SB0354sam001 100TH GENERAL ASSEMBLY

Sen. Daniel Biss

Filed: 4/18/2018

10000SB0354sam001 LRB100 05066 KTG 38822 a

AMENDMENT TO SENATE BILL 354

AMENDMENT NO. ______. Amend Senate Bill 354 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Affordable Long-Term Services and Supports for Illinois Families Act.

Section 5. Purpose. The purpose of this Act is to provide security for Illinois families by pooling resources to create a benefit to assist with long-term care costs that otherwise can be an impossible burden for families or become costs to the State's Medical Assistance Program. This Act will also serve to support the State's effort to rebalance long-term care toward investing in home-based and community-based services and supports.

Section 10. Definitions. As used in this Act:

"Commission" means the Long-Term Services and Supports Trust Commission created in Section 25.

"Consumer direction" means an orientation to the delivery of home-based and community-based services under which informed individuals make choices about the services they receive. Individuals can consider their own needs, determine how and by whom these needs should be met, and monitor the quality of services received. Individuals can also independently make all decisions and manage services directly. The unifying principle in consumer-directed long-term services and supports arrangements is that individuals have the primary authority to make choices that work best for them.

"Eligible beneficiary" means an Illinois resident with a long-term care need, as established in an assessment by a needs assessor, who is not receiving long-term care services and supports under the State's Medical Assistance Program and, if using Medicare-paid rehabilitation services, has unmet needs under Medicare.

"Existing long-term care programs" includes the following programs existing on the effective date of this Act: the Community Care Program, the Home Services Program, the Home-Based Support Services Program, and any other long-term care provided by the State under the Medical Assistance Program.

"Home-based and community-based services" includes long-term services and supports that meet the requirements set forth in the Centers for Medicare and Medicaid Services' Home and Community-Based Services Settings Final Rule (CMS 2249-F/2296-F), published in the Federal Register on January 16, 2014.

"Medical assistance" means medical assistance coverage under the Medical Assistance Program.

"Medical Assistance Program" means the medical assistance program administered by the Department of Healthcare and Family Services under Article V of the Illinois Public Aid Code.

"Long-term care need" means an assessment indicating the need for ongoing assistance in routine life activities consistent with the eligibility threshold for long-term services and supports set in accordance with this Act, on the universal assessment tool procured by the State and described in Section 25 of the Older Adult Services Act.

"Long-term services and supports benefit" or "benefit" means an amount available to eligible beneficiaries in a dollar amount per day to pay for the services of a qualified long-term services and supports provider from the Long-Term Services and Supports Trust Fund created in Section 35.

"Needs assessor" means an organization employing individuals trained to assess needs using the universal assessment tool described in Section 25 of the Older Adult Services Act. "Needs assessor" includes care coordination units as described in the Illinois Act on the Aging and organizations led by and for people with disabilities such as the Centers for Independent Living.

"Person-centered" means delivery of care in which individuals' values and preferences are elicited and, once expressed, guide all aspects of their care, supporting their realistic health and life goals. Person-centered care requires sustained collaboration among individuals, others who are important to them, and relevant care providers, which informs decision-making to the extent that the individual desires.

"Qualified long-term services and supports provider" means a provider of one of the types listed in Section 30 that are participating providers in the existing long-term care programs and in accordance with the process set forth in Section 30 have been deemed by the Long-Term Services and Supports Trust Commission to provide safe, consumer-directed or person-centered, and cost-effective long-term services and supports.

"Trust Fund" means the Long-Term Services and Supports Trust Fund created in Section 35.

"Universal assessment tool" means the universal assessment tool described in Section 25 of the Older Adult Services Act.

Section 15. Affordable long-term care services and supports benefit or program; benchmark.

(a) By January 1, 2020, Illinois shall have in place a long-term services and supports benefit or program for at least those who have a long-term care need consistent with the level of care criteria in place on the effective date of this Act for existing long-term care programs.

(b) Illinois shall create a long-term services and supports benefit for eligible beneficiaries. The benefit shall be a dollar amount available in an amount per day to pay for the services of a qualified long-term services and supports provider. A dedicated Trust Fund for this purpose is created in Section 35.

