Full Text of SB0765 95th General Assembly
SB0765sam006 95TH GENERAL ASSEMBLY
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Sen. M. Maggie Crotty
Filed: 3/30/2007
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| AMENDMENT TO SENATE BILL 765
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| AMENDMENT NO. ______. Amend Senate Bill 765, AS AMENDED, by | 3 |
| replacing everything after the enacting clause with the | 4 |
| following:
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| "Section 5. The Disabilities Services Act of 2003 is | 6 |
| amended by adding a heading to Article 1 immediately before | 7 |
| Section 1 of the Act, by adding a heading to Article 2 | 8 |
| immediately before Section 5 of the Act, by adding Article 3 | 9 |
| and a heading to Article 99 immediately before Section 90 of | 10 |
| the Act as follows: | 11 |
| (20 ILCS 2407/Art. 1 heading new) | 12 |
| ARTICLE 1. SHORT TITLE | 13 |
| (20 ILCS 2407/Art. 2 heading new) | 14 |
| ARTICLE 2. DISABILITIES SERVICES ACT of 2003 |
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| (20 ILCS 2407/Art. 3 heading new) | 2 |
| ARTICLE 3. OLMSTEAD IMPLEMENTATION ACT | 3 |
| (20 ILCS 2407/51 new)
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| Sec. 51. Legislative intent. It is the intent of the | 5 |
| General Assembly to promote the civil rights of persons with | 6 |
| disabilities by providing community-based services for persons | 7 |
| with disabilities when such services are determined | 8 |
| appropriate and desired by the affected persons, as required by | 9 |
| Title II of the Americans with Disabilities Act under the | 10 |
| United States Supreme Court's decision in Olmstead v. L.C., 527 | 11 |
| U.S. 581 (1999). In accordance with Section 6071 of the Deficit | 12 |
| Reduction Act of 2005 (P.L. 109-171), the purpose of this Act | 13 |
| is: (i) to eliminate barriers or mechanisms, whether in State | 14 |
| law, the State Medicaid plan, the State budget, or otherwise, | 15 |
| that prevent or restrict the flexible use of public funds to | 16 |
| enable individuals with disabilities to receive support for | 17 |
| appropriate and necessary long-term services in settings of | 18 |
| their choice; (ii) to increase the use of home and | 19 |
| community-based long-term care services, rather than | 20 |
| institutions or long-term care facilities; (iii) to increase | 21 |
| the ability of the State Medicaid program to assure continued | 22 |
| provision of home and community-based long-term care services | 23 |
| to eligible individuals who choose to transition from an | 24 |
| institution or a long-term care facility to a community |
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| setting; and (iv) to ensure that procedures are in place that | 2 |
| are at least comparable to those required under the qualified | 3 |
| home and community based program to provide quality assurance | 4 |
| for eligible individuals receiving Medicaid home and | 5 |
| community-based long-term care services and to provide for | 6 |
| continuous quality improvement in such services. More | 7 |
| specifically, this Article amends the Disabilities Services | 8 |
| Act of 2003 (notwithstanding Section 30 of the Act) and the | 9 |
| Illinois Act on the Aging to mandate the creation of a flexible | 10 |
| system of financing for long-term services and supports in | 11 |
| Illinois that would allow available Medicaid funds to be spent | 12 |
| on home and community-based services when an individual | 13 |
| residing in an institution or long-term care facility moves to | 14 |
| the most appropriate and preferred community-based setting of | 15 |
| his or her choice. | 16 |
| (20 ILCS 2407/52 new)
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| Sec. 52. Applicability; definitions. In accordance with | 18 |
| section 6071 of the Deficit Reduction Act of 2005 (P.L. | 19 |
| 109-171), as used in this Article: | 20 |
| "Home and community-based long-term care services". The | 21 |
| term "home and community-based long-term care services" means, | 22 |
| with respect to a State Medicaid program, a service aid, or | 23 |
| benefit, home and community-based services, including but not | 24 |
| limited to home health and personal care services, that are | 25 |
| provided to a person with a disability, and are voluntarily |
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| accepted, as part of his or her long-term care that: (i) is | 2 |
| provided under the State's qualified home and community based | 3 |
| program or that could be provided under such a program but is | 4 |
| otherwise provided under the Medicaid program; (ii) is | 5 |
| delivered in a qualified residence; and (iii) is necessary for | 6 |
| the person with a disability to live in the community. | 7 |
| "Case manager". The term "case manager" has the meaning as | 8 |
| defined in the Illinois Act on the Aging.
