or Long Term Care for Under
14 Age 22 facilities, the rates taking effect on July 1, 2000
15 shall include an increase of 2.5% per resident-day, as defined
16 by the Department. For facilities licensed by the Department of
17 Public Health under the Nursing Home Care Act as Skilled
18 Nursing facilities or Intermediate Care facilities, the rates
19 taking effect on July 1, 2000 shall include an increase of 2.5%
20 per resident-day, as defined by the Department.
21     For facilities licensed by the Department of Public Health
22 under the Nursing Home Care Act as skilled nursing facilities
23 or intermediate care facilities, a new payment methodology must
24 be implemented for the nursing component of the rate effective
25 July 1, 2003. The Department of Public Aid shall develop the
26 new payment methodology using the Minimum Data Set (MDS) as the
27 instrument to collect information concerning nursing home
28 resident condition necessary to compute the rate. The
29 Department of Public Aid shall develop the new payment
30 methodology to meet the unique needs of Illinois nursing home
31 residents while remaining subject to the appropriations
32 provided by the General Assembly. A transition period from the
33 payment methodology in effect on June 30, 2003 to the payment
34 methodology in effect on July 1, 2003 shall be provided for a

 

 

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1 period not exceeding 2 years after implementation of the new
2 payment methodology as follows:
3         (A) For a facility that would receive a lower nursing
4     component rate per patient day under the new system than
5     the facility received effective on the date immediately
6     preceding the date that the Department implements the new
7     payment methodology, the nursing component rate per
8     patient day for the facility shall be held at the level in
9     effect on the date immediately preceding the date that the
10     Department implements the new payment methodology until a
11     higher nursing component rate of reimbursement is achieved
12     by that facility.
13         (B) For a facility that would receive a higher nursing
14     component rate per patient day under the payment
15     methodology in effect on July 1, 2003 than the facility
16     received effective on the date immediately preceding the
17     date that the Department implements the new payment
18     methodology, the nursing component rate per patient day for
19     the facility shall be adjusted.
20         (C) Notwithstanding paragraphs (A) and (B), the
21     nursing component rate per patient day for the facility
22     shall be adjusted subject to appropriations provided by the
23     General Assembly.
24     For facilities licensed by the Department of Public Health
25 under the Nursing Home Care Act as Intermediate Care for the
26 Developmentally Disabled facilities or Long Term Care for Under
27 Age 22 facilities, the rates taking effect on March 1, 2001
28 shall include a statewide increase of 7.85%, as defined by the
29 Department.
30     For facilities licensed by the Department of Public Health
31 under the Nursing Home Care Act as Intermediate Care for the
32 Developmentally Disabled facilities or Long Term Care for Under
33 Age 22 facilities, the rates taking effect on April 1, 2002
34 shall include a statewide increase of 2.0%, as defined by the

 

 

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1 Department. This increase terminates on July 1, 2002; beginning
2 July 1, 2002 these rates are reduced to the level of the rates
3 in effect on March 31, 2002, as defined by the Department.
4     For facilities licensed by the Department of Public Health
5 under the Nursing Home Care Act as skilled nursing facilities
6 or intermediate care facilities, the rates taking effect on
7 July 1, 2001 shall be computed using the most recent cost
8 reports on file with the Department of Public Aid no later than
9 April 1, 2000, updated for inflation to January 1, 2001. For
10 rates effective July 1, 2001 only, rates shall be the greater
11 of the rate computed for July 1, 2001 or the rate effective on
12 June 30, 2001.
13     Notwithstanding any other provision of this Section, for
14 facilities licensed by the Department of Public Health under
15 the Nursing Home Care Act as skilled nursing facilities or
16 intermediate care facilities, the Illinois Department shall
17 determine by rule the rates taking effect on July 1, 2002,
18 which shall be 5.9% less than the rates in effect on June 30,
19 2002.
20     Notwithstanding any other provision of this Section, for
21 facilities licensed by the Department of Public Health under
22 the Nursing Home Care Act as skilled nursing facilities or
23 intermediate care facilities, if the payment methodologies
24 required under Section 5A-12 and the waiver granted under 42
25 CFR 433.68 are approved by the United States Centers for
26 Medicare and Medicaid Services, the rates taking effect on July
27 1, 2004 shall be 3.0% greater than the rates in effect on June
28 30, 2004. These rates shall take effect only upon approval and
29 implementation of the payment methodologies required under
30 Section 5A-12.
31     Notwithstanding any other provisions of this Section, for
32 facilities licensed by the Department of Public Health under
33 the Nursing Home Care Act as skilled nursing facilities or
34 intermediate care facilities, the rates taking effect on