(c) The long-term services and supports benefit is not intended to replace the Community Care Program, Home Services Program, the Home-Based Support Services Program, or any other long-term services and supports provided by the State through the Medical Assistance Program. Maintenance of existing long-term care programs shall help to fulfill the requirement under subsection (a). The long-term services and supports benefit is intended to improve investment in home-based and community-based services in Illinois, including those described in the State's Medicaid waivers and other existing long-term care programs. The existing long-term care programs and the benefit described in this Act may not be used concurrently, but may be used sequentially.

(d) No later than January 1, 2025, the long-term services and supports benefit shall be available for eligible beneficiaries. The Long-Term Services and Supports Trust Commission may set an earlier date for the initial availability of the benefit described in Section 25.

Section 20. Comprehensive study and actuarial modeling.

(a) The Department of Healthcare and Family Services shall commission a comprehensive study of long-term care trends, future projections, and actuarial analysis of a new long-term services and supports benefit. Upon completion of the study, the Department shall prepare a report on the study that includes the following:

(1) an extensive analysis of long-term care trends in Illinois, including the number of Illinoisans needing long-term care, the number of paid and unpaid caregivers, the existing long-term care programs' utilization and impact on the State budget; out-of-pocket spending and spend-down to qualify for medical assistance coverage, the financial and health impacts of caregiving on the family, wages of paid caregivers and the effects of compensation on the availability of this workforce, the current market for private long-term care insurance, and a brief assessment of the existing system of long-term services and supports in terms of health, well-being, and the ability of participants to continue living in their communities;

(2) an analysis of: long-term care costs and utilization projections through at least 2050 and the estimated impact of such costs and utilization projections on the State budget; increases in the senior population; projections of the number of paid and unpaid caregivers in relation to demand for services; and projections of the impact of housing cost burdens and a lack of affordable housing on seniors and people with disabilities;

(3) an actuarial analysis of a new long-term services and supports benefit program, including an analysis of potential tax sources and necessary levels, a vesting period, the maximum daily benefit dollar amount, the total maximum dollar amount of the benefit, and the duration of the benefit; and

(4) a qualitative analysis of a new benefit's impact on seniors and people with disabilities, including their families and caregivers, public and private long-term care services, and the State budget.

The report must project under multiple possible configurations the numbers of persons covered year over year, utilization rates, total spending, and the Trust Fund's ratio balance and solvency. The Trust Fund must initially be structured to be solvent for 75 years. The report must detail the sensitivity of these projections to the level of care criteria that define long-term care need and examine the feasibility of setting a lower threshold, based on a lower need for ongoing assistance in routine life activities.

The report must also detail the amount of out-of-pocket costs avoided, the number of persons who delayed or avoided utilization of medical assistance benefits, an analysis on the projected increased utilization of home-based and community-based services over skilled nursing facilities and savings therewith, and savings to the existing long-term care programs due to the new long-term services and supports benefit.

(b) The financing options to be studied in the actuarial analysis shall conform to the main benchmarks listed in Section 15.

(c) The entity chosen to conduct the actuarial analysis shall be a nationally-recognized organization with experience modeling public and private long-term care financing programs.

(d) The study shall be completed before April 1, 2019. Upon completion, the report on the study shall to be delivered to the Long-Term Services and Supports Trust Commission established in Section 25.

Section 25. Long-Term Services and Supports Trust Commission.

(a) The Long-Term Services and Supports Trust Commission is created on April 1, 2019. The Commission shall include the following members:

(1) One member of the Senate appointed by the President of the Senate, and one member of the Senate appointed by the Minority Leader of the Senate.

(2) One member of the House of Representatives appointed by the Speaker of the House of Representatives, and one member of the House of Representatives appointed by the Minority Leader of the House of Representatives.

(3) The Director of Healthcare and Family Services, or his or her designee.

(4) The Director of Aging, or his or her designee.

(5) The Secretary of Human Services, or his or her designee.

(6) Two individuals who receive long-term services and supports.

