Illinois General Assembly - Full Text of HB0691
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Full Text of HB0691  95th General Assembly

HB0691sam002 95TH GENERAL ASSEMBLY

Sen. Donne E. Trotter

Filed: 8/14/2007

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 691

2     AMENDMENT NO. ______. Amend House Bill 691, AS AMENDED, by
3 replacing everything after the enacting clause with the
4 following:
 
5     "Section 1. Short title. This Act may be cited as the FY08
6 Human Services Budget Implementation Act.
 
7     Section 3. The State Employees Group Insurance Act of 1971
8 is amended by changing Section 10 as follows:
 
9     (5 ILCS 375/10)  (from Ch. 127, par. 530)
10     Sec. 10. Payments by State; premiums.
11     (a) The State shall pay the cost of basic non-contributory
12 group life insurance and, subject to member paid contributions
13 set by the Department or required by this Section, the basic
14 program of group health benefits on each eligible member,
15 except a member, not otherwise covered by this Act, who has

 

 

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1 retired as a participating member under Article 2 of the
2 Illinois Pension Code but is ineligible for the retirement
3 annuity under Section 2-119 of the Illinois Pension Code, and
4 part of each eligible member's and retired member's premiums
5 for health insurance coverage for enrolled dependents as
6 provided by Section 9. The State shall pay the cost of the
7 basic program of group health benefits only after benefits are
8 reduced by the amount of benefits covered by Medicare for all
9 members and dependents who are eligible for benefits under
10 Social Security or the Railroad Retirement system or who had
11 sufficient Medicare-covered government employment, except that
12 such reduction in benefits shall apply only to those members
13 and dependents who (1) first become eligible for such Medicare
14 coverage on or after July 1, 1992; or (2) are Medicare-eligible
15 members or dependents of a local government unit which began
16 participation in the program on or after July 1, 1992; or (3)
17 remain eligible for, but no longer receive Medicare coverage
18 which they had been receiving on or after July 1, 1992. The
19 Department may determine the aggregate level of the State's
20 contribution on the basis of actual cost of medical services
21 adjusted for age, sex or geographic or other demographic
22 characteristics which affect the costs of such programs.
23     The cost of participation in the basic program of group
24 health benefits for the dependent or survivor of a living or
25 deceased retired employee who was formerly employed by the
26 University of Illinois in the Cooperative Extension Service and

 

 

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1 would be an annuitant but for the fact that he or she was made
2 ineligible to participate in the State Universities Retirement
3 System by clause (4) of subsection (a) of Section 15-107 of the
4 Illinois Pension Code shall not be greater than the cost of
5 participation that would otherwise apply to that dependent or
6 survivor if he or she were the dependent or survivor of an
7 annuitant under the State Universities Retirement System.
8     (a-1) Beginning January 1, 1998, for each person who
9 becomes a new SERS annuitant and participates in the basic
10 program of group health benefits, the State shall contribute
11 toward the cost of the annuitant's coverage under the basic
12 program of group health benefits an amount equal to 5% of that
13 cost for each full year of creditable service upon which the
14 annuitant's retirement annuity is based, up to a maximum of
15 100% for an annuitant with 20 or more years of creditable
16 service. The remainder of the cost of a new SERS annuitant's
17 coverage under the basic program of group health benefits shall
18 be the responsibility of the annuitant. In the case of a new
19 SERS annuitant who has elected to receive an alternative
20 retirement cancellation payment under Section 14-108.5 of the
21 Illinois Pension Code in lieu of an annuity, for the purposes
22 of this subsection the annuitant shall be deemed to be
23 receiving a retirement annuity based on the number of years of
24 creditable service that the annuitant had established at the
25 time of his or her termination of service under SERS.
26     (a-2) Beginning January 1, 1998, for each person who

 

 

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1 becomes a new SERS survivor and participates in the basic
2 program of group health benefits, the State shall contribute
3 toward the cost of the survivor's coverage under the basic
4 program of group health benefits an amount equal to 5% of that
5 cost for each full year of the deceased employee's or deceased
6 annuitant's creditable service in the State Employees'
7 Retirement System of Illinois on the date of death, up to a
8 maximum of 100% for a survivor of an employee or annuitant with
9 20 or more years of creditable service. The remainder of the
10 cost of the new SERS survivor's coverage under the basic
11 program of group health benefits shall be the responsibility of
12 the survivor. In the case of a new SERS survivor who was the
13 dependent of an annuitant who elected to receive an alternative
14 retirement cancellation payment under Section 14-108.5 of the
15 Illinois Pension Code in lieu of an annuity, for the purposes
16 of this subsection the deceased annuitant's creditable service
17 shall be determined as of the date of termination of service
18 rather than the date of death.
19     (a-3) Beginning January 1, 1998, for each person who
20 becomes a new SURS annuitant and participates in the basic
21 program of group health benefits, the State shall contribute
22 toward the cost of the annuitant's coverage under the basic
23 program of group health benefits an amount equal to 5% of that
24 cost for each full year of creditable service upon which the
25 annuitant's retirement annuity is based, up to a maximum of
26 100% for an annuitant with 20 or more years of creditable

 

 

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1 service. The remainder of the cost of a new SURS annuitant's
2 coverage under the basic program of group health benefits shall
3 be the responsibility of the annuitant.
4     (a-4) (Blank).
5     (a-5) Beginning January 1, 1998, for each person who
6 becomes a new SURS survivor and participates in the basic
7 program of group health benefits, the State shall contribute
8 toward the cost of the survivor's coverage under the basic
9 program of group health benefits an amount equal to 5% of that
10 cost for each full year of the deceased employee's or deceased
11 annuitant's creditable service in the State Universities
12 Retirement System on the date of death, up to a maximum of 100%
13 for a survivor of an employee or annuitant with 20 or more
14 years of creditable service. The remainder of the cost of the
15 new SURS survivor's coverage under the basic program of group
16 health benefits shall be the responsibility of the survivor.
17     (a-6) Beginning July 1, 1998, for each person who becomes a
18 new TRS State annuitant and participates in the basic program
19 of group health benefits, the State shall contribute toward the
20 cost of the annuitant's coverage under the basic program of
21 group health benefits an amount equal to 5% of that cost for
22 each full year of creditable service as a teacher as defined in
23 paragraph (2), (3), or (5) of Section 16-106 of the Illinois
24 Pension Code upon which the annuitant's retirement annuity is
25 based, up to a maximum of 100%; except that the State
26 contribution shall be 12.5% per year (rather than 5%) for each

 

 