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| "Departments". The term "Departments" means for the | 10 |
| purposes of this Act, the Department of Human Services, the | 11 |
| Department on Aging, Department of Children and Family | 12 |
| Services, Department of Healthcare and Family Services and | 13 |
| Department of Public Health, unless otherwise noted. | 14 |
| "Eligible Individual". The term "eligible individual" | 15 |
| means a person in Illinois who (i) has resided, for a period of | 16 |
| not less than 6 months, in a long-term care facility; (ii) is | 17 |
| receiving Medicaid benefits for long-term care services | 18 |
| furnished by that long-term care facility; (iii) with respect | 19 |
| to whom a determination has been made that, but for the | 20 |
| provision of home and community-based long-term care services, | 21 |
| the individual would continue to require the level of care | 22 |
| provided in a long-term care facility; (iv) who is deemed | 23 |
| appropriate by the inter-disciplinary team or case managers for | 24 |
| home or community-based long-term care services; and (v) who | 25 |
| wants to transfer from a long-term care facility to a qualified | 26 |
| residence. For the purposes of this Act, "eligible individual" |
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| does not include a person with a disability receiving acute | 2 |
| care mental health treatment in a State-operated mental health | 3 |
| center for less than 30 consecutive days in a one-year period, | 4 |
| or a person committed to a State-operated mental health | 5 |
| forensic program, or developmental center forensic program. | 6 |
| "Long-term care facility". The term "long-term care | 7 |
| facility", for the purposes of this Article, means a skilled | 8 |
| nursing or intermediate long-term care facility subject to | 9 |
| licensure by the Department of Public Health under the Nursing | 10 |
| Home Care Act, an intermediate care facility for the | 11 |
| developmentally disabled (ICF-DDs), an institution for mental | 12 |
| diseases, child care institutions licensed by the Department of | 13 |
| Children and Family Services, any community living facility as | 14 |
| defined in the Community Living Facilities Licensing Act (210 | 15 |
| ILCS 35), any community residential alternative as defined in | 16 |
| the Community Residential Alternatives Licensing Act (405 ILCS | 17 |
| 30), any Supportive Living Facility as provided in the Public | 18 |
| Aid Code (305 ILCS 5/5-5.01a), and a State-operated | 19 |
| developmental center or mental health center, whether publicly | 20 |
| or privately owned. | 21 |
| "Interdisciplinary team" means a group of persons that | 22 |
| represents those professions, disciplines, or service areas | 23 |
| that are relevant to identifying an individual's strengths and | 24 |
| needs, and designs a program to meet those needs. This team | 25 |
| shall include at least a physician, a social worker, other | 26 |
| professionals, and the individual. In facilities serving |
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| individuals with developmental disabilities, at least one | 2 |
| member of the team shall be a qualified mental retardation | 3 |
| professional. The interdisciplinary team includes the | 4 |
| individual, the individual's guardian, the individual's | 5 |
| authorized representative, the individual's primary service | 6 |
| providers, including staff most familiar with the individual's | 7 |
| needs. The individual or his or her guardian may also invite | 8 |
| other individuals to meet with the interdisciplinary team and | 9 |
| participate in the process of identifying the individual's | 10 |
| strengths and needs. | 11 |
| "Qualified residence". The term "qualified residence" | 12 |
| means, with respect to an eligible individual: (i) a home owned | 13 |
| or leased by the individual or the individual's authorized | 14 |
| representative (as defined by P.L. 109-171); (ii) an apartment | 15 |
| with an individual lease, with lockable access and egress, and | 16 |
| which includes living, sleeping, bathing, and cooking areas | 17 |
| over which the individual or the individual's family has domain | 18 |
| and control; and (iii) a residence, in a community-based | 19 |
| residential setting, as defined by administrative rule. | 20 |
| "Self-directed services". The term "self-directed | 21 |
| services" means, with respect to home and community-based | 22 |
| long-term care services for an eligible individual, those | 23 |
| services for the individual that are planned and purchased | 24 |
| under the direction and control of the individual or the | 25 |
| individual's authorized representative, including the amount, | 26 |
| duration, scope, provider, and location of such services, under |
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| the State Medicaid program consistent with the following | 2 |
| requirements: | 3 |
| (a) Assessment: there is an assessment of the needs,
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| capabilities, and preferences of the individual with | 5 |
| respect to such services.