 

 

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1 January 1, 2005 shall be 3% more than the rates in effect on
2 December 31, 2004.
3     For facilities licensed by the Department of Public Health
4 under the Nursing Home Care Act as Intermediate Care for the
5 Developmentally Disabled facilities or as long-term care
6 facilities for residents under 22 years of age, the rates
7 taking effect on July 1, 2003 shall include a statewide
8 increase of 4%, as defined by the Department.
9     Notwithstanding any other provision of this Section, for
10 facilities licensed by the Department of Public Health under
11 the Nursing Home Care Act as skilled nursing facilities or
12 intermediate care facilities, effective January 1, 2005,
13 facility rates shall be increased by the difference between (i)
14 a facility's per diem property, liability, and malpractice
15 insurance costs as reported in the cost report filed with the
16 Department of Public Aid and used to establish rates effective
17 July 1, 2001 and (ii) those same costs as reported in the
18 facility's 2002 cost report. These costs shall be passed
19 through to the facility without caps or limitations, except for
20 adjustments required under normal auditing procedures.
21     Rates established effective each July 1 shall govern
22 payment for services rendered throughout that fiscal year,
23 except that rates established on July 1, 1996 shall be
24 increased by 6.8% for services provided on or after January 1,
25 1997. Such rates will be based upon the rates calculated for
26 the year beginning July 1, 1990, and for subsequent years
27 thereafter until June 30, 2001 shall be based on the facility
28 cost reports for the facility fiscal year ending at any point
29 in time during the previous calendar year, updated to the
30 midpoint of the rate year. The cost report shall be on file
31 with the Department no later than April 1 of the current rate
32 year. Should the cost report not be on file by April 1, the
33 Department shall base the rate on the latest cost report filed
34 by each skilled care facility and intermediate care facility,

 

 

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1 updated to the midpoint of the current rate year. In
2 determining rates for services rendered on and after July 1,
3 1985, fixed time shall not be computed at less than zero. The
4 Department shall not make any alterations of regulations which
5 would reduce any component of the Medicaid rate to a level
6 below what that component would have been utilizing in the rate
7 effective on July 1, 1984.
8     (2) Shall take into account the actual costs incurred by
9 facilities in providing services for recipients of skilled
10 nursing and intermediate care services under the medical
11 assistance program.
12     (3) Shall take into account the medical and psycho-social
13 characteristics and needs of the patients.
14     (4) Shall take into account the actual costs incurred by
15 facilities in meeting licensing and certification standards
16 imposed and prescribed by the State of Illinois, any of its
17 political subdivisions or municipalities and by the U.S.
18 Department of Health and Human Services pursuant to Title XIX
19 of the Social Security Act.
20     The Department of Public Aid shall develop precise
21 standards for payments to reimburse nursing facilities for any
22 utilization of appropriate rehabilitative personnel for the
23 provision of rehabilitative services which is authorized by
24 federal regulations, including reimbursement for services
25 provided by qualified therapists or qualified assistants, and
26 which is in accordance with accepted professional practices.
27 Reimbursement also may be made for utilization of other
28 supportive personnel under appropriate supervision.
29 (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597,
30 eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20,
31 eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; 93-841,
32 eff. 7-30-04; 93-1087, eff. 2-28-05.)
 
33     (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)

 

 