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1 full year of creditable service as a regional superintendent or
2 assistant regional superintendent of schools. The remainder of
3 the cost of a new TRS State annuitant's coverage under the
4 basic program of group health benefits shall be the
5 responsibility of the annuitant.
6     (a-7) Beginning July 1, 1998, for each person who becomes a
7 new TRS State survivor and participates in the basic program of
8 group health benefits, the State shall contribute toward the
9 cost of the survivor's coverage under the basic program of
10 group health benefits an amount equal to 5% of that cost for
11 each full year of the deceased employee's or deceased
12 annuitant's creditable service as a teacher as defined in
13 paragraph (2), (3), or (5) of Section 16-106 of the Illinois
14 Pension Code on the date of death, up to a maximum of 100%;
15 except that the State contribution shall be 12.5% per year
16 (rather than 5%) for each full year of the deceased employee's
17 or deceased annuitant's creditable service as a regional
18 superintendent or assistant regional superintendent of
19 schools. The remainder of the cost of the new TRS State
20 survivor's coverage under the basic program of group health
21 benefits shall be the responsibility of the survivor.
22     (a-8) A new SERS annuitant, new SERS survivor, new SURS
23 annuitant, new SURS survivor, new TRS State annuitant, or new
24 TRS State survivor may waive or terminate coverage in the
25 program of group health benefits. Any such annuitant or
26 survivor who has waived or terminated coverage may enroll or

 

 

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1 re-enroll in the program of group health benefits only during
2 the annual benefit choice period, as determined by the
3 Director; except that in the event of termination of coverage
4 due to nonpayment of premiums, the annuitant or survivor may
5 not re-enroll in the program.
6     (a-9) No later than May 1 of each calendar year, the
7 Director of Central Management Services shall certify in
8 writing to the Executive Secretary of the State Employees'
9 Retirement System of Illinois the amounts of the Medicare
10 supplement health care premiums and the amounts of the health
11 care premiums for all other retirees who are not Medicare
12 eligible.
13     A separate calculation of the premiums based upon the
14 actual cost of each health care plan shall be so certified.
15     The Director of Central Management Services shall provide
16 to the Executive Secretary of the State Employees' Retirement
17 System of Illinois such information, statistics, and other data
18 as he or she may require to review the premium amounts
19 certified by the Director of Central Management Services.
20     (b) State employees who become eligible for this program on
21 or after January 1, 1980 in positions normally requiring actual
22 performance of duty not less than 1/2 of a normal work period
23 but not equal to that of a normal work period, shall be given
24 the option of participating in the available program. If the
25 employee elects coverage, the State shall contribute on behalf
26 of such employee to the cost of the employee's benefit and any

 

 

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1 applicable dependent supplement, that sum which bears the same
2 percentage as that percentage of time the employee regularly
3 works when compared to normal work period.
4     (c) The basic non-contributory coverage from the basic
5 program of group health benefits shall be continued for each
6 employee not in pay status or on active service by reason of
7 (1) leave of absence due to illness or injury, (2) authorized
8 educational leave of absence or sabbatical leave, or (3)
9 military leave with pay and benefits. This coverage shall
10 continue until expiration of authorized leave and return to
11 active service, but not to exceed 24 months for leaves under
12 item (1) or (2). This 24-month limitation and the requirement
13 of returning to active service shall not apply to persons
14 receiving ordinary or accidental disability benefits or
15 retirement benefits through the appropriate State retirement
16 system or benefits under the Workers' Compensation or
17 Occupational Disease Act.
18     (d) The basic group life insurance coverage shall continue,
19 with full State contribution, where such person is (1) absent
20 from active service by reason of disability arising from any
21 cause other than self-inflicted, (2) on authorized educational
22 leave of absence or sabbatical leave, or (3) on military leave
23 with pay and benefits.
24     (e) Where the person is in non-pay status for a period in
25 excess of 30 days or on leave of absence, other than by reason
26 of disability, educational or sabbatical leave, or military

 

 

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1 leave with pay and benefits, such person may continue coverage
2 only by making personal payment equal to the amount normally
3 contributed by the State on such person's behalf. Such payments
4 and coverage may be continued: (1) until such time as the
5 person returns to a status eligible for coverage at State
6 expense, but not to exceed 24 months, (2) until such person's
7 employment or annuitant status with the State is terminated, or
8 (3) for a maximum period of 4 years for members on military
9 leave with pay and benefits and military leave without pay and
10 benefits (exclusive of any additional service imposed pursuant
11 to law).
12     (f) The Department shall establish by rule the extent to
13 which other employee benefits will continue for persons in
14 non-pay status or who are not in active service.
15     (g) The State shall not pay the cost of the basic
16 non-contributory group life insurance, program of health
17 benefits and other employee benefits for members who are
18 survivors as defined by paragraphs (1) and (2) of subsection
19 (q) of Section 3 of this Act. The costs of benefits for these
20 survivors shall be paid by the survivors or by the University
21 of Illinois Cooperative Extension Service, or any combination
22 thereof. However, the State shall pay the amount of the
23 reduction in the cost of participation, if any, resulting from
24 the amendment to subsection (a) made by this amendatory Act of
25 the 91st General Assembly.
26     (h) Those persons occupying positions with any department

 

 

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1 as a result of emergency appointments pursuant to Section 8b.8
2 of the Personnel Code who are not considered employees under
3 this Act shall be given the option of participating in the
4 programs of group life insurance, health benefits and other
5 employee benefits. Such persons electing coverage may
6 participate only by making payment equal to the amount normally
7 contributed by the State for similarly situated employees. Such
8 amounts shall be determined by the Director. Such payments and
9 coverage may be continued until such time as the person becomes
10 an employee pursuant to this Act or such person's appointment
11 is terminated.
12     (i) Any unit of local government within the State of
13 Illinois may apply to the Director to have its employees,
14 annuitants, and their dependents provided group health
15 coverage under this Act on a non-insured basis. To participate,
16 a unit of local government must agree to enroll all of its
17 employees, who may select coverage under either the State group
18 health benefits plan or a health maintenance organization that
19 has contracted with the State to be available as a health care
20 provider for employees as defined in this Act. A unit of local
21 government must remit the entire cost of providing coverage
22 under the State group health benefits plan or, for coverage
23 under a health maintenance organization, an amount determined
24 by the Director based on an analysis of the sex, age,
25 geographic location, or other relevant demographic variables
26 for its employees, except that the unit of local government

 

 

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1 shall not be required to enroll those of its employees who are
2 covered spouses or dependents under this plan or another group
3 policy or plan providing health benefits as long as (1) an
4 appropriate official from the unit of local government attests
5 that each employee not enrolled is a covered spouse or
6 dependent under this plan or another group policy or plan, and
7 (2) at least 85% of the employees are enrolled and the unit of
8 local government remits the entire cost of providing coverage
9 to those employees, except that a participating school district
10 must have enrolled at least 85% of its full-time employees who
11 have not waived coverage under the district's group health plan
12 by participating in a component of the district's cafeteria
13 plan. A participating school district is not required to enroll
14 a full-time employee who has waived coverage under the
15 district's health plan, provided that an appropriate official
16 from the participating school district attests that the
17 full-time employee has waived coverage by participating in a
18 component of the district's cafeteria plan. For the purposes of
19 this subsection, "participating school district" includes a
20 unit of local government whose primary purpose is education as
21 defined by the Department's rules.
22     Employees of a participating unit of local government who
23 are not enrolled due to coverage under another group health
24 policy or plan may enroll in the event of a qualifying change
25 in status, special enrollment, special circumstance as defined
26 by the Director, or during the annual Benefit Choice Period. A

 

 

