SB2610 EngrossedLRB099 19934 MJP 44333 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Continuum of Care Services for the Developmentally Disabled
6Act.
 
7    Section 5. Purpose. The purpose of this Act is to authorize
8a new type of license for organizations providing services to
9individuals with developmental disabilities to be known as a
10continuum of care license; to define the requirements for a
11continuum of care facility to receive and maintain such a
12license; to establish a process for the development of an
13alternative budget-neutral reimbursement mechanism for such a
14facility; and to authorize a request to the federal government
15for a waiver pursuant to Section 1115 of the federal Social
16Security Act.
 
17    Section 10. Definitions. As used in this Act, unless the
18context requires otherwise:
19    "Applicable requirements of law" means State and federal
20statutes, rules, regulations, and guidance, as such may from
21time to time be amended or revised, governing the rights,
22protections, and services, including reimbursement for such

 

 

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1services, afforded to individuals with developmental
2disabilities.
3    "Campus group home" means a residential facility meeting
4the requirements of Section 30 of this Act and operated as part
5of a continuum of care facility licensed under this Act.
6    "Continuum of care facility" means a legally incorporated
7entity that provides a comprehensive range of programs,
8services, and supports for adults with developmental
9disabilities, positioned at a central geographic campus
10facility, and including all of the following:
11        (1) community-integrated living arrangements provided
12    within reasonable geographic proximity of the campus and in
13    accordance with applicable requirements of law;
14        (2) employment opportunities, including both on-campus
15    compensated work opportunities and off-campus supported
16    employment opportunities provided in accordance with
17    applicable requirements of law;
18        (3) developmental training programs and services
19    provided in accordance with applicable requirements of
20    law;
21        (4) on-campus community living facility opportunities
22    provided on-campus and in accordance with applicable
23    requirements of law;
24        (5) campus group home opportunities as authorized and
25    defined in this Act and provided in accordance with
26    applicable requirements of law; and

 

 

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1        (6) medically complex for the developmentally disabled
2    facility opportunities provided on-campus and in
3    accordance with applicable requirements of law.
4    "Continuum of care license" means a license issued to a
5continuum of care facility in accordance with the terms of this
6Act.
7    "Continuum of care plan" means a formal, written plan
8meeting the requirements of Section 25 of this Act.
9    "Facility constituent elements" means the particular,
10discrete programs, services, and supports delineated in the
11definition of "continuum of care facility" and provided
12collectively by the facility.
 
13    Section 15. Powers and duties. The Director of Human
14Services, acting in consultation and coordination as necessary
15with the Director of Public Health and the Director of
16Healthcare and Family Services, shall establish a system of
17licensure for continuum of care facilities, in accordance with
18this Act, for the following purposes:
19        (1) protecting the welfare, safety, and rights of
20    individuals with developmental disabilities;
21        (2) providing additional options for care and services
22    for individuals with developmental disabilities; and
23        (3) providing a model of care that can transition
24    individuals with developmental disabilities in a seamless
25    and timely manner across the continuum of residential care

 

 

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1    settings and supportive services, training, education, and
2    employment opportunities in a manner that maximizes
3    beneficiary choice and satisfaction.
 
4    Section 20. Licensing standards. The Director of Human
5Services shall adopt rules establishing standards for
6licensing of continuum of care facilities under a single
7license. These rules shall ensure that an applicant for
8licensure:
9        (1) meets the definition of "continuum of care
10    facility" and provides all of the programs, services, and
11    supports required by that definition;
12        (2) develops, submits, and maintains adherence to a
13    continuum of care plan that meets the requirements of
14    Section 25 of this Act;
15        (3) meets the regulatory requirements set forth in
16    Section 30 of this Act;
17        (4) meets such requirements as the Director of Human
18    Services may determine appropriate for renewal of
19    licensure or for amendment of licensure to account for
20    changes in the composition of facility constituent
21    elements providing programs or services under the license;
22    and
23        (5) meets such other requirements as the Director of
24    Human Services may determine appropriate for the effective
25    implementation of this Act.
 

 

 

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1    Section 25. Continuum of care plan. An applicant for a
2continuum of care license shall submit to the Director of Human
3Services, in such form and manner as the Director of Human
4Services shall require, a continuum of care plan that
5demonstrates how the applicant will:
6        (1) undertake a comprehensive approach to facilitating
7    the movement of individuals to the most appropriate site
8    and level of care and services provided based on that
9    individual's preference and needs;
10        (2) provide for the seamless integrated transition of
11    individuals between and among the required care settings
12    and services in a manner that addresses the individual's
13    location on the spectrum of disability and progression
14    along the age spectrum;
15        (3) maximize employment and training opportunities
16    consistent with the individual's preferences and
17    capabilities;
18        (4) provide programs, services, and supports geared to
19    addressing the demand for services for a growing population
20    of aging individuals and individuals who need the services
21    offered by a medically complex for the developmentally
22    disabled facility; and
23        (5) demonstrate a commitment to providing informed,
24    free, and meaningful choice regarding the type of community
25    in which the individual prefers to live and the type of

 

 

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1    employment opportunities or developmental training the
2    individual prefers to receive; beneficiary engagement;
3    annual care planning and ongoing treatment focused on the
4    needs and preferences of the individual and adherence to
5    other applicable requirements of law relevant to
6    protecting the rights and welfare of individuals with
7    developmental disabilities.
 