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1     Sec. 5-5.12. Pharmacy payments.
2     (a) Every request submitted by a pharmacy for reimbursement
3 under this Article for prescription drugs provided to a
4 recipient of aid under this Article shall include the name of
5 the prescriber or an acceptable identification number as
6 established by the Department.
7     (b) Pharmacies providing prescription drugs under this
8 Article shall be reimbursed at a rate which shall include a
9 professional dispensing fee as determined by the Illinois
10 Department, plus the current acquisition cost of the
11 prescription drug dispensed. The Illinois Department shall
12 update its information on the acquisition costs of all
13 prescription drugs no less frequently than every 30 days.
14 However, the Illinois Department may set the rate of
15 reimbursement for the acquisition cost, by rule, at a
16 percentage of the current average wholesale acquisition cost.
17     (c) (Blank). Reimbursement under this Article for
18 prescription drugs shall be limited to reimbursement for 4
19 brand-name prescription drugs per patient per month. This
20 subsection applies only if (i) the brand-name drug was not
21 prescribed for an acute or urgent condition, (ii) the
22 brand-name drug was not prescribed for Alzheimer's disease,
23 arthritis, diabetes, HIV/AIDS, a mental health condition, or
24 respiratory disease, and (iii) a therapeutically equivalent
25 generic medication has been approved by the federal Food and
26 Drug Administration.
27     (d) The Department shall not impose requirements for prior
28 approval based on a preferred drug list for anti-retroviral,
29 anti-hemophilic factor concentrates, or any atypical
30 antipsychotics, conventional antipsychotics, or
31 anticonvulsants used for the treatment of serious mental
32 illnesses until 30 days after it has conducted a study of the
33 impact of such requirements on patient care and submitted a
34 report to the Speaker of the House of Representatives and the

 

 

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1 President of the Senate.
2 (Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02;
3 93-106, eff. 7-8-03.)
 
4     (305 ILCS 5/5-11)  (from Ch. 23, par. 5-11)
5     Sec. 5-11. Co-operative arrangements; contracts with other
6 State agencies, health care and rehabilitation organizations,
7 and fiscal intermediaries.
8     (a) The Illinois Department may enter into co-operative
9 arrangements with State agencies responsible for administering
10 or supervising the administration of health services and
11 vocational rehabilitation services to the end that there may be
12 maximum utilization of such services in the provision of
13 medical assistance.
14     The Illinois Department shall, not later than June 30,
15 1993, enter into one or more co-operative arrangements with the
16 Department of Mental Health and Developmental Disabilities
17 providing that the Department of Mental Health and
18 Developmental Disabilities will be responsible for
19 administering or supervising all programs for services to
20 persons in community care facilities for persons with
21 developmental disabilities, including but not limited to
22 intermediate care facilities, that are supported by State funds
23 or by funding under Title XIX of the federal Social Security
24 Act. The responsibilities of the Department of Mental Health
25 and Developmental Disabilities under these agreements are
26 transferred to the Department of Human Services as provided in
27 the Department of Human Services Act.
28     The Department may also contract with such State health and
29 rehabilitation agencies and other public or private health care
30 and rehabilitation organizations to act for it in supplying
31 designated medical services to persons eligible therefor under
32 this Article. Any contracts with health services or health
33 maintenance organizations shall be restricted to organizations

 

 

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1 which have been certified as being in compliance with standards
2 promulgated pursuant to the laws of this State governing the
3 establishment and operation of health services or health
4 maintenance organizations. The Department shall renegotiate
5 the contracts with health maintenance organizations and
6 managed care community networks that took effect August 1,
7 2003, so as to produce $70,000,000 savings to the Department
8 net of resulting increases to the fee-for-service program for
9 State fiscal year 2006. The Department may also contract with
10 insurance companies or other corporate entities serving as
11 fiscal intermediaries in this State for the Federal Government
12 in respect to Medicare payments under Title XVIII of the
13 Federal Social Security Act to act for the Department in paying
14 medical care suppliers. The provisions of Section 9 of "An Act
15 in relation to State finance", approved June 10, 1919, as
16 amended, notwithstanding, such contracts with State agencies,
17 other health care and rehabilitation organizations, or fiscal
18 intermediaries may provide for advance payments.
19     (b) For purposes of this subsection (b), "managed care
20 community network" means an entity, other than a health
21 maintenance organization, that is owned, operated, or governed
22 by providers of health care services within this State and that
23 provides or arranges primary, secondary, and tertiary managed
24 health care services under contract with the Illinois
25 Department exclusively to persons participating in programs
26 administered by the Illinois Department.
27     The Illinois Department may certify managed care community
28 networks, including managed care community networks owned,
29 operated, managed, or governed by State-funded medical
30 schools, as risk-bearing entities eligible to contract with the
31 Illinois Department as Medicaid managed care organizations.
32 The Illinois Department may contract with those managed care
33 community networks to furnish health care services to or
34 arrange those services for individuals participating in

 

 

