HB6304eng 99TH GENERAL ASSEMBLY

HB6304 Engrossed LRB099 19933 MJP 44332 b

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Continuum of Care Services for the Developmentally Disabled Act.

Section 5. Purpose. The purpose of this Act is to authorize a new type of license for organizations providing services to individuals with developmental disabilities to be known as a continuum of care license; to define the requirements for a continuum of care facility to receive and maintain such a license; to establish a process for the development of an alternative budget-neutral reimbursement mechanism for such a facility; and to authorize a request to the federal government for a waiver pursuant to Section 1115 of the federal Social Security Act.

Section 10. Definitions. As used in this Act, unless the context requires otherwise:

"Applicable requirements of law" means State and federal statutes, rules, regulations, and guidance, as such may from time-to-time be amended or revised, governing the rights, protections, and services, including reimbursement for such services, afforded to individuals with developmental disabilities.

"Campus group home" means a residential facility meeting the requirements of Section 30 of this Act and operated as part of a continuum of care facility licensed under this Act.

"Continuum of care facility" means a legally incorporated entity that provides a comprehensive range of programs, services, and supports for adults with developmental disabilities, positioned at a central geographic campus facility, and including all of the following:

(1) community-integrated living arrangements provided within reasonable geographic proximity of the campus and in accordance with applicable requirements of law;

(2) employment opportunities, including both on-campus sheltered employment and off-campus supported employment opportunities provided in accordance with applicable requirements of law;

(3) developmental training programs and services provided in accordance with applicable requirements of law;

(4) on-campus community living facility opportunities provided on-campus and in accordance with applicable requirements of law;

(5) campus group home opportunities as authorized and defined in this Act and provided in accordance with applicable requirements of law; and

(6) medically complex for the developmentally disabled facility opportunities provided on-campus and in accordance with applicable requirements of law.

"Continuum of care license" means a license issued to a continuum of care facility in accordance with the terms of this Act.

"Continuum of care plan" means a formal, written plan meeting the requirements of Section 25 of this Act.

"Facility constituent elements" means the particular, discrete programs, services, and supports delineated in the definition of "continuum of care facility" and provided collectively by the facility.

Section 15. Powers and duties. The Director of Human Services, acting in consultation and coordination as necessary with the Director of Public Health and the Director of Healthcare and Family Services, shall establish a system of licensure for continuum of care facilities, in accordance with this Act, for the following purposes:

(1) protecting the welfare, safety, and rights of individuals with developmental disabilities;

(2) providing additional options for care and services for individuals with developmental disabilities; and

(3) providing a model of care that can transition individuals with developmental disabilities in a seamless and timely manner across the continuum of residential care settings and supportive services, training, education, and employment opportunities in a manner that maximizes beneficiary choice and satisfaction.

Section 20. Licensing standards. The Director of Human Services shall adopt rules establishing standards for licensing of continuum of care facilities under a single license. These rules shall ensure that an applicant for licensure:

(1) meets the definition of "continuum of care facility" and provides all of the programs, services, and supports required by that definition;

(2) develops, submits, and maintains adherence to a continuum of care plan that meets the requirements of Section 25 of this Act;

(3) meets the regulatory requirements set forth in Section 30 of this Act;

(4) meets such requirements as the Director of Human Services may determine appropriate for renewal of licensure or for amendment of licensure to account for changes in the composition of facility constituent elements providing programs or services under the license; and

(5) meets such other requirements as the Director of Human Services may determine appropriate for the effective implementation of this Act.

Section 25. Continuum of care plan. An applicant for a continuum of care license shall submit to the Director of Human Services, in such form and manner as the Director of Human Services shall require, a continuum of care plan that demonstrates how the applicant will:

(1) undertake a comprehensive approach to facilitating the movement of individuals to the most appropriate site and level of care and services provided based on that individual's preference and needs;

(2) provide for the seamless integrated transition of individuals between and among the required care settings and services in a manner that addresses the individual's location on the spectrum of disability and progression along the age spectrum;

(3) maximize employment and training opportunities consistent with the individual's preferences and capabilities;

(4) provide programs, services, and supports geared to addressing the demand for services for a growing population of aging and medically complex individuals with developmental disabilities; and

(5) demonstrate a commitment to providing informed, free, and meaningful choice regarding the type of community in which the individual prefers to live and the type of employment opportunities or developmental training the individual prefers to receive; beneficiary engagement; annual care planning and ongoing treatment focused on the needs and preferences of the individual and adherence to other applicable requirements of law relevant to protecting the rights and welfare of individuals with developmental disabilities.

