Public Act 099-0892
 
SB2610 EnrolledLRB099 19934 MJP 44333 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 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 
    compensated work opportunities 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 Secretary 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, within 12 months after 
the effective date of this Act,  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 Secretary of Human 
Services shall, within 12 months after the effective date of 
this Act, file 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 Secretary 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 Secretary 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 Secretary of 
Human Services, in such form and manner as the Secretary 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 individuals and individuals who need the services 
    offered by a medically complex for the developmentally 
    disabled facility;

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; and
        (6) use an evidence-based assessment tool, approved by 
    the Department of Human Services and the Department of 
    Healthcare and Family Services, to periodically reassess 
    and confirm that individuals receiving more intense or 
    restrictive services continue to require, or to choose if 
    applicable, that level of support and services.
 
    Section 30. Applicable requirements. The Secretary 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, consistent 
    with all applicable requirements of law, 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;


        (5)   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;


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

and
        (7)   the applicant complies with such other 
    requirements as the Secretary of Human Services may 
    consider necessary and appropriate to carry out the 
    purposes of this Act and other applicable requirements of 
    law.
    A continuum of care license may be issued to a continuum of 
care facility upon the adoption of the rules provided for in 
Section 20 of this Act.

 
    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 
pursuant to such requirements.


    (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 
(Ligas).

While the consent decree in Ligas remains in effect, 
members of the class in Ligas residing in ID/DD facilities on 
June 15, 2011 may move to community-integrated living 
arrangements as they choose to do so; members of the class in 
Ligas admitted to ID/DD facilities after June 15, 2011 must 
enroll on the Prioritization of Urgency of Need for Services 
waiting list and be selected for community-integrated living 
arrangements services prior to moving.
    (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 Secretary 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)   a continuum of care licensee shall enter into a 
        single provider agreement with the Director of 
        Healthcare and Family Services or the Secretary of 
        Human 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; the initial methodology shall produce 
    payments that are budget neutral as compared to the 
    services provided by the licensee prior to the 
    implementation of the continuum of care license; the 
    effectiveness of the methodology and corresponding rate 
    levels shall be evaluated 18 months following the 
    implementation of the methodology and every 12 months 
    thereafter and shall be adjusted as necessary, subject to 
    appropriation.
 
    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 the federal Social Security Act or a State plan 
amendment.
    (a)   The Director of Healthcare and Family Services, in 
collaboration and coordination with the Secretary 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 the federal 
Social Security Act or a State plan amendment consistent with 
the purpose of subsection (b) of this Section and requirements 
of subsection (c) of this Section.
    (b)    The purpose of the waiver or a State plan amendment 
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 or a State plan amendment 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.