HB4918 104TH GENERAL ASSEMBLY

LRB104 17999 KTG 31436 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4918

Introduced , by Rep. Justin Cochran

SYNOPSIS AS INTRODUCED:

New Act

Creates the Long-Term Care Trust Act. Establishes the Long-Term Services and Supports Trust Program (Trust Program) within the Department on Aging to provide long-term services and supports funding benefits to eligible employees through payroll deductions to be deposited into the Long-Term Services and Supports Trust Fund created under the Act. Requires the Department on Aging, an actuary contracted with the Department on Aging, and the Department of Revenue to have the responsibilities of implementing and administering the Trust Program. Sets forth the Department on Aging's responsibilities, including, but not limited to: (i) making determinations regarding an individual's status as an eligible beneficiary; (ii) approving long-term services and supports eligible for payment; (iii) registering long-term services and supports providers that meet minimum qualifications; and (iv) disbursing payments of benefits to registered long-term services and supports providers. Requires the Department of Revenue to collect and assess employee premiums under the program, make eligibility determinations, and other responsibilities. Contains provisions on the responsibilities of the contracted actuary; the establishment of a Long-Term Services and Supports Trust Commission and a Long-Term Services and Supports Trust Council; qualifying beneficiary requirements; payroll premiums and the disbursement of benefits; coverage for self-employed individuals; the management of the Long-Term Services and Supports Trust Fund; appeals of benefit determinations; federal waiver requirements; reporting requirements; and other matters. Effective immediately.

A BILL FOR

AN ACT concerning aging.

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

Section 1. Short title. This Act may be cited as the Long-Term Care Trust Act.

Section 2. Definitions. As used in this Act:

"Approved service" means long-term services and supports, including, but not limited to:

(1) Adult day services.

(2) Care transition coordination.

(3) Memory care.

(4) Adaptive equipment and technology.

(5) Environmental modification.

(6) Personal emergency response system.

(7) Home safety evaluation.

(8) Respite for family caregivers.

(9) Home delivered meals.

(10) Transportation.

(11) Dementia supports.

(12) Education and consultation.

(13) Eligible relative care.

(14) Professional services.

(15) Assisted living services.

(16) Adult family home services.

(17) Nursing home services.

"Benefit unit" means up to $100 paid by the Department to a long-term services and supports provider as reimbursement for approved services provided to an eligible beneficiary on a specific date.

"Commission" means the Long-Term Services and Supports Trust Commission established under Section 4.

"Consumer Price Index" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100.

"Council" means the Long-Term Services and Supports Trust Council established under Section 5.

"Department" means the Department on Aging.

"Eligible beneficiary" means a qualified individual who is 18 years of age or older, resides in this State, was not disabled before 18 years of age, has been determined to meet the minimum level of assistance with activities of daily living necessary to receive benefits through the program and who has not exhausted the lifetime limit of benefit units.

"Long-term services and supports provider" means a person that meets the qualifications applicable under law to the approved service that the person provides, including a qualified or certified home care aide, licensed assisted living facility, licensed adult family home, licensed nursing home, licensed in-home services agency, adult day services program, vendor, instructor, qualified family member, or other entities as registered by the Department.

"Medicaid" or "State's Medicaid program" means the medical assistance program established and administered in Article V of the Illinois Public Aid Code as authorized under Section 1902 of the Social Security Act.

"Premium" means the payments required under Section 9 and paid to the Department of Revenue for deposit into the Trust Fund.

"Program" means the Long-Term Services and Supports Trust Program established under Section 3.

"Qualified family member" means a relative of an eligible beneficiary qualified to meet the requirements established under law for the approved service the relative provides that would be required of any other long-term services and supports provider to receive payments from the State.

"Qualified individual" means an individual who meets the duration of payment requirements established under this Act.

"Trust Fund" means the Long-Term Services and Supports Trust Fund established under Section 11.

Section 3. Long-Term Services and Supports Trust Program.

(a) Establishment. The Long-Term Services and Supports Trust Program is established within the Department on Aging.

(b) Administration. The Department, an actuary contracted by the Department, and the Department of Revenue shall have the responsibilities of implementing and administering the program as provided under this Section.

(c) Department on Aging. The Department shall:

(1) Make determinations regarding an individual's status as an eligible beneficiary under Section 7.

(2) Approve long-term services and supports eligible for payment as approved services under the program, as informed by the Long-Term Services and Supports Trust Commission established under Section 4.

(3) Register long-term services and supports providers that meet minimum qualifications.