(7) Two representatives from organizations representing the population receiving long-term services and supports, one of whom is from an organization representing seniors and one of whom is from an organization representing people with disabilities.

(8) Two representatives of caregivers, one of whom is a representative of a union representing long-term care workers and one of whom is a family caregiver.

(b) Members of the Commission shall be appointed for terms of 2 years, except that the Governor shall appoint the initial members identified in paragraphs (6), (7), and (8) of subsection (a) to staggered terms not to exceed 4 years. Appointments by the Governor shall be subject to the advice and consent of the Senate.

(c) On April 1, 2019, the Commission shall receive a report on the completed study of long-term services and supports needs and actuarial modeling. The Commission shall use the study results to set the initial per-day long-term services and supports benefit, the benefit's duration, the formula for an annual adjustment of the benefit amount, the start date for payouts, and other terms as may be necessary, and shall identify a funding mechanism, inclusive of rates of tax, that is consistent with these terms and in a manner that is actuarially sound. The Commission may set the eligibility threshold that defines long-term care need for the new benefit lower, but not higher, than the level of care criteria in place on the effective date of this Act for existing long-term care programs. In setting the initial per-day benefit, the Commission shall primarily consider the cost of home-based and community-based services, and shall address deficiencies in current rates of payment and workers' wages for those services identified as contributing to weaknesses in the system of long-term care services and supports. Within 30 days after the Commission receives the report, the Commission shall submit a separate report to the General Assembly with its recommendation for a funding mechanism for the long-term services and supports benefit.

(d) The Commission member from the Department of Healthcare and Family Services shall convene the first meeting. The members shall elect a chair at the first meeting. Meetings of the Commission shall be at the call of the chair, but shall occur no less frequently than annually.

(e) Regular duties of the Commission shall include:

(1) establishing and following a process for annual adjustment of the long-term services and supports benefit amount based primarily on increases in the cost of home-based and community-based services;

(2) monitoring the fiscal condition of the Trust Fund;

(3) establishing and monitoring outcomes of procedures for determining that an individual has a long-term care need as defined in this Act;

(4) setting standards for qualifying long-term services and supports providers and deciding which types of providers that may qualify under Section 30 meet the definition of qualifying providers;

(5) setting standards for organizations to be needs assessors;

(6) monitoring the role of the long-term care services and supports benefit in supporting family caregivers, inclusive of reviewing the role of particular features of benefit design or administration and of proposing changes to ensure the benefit supports family caregivers appropriately; and

(7) monitoring the role of the long-term care services and supports benefit in recruiting and retaining a caregiving workforce, inclusive of collecting information on the wages, benefits, and working conditions of paid caregivers, and of proposing changes to benefit design or administration to ensure the benefit supports this workforce appropriately.

(f) The Department of Healthcare and Family Services shall provide administrative support to the Commission.

Section 30. Long-term services and supports providers.

(a) The provider types that may become qualified providers by decision of the Commission are: home care or homemaker services providers participating in the Community Care Program or Home Services Program; personal assistants or other independent providers participating in the Home Services Program; adult day programs participating in the Community Care Program or Home Services Program; respite care providers participating in the Home Services Program; home modification or environmental accessibility modification providers participating in the Home Services Program; personal support providers participating as waiver providers in the Medical Assistance Program; community-integrated living arrangements participating as waiver providers in the Medical Assistance Program; supportive living facilities participating in the Medical Assistance Program; and nursing facilities participating as providers in the Medical Assistance Program.

(b) Participating providers described in subsection (a) shall be qualified long-term services and supports providers if their provider type is deemed by the Commission to provide safe, consumer-directed or person-centered, and cost-effective long-term services and supports. In making these decisions, the Commission shall evaluate whether home-based and community-based services are consumer-directed, and shall evaluate whether other institutional provider types provide services in a person-centered fashion.

(c) Family caregivers may deliver services under this Act if the arrangement complies with the requirements for a type of provider that is a qualified provider as set forth in subsections (a) and (b). If, after the effective date of this Act, the requirements for any type of qualified providers become more restrictive with regard to family caregivers, the Commission shall review whether these changes diminish the ability of the long-term services and support benefit to support family caregiving, in accordance with paragraph (6) of subsection (e) of Section 25.