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| (b) Individual service care or treatment plan: based on | 7 |
| the assessment, there is developed
jointly with such | 8 |
| individual or the individual's authorized representative, | 9 |
| a plan for such services for the individual that is | 10 |
| approved by the State and that (i) specifies those | 11 |
| services, if any, that the individual or the individual's | 12 |
| authorized representative would be responsible for | 13 |
| directing; (ii) identifies the methods by which the | 14 |
| individual or the individual's authorized representative | 15 |
| or an agency designated by an individual or representative | 16 |
| will select, manage, and dismiss providers of such | 17 |
| services.
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| "Public Funds" means any funds appropriated by the General | 19 |
| Assembly to
the Department of Human Services, the Department on | 20 |
| Aging, the Department of Children and Family Services, or the | 21 |
| Department of Healthcare and Family Services, for settings and | 22 |
| services as defined in this Article. | 23 |
| (20 ILCS 2407/53 new)
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| Sec. 53. Allocation of public funds. | 25 |
| (a) Any eligible individual, as defined in Section 52, has |
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| the right to have public funds available to pay for his or her | 2 |
| home and community-based long-term care services in a qualified | 3 |
| residence when such individual moves from a long-term care | 4 |
| facility to the most appropriate and preferred community-based | 5 |
| setting of his or her choice. The amount of public funds | 6 |
| available shall be funded in accordance with the individual | 7 |
| service, care, or treatment plan and shall be the greater of | 8 |
| (A) the funding that would be available to the individual | 9 |
| through the applicable State-operated home and community based | 10 |
| waiver program as determined by administrative rule or statute, | 11 |
| or (B)(i) an amount no greater than the licensure category of | 12 |
| the facility in which the individual received care reduced by | 13 |
| the average capital component of the overall facility rate and | 14 |
| (ii) further qualified by the weighted average rate by | 15 |
| geographic area grouping that a facility of the same licensure | 16 |
| category would receive in the area of the individual's | 17 |
| qualified residence. | 18 |
| (b) In accordance with Sections 15(2) and 20(b)(2) of this | 19 |
| Act, all eligible individuals under this Act shall have an | 20 |
| individual service, care, or treatment plan that is reviewed by | 21 |
| the interdisciplinary team or case managers at least annually | 22 |
| that is consistent with the requirements under subparts (A) and | 23 |
| (B) of item 8 of subsection (b) of the Deficit Reduction Act of | 24 |
| 2005 (P.L. 109-171), and that includes an individualized budget | 25 |
| that identifies the dollar value of the services consistent | 26 |
| with the requirements under subsection (b)(8)(C) of section |
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| 6071 and supports under the control and direction of the | 2 |
| individual or the individual's authorized representative. The | 3 |
| service, care, or treatment plan must contain assurances that | 4 |
| each eligible individual has been provided the opportunity to | 5 |
| make an informed choice regarding their right under subsection | 6 |
| (a). | 7 |
| (c) In accordance with any Disabilities Services Plan or | 8 |
| plan update under
this Act and section 6071 of the Deficit | 9 |
| Reduction Act of 2005 (P.L. 109-171) and the Older Adult | 10 |
| Services Act, the Departments, in consultation with | 11 |
| organizations comprised of or representing people with | 12 |
| disabilities or people aged 60 or older and providers of | 13 |
| Medicaid acute and long-term care services, shall develop | 14 |
| appropriate fiscal payment mechanisms and methodologies, by | 15 |
| December 1, 2008, that effectively support choice and eliminate | 16 |
| any legal, budgetary, or other barriers to flexibility in the | 17 |
| availability of Medicaid funds to pay for long-term care | 18 |