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1 programs administered by the Illinois Department. The rates for
2 those provider-sponsored organizations may be determined on a
3 prepaid, capitated basis. A managed care community network may
4 choose to contract with the Illinois Department to provide only
5 pediatric health care services. The Illinois Department shall
6 by rule adopt the criteria, standards, and procedures by which
7 a managed care community network may be permitted to contract
8 with the Illinois Department and shall consult with the
9 Department of Insurance in adopting these rules.
10     A county provider as defined in Section 15-1 of this Code
11 may contract with the Illinois Department to provide primary,
12 secondary, or tertiary managed health care services as a
13 managed care community network without the need to establish a
14 separate entity and shall be deemed a managed care community
15 network for purposes of this Code only to the extent it
16 provides services to participating individuals. A county
17 provider is entitled to contract with the Illinois Department
18 with respect to any contracting region located in whole or in
19 part within the county. A county provider is not required to
20 accept enrollees who do not reside within the county.
21     In order to (i) accelerate and facilitate the development
22 of integrated health care in contracting areas outside counties
23 with populations in excess of 3,000,000 and counties adjacent
24 to those counties and (ii) maintain and sustain the high
25 quality of education and residency programs coordinated and
26 associated with local area hospitals, the Illinois Department
27 may develop and implement a demonstration program from managed
28 care community networks owned, operated, managed, or governed
29 by State-funded medical schools. The Illinois Department shall
30 prescribe by rule the criteria, standards, and procedures for
31 effecting this demonstration program.
32     A managed care community network that contracts with the
33 Illinois Department to furnish health care services to or
34 arrange those services for enrollees participating in programs

 

 

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1 administered by the Illinois Department shall do all of the
2 following:
3         (1) Provide that any provider affiliated with the
4     managed care community network may also provide services on
5     a fee-for-service basis to Illinois Department clients not
6     enrolled in such managed care entities.
7         (2) Provide client education services as determined
8     and approved by the Illinois Department, including but not
9     limited to (i) education regarding appropriate utilization
10     of health care services in a managed care system, (ii)
11     written disclosure of treatment policies and restrictions
12     or limitations on health services, including, but not
13     limited to, physical services, clinical laboratory tests,
14     hospital and surgical procedures, prescription drugs and
15     biologics, and radiological examinations, and (iii)
16     written notice that the enrollee may receive from another
17     provider those covered services that are not provided by
18     the managed care community network.
19         (3) Provide that enrollees within the system may choose
20     the site for provision of services and the panel of health
21     care providers.
22         (4) Not discriminate in enrollment or disenrollment
23     practices among recipients of medical services or
24     enrollees based on health status.
25         (5) Provide a quality assurance and utilization review
26     program that meets the requirements established by the
27     Illinois Department in rules that incorporate those
28     standards set forth in the Health Maintenance Organization
29     Act.
30         (6) Issue a managed care community network
31     identification card to each enrollee upon enrollment. The
32     card must contain all of the following:
33             (A) The enrollee's health plan.
34             (B) The name and telephone number of the enrollee's

 

 

09400HB1197sam001 - 25 - LRB094 06321 WGH 47439 a

1         primary care physician or the site for receiving
2         primary care services.
3             (C) A telephone number to be used to confirm
4         eligibility for benefits and authorization for
5         services that is available 24 hours per day, 7 days per
6         week.
7         (7) Ensure that every primary care physician and
8     pharmacy in the managed care community network meets the
9     standards established by the Illinois Department for
10     accessibility and quality of care. The Illinois Department
11     shall arrange for and oversee an evaluation of the
12     standards established under this paragraph (7) and may
13     recommend any necessary changes to these standards.
14         (8) Provide a procedure for handling complaints that
15     meets the requirements established by the Illinois
16     Department in rules that incorporate those standards set
17     forth in the Health Maintenance Organization Act.
18         (9) Maintain, retain, and make available to the
19     Illinois Department records, data, and information, in a
20     uniform manner determined by the Illinois Department,
21     sufficient for the Illinois Department to monitor
22     utilization, accessibility, and quality of care.
23         (10) Provide that the pharmacy formulary used by the
24     managed care community network and its contract providers
25     be no more restrictive than the Illinois Department's
26     pharmaceutical program on the effective date of this
27     amendatory Act of 1998 and as amended after that date.
28     The Illinois Department shall contract with an entity or
29 entities to provide external peer-based quality assurance
30 review for the managed health care programs administered by the
31 Illinois Department. The entity shall be representative of
32 Illinois physicians licensed to practice medicine in all its
33 branches and have statewide geographic representation in all
34 specialities of medical care that are provided in managed

 

 