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1 participating unit of local government may also elect to cover
2 its annuitants. Dependent coverage shall be offered on an
3 optional basis, with the costs paid by the unit of local
4 government, its employees, or some combination of the two as
5 determined by the unit of local government. The unit of local
6 government shall be responsible for timely collection and
7 transmission of dependent premiums.
8     The Director shall annually determine monthly rates of
9 payment, subject to the following constraints:
10         (1) In the first year of coverage, the rates shall be
11     equal to the amount normally charged to State employees for
12     elected optional coverages or for enrolled dependents
13     coverages or other contributory coverages, or contributed
14     by the State for basic insurance coverages on behalf of its
15     employees, adjusted for differences between State
16     employees and employees of the local government in age,
17     sex, geographic location or other relevant demographic
18     variables, plus an amount sufficient to pay for the
19     additional administrative costs of providing coverage to
20     employees of the unit of local government and their
21     dependents.
22         (2) In subsequent years, a further adjustment shall be
23     made to reflect the actual prior years' claims experience
24     of the employees of the unit of local government.
25     In the case of coverage of local government employees under
26 a health maintenance organization, the Director shall annually

 

 

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1 determine for each participating unit of local government the
2 maximum monthly amount the unit may contribute toward that
3 coverage, based on an analysis of (i) the age, sex, geographic
4 location, and other relevant demographic variables of the
5 unit's employees and (ii) the cost to cover those employees
6 under the State group health benefits plan. The Director may
7 similarly determine the maximum monthly amount each unit of
8 local government may contribute toward coverage of its
9 employees' dependents under a health maintenance organization.
10     Monthly payments by the unit of local government or its
11 employees for group health benefits plan or health maintenance
12 organization coverage shall be deposited in the Local
13 Government Health Insurance Reserve Fund.
14     The Local Government Health Insurance Reserve Fund is
15 hereby created as a nonappropriated trust fund to be held
16 outside the State Treasury, with the State Treasurer as
17 custodian. The Local Government Health Insurance Reserve Fund
18 shall be a continuing fund not subject to fiscal year
19 limitations. All revenues arising from the administration of
20 the health benefits program established under this Section
21 shall be deposited into the Local Government Health Insurance
22 Reserve Fund. Any interest earned on moneys in the Local
23 Government Health Insurance Reserve Fund shall be deposited
24 into the Fund. All expenditures from this Fund shall be used
25 for payments for health care benefits for local government and
26 rehabilitation facility employees, annuitants, and dependents,

 

 

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1 and to reimburse the Department or its administrative service
2 organization for all expenses incurred in the administration of
3 benefits. No other State funds may be used for these purposes.
4     A local government employer's participation or desire to
5 participate in a program created under this subsection shall
6 not limit that employer's duty to bargain with the
7 representative of any collective bargaining unit of its
8 employees.
9     (j) Any rehabilitation facility within the State of
10 Illinois may apply to the Director to have its employees,
11 annuitants, and their eligible dependents provided group
12 health coverage under this Act on a non-insured basis. To
13 participate, a rehabilitation facility must agree to enroll all
14 of its employees and remit the entire cost of providing such
15 coverage for its employees, except that the rehabilitation
16 facility shall not be required to enroll those of its employees
17 who are covered spouses or dependents under this plan or
18 another group policy or plan providing health benefits as long
19 as (1) an appropriate official from the rehabilitation facility
20 attests that each employee not enrolled is a covered spouse or
21 dependent under this plan or another group policy or plan, and
22 (2) at least 85% of the employees are enrolled and the
23 rehabilitation facility remits the entire cost of providing
24 coverage to those employees. Employees of a participating
25 rehabilitation facility who are not enrolled due to coverage
26 under another group health policy or plan may enroll in the

 

 

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1 event of a qualifying change in status, special enrollment,
2 special circumstance as defined by the Director, or during the
3 annual Benefit Choice Period. A participating rehabilitation
4 facility may also elect to cover its annuitants. Dependent
5 coverage shall be offered on an optional basis, with the costs
6 paid by the rehabilitation facility, its employees, or some
7 combination of the 2 as determined by the rehabilitation
8 facility. The rehabilitation facility shall be responsible for
9 timely collection and transmission of dependent premiums.
10     The Director shall annually determine quarterly rates of
11 payment, subject to the following constraints:
12         (1) In the first year of coverage, the rates shall be
13     equal to the amount normally charged to State employees for
14     elected optional coverages or for enrolled dependents
15     coverages or other contributory coverages on behalf of its
16     employees, adjusted for differences between State
17     employees and employees of the rehabilitation facility in
18     age, sex, geographic location or other relevant
19     demographic variables, plus an amount sufficient to pay for
20     the additional administrative costs of providing coverage
21     to employees of the rehabilitation facility and their
22     dependents.
23         (2) In subsequent years, a further adjustment shall be
24     made to reflect the actual prior years' claims experience
25     of the employees of the rehabilitation facility.
26     Monthly payments by the rehabilitation facility or its

 

 

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1 employees for group health benefits shall be deposited in the
2 Local Government Health Insurance Reserve Fund.
3     (k) Any domestic violence shelter or service within the
4 State of Illinois may apply to the Director to have its
5 employees, annuitants, and their dependents provided group
6 health coverage under this Act on a non-insured basis. To
7 participate, a domestic violence shelter or service must agree
8 to enroll all of its employees and pay the entire cost of
9 providing such coverage for its employees. A participating
10 domestic violence shelter may also elect to cover its
11 annuitants. Dependent coverage shall be offered on an optional
12 basis, with employees, or some combination of the 2 as
13 determined by the domestic violence shelter or service. The
14 domestic violence shelter or service shall be responsible for
15 timely collection and transmission of dependent premiums.
16     The Director shall annually determine rates of payment,
17 subject to the following constraints:
18         (1) In the first year of coverage, the rates shall be
19     equal to the amount normally charged to State employees for
20     elected optional coverages or for enrolled dependents
21     coverages or other contributory coverages on behalf of its
22     employees, adjusted for differences between State
23     employees and employees of the domestic violence shelter or
24     service in age, sex, geographic location or other relevant
25     demographic variables, plus an amount sufficient to pay for
26     the additional administrative costs of providing coverage

 

 

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1     to employees of the domestic violence shelter or service
2     and their dependents.
3         (2) In subsequent years, a further adjustment shall be
4     made to reflect the actual prior years' claims experience
5     of the employees of the domestic violence shelter or
6     service.
7     Monthly payments by the domestic violence shelter or
8 service or its employees for group health insurance shall be
9 deposited in the Local Government Health Insurance Reserve
10 Fund.
11     (l) A public community college or entity organized pursuant
12 to the Public Community College Act may apply to the Director
13 initially to have only annuitants not covered prior to July 1,
14 1992 by the district's health plan provided health coverage
15 under this Act on a non-insured basis. The community college
16 must execute a 2-year contract to participate in the Local
17 Government Health Plan. Any annuitant may enroll in the event
18 of a qualifying change in status, special enrollment, special
19 circumstance as defined by the Director, or during the annual
20 Benefit Choice Period.
21     The Director shall annually determine monthly rates of
22 payment subject to the following constraints: for those
23 community colleges with annuitants only enrolled, first year
24 rates shall be equal to the average cost to cover claims for a
25 State member adjusted for demographics, Medicare
26 participation, and other factors; and in the second year, a