(4) Discontinue the registration of long-term services and supports providers that:

(i) fail to meet the minimum qualifications applicable in law to the approved service that the long-term services and supports providers provide; or

(ii) violate the operational standards of the program.

(5) Disburse payments of benefits to registered long-term services and supports providers, utilizing and leveraging existing payment systems for the provision of approved services to eligible beneficiaries under Section 8.

(6) Prepare and distribute written or electronic materials to qualified individuals, eligible beneficiaries, and the public as deemed necessary by the Commission to inform the public of program design and updates.

(7) Provide customer service and address questions and complaints, including referring individuals to other appropriate agencies.

(8) Provide administrative and operational support to the Commission.

(9) Track data useful in monitoring and informing the program, as identified by the Commission.

(10) Track the use of lifetime benefit units to verify the individual's status as an eligible beneficiary.

(11) Ensure approved services are provided through audits or service verification processes within the service provider payment system for registered long-term services and supports providers and recoup any inappropriate payments.

(12) Establish criteria for the payment of benefits to registered long-term services and supports providers under Section 8.

(13) Establish rules and procedures for benefit coordination when the eligible beneficiary is also funded for Medicaid and other long-term services and supports, including Medicare, workers' compensation, and private long-term care coverage.

(14) Adopt rules necessary to implement and administer the activities specified under this Section related to the program.

(d) Department of Revenue. The Department of Revenue shall:

(1) Collect and assess employee premiums as provided in Section 9.

(2) Assist the Commission, the Long-Term Services and Supports Trust Council established under Section 5, and the actuary contracted by the Department on Aging as provided in subsection (e) in monitoring the solvency and financial status of the program.

(3) Make determinations regarding an individual's status as a qualified individual under Section 6.

(4) Adopt rules necessary to implement and administer the activities specified under this Section.

(e) Actuary. The Department on Aging shall contract with an actuary and the contract shall include that the actuary do the following:

(1) Beginning January 1, 2029, and biennially thereafter, perform an actuarial audit and valuation of the Long-Term Services and Supports Trust Fund established under Section 11. Additional or more frequent actuarial audits and valuations may be performed at the request of the Council.

(2) Make recommendations to the Council and the General Assembly on actions necessary to maintain fund solvency. The recommendations shall include options to redesign or reduce benefit units, approved services, or both, to prevent or eliminate any unfunded actuarially accrued liability in the trust or to maintain solvency.

(3) Select and contract for actuarial, research, technical, and other consultants as the actuary deems necessary to perform the actuary's duties under this Act.

Section 4. Long-Term Services and Supports Trust Commission.

(a) Establishment. The Long-Term Services and Supports Trust Commission is established. The Commission's recommendations and decisions shall be guided by the joint goals of maintaining benefit adequacy and maintaining fund solvency and sustainability.

(b) Membership. The Commission shall include:

(1) The Director of Aging, or the Director's designee.

(2) The Director of Revenue or the Director's designee.

(3) Two members of the Senate, appointed by the President of the Senate.

(4) Two members of the House of Representatives, appointed by the Speaker of the House of Representatives.

(5) One representative of an organization representing Area Agencies on Aging.

(6) One representative of a home care association that represents caregivers who provide services to private pay and Medicaid clients.

(7) One representative of a union representing long-term care workers.

(8) One representative of an organization representing retired individuals.

(9) One representative of an association representing skilled nursing facilities and assisted living providers.

(10) One representative of an association representing adult family home providers.

(11) Two individuals receiving long-term services and supports, or their designees, or representatives of consumers receiving long-term services and supports under the program.

(12) One member who is a worker who is, or will likely be, paying the premium established under Section 9 and who is not employed by a long-term services and supports provider.

(13) One representative of an organization of employers whose members collect, or will likely be collecting, the premium established under Section 9.

(c) Terms. Except for the members under paragraphs (1), (2), (3), and (4) of subsection (b), members of the Commission shall be appointed by the Governor for terms of 2 years, except that the Governor shall appoint the initial members to staggered terms not to exceed 4 years.

(d) Chair. The Director of Aging, or the Director's designee, shall serve as chair of the Commission.

(e) Meetings and quorum. Meetings of the Commission shall be at the call of the chair. A majority of the voting members of the Commission shall constitute a quorum for any votes of the Commission. Approval of 60% of those voting members of the Commission who are in attendance is required for the passage of any vote.

(f) Recommendations. Beginning January 1, 2027, the Commission shall propose recommendations to the Department regarding:

(1) The establishment of criteria for determining that an individual has met the requirements to be a qualified individual as established under Section 6 or an eligible beneficiary as established under Section 7.

(2) The establishment of criteria for minimum qualifications for the registration