|
Americans with Disabilities Act under the United States Supreme |
Court's decision in Olmstead v. L.C., 527 U.S. 581 (1999). In |
accordance with Section 6071 of the Deficit Reduction Act of |
2005 (P.L. 109-171), the purpose of this Act is (i) to identify |
and reduce barriers or mechanisms, whether in State law, the |
State Medicaid Plan, the State budget, or otherwise, that |
prevent or restrict the flexible use of public funds to enable |
individuals with disabilities to receive support for |
appropriate and necessary long-term care services in settings |
of their choice; (ii) to increase the use of home and |
community-based long-term care services, rather than |
institutions or long-term care facilities; (iii) to increase |
the ability of the State Medicaid program to assure continued |
provision of home and community-based long-term care services |
to eligible individuals who choose to transition from an |
institution or a long-term care facility to a community |
setting; and (iv) to ensure that procedures are in place that |
are at least comparable to those required under the qualified |
home and community-based program to provide quality assurance |
for eligible individuals receiving Medicaid home and |
community-based long-term care services and to provide for |
continuous quality improvement in such services. Utilizing the |
framework created by the "Money Follows the Person" |
demonstration project, approval received by the State on May |
14, 2007, the purpose of this Act is to codify and reinforce |
the State's commitment to promote individual choice and control |
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and increase utilization of home and community-based services |
through: |
(a) Increased ability of the State Medicaid program to |
ensure continued provision of home and community-based |
long-term care services to eligible individuals who choose |
to transition from an institution to a community setting. |
(b) Assessment and removal of barriers to community |
reintegration, including development of a comprehensive |
housing strategy. |
(c) Expand availability of consumer self-directed |
service options. |
(d) Increased use of home and community-based |
long-term care services, rather than institutions or |
long-term care facilities, such that the percentage of the |
State long-term care budget expended for community-based |
services increases from its current 28.5% to at least 37% |
in the next 5 years. |
(e) Creation and implementation of interagency |
agreements or budgetary mechanisms to allow for the |
flexible movement of allocated dollars from institutional |
budget appropriations to appropriations supporting home |
and community-based services or Medicaid State Plan |
options. |
(f) Creation of an equitable, clinically sound and |
cost-effective system for identification and review of |
community transition candidates across all long-term care |
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systems; including improvement of prescreening, assessment |
for rapid reintegration and targeted review of longer stay |
residents, training and outreach education for providers |
and consumers on community alternatives across all |
long-term care systems. |
(g) Development and implementation of data and |
information systems to track individuals across service |
systems and funding streams; support responsive |
eligibility determination; facilitate placement and care |
decisions; identify individuals with potential for |
transition; and drive planning for the development of |
community-based alternatives. |
(h) Establishment of procedures that are at least |
comparable to those required under the qualified home and |
community-based program to provide quality assurance for |
eligible individuals receiving Medicaid home and |
community-based long-term care services and to provide for |
continuous quality improvement in such services. |
(i) Nothing in this amendatory Act of the 95th General |
Assembly shall diminish or restrict the choice of an |
individual to reside in an institution or the quality of |
care they receive.
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(20 ILCS 2407/52 new) |
Sec. 52. Applicability; definitions. In accordance with |
Section 6071 of the Deficit Reduction Act of 2005 (P.L. |
|
109-171), as used in this Article: |
"Departments". The term "Departments" means for the |
purposes of this Act, the Department of Human Services, the |
Department on Aging, Department of Healthcare and Family |
Services and Department of Public Health, unless otherwise |
noted. |
"Home and community-based long-term care services". The |
term "home and community-based long-term care services" means, |
with respect to the State Medicaid program, a service aid, or |
benefit, home and community-based services, including but not |
limited to home health and personal care services, that are |
provided to a person with a disability, and are voluntarily |
accepted, as part of his or her long-term care that: (i) is |
provided under the State's qualified home and community-based |
program or that could be provided under such a program but is |
otherwise provided under the Medicaid program; (ii) is |
delivered in a qualified residence; and (iii) is necessary for |
the person with a disability to live in the community. |
"Long-term care facility". The term "long-term care |
facility", for the purposes of this Article, means a skilled |
nursing or intermediate long-term care facility subject to |
licensure by the Department of Public Health under the Nursing |
Home Care Act, an intermediate care facility for the |
developmentally disabled (ICF-DDs), and a State-operated |
developmental center or mental health center, whether publicly |
or privately owned. |
|
"Money Follows the Person" Demonstration. Enacted by the |
Deficit Reduction Act of 2005, the Money Follows the Person |
(MFP) Rebalancing Demonstration is part of a comprehensive, |
coordinated strategy to assist states, in collaboration with |
stakeholders, to make widespread changes to their long-term |
care support systems. This initiative will assist states in |
their efforts to reduce their reliance on institutional care |
while developing community-based long-term care opportunities, |
enabling the elderly and people with disabilities to fully |
participate in their communities. |
"Public funds" mean any funds appropriated by the General |
Assembly to the Departments of Human Services, on Aging, of |
Healthcare and Family Services and of Public Health for |
settings and services as defined in this Article. |
"Qualified residence". The term "qualified residence" |
means, with respect to an eligible individual: (i) a home owned |
or leased by the individual or the individual's authorized |
representative (as defined by P.L. 109-171); (ii) an apartment |
with an individual lease, with lockable access and egress, and |
which includes living, sleeping, bathing, and cooking areas |
over which the individual or the individual's family has domain |
and control; or (iii) a residence, in a community-based |
residential setting, in which no more than 4 unrelated |
individuals reside. Where qualified residences are not |
sufficient to meet the demand of eligible individuals, |
time-limited exceptions to this definition may be developed |
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through administrative rule. |
"Self-directed services". The term "self-directed |
services" means, with respect to home and community-based |
long-term services for an eligible individual, those services |
for the individual that are planned and purchased under the |
direction and control of the individual or the individual's |
authorized representative, including the amount, duration, |
scope, provider, and location of such services, under the State |
Medicaid program consistent with the following requirements: |
(a) Assessment: there is an assessment of the needs, |
capabilities, and preference of the individual with |
respect to such services. |
(b) Individual service care or treatment plan: based on |
the assessment, there is development jointly with such |
individual or individual's authorized representative, a |
plan for such services for the individual that (i) |
specifies those services, if any, that the individual or |
the individual's authorized representative would be |
responsible for directing; (ii) identifies the methods by |
which the individual or the individual's authorized |
representative or an agency designated by an individual or |
representative will select, manage, and dismiss providers |
of such services.