 

 

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1 further adjustment of rates shall be made to reflect the actual
2 first year's claims experience of the covered annuitants.
3     (l-5) The provisions of subsection (l) become inoperative
4 on July 1, 1999.
5     (m) The Director shall adopt any rules deemed necessary for
6 implementation of this amendatory Act of 1989 (Public Act
7 86-978).
8     (n) Any child advocacy center within the State of Illinois
9 may apply to the Director to have its employees, annuitants,
10 and their dependants provided group health coverage under this
11 Act on a non-insured basis. To participate, a child advocacy
12 center must agree to enroll all of its employees and pay the
13 entire cost of providing coverage for its employees. A
14 participating child advocacy center may also elect to cover its
15 annuitants. Dependent coverage shall be offered on an optional
16 basis, with the costs paid by the child advocacy center, its
17 employees, or some combination of the 2 as determined by the
18 child advocacy center. The child advocacy center shall be
19 responsible for timely collection and transmission of
20 dependent premiums.
21     The Director shall annually determine rates of payment,
22 subject to the following constraints:
23         (1) In the first year of coverage, the rates shall be
24     equal to the amount normally charged to State employees for
25     elected optional coverages or for enrolled dependents
26     coverages or other contributory coverages on behalf of its

 

 

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1     employees, adjusted for differences between State
2     employees and employees of the child advocacy center in
3     age, sex, geographic location, or other relevant
4     demographic variables, plus an amount sufficient to pay for
5     the additional administrative costs of providing coverage
6     to employees of the child advocacy center and their
7     dependents.
8         (2) In subsequent years, a further adjustment shall be
9     made to reflect the actual prior years' claims experience
10     of the employees of the child advocacy center.
11     Monthly payments by the child advocacy center or its
12 employees for group health insurance shall be deposited into
13 the Local Government Health Insurance Reserve Fund.
14 (Source: P.A. 93-839, eff. 7-30-04; 94-839, eff. 6-6-06;
15 94-860, eff. 6-16-06; revised 8-3-06.)
 
16     Section 5. The Mental Health and Developmental
17 Disabilities Administrative Act is amended by changing Section
18 18.5 as follows:
 
19     (20 ILCS 1705/18.5)
20     Sec. 18.5. Community Developmental Disability Services
21 Medicaid Trust Fund; reimbursement.
22     (a) The Community Developmental Disability Services
23 Medicaid Trust Fund is hereby created in the State treasury.
24     (b) Except as provided in subsection (b-5), any Any funds

 

 

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1 in excess of $16,700,000 in any fiscal year paid to the State
2 by the federal government under Title XIX or Title XXI of the
3 Social Security Act for services delivered by community
4 developmental disability services providers for services
5 relating to Developmental Training and Community Integrated
6 Living Arrangements as a result of the conversion of such
7 providers from a grant payment methodology to a fee-for-service
8 payment methodology, or any other funds paid to the State for
9 any subsequent revenue maximization initiatives performed by
10 such providers, and any interest earned thereon, shall be
11 deposited directly into the Community Developmental Disability
12 Services Medicaid Trust Fund. One-third of this amount shall be
13 used only to pay for Medicaid-reimbursed community
14 developmental disability services provided to eligible
15 individuals, and the remainder shall be transferred to the
16 General Revenue Fund.
17     (b-5) Beginning in State fiscal year 2008, any funds paid
18 to the State by the federal government under Title XIX or Title
19 XXI of the Social Security Act for services delivered through
20 the Children's Residential Waiver and the Children's In-Home
21 Support Waiver shall be deposited directly into the Community
22 Developmental Disability Services Medicaid Trust Fund and
23 shall not be subject to the transfer provisions of subsection
24 (b).
25     (c) For purposes of this Section:
26     "Medicaid-reimbursed developmental disability services"

 

 

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1 means services provided by a community developmental
2 disability provider under an agreement with the Department that
3 is eligible for reimbursement under the federal Title XIX
4 program or Title XXI program.
5     "Provider" means a qualified entity as defined in the
6 State's Home and Community-Based Services Waiver for Persons
7 with Developmental Disabilities that is funded by the
8 Department to provide a Medicaid-reimbursed service.
9     "Revenue maximization alternatives" do not include
10 increases in funds paid to the State as a result of growth in
11 spending through service expansion or rate increases.
12 (Source: P.A. 93-841, eff. 7-30-04.)
 
13     Section 7. The State Finance Act is amended by adding
14 Sections 5.675 and 6z-69 and changing Section 8.27 as follows:
 
15     (30 ILCS 105/5.675 new)
16     Sec. 5.675. The Priority Capital Grant Program Fund.
 
17     (30 ILCS 105/6z-69 new)
18     Sec. 6z-69. Priority Capital Grant Program Fund. The
19 Priority Capital Grant Program Fund is created as a special
20 fund in the State treasury. Subject to appropriation, the
21 Department of Human Services shall use moneys in the Fund to
22 make grants to the Illinois Facilities Fund, a not-for-profit
23 corporation, to make long term below market rate loans and

 

 

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1 grants to assist nonprofit human service providers working
2 under contract to the State of Illinois to assist those
3 providers in meeting their capital needs. The loans or grants
4 shall be for the purpose of such capital needs, including but
5 not limited to special use facilities, requirements for serving
6 the disabled, mentally ill, or substance abusers, and medical
7 and technology equipment. Loan repayments shall be deposited
8 into the Priority Capital Grant Program Fund. Interest income
9 may be used to cover expenses of the program.
 
10     (30 ILCS 105/8.27)  (from Ch. 127, par. 144.27)
11     Sec. 8.27. All receipts from federal financial
12 participation in the Foster Care and Adoption Services program
13 under Title IV-E of the federal Social Security Act, including
14 receipts for related indirect costs, shall be deposited in the
15 DCFS Children's Services Fund.
16     Eighty percent of the federal funds received by the
17 Illinois Department of Human Services under the Title IV-A
18 Emergency Assistance program as reimbursement for expenditures
19 made from the Illinois Department of Children and Family
20 Services appropriations for the costs of services in behalf of
21 Department of Children and Family Services clients shall be
22 deposited into the DCFS Children's Services Fund.
23     All receipts from federal financial participation in the
24 Child Welfare Services program under Title IV-B of the federal
25 Social Security Act, including receipts for related indirect

 

 