8    Section 30. Applicable requirements. The Director of Human
9Services, acting as appropriate through or in coordination with
10the Director of Public Health, shall in licensing a continuum
11of care facility ensure the following:
12        (1) community-integrated living arrangements provided
13    by such licensee meet all otherwise applicable
14    requirements of law pertaining to such arrangements,
15    including those set forth in the Community-Integrated
16    Living Arrangements Licensure and Certification Act,
17    except that a continuum of care facility may prioritize the
18    movement of individuals into or out of
19    community-integrated living arrangements from or into
20    other residential facility constituent elements;
21        (2) on-campus and off-campus employment opportunities
22    provided by the licensee meet all otherwise applicable
23    requirements of law pertaining to such opportunities;
24        (3) developmental training programs and services
25    provided by the licensee meet all otherwise applicable

 

 

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1    requirements of law pertaining to such programs and
2    services;
3        (4) community living facility opportunities provided
4    by the licensee meet all otherwise applicable requirements
5    of law pertaining to such opportunities;
6        (5) campus group homes provided by the licensee meet
7    all otherwise applicable requirements of law pertaining to
8    an ID/DD facility under the ID/DD Community Care Act;
9        (6) medically complex for the developmentally disabled
10    facility opportunities provided by the licensee meet all
11    otherwise applicable requirements of law pertaining to
12    such opportunities; and
13        (7) the applicant complies with such other
14    requirements as the Director of Human Services may consider
15    necessary and appropriate to carry out the purposes of this
16    Act and other applicable requirements of law.
 
17    Section 35. Existing and future programs and services.
18    (a) To the extent necessary to carry out the purposes of
19this Act and to maintain eligibility for reimbursement for
20services under applicable State and federal programs,
21including Title XIX of the federal Social Security Act,
22facility constituent elements of an entity licensed as a
23continuum of care facility may be considered to be licensed
24pursuant to the otherwise applicable requirements of law as set
25forth in Section 30 of this Act.

 

 

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1    (b) In the event that a continuum of care facility ceases
2to retain licensure as a continuum of care facility, facility
3constituent elements that meet all otherwise applicable
4requirements of law with respect to such element as set forth
5in Section 30 of this Act shall be deemed to be licensed
6pursuant to such requirements.
7    (c) Residents of campus group homes and
8community-integrated living arrangements that are facility
9constituent elements shall continue to be beneficiaries of and
10have the rights and protections provided to residents of ID/DD
11facilities and community-integrated living arrangements,
12respectively, under the consent decree entered by the United
13States District Court for the Northern District of Illinois in
14the matter of Ligas v. Hamos, No. 1:05-CV-4331 on June 15,
152011.
16    (d) A continuum of care licensee shall be permitted to add
17new facility constituent elements under its license provided
18that it demonstrates a need for the new facility constituent
19elements and that the facility constituent elements meet all
20applicable requirements of law.
 
21    Section 40. Reimbursement rules. The Director of Human
22Services and the Director of Healthcare and Family Services
23shall:
24        (1) ensure that reimbursement utilizing federal and
25    State resources for services provided to eligible

 

 

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1    beneficiaries through a continuum of care facility
2    comports with the following requirements:
3            (A) such services shall be reimbursed in a
4        budget-neutral manner such that reimbursement for
5        services provided by the facility constituent elements
6        of a continuum of care licensee shall be neither
7        greater nor lesser than the reimbursement received for
8        such services provided by that facility constituent
9        element prior to the licensing of the continuum of care
10        facility, adjusted to take into account any subsequent
11        changes in reimbursement for such similar services,
12        or, if the facility constituent element is a new
13        facility reimbursement for the services provided by
14        the new facility shall be no less than the
15        reimbursement received for such services by a
16        comparable facility constituent element of that
17        continuum of care facility; and
18            (B) for purposes of reimbursement under Title XIX
19        of the federal Social Security Act, a continuum of care
20        licensee shall enter into a single provider agreement
21        with the Director of Healthcare and Family Services;
22        changes that may occur from time to time in the
23        facility constituent elements under the continuum of
24        care license shall be addressed as may be required by
25        applicable requirements of law through amendments to
26        the provider agreement; the Director of Healthcare and

 

 

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1        Family Services shall make all reasonable efforts to
2        ensure that all facility constituent elements that are
3        approved parts of a continuum of care license remain
4        qualified for reimbursement under relevant State and
5        federal programs including Title XIX of the federal
6        Social Security Act; and
7        (2) in cooperation with interested stakeholders,
8    develop an alternative payment methodology for a continuum
9    of care facility involving the utilization of an annualized
10    global payment amount or other mechanism.
 
11    Section 45. The Department of Healthcare and Family
12Services Law of the Civil Administrative Code of Illinois is
13amended by adding Section 2205-13 as follows:
 
14    (20 ILCS 2205/2205-13 new)
15    Sec. 2205-13. Authorization to secure a federal waiver
16pursuant to Section 1115 of the federal Social Security Act.
17    (a) The Director of Healthcare and Family Services, in
18collaboration and coordination with the Director of Human
19Services, shall develop and submit to the United States
20Department of Health and Human Services, Centers for Medicare
21and Medicaid Services, Center for Medicaid and State
22Operations, a request for a waiver pursuant to Section 1115 of
23the federal Social Security Act consistent with the purpose of
24subsection (b) of this Section and requirements of subsection

 

 

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1(c) of this Section.
2    (b) The purpose of the waiver authorized by subsection (a)
3of this Section is to obtain approval for the use of funds
4under Title XIX of the federal Social Security Act to provide
5for an alternative model of licensure, reimbursement, and
6quality assurance for services to individuals with
7developmental disabilities consistent with the Continuum of
8Care Services for the Developmentally Disabled Act.
9    (c) A waiver requested pursuant to this authorization must
10involve the licensure of a continuum of care facility pursuant
11to and consistent with all requirements of the Continuum of
12Care Services for the Developmentally Disabled Act and a
13proposal for a reimbursement methodology developed under
14paragraph (2) of Section 40 of the Continuum of Care Services
15for the Developmentally Disabled Act.