|
(20 ILCS 2407/53 new) |
Sec. 53. Rebalancing benchmarks. |
|
(a) Illinois' long-term care system is in a state of |
transformation, as evidenced by the creation and subsequent |
work products of the Disability Services Advisory Committee, |
Older Adult Services Advisory Committee, Housing Task Force and |
other executive and legislative branch initiatives. |
(b) Illinois' Money Follows the Person demonstration |
approval capitalizes on this progress and commits the State to |
transition approximately 3,357 older persons and persons with |
developmental, physical or psychiatric disabilities from |
institutional to home and community-based settings, resulting |
in an increased percentage of long-term care community spending |
over the next 5 years. |
(c) The State will endeavor to increase the percentage of |
community-based long-term care spending over the next 5 years |
according to the following timeline: |
Estimated baseline: 28.5% |
Year 1: 30% |
Year 2: 31% |
Year 3: 32% |
Year 4: 35% |
Year 5: 37% |
(d) The Departments will utilize interagency agreements |
and will seek legislative authority to implement a Money |
Follows the Person budgetary mechanism to allocate or |
reallocate funds for the purpose of expanding the availability, |
quality or stability of home and community-based long-term care |
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services and supports for persons with disabilities. |
(e) The allocation of public funds for home and |
community-based long-term care services shall not have the |
effect of: (i) diminishing or reducing the quality of services |
available to residents of long-term care facilities; (ii) |
forcing any residents of long-term care facilities to |
involuntarily accept home and community-based long-term care |
services, or causing any residents of long-term care facilities |
to be involuntarily transferred or discharged; (iii) causing |
reductions in long-term care facility reimbursement rates in |
effect as of July 1, 2008; or (iv) diminishing access to a full |
array of long-term care options.
|
(20 ILCS 2407/54 new) |
Sec. 54. Quality assurance and quality improvement. |
(a) In accordance with subsection (11) of Section 6071 of |
the Deficit Reduction Act of 2005 (P.L. 109-171), the |
Departments shall develop a plan for quality assurance and |
quality improvement for home and community-based long-term |
care services under the State Medicaid program, including a |
plan to assure the health and welfare of eligible individuals |
under this Act. |
(b) This plan shall require the Departments to apply for |
any available funding to support the intent of this |
legislation, and to seek any appropriate federal Medicaid |
approval.
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|
(20 ILCS 2407/55 new) |
Sec. 55. Dissemination of reports. |
(a) On or before April 1 of each year, in conjunction with |
their annual report, the Department of Healthcare and Family |
Services, in cooperation with the other involved agencies, |
shall report to the Governor and the General Assembly on the |
implementation of this Act and include, at a minimum, the |
following data: (i) a description of any interagency |
agreements, fiscal payment mechanisms or methodologies |
developed under this Act that effectively support choice; (ii) |
information concerning the dollar amounts of State Medicaid |
long-term care expenditures and the percentage of such |
expenditures that were for institutional long-term care |
services or were for home and community-based long-term care |
services; and (iii) documentation that the Departments have met |
the requirements under Section 54(a) to assure the health and |
welfare of eligible individuals receiving home and |
community-based long-term care services. This report must be |
made available to the general public, including via the |
Departmental websites.
|
(20 ILCS 2407/56 new) |
Sec. 56. Effect on existing rights. |
(a) This Article does not alter or affect the manner in |
which persons with disabilities are determined eligible or |
|
appropriate for home and community-based long-term care |
services. |
(b) This Article shall not be read to limit in any way the |
rights of persons with disabilities under the U.S. |
Constitution, the Americans with Disabilities Act, Section 504 |
of the Rehabilitation Act, the Social Security Act, or any |
other federal or State law.
|
(20 ILCS 2407/57 new) |
Sec. 57. Rules. The Departments of Human Services, on |
Aging, of Healthcare and Family Services and of Public Health |
shall adopt any rules necessary for the implementation and |
administration of this Act. |