09500HB0691sam002 - 23 - LRB095 08369 WGH 38691 a

1 costs, shall be deposited into the DCFS Children's Services
2 Fund for those moneys received as reimbursement for services
3 provided on or after July 1, 1994.
4     In addition, as soon as may be practicable after the first
5 day of November, 1994, the Department of Children and Family
6 Services shall request the Comptroller to order transferred and
7 the Treasurer shall transfer the unexpended balance of the
8 Child Welfare Services Fund to the DCFS Children's Services
9 Fund. Upon completion of the transfer, the Child Welfare
10 Services Fund will be considered dissolved and any outstanding
11 obligations or liabilities of that fund will pass to the DCFS
12 Children's Services Fund.
13     For services provided on or after July 1, 2007, all federal
14 funds received pursuant to the John H. Chafee Foster Care
15 Independence Program shall be deposited into the DCFS
16 Children's Services Fund.
17     Monies in the Fund may be used by the Department, pursuant
18 to appropriation by the General Assembly, for the ordinary and
19 contingent expenses of the Department.
20     In fiscal year 1988 and in each fiscal year thereafter
21 through fiscal year 2000, the Comptroller shall order
22 transferred and the Treasurer shall transfer an amount of
23 $16,100,000 from the DCFS Children's Services Fund to the
24 General Revenue Fund in the following manner: As soon as may be
25 practicable after the 15th day of September, December, March
26 and June, the Comptroller shall order transferred and the

 

 

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1 Treasurer shall transfer, to the extent that funds are
2 available, 1/4 of $16,100,000, plus any cumulative
3 deficiencies in such transfers for prior transfer dates during
4 such fiscal year. In no event shall any such transfer reduce
5 the available balance in the DCFS Children's Services Fund
6 below $350,000.
7     In accordance with subsection (q) of Section 5 of the
8 Children and Family Services Act, disbursements from
9 individual children's accounts shall be deposited into the DCFS
10 Children's Services Fund.
11     Receipts from public and unsolicited private grants, fees
12 for training, and royalties earned from the publication of
13 materials owned by or licensed to the Department of Children
14 and Family Services shall be deposited into the DCFS Children's
15 Services Fund.
16     As soon as may be practical after September 1, 2005, upon
17 the request of the Department of Children and Family Services,
18 the Comptroller shall order transferred and the Treasurer shall
19 transfer the unexpended balance of the Department of Children
20 and Family Services Training Fund into the DCFS Children's
21 Services Fund. Upon completion of the transfer, the Department
22 of Children and Family Services Training Fund is dissolved and
23 any outstanding obligations or liabilities of that Fund pass to
24 the DCFS Children's Services Fund.
25 (Source: P.A. 94-91, eff. 7-1-05.)
 

 

 

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1     Section 9. The Hospital Licensing Act is amended by
2 changing Section 8 as follows:
 
3     (210 ILCS 85/8)  (from Ch. 111 1/2, par. 149)
4     Sec. 8. Facility plan review; fees.
5     (a) Before commencing construction of new facilities or
6 specified types of alteration or additions to an existing
7 hospital involving major construction, as defined by rule by
8 the Department, with an estimated cost greater than $100,000,
9 architectural plans and specifications therefor shall be
10 submitted by the licensee to the Department for review and
11 approval. A hospital may submit architectural drawings and
12 specifications for other construction projects for Department
13 review according to subsection (b) that shall not be subject to
14 fees under subsection (d). The Department must give a hospital
15 that is planning to submit a construction project for review
16 the opportunity to discuss its plans and specifications with
17 the Department before the hospital formally submits the plans
18 and specifications for Department review. Review of drawings
19 and specifications shall be conducted by an employee of the
20 Department meeting the qualifications established by the
21 Department of Central Management Services class specifications
22 for such an individual's position or by a person contracting
23 with the Department who meets those class specifications. Final
24 approval of the plans and specifications for compliance with
25 design and construction standards shall be obtained from the

 

 

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1 Department before the alteration, addition, or new
2 construction is begun. Subject to this Section 8, and prior to
3 January 1, 2012, the Department shall consider the re-licensing
4 of an existing hospital structure according to the standards
5 for an existing hospital, as set forth in the Department's
6 rules. Re-licensing under this provision shall occur only if
7 that facility operated as a licensed hospital on July 1, 2005,
8 has had no intervening use as other than a hospital, and exists
9 in a county with a population of less than 20,000 that does not
10 have another licensed hospital on the effective date of this
11 amendatory Act of the 95th General Assembly.
12     (b) The Department shall inform an applicant in writing
13 within 10 working days after receiving drawings and
14 specifications and the required fee, if any, from the applicant
15 whether the applicant's submission is complete or incomplete.
16 Failure to provide the applicant with this notice within 10
17 working days shall result in the submission being deemed
18 complete for purposes of initiating the 60-day review period
19 under this Section. If the submission is incomplete, the
20 Department shall inform the applicant of the deficiencies with
21 the submission in writing. If the submission is complete and
22 the required fee, if any, has been paid, the Department shall
23 approve or disapprove drawings and specifications submitted to
24 the Department no later than 60 days following receipt by the
25 Department. The drawings and specifications shall be of
26 sufficient detail, as provided by Department rule, to enable

 

 

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1 the Department to render a determination of compliance with
2 design and construction standards under this Act. If the
3 Department finds that the drawings are not of sufficient detail
4 for it to render a determination of compliance, the plans shall
5 be determined to be incomplete and shall not be considered for
6 purposes of initiating the 60 day review period. If a
7 submission of drawings and specifications is incomplete, the
8 applicant may submit additional information. The 60-day review
9 period shall not commence until the Department determines that
10 a submission of drawings and specifications is complete or the
11 submission is deemed complete. If the Department has not
12 approved or disapproved the drawings and specifications within
13 60 days, the construction, major alteration, or addition shall
14 be deemed approved. If the drawings and specifications are
15 disapproved, the Department shall state in writing, with
16 specificity, the reasons for the disapproval. The entity
17 submitting the drawings and specifications may submit
18 additional information in response to the written comments from
19 the Department or request a reconsideration of the disapproval.
20 A final decision of approval or disapproval shall be made
21 within 45 days of the receipt of the additional information or
22 reconsideration request. If denied, the Department shall state
23 the specific reasons for the denial and the applicant may elect
24 to seek dispute resolution pursuant to Section 25 of the
25 Illinois Building Commission Act, which the Department must
26 participate in.

 

 

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1     (c) The Department shall provide written approval for
2 occupancy pursuant to subsection (g) and shall not issue a
3 violation to a facility as a result of a licensure or complaint
4 survey based upon the facility's physical structure if:
5         (1) the Department reviewed and approved or deemed
6     approved the drawing and specifications for compliance
7     with design and construction standards;
8         (2) the construction, major alteration, or addition
9     was built as submitted;
10         (3) the law or rules have not been amended since the
11     original approval; and
12         (4) the conditions at the facility indicate that there
13     is a reasonable degree of safety provided for the patients.
14     (c-5) The Department shall not issue a violation to a
15 facility if the inspected aspects of the facility were
16 previously found to be in compliance with applicable standards,
17 the relevant law or rules have not been amended, conditions at
18 the facility reasonably protect the safety of its patients, and
19 alterations or new hazards have not been identified.
20     (d) The Department shall charge the following fees in
21 connection with its reviews conducted before June 30, 2004
22 under this Section:
23         (1) (Blank).
24         (2) (Blank).
25         (3) If the estimated dollar value of the major
26     construction is greater than $500,000, the fee shall be

 

 