(d) An eligible beneficiary seeking to use the long-term services and supports benefit to pay a qualified provider that is a nursing facility, and nursing facilities seeking payment from the long-term services and supports benefit for services to an eligible beneficiary, shall be subject to additional requirements. An eligible beneficiary seeking to use the long-term services and supports benefit to pay a nursing facility must have an assessment consistent with a determination of need score of 37 or higher or an assessment indicating the same level of need for ongoing assistance in routine life activities on the universal assessment tool. An eligible beneficiary must also secure an exception documented by his or her needs assessor, and approved by the Department of Healthcare and Family Services, that it is not possible for the eligible beneficiary to use the benefit to live at home with home-based and community-based supports. An eligible beneficiary may not use more than 75% of the cumulative total value of the benefit over its duration to pay a nursing facility. In arranging payment, nursing facilities shall submit information on actual costs of direct-care labor being charged, capital costs being charged, and all other costs being charged. The long-term services and supports benefit shall not be used to pay for nursing facility capital costs.

Section 35. Long-Term Services and Supports Trust Fund.

(a) The Long-Term Services and Supports Trust Fund is created as a special fund in the State treasury for the purpose of receiving funds dedicated to paying the long-term services and supports benefit created under this Act. Dedicated funds shall come from a tax set at rates deemed to be actuarially sound as set forth in subsection (b). All receipts under subsection (b) must be deposited into the Trust Fund. These funds shall be held separate and apart from all public moneys or funds of the State, as provided in this Section, and shall be administered as set forth in Section 40 exclusively for the purposes of this Act. Expenditures from the Trust Fund may be used solely for payment of long-term services and supports benefits and for necessary administrative activities.

(b) The benefit shall be paid for through a tax, the nature of which shall be determined by the actuarial study set forth in paragraph (3) of subsection (a) of Section 20. The Commission shall recommend tax rates that are actuarially sound in its report to the General Assembly as required under subsection (c) of Section 25.

(c) Funds deposited into the Trust Fund may be used only for the purposes set forth in this Act, and shall not be subject to administrative charges or chargebacks unless otherwise authorized by this Act. The Trust Fund is exempt from any sweep, transfer, or other budgetary maneuver that may result in the use of the Trust Fund's moneys for a purpose other than the purposes set forth in this Act.

(d) This Section shall not become operative until legislation is enacted into law by the General Assembly that imposes or authorizes a new tax for the purposes set forth in this Act.

Section 40. Administration.

(a) The Department of Healthcare and Family Services shall maintain rolls of eligible beneficiaries based in part on assessments of long-term care need performed by needs assessors. The Department of Healthcare and Family Services shall be responsible for making payments from benefits to qualified long-term services and supports providers on behalf of eligible beneficiaries for the provision of services to those beneficiaries.

(b) The Department of Healthcare and Family Services shall maintain a list of qualified long-term services and supports providers. This list shall conform to determinations made by the Commission as to which types of providers appear on the list. Within each type of provider, the particular providers that qualify shall be those participating in the existing long-term care programs.

(c) The Department of Healthcare and Family Services shall assist the Commission in monitoring the solvency and financial status of the Trust Fund.

(d) The Department of Healthcare and Family Services shall prepare and distribute written or electronic materials to eligible beneficiaries, family caregivers, seniors, and the public at large as necessary to inform or update them regarding the long-term services and supports benefit.

(e) The Department on Aging shall maintain a statewide network of needs assessors and shall be charged with reimbursing the needs assessors for eligibility assessment services.

(f) This Section shall not become operative until (i) legislation is enacted into law by the General Assembly that imposes or authorizes a new tax for the purposes set forth in this Act and (ii) the Trust Fund in Section 35 has been created.

Section 45. The State Finance Act is amended by adding Section 5.886 as follows:

(30 ILCS 105/5.886 new)

Sec. 5.886. The Long-Term Services and Supports Trust Fund.

Section 99. Effective date. This Act takes effect upon becoming law.".