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1 health care programs administered by the Illinois Department.
2 The entity may not be a third party payer and shall maintain
3 offices in locations around the State in order to provide
4 service and continuing medical education to physician
5 participants within those managed health care programs
6 administered by the Illinois Department. The review process
7 shall be developed and conducted by Illinois physicians
8 licensed to practice medicine in all its branches. In
9 consultation with the entity, the Illinois Department may
10 contract with other entities for professional peer-based
11 quality assurance review of individual categories of services
12 other than services provided, supervised, or coordinated by
13 physicians licensed to practice medicine in all its branches.
14 The Illinois Department shall establish, by rule, criteria to
15 avoid conflicts of interest in the conduct of quality assurance
16 activities consistent with professional peer-review standards.
17 All quality assurance activities shall be coordinated by the
18 Illinois Department.
19     Each managed care community network must demonstrate its
20 ability to bear the financial risk of serving individuals under
21 this program. The Illinois Department shall by rule adopt
22 standards for assessing the solvency and financial soundness of
23 each managed care community network. Any solvency and financial
24 standards adopted for managed care community networks shall be
25 no more restrictive than the solvency and financial standards
26 adopted under Section 1856(a) of the Social Security Act for
27 provider-sponsored organizations under Part C of Title XVIII of
28 the Social Security Act.
29     The Illinois Department may implement the amendatory
30 changes to this Code made by this amendatory Act of 1998
31 through the use of emergency rules in accordance with Section
32 5-45 of the Illinois Administrative Procedure Act. For purposes
33 of that Act, the adoption of rules to implement these changes
34 is deemed an emergency and necessary for the public interest,

 

 

09400HB1197sam001 - 27 - LRB094 06321 WGH 47439 a

1 safety, and welfare.
2     (c) Not later than June 30, 1996, the Illinois Department
3 shall enter into one or more cooperative arrangements with the
4 Department of Public Health for the purpose of developing a
5 single survey for nursing facilities, including but not limited
6 to facilities funded under Title XVIII or Title XIX of the
7 federal Social Security Act or both, which shall be
8 administered and conducted solely by the Department of Public
9 Health. The Departments shall test the single survey process on
10 a pilot basis, with both the Departments of Public Aid and
11 Public Health represented on the consolidated survey team. The
12 pilot will sunset June 30, 1997. After June 30, 1997, unless
13 otherwise determined by the Governor, a single survey shall be
14 implemented by the Department of Public Health which would not
15 preclude staff from the Department of Public Aid from going
16 on-site to nursing facilities to perform necessary audits and
17 reviews which shall not replicate the single State agency
18 survey required by this Act. This Section shall not apply to
19 community or intermediate care facilities for persons with
20 developmental disabilities.
21     (d) Nothing in this Code in any way limits or otherwise
22 impairs the authority or power of the Illinois Department to
23 enter into a negotiated contract pursuant to this Section with
24 a managed care community network or a health maintenance
25 organization, as defined in the Health Maintenance
26 Organization Act, that provides for termination or nonrenewal
27 of the contract without cause, upon notice as provided in the
28 contract, and without a hearing.
29 (Source: P.A. 92-370, eff. 8-15-01.)
 
30     (305 ILCS 5/12-4.35)
31     Sec. 12-4.35. Medical services for certain noncitizens.
32     (a) Notwithstanding Subject to specific appropriation for
33 this purpose, and notwithstanding Section 1-11 of this Code or

 

 

09400HB1197sam001 - 28 - LRB094 06321 WGH 47439 a

1 Section 20(a) of the Children's Health Insurance Program Act,
2 the Department of Public Aid may provide medical services to
3 noncitizens who have not yet attained 19 years of age and who
4 are not eligible for medical assistance under Article V of this
5 Code or under the Children's Health Insurance Program created
6 by the Children's Health Insurance Program Act due to their not
7 meeting the otherwise applicable provisions of Section 1-11 of
8 this Code or Section 20(a) of the Children's Health Insurance
9 Program Act. The medical services available, standards for
10 eligibility, and other conditions of participation under this
11 Section shall be established by rule by the Department;
12 however, any such rule shall be at least as restrictive as the
13 rules for medical assistance under Article V of this Code or
14 the Children's Health Insurance Program created by the
15 Children's Health Insurance Program Act.
16     (b) The Department is authorized to take any action,
17 including without limitation cessation of enrollment,
18 reduction of available medical services, and changing
19 standards for eligibility, that is deemed necessary by the
20 Department during a State fiscal year to assure that payments
21 under this Section do not exceed available funds the amounts
22 appropriated for this purpose.
23     (c) Continued In the event that the appropriation in any
24 fiscal year for the Children's Health Insurance Program created
25 by the Children's Health Insurance Program Act is determined by
26 the Department to be insufficient to continue enrollment of
27 otherwise eligible children under that Program during that
28 fiscal year, the Department is authorized to use funds
29 appropriated for the purposes of this Section to fund that
30 Program and to take any other action necessary to continue the
31 operation of that Program. Furthermore, continued enrollment
32 of individuals into the program created under this Section in
33 any fiscal year is contingent upon continued enrollment of
34 individuals into the Children's Health Insurance Program