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1     established by the Department pursuant to rules that
2     reflect the reasonable and direct cost of the Department in
3     conducting the architectural reviews required under this
4     Section. The estimated dollar value of the major
5     construction subject to review under this Section shall be
6     annually readjusted to reflect the increase in
7     construction costs due to inflation.
8     The fees provided in this subsection (d) shall not apply to
9 major construction projects involving facility changes that
10 are required by Department rule amendments or to projects
11 related to homeland security.
12     The fees provided in this subsection (d) shall also not
13 apply to major construction projects if 51% or more of the
14 estimated cost of the project is attributed to capital
15 equipment. For major construction projects where 51% or more of
16 the estimated cost of the project is attributed to capital
17 equipment, the Department shall by rule establish a fee that is
18 reasonably related to the cost of reviewing the project.
19     Disproportionate share hospitals and rural hospitals shall
20 only pay one-half of the fees required in this subsection (d).
21 For the purposes of this subsection (d), (i) "disproportionate
22 share hospital" means a hospital described in items (1) through
23 (5) of subsection (b) of Section 5-5.02 of the Illinois Public
24 Aid Code and (ii) "rural hospital" means a hospital that is (A)
25 located outside a metropolitan statistical area or (B) located
26 15 miles or less from a county that is outside a metropolitan

 

 

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1 statistical area and is licensed to perform medical/surgical or
2 obstetrical services and has a combined total bed capacity of
3 75 or fewer beds in these 2 service categories as of July 14,
4 1993, as determined by the Department.
5     The Department shall not commence the facility plan review
6 process under this Section until the applicable fee has been
7 paid.
8     (e) All fees received by the Department under this Section
9 shall be deposited into the Health Facility Plan Review Fund, a
10 special fund created in the State treasury. All fees paid by
11 hospitals under subsection (d) shall be used only to cover the
12 direct and reasonable costs relating to the Department's review
13 of hospital projects under this Section. Moneys shall be
14 appropriated from that Fund to the Department only to pay the
15 costs of conducting reviews under this Section. None of the
16 moneys in the Health Facility Plan Review Fund shall be used to
17 reduce the amount of General Revenue Fund moneys appropriated
18 to the Department for facility plan reviews conducted pursuant
19 to this Section.
20     (f) (Blank).
21     (g) The Department shall conduct an on-site inspection of
22 the completed project no later than 15 business days after
23 notification from the applicant that the project has been
24 completed and all certifications required by the Department
25 have been received and accepted by the Department. The
26 Department may extend this deadline only if a federally

 

 

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1 mandated survey time frame takes precedence. The Department
2 shall provide written approval for occupancy to the applicant
3 within 5 working days of the Department's final inspection,
4 provided the applicant has demonstrated substantial compliance
5 as defined by Department rule. Occupancy of new major
6 construction is prohibited until Department approval is
7 received, unless the Department has not acted within the time
8 frames provided in this subsection (g), in which case the
9 construction shall be deemed approved. Occupancy shall be
10 authorized after any required health inspection by the
11 Department has been conducted.
12     (h) The Department shall establish, by rule, a procedure to
13 conduct interim on-site review of large or complex construction
14 projects.
15     (i) The Department shall establish, by rule, an expedited
16 process for emergency repairs or replacement of like equipment.
17     (j) Nothing in this Section shall be construed to apply to
18 maintenance, upkeep, or renovation that does not affect the
19 structural integrity of the building, does not add beds or
20 services over the number for which the facility is licensed,
21 and provides a reasonable degree of safety for the patients.
22 (Source: P.A. 92-563, eff. 6-24-02; 92-803, eff. 8-16-02;
23 93-41, eff. 6-27-03.)
 
24     Section 10. The Illinois Public Aid Code is amended by
25 changing Sections 5-5.4 and 5B-8 and adding Section 5-27 as

 

 

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1 follows:
 
2     (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
3     Sec. 5-5.4. Standards of Payment - Department of Healthcare
4 and Family Services. The Department of Healthcare and Family
5 Services shall develop standards of payment of skilled nursing
6 and intermediate care services in facilities providing such
7 services under this Article which:
8     (1) Provide for the determination of a facility's payment
9 for skilled nursing and intermediate care services on a
10 prospective basis. The amount of the payment rate for all
11 nursing facilities certified by the Department of Public Health
12 under the Nursing Home Care Act as Intermediate Care for the
13 Developmentally Disabled facilities, Long Term Care for Under
14 Age 22 facilities, Skilled Nursing facilities, or Intermediate
15 Care facilities under the medical assistance program shall be
16 prospectively established annually on the basis of historical,
17 financial, and statistical data reflecting actual costs from
18 prior years, which shall be applied to the current rate year
19 and updated for inflation, except that the capital cost element
20 for newly constructed facilities shall be based upon projected
21 budgets. The annually established payment rate shall take
22 effect on July 1 in 1984 and subsequent years. No rate increase
23 and no update for inflation shall be provided on or after July
24 1, 1994 and before July 1, 2008, unless specifically provided
25 for in this Section. The changes made by Public Act 93-841

 

 

09500HB0691sam002 - 33 - LRB095 08369 WGH 38691 a

1 extending the duration of the prohibition against a rate
2 increase or update for inflation are effective retroactive to
3 July 1, 2004.
4     For facilities licensed by the Department of Public Health
5 under the Nursing Home Care Act as Intermediate Care for the
6 Developmentally Disabled facilities or Long Term Care for Under
7 Age 22 facilities, the rates taking effect on July 1, 1998
8 shall include an increase of 3%. For facilities licensed by the
9 Department of Public Health under the Nursing Home Care Act as
10 Skilled Nursing facilities or Intermediate Care facilities,
11 the rates taking effect on July 1, 1998 shall include an
12 increase of 3% plus $1.10 per resident-day, as defined by the
13 Department. For facilities licensed by the Department of Public
14 Health under the Nursing Home Care Act as Intermediate Care
15 Facilities for the Developmentally Disabled or Long Term Care
16 for Under Age 22 facilities, the rates taking effect on January
17 1, 2006 shall include an increase of 3%.
18     For facilities licensed by the Department of Public Health
19 under the Nursing Home Care Act as Intermediate Care for the
20 Developmentally Disabled facilities or Long Term Care for Under
21 Age 22 facilities, the rates taking effect on July 1, 1999
22 shall include an increase of 1.6% plus $3.00 per resident-day,
23 as defined by the Department. For facilities licensed by the
24 Department of Public Health under the Nursing Home Care Act as
25 Skilled Nursing facilities or Intermediate Care facilities,
26 the rates taking effect on July 1, 1999 shall include an

 

 

09500HB0691sam002 - 34 - LRB095 08369 WGH 38691 a

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

 

 

09500HB0691sam002 - 35 - LRB095 08369 WGH 38691 a

1 to the payment methodology in effect on July 1, 2003 shall be
2 provided for a period not exceeding 3 years and 184 days after
3 implementation of the new payment methodology as follows:
4         (A) For a facility that would receive a lower nursing
5     component rate per patient day under the new system than
6     the facility received effective on the date immediately
7     preceding the date that the Department implements the new
8     payment methodology, the nursing component rate per
9     patient day for the facility shall be held at the level in
10     effect on the date immediately preceding the date that the
11     Department implements the new payment methodology until a
12     higher nursing component rate of reimbursement is achieved
13     by that facility.
14         (B) For a facility that would receive a higher nursing
15     component rate per patient day under the payment
16     methodology in effect on July 1, 2003 than the facility
17     received effective on the date immediately preceding the
18     date that the Department implements the new payment
19     methodology, the nursing component rate per patient day for
20     the facility shall be adjusted.
21         (C) Notwithstanding paragraphs (A) and (B), the
22     nursing component rate per patient day for the facility
23     shall be adjusted subject to appropriations provided by the
24     General Assembly.
25     Notwithstanding any other provision of this Section, for
26 facilities licensed by the Department of Public Health under