| services for individuals in the appropriate home and | 19 |
| community-based long-term care settings of their choice, | 20 |
| including costs to transition from a long-term care facility to | 21 |
| a qualified residence. With respect to the individualized | 22 |
| budgets described in subsection (b), the fiscal payment | 23 |
| mechanisms and methodologies must: (i) describe the method for | 24 |
| calculating the dollar values in such budgets based on reliable | 25 |
| costs and service utilization; (ii) define a process for making | 26 |
| adjustments in such dollar values to reflect changes in |
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| individual assessments and service, care, or treatment plans; | 2 |
| and (iii) provide a procedure to evaluate expenditures under | 3 |
| such budgets. | 4 |
| (d) In addition to Section 4.4 of the Community Services | 5 |
| Act of 2004 (P.A. 094-0498), to the extent that savings are | 6 |
| realized, those moneys must be deposited into the Olmstead | 7 |
| Implementation Fund, created as a special fund in the State | 8 |
| treasury, and the Older Adult Services Fund, created as a | 9 |
| special fund in the State treasury, with the allocation between | 10 |
| these 2 funds based on a formula determined by the Departments | 11 |
| by administrative rule, and shall be used to expand the | 12 |
| availability, quality, or stability of home and | 13 |
| community-based long-term care services and supports for | 14 |
| persons with disabilities including, but not limited to the | 15 |
| following: in-home consumer/family supports; integrated, | 16 |
| accessible, and affordable housing options and home | 17 |
| modifications. | 18 |
| (e) The allocation of public funds for home and | 19 |
| community-based long-term care services shall not have the | 20 |
| effect of: (i) diminishing or reducing the quality of services | 21 |
| available to residents of long-term care facilities; (ii) | 22 |
| forcing any residents of long-term care facilities to | 23 |
| involuntarily accept home and community-based long-term care | 24 |
| services, or causing any residents of long-term care facilities | 25 |
| to be involuntarily transferred or discharged; (iii) causing | 26 |
| reductions in long-term care facility reimbursement rates in |
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| effect as of July 1, 2008; (iv) causing any delay of long-term | 2 |
| care facility payments; or (v) diminishing access to a full | 3 |
| array of long-term care options. If an eligible individual | 4 |
| moves to a qualified residence and determines it is not the | 5 |
| appropriate or preferred setting, they remain entitled to | 6 |
| return to a long-term care facility under Title XIX of the | 7 |
| Social Security Act (42 U.S.C §1396a(a)(10)(A), §1396d(a)(15), | 8 |
| §1396a(a)(1) at the established rate for that facility. | 9 |
| (f) Funding for eligible individuals under this Act shall | 10 |
| remain available to the eligible individual, in accordance with | 11 |
| the individual service or treatment plan, as long as he or she | 12 |
| remains eligible for services in a long-term care facility and | 13 |
| prefers home and community-based long-term care services.
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| (20 ILCS 2407/54 new)
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| Sec. 54. Quality assurance and quality improvement. | 16 |
| (a) In accordance with subsection (c) (11) of section 6071 | 17 |
| of the Deficit Reduction Act of 2005 (P.L. 109-171), the | 18 |
| Departments shall develop a plan for quality assurance and | 19 |
| quality improvement for home and community-based long-term | 20 |
| care services under the State Medicaid program, including a | 21 |
| regulatory plan to assure the health and welfare of eligible | 22 |
| individuals under this Act. | 23 |
| (b) This plan shall require the Departments to apply for | 24 |
| any available federal strategic planning and implementation | 25 |
| funding to carry out the intent of this legislation, and to |
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| seek any appropriate Federal Medicaid waivers to maximize | 2 |
| Federal financial participation.