 

 

09400HB1197sam001 - 29 - LRB094 06321 WGH 47439 a

1 during that fiscal year.
2     (d) (Blank). The General Assembly finds that the adoption
3 of rules to meet the purposes of subsections (a), (b), and (c)
4 is an emergency and necessary for the public interest, safety,
5 and welfare. The Department may adopt such rules through the
6 use of emergency rulemaking in accordance with Section 5-45 of
7 the Illinois Administrative Procedure Act, except that the
8 limitation on the number of emergency rules that may be adopted
9 in a 24-month period shall not apply.
10 (Source: P.A. 90-588, eff. 7-1-98.)
 
11     Section 25. The All-Inclusive Care for the Elderly Act is
12 amended by changing Sections 10 and 15 as follows:
 
13     (320 ILCS 40/10)  (from Ch. 23, par. 6910)
14     Sec. 10. Services for eligible persons. Within the context
15 of the PACE program established under this Act, the Illinois
16 Department of Public Aid may include any or all of the services
17 in Article 5 of the Illinois Public Aid Code.
18     An eligible person may elect to receive services from the
19 PACE program. If such an election is made, the eligible person
20 shall not remain eligible for payment through the regular
21 Medicare or Medicaid program. All services and programs
22 provided through the PACE program shall be provided in
23 accordance with this Act. An eligible person may elect to
24 disenroll from the PACE program at any time.
25     For purposes of this Act, "eligible person" means a frail
26 elderly individual who voluntarily enrolls in the PACE program,
27 whose income and resources do not exceed limits established by
28 the Illinois Department of Public Aid and for whom a licensed
29 physician certifies that such a program provides an appropriate
30 alternative to institutionalized care. The term "frail
31 elderly" means an individual who meets the age and functional
32 eligibility requirements, as established by the Illinois

 

 

09400HB1197sam001 - 30 - LRB094 06321 WGH 47439 a

1 Department of Public Aid and the Department on Aging for
2 nursing home care, and who is 65 years of age or older.
3 (Source: P.A. 87-411.)
 
4     (320 ILCS 40/15)  (from Ch. 23, par. 6915)
5     Sec. 15. Program implementation.
6     (a) Upon receipt of federal approval waivers, the Illinois
7 Department of Public Aid shall implement the PACE program
8 pursuant to the provisions of the approved Title XIX State plan
9 as a demonstration program to provide the services set forth in
10 Section 10 to eligible persons, as defined in Section 10, for a
11 period of 3 years. After the 3 year demonstration, the General
12 Assembly shall reexamine the PACE program and determine if the
13 program should be implemented on a permanent basis.
14     (b) Using a risk-based financing model, the nonprofit
15 organization providing the PACE program shall assume
16 responsibility for all costs generated by the PACE program
17 participants, and it shall create and maintain a risk reserve
18 fund that will cover any cost overages for any participant. The
19 PACE program is responsible for the entire range of services in
20 the consolidated service model, including hospital and nursing
21 home care, according to participant need as determined by a
22 multidisciplinary team. The nonprofit organization providing
23 the PACE program is responsible for the full financial risk at
24 the conclusion of the demonstration period and when permanent
25 waivers from the federal Health Care Financing Administration
26 are granted. Specific arrangements of the risk-based financing
27 model shall be adopted and negotiated by the federal Centers
28 for Medicare and Medicaid Services Health Care Financing
29 Administration, the nonprofit organization providing the PACE
30 program, and the Illinois Department of Public Aid.
31 (Source: P.A. 87-411.)
 
32     Section 99. Effective date. This Act takes effect July 1,

 

 

09400HB1197sam001 - 31 - LRB094 06321 WGH 47439 a

1 2005.".