 

 

09500HB0691sam002 - 36 - LRB095 08369 WGH 38691 a

1 the Nursing Home Care Act as skilled nursing facilities or
2 intermediate care facilities, the numerator of the ratio used
3 by the Department of Healthcare and Family Services to compute
4 the rate payable under this Section using the Minimum Data Set
5 (MDS) methodology shall incorporate the following annual
6 amounts as the additional funds appropriated to the Department
7 specifically to pay for rates based on the MDS nursing
8 component methodology in excess of the funding in effect on
9 December 31, 2006:
10         (i) For rates taking effect January 1, 2007,
11     $60,000,000.
12         (ii) For rates taking effect October 1, 2007,
13     $110,000,000.
14     Notwithstanding any other provision of this Section, for
15 facilities licensed by the Department of Public Health under
16 the Nursing Home Care Act as skilled nursing facilities or
17 intermediate care facilities, the support component of the
18 rates taking effect on October 1, 2007 shall be computed using
19 the most recent cost reports on file with the Department of
20 Healthcare and Family Services no later than April 1, 2005,
21 updated for inflation to January 1, 2006.
22     For facilities licensed by the Department of Public Health
23 under the Nursing Home Care Act as Intermediate Care for the
24 Developmentally Disabled facilities or Long Term Care for Under
25 Age 22 facilities, the rates taking effect on March 1, 2001
26 shall include a statewide increase of 7.85%, as defined by the

 

 

09500HB0691sam002 - 37 - LRB095 08369 WGH 38691 a

1 Department.
2     For facilities licensed by the Department of Public Health
3 under the Nursing Home Care Act as Intermediate Care for the
4 Developmentally Disabled facilities or Long Term Care for Under
5 Age 22 facilities, the rates taking effect on April 1, 2002
6 shall include a statewide increase of 2.0%, as defined by the
7 Department. This increase terminates on July 1, 2002; beginning
8 July 1, 2002 these rates are reduced to the level of the rates
9 in effect on March 31, 2002, as defined by the Department.
10     For facilities licensed by the Department of Public Health
11 under the Nursing Home Care Act as skilled nursing facilities
12 or intermediate care facilities, the rates taking effect on
13 July 1, 2001 shall be computed using the most recent cost
14 reports on file with the Department of Public Aid no later than
15 April 1, 2000, updated for inflation to January 1, 2001. For
16 rates effective July 1, 2001 only, rates shall be the greater
17 of the rate computed for July 1, 2001 or the rate effective on
18 June 30, 2001.
19     Notwithstanding any other provision of this Section, for
20 facilities licensed by the Department of Public Health under
21 the Nursing Home Care Act as skilled nursing facilities or
22 intermediate care facilities, the Illinois Department shall
23 determine by rule the rates taking effect on July 1, 2002,
24 which shall be 5.9% less than the rates in effect on June 30,
25 2002.
26     Notwithstanding any other provision of this Section, for

 

 

09500HB0691sam002 - 38 - LRB095 08369 WGH 38691 a

1 facilities licensed by the Department of Public Health under
2 the Nursing Home Care Act as skilled nursing facilities or
3 intermediate care facilities, if the payment methodologies
4 required under Section 5A-12 and the waiver granted under 42
5 CFR 433.68 are approved by the United States Centers for
6 Medicare and Medicaid Services, the rates taking effect on July
7 1, 2004 shall be 3.0% greater than the rates in effect on June
8 30, 2004. These rates shall take effect only upon approval and
9 implementation of the payment methodologies required under
10 Section 5A-12.
11     Notwithstanding any other provisions of this Section, for
12 facilities licensed by the Department of Public Health under
13 the Nursing Home Care Act as skilled nursing facilities or
14 intermediate care facilities, the rates taking effect on
15 January 1, 2005 shall be 3% more than the rates in effect on
16 December 31, 2004.
17     Notwithstanding any other provisions of this Section, for
18 facilities licensed by the Department of Public Health under
19 the Nursing Home Care Act as intermediate care facilities that
20 are federally defined as Institutions for Mental Disease, a
21 socio-development component rate equal to 6.6% of the
22 facility's nursing component rate as of January 1, 2006 shall
23 be established and paid effective July 1, 2006. The
24 socio-development component of the rate as of July 1, 2007
25 shall be increased by a factor of 2.53. The Illinois Department
26 may by rule adjust these socio-development component rates, but

 

 

09500HB0691sam002 - 39 - LRB095 08369 WGH 38691 a

1 in no case may such rates be diminished.
2     For facilities licensed by the Department of Public Health
3 under the Nursing Home Care Act as Intermediate Care for the
4 Developmentally Disabled facilities or as long-term care
5 facilities for residents under 22 years of age, the rates
6 taking effect on July 1, 2003 shall include a statewide
7 increase of 4%, as defined by the Department.
8     For facilities licensed by the Department of Public Health
9 under the Nursing Home Care Act as Intermediate Care for the
10 Developmentally Disabled facilities or Long Term Care for Under
11 Age 22 facilities, the rates taking effect on October 1, 2007
12 shall include a statewide increase of 2.5%, as defined by the
13 Department.
14     Notwithstanding any other provision of this Section, for
15 facilities licensed by the Department of Public Health under
16 the Nursing Home Care Act as skilled nursing facilities or
17 intermediate care facilities, effective January 1, 2005,
18 facility rates shall be increased by the difference between (i)
19 a facility's per diem property, liability, and malpractice
20 insurance costs as reported in the cost report filed with the
21 Department of Public Aid and used to establish rates effective
22 July 1, 2001 and (ii) those same costs as reported in the
23 facility's 2002 cost report. These costs shall be passed
24 through to the facility without caps or limitations, except for
25 adjustments required under normal auditing procedures.
26     Rates established effective each July 1 shall govern

 

 

09500HB0691sam002 - 40 - LRB095 08369 WGH 38691 a

1 payment for services rendered throughout that fiscal year,
2 except that rates established on July 1, 1996 shall be
3 increased by 6.8% for services provided on or after January 1,
4 1997. Such rates will be based upon the rates calculated for
5 the year beginning July 1, 1990, and for subsequent years
6 thereafter until June 30, 2001 shall be based on the facility
7 cost reports for the facility fiscal year ending at any point
8 in time during the previous calendar year, updated to the
9 midpoint of the rate year. The cost report shall be on file
10 with the Department no later than April 1 of the current rate
11 year. Should the cost report not be on file by April 1, the
12 Department shall base the rate on the latest cost report filed
13 by each skilled care facility and intermediate care facility,
14 updated to the midpoint of the current rate year. In
15 determining rates for services rendered on and after July 1,
16 1985, fixed time shall not be computed at less than zero. The
17 Department shall not make any alterations of regulations which
18 would reduce any component of the Medicaid rate to a level
19 below what that component would have been utilizing in the rate
20 effective on July 1, 1984.
21     (2) Shall take into account the actual costs incurred by
22 facilities in providing services for recipients of skilled
23 nursing and intermediate care services under the medical
24 assistance program.
25     (3) Shall take into account the medical and psycho-social
26 characteristics and needs of the patients.