Section 30. Applicable requirements. The Director of Human Services, acting as appropriate through or in coordination with the Director of Public Health, shall in licensing a continuum of care facility ensure the following:

(1) community-integrated living arrangements provided by such licensee meet all otherwise applicable requirements of law pertaining to such arrangements, including those set forth in the Community-Integrated Living Arrangements Licensure and Certification Act, except that a continuum of care facility may prioritize the movement of individuals into or out of community-integrated living arrangements from or into other residential facility constituent elements;

(2) on-campus and off-campus employment opportunities provided by the licensee meet all otherwise applicable requirements of law pertaining to such opportunities;

(3) developmental training programs and services provided by the licensee meet all otherwise applicable requirements of law pertaining to such programs and services;

(4) community living facility opportunities provided by the licensee meet all otherwise applicable requirements of law pertaining to such opportunities;

(4) campus group homes provided by the licensee meet all otherwise applicable requirements of law pertaining to an ID/DD facility under the ID/DD Community Care Act;

(5) medically complex for the developmentally disabled facility opportunities provided by the licensee meet all otherwise applicable requirements of law pertaining to such opportunities; and

(6) the applicant complies with such other requirements as the Director of Human Services may consider necessary and appropriate to carry out the purposes of this Act and other applicable requirements of law.

Section 35. Existing and future programs and services.

(a) To the extent necessary to carry out the purposes of this Act and to maintain eligibility for reimbursement for services under applicable State and federal programs, including Title XIX of the federal Social Security Act, facility constituent elements of an entity licensed as a continuum of care facility may be considered to be licensed pursuant to the otherwise applicable requirements of law as set forth in Section 30 of this Act.

(b) In the event that a continuum of care facility ceases to retain licensure as a continuum of care facility, facility constituent elements that meet all otherwise applicable requirements of law with respect to such element as set forth in Section 30 of this Act shall be deemed to be licensed.

(c) Residents of campus group homes and community-integrated living arrangements that are facility constituent elements shall continue to be beneficiaries of and have the rights and protections provided to residents of ID/DD facilities and community-integrated living arrangements, respectively, under the consent decree entered by the United States District Court for the Northern District of Illinois in the matter of Ligas v. Hamos, No. 1:05-CV-4331 on June 15, 2011.

(d) A continuum of care licensee shall be permitted to add new facility constituent elements under its license provided that it demonstrates a need for the new facility constituent elements and that the facility constituent elements meet all applicable requirements of law.

Section 40. Reimbursement rules. The Director of Human Services and the Director of Healthcare and Family Services shall:

(1) ensure that reimbursement utilizing federal and State resources for services provided to eligible beneficiaries through a continuum of care facility comports with the following requirements:

(A) such services shall be reimbursed in a budget-neutral manner such that reimbursement for services provided by the facility constituent elements of a continuum of care licensee shall be neither greater nor lesser than the reimbursement received for such services provided by that facility constituent element prior to the licensing of the continuum of care facility, adjusted to take into account any subsequent changes in reimbursement for such similar services, or, if the facility constituent element is a new facility reimbursement for the services provided by the new facility shall be no less than the reimbursement received for such services by a comparable facility constituent element of that continuum of care facility; and

(B) for purposes of reimbursement under Title XIX of the federal Social Security Act, a continuum of care licensee shall enter into a single provider agreement with the Director of Healthcare and Family Services; changes that may occur from time to time in the facility constituent elements under the continuum of care license shall be addressed as may be required by applicable requirements of law through amendments to the provider agreement; the Director of Healthcare and Family Services shall make all reasonable efforts to ensure that all facility constituent elements that are approved parts of a continuum of care license remain qualified for reimbursement under relevant State and federal programs including Title XIX of the federal Social Security Act; and

(2) in cooperation with interested stakeholders, develop an alternative payment methodology for a continuum of care facility involving the utilization of an annualized global payment amount or other mechanism.

Section 45. The Department of Healthcare and Family Services Law of the Civil Administrative Code of Illinois is amended by adding Section 2205-13 as follows:

(20 ILCS 2205/2205-13 new)

Sec. 2205-13. Authorization to secure a federal waiver pursuant to Section 1115 of the federal Social Security Act.

(a) The Director of Healthcare and Family Services, in collaboration and coordination with the Director of Human Services, shall develop and submit to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, Center for Medicaid and State Operations, a request for a waiver pursuant to Section 1115 of the federal Social Security Act consistent with the purpose of subsection (b) of this Section and requirements of subsection (c) of this Section.

(b) The purpose of the waiver authorized by subsection (a) of this Section is to obtain approval for the use of funds under Title XIX of the federal Social Security Act to provide for an alternative model of licensure, reimbursement, and quality assurance for services to individuals with developmental disabilities consistent with the Continuum of Care Services for the Developmentally Disabled Act.

(c) A waiver requested pursuant to this authorization must involve the licensure of a continuum of care facility pursuant to and consistent with all requirements of the Continuum of Care Services for the Developmentally Disabled Act and a proposal for a reimbursement methodology developed under paragraph (2) of Section 40 of the Continuum of Care Services for the Developmentally Disabled Act.