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| (20 ILCS 2407/55 new)
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| Sec. 55. Dissemination of information; reports. | 5 |
| (a) The State shall ensure that all eligible individuals | 6 |
| are informed of their right to receive home and community-based | 7 |
| long-term care services under this Act. The Departments shall | 8 |
| work together with organizations comprised of, or representing | 9 |
| people with disabilities or people aged 60 or older and | 10 |
| providers of Medicaid acute and long-term care services, to | 11 |
| ensure that persons with disabilities and their families, | 12 |
| guardians, and advocates are informed of their rights under | 13 |
| this Act in a manner that is easily understandable and | 14 |
| accessible to people with disabilities. The Departments shall | 15 |
| ensure that multiple methods of dissemination are employed and | 16 |
| shall make concerted efforts to inform people currently in | 17 |
| long-term care facilities, including at their individual team | 18 |
| or program meetings. The Department of Public Health shall | 19 |
| ensure that, as a condition of licensing and certification, all | 20 |
| long-term care facilities covered under this Act shall inform | 21 |
| all residents annually of their opportunities to choose home | 22 |
| and community alternatives under this Act. Additionally, the | 23 |
| Department shall require each long-term care facility to post | 24 |
| in a prominent location a notice containing information on | 25 |
| rights and services available under this Act. Notices posted |
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| shall comply with the accessibility standards of the Americans | 2 |
| with Disabilities Act. | 3 |
| (b) On or before April 1 of each year, in conjunction with | 4 |
| their annual reports, the Departments shall report to the | 5 |
| Governor and the General Assembly on the implementation of this | 6 |
| Act and include, at a minimum, the following data; (i) a | 7 |
| description of the fiscal payment mechanisms and methodologies | 8 |
| developed under this Act that effectively support choice; (ii) | 9 |
| an accounting of the savings realized under this Act and the | 10 |
| ways in which these savings were spent; (iii) information | 11 |
| concerning the dollar amounts of State Medicaid expenditures | 12 |
| for fiscal years 2009 and 2010, for long-term care services and | 13 |
| the percentage of such expenditures that were for an | 14 |
| institution or long-term care services or were for home and | 15 |
| community-based long-term care services; (iv) a description of | 16 |
| the Departments' efforts to inform all eligible individuals of | 17 |
| their rights under this Act; (v) the number of eligible | 18 |
| individuals referred or identified under this Act in the | 19 |
| previous fiscal year, the number of eligible individuals who | 20 |
| applied to transfer to home and community-based long-term care | 21 |
| services in the previous fiscal year, and the number of | 22 |
| eligible individuals who, in fact, transferred from a long-term | 23 |
| care facility to a qualified residence in the previous fiscal | 24 |
| year; (vi) documentation that the Departments have met the | 25 |
| requirements under Section 5 to assure the health and welfare | 26 |
| of eligible individuals receiving home and community-based |
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| long-term care services; and (vii) any obstacles the | 2 |
| Departments confronted in assisting residents of long-term | 3 |
| care facilities to make the transition to a qualified | 4 |
| residence, and the Departments' recommendations for removing | 5 |
| those obstacles. This report must be made available to the | 6 |
| general public, including via the Departments' websites.
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| (20 ILCS 2407/56 new)
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| Sec. 56. Effect on existing rights. | 9 |
| (a) This Article does not alter or affect the manner in | 10 |
| which persons with disabilities are determined eligible or | 11 |
| appropriate for home and community-based long-term care | 12 |
| services, except to the extent the determinations are based on | 13 |
| the availability of community services. | 14 |
| (b) This Article shall not be read to limit in any way the | 15 |
| rights of people with disabilities under the U.S. Constitution, | 16 |
| the Americans with Disabilities Act, Section 504 of the | 17 |
| Rehabilitation Act, the Social Security Act, or any other | 18 |
| federal or State law.
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| (20 ILCS 2407/57 new)
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| Sec. 57. Rules. The Departments shall adopt any rules | 21 |
| necessary for the implementation and administration of this Act | 22 |
| within 6 months of the effective date of this Act. | 23 |
| (20 ILCS 2407/58 new)
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| Sec. 58. Service provider cost reporting and | 2 |
| accountability. The Departments shall adopt any rules | 3 |
| necessary for the implementation of service provider cost | 4 |
| reporting to ensure accountability under this Act within 6 | 5 |
| months of the effective date of this Act.
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| (20 ILCS 2407/Art. 99 heading new)
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| ARTICLE 99. AMENDATORY PROVISIONS; EFFECTIVE DATE
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| Section 90. The State Finance Act is amended by adding | 9 |
| Sections 5.675 and 5.676 as follows: | 10 |
| (30 ILCS 105/5.675 new) | 11 |
| Sec. 5.675. The Olmstead Implementation Fund. | 12 |
| (30 ILCS 105/5.676 new)
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| Sec. 5.676. The Older Adult Services Fund.
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| Section 99. Effective date. This Act takes effect July 1, | 15 |
| 2008.".
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