 

 

09500HB0691sam002 - 41 - LRB095 08369 WGH 38691 a

1     (4) Shall take into account the actual costs incurred by
2 facilities in meeting licensing and certification standards
3 imposed and prescribed by the State of Illinois, any of its
4 political subdivisions or municipalities and by the U.S.
5 Department of Health and Human Services pursuant to Title XIX
6 of the Social Security Act.
7     The Department of Healthcare and Family Services shall
8 develop precise standards for payments to reimburse nursing
9 facilities for any utilization of appropriate rehabilitative
10 personnel for the provision of rehabilitative services which is
11 authorized by federal regulations, including reimbursement for
12 services provided by qualified therapists or qualified
13 assistants, and which is in accordance with accepted
14 professional practices. Reimbursement also may be made for
15 utilization of other supportive personnel under appropriate
16 supervision.
17 (Source: P.A. 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697,
18 eff. 11-21-05; 94-838, eff. 6-6-06; 94-964, eff. 6-28-06;
19 95-12, eff. 7-2-07.)
 
20     (305 ILCS 5/5-27 new)
21     Sec. 5-27. Pilot mandatory managed care program. To
22 determine the potential for savings and improved quality of
23 care in the Medicaid program, the Department shall implement in
24 State fiscal year 2008 a pilot mandatory managed care program
25 requiring recipients to enroll with a Managed Care Entity (MCE)

 

 

09500HB0691sam002 - 42 - LRB095 08369 WGH 38691 a

1 meeting the requirements of Section 1932 of the Social Security
2 Act and under contract with the Department. The program shall
3 be implemented in at least 2 contiguous counties with not less
4 than 200,000 inhabitants and not more than 2,000,000
5 inhabitants. The program shall have the following features:
6         (1) All recipients in the selected counties who do not
7     have eligibility through the spend-down program and who are
8     not excluded from State plan based mandatory managed care
9     by the Social Security Act shall be enrolled in the
10     program.
11         (2) Only the following services may be excluded from
12     the program and shall be delivered to eligible recipients
13     through the fee-for-service system: nursing facility and
14     assisted living long term care services, services provided
15     through waivers granted pursuant to Sections 1115 and 1915
16     of the Social Security Act, and pharmacy services.
17         (3) Up to 3 Managed Care Entities shall be selected for
18     the program.
19         (4) The Department must use the following criteria in
20     selecting MCEs to participate in the pilot program: (A)
21     network adequacy ensuring availability and access to care;
22     (B) provider payment levels; (C) quality assurance plans
23     including utilization management and peer review; (D) past
24     performance on quality outcome measures (for example, the
25     Health Plan Employer Data and Information Set (HEDIS)); (E)
26     plan for care management; (F) data system adequacy, member

 

 

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1     enrollment, and communication plan; and (G) any other
2     criteria that the Department determines appropriate.
3         (5) The Department shall require that the MCEs in the
4     pilot counties keep case-specific data under the pilot
5     program and produce periodic and final reports based on
6     that data of, at a minimum, the types and frequency of care
7     provided to enrollees and the types and frequency of
8     specialty and hospital care provided. The Department shall
9     require case-specific data in a manner that does not
10     violate applicable privacy laws.
11         (6) The Department shall perform an annual analysis of
12     healthcare outcomes for the population served under the
13     pilot program compared to healthcare outcomes for the
14     medical assistance population enrolled in the primary care
15     case management program under this Article. The Department
16     shall present this analysis to the General Assembly no
17     later than 60 days after the end of the month for which
18     HEDIS measures are reported for the calendar year.
 
19     (305 ILCS 5/5B-8)  (from Ch. 23, par. 5B-8)
20     Sec. 5B-8. Long-Term Care Provider Fund.
21     (a) There is created in the State Treasury the Long-Term
22 Care Provider Fund. Interest earned by the Fund shall be
23 credited to the Fund. The Fund shall not be used to replace any
24 moneys appropriated to the Medicaid program by the General
25 Assembly.

 

 

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1     (b) The Fund is created for the purpose of receiving and
2 disbursing moneys in accordance with this Article.
3 Disbursements from the Fund shall be made only as follows:
4         (1) For payments to skilled or intermediate nursing
5     facilities, including county nursing facilities but
6     excluding State-operated facilities, under Title XIX of
7     the Social Security Act and Article V of this Code.
8         (2) For the reimbursement of moneys collected by the
9     Illinois Department through error or mistake, and for
10     making required payments under Section 5-4.38(a)(1) if
11     there are no moneys available for such payments in the
12     Medicaid Long Term Care Provider Participation Fee Trust
13     Fund.
14         (3) For payment of administrative expenses incurred by
15     the Illinois Department or its agent in performing the
16     activities authorized by this Article.
17         (3.5) For reimbursement of expenses incurred by
18     long-term care facilities, and payment of administrative
19     expenses incurred by the Department of Public Health, in
20     relation to the conduct and analysis of background checks
21     for identified offenders under the Nursing Home Care Act.
22         (4) For payments of any amounts that are reimbursable
23     to the federal government for payments from this Fund that
24     are required to be paid by State warrant.
25         (5) For making transfers to the General Obligation Bond
26     Retirement and Interest Fund, as those transfers are

 

 

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1     authorized in the proceedings authorizing debt under the
2     Short Term Borrowing Act, but transfers made under this
3     paragraph (5) shall not exceed the principal amount of debt
4     issued in anticipation of the receipt by the State of
5     moneys to be deposited into the Fund.
6     Disbursements from the Fund, other than transfers to the
7 General Obligation Bond Retirement and Interest Fund, shall be
8 by warrants drawn by the State Comptroller upon receipt of
9 vouchers duly executed and certified by the Illinois
10 Department.
11     (c) The Fund shall consist of the following:
12         (1) All moneys collected or received by the Illinois
13     Department from the long-term care provider assessment
14     imposed by this Article.
15         (2) All federal matching funds received by the Illinois
16     Department as a result of expenditures made by the Illinois
17     Department that are attributable to moneys deposited in the
18     Fund.
19         (3) Any interest or penalty levied in conjunction with
20     the administration of this Article.
21         (4) Any balance in the Medicaid Long Term Care Provider
22     Participation Fee Fund in the State Treasury. The balance
23     shall be transferred to the Fund upon certification by the
24     Illinois Department to the State Comptroller that all of
25     the disbursements required by Section 5-4.31(b) of this
26     Code have been made.

 

 

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1         (5) All other monies received for the Fund from any
2     other source, including interest earned thereon.
3 (Source: P.A. 89-626, eff. 8-9-96.)
 
4     Section 99. Effective date. This Act takes effect upon
5 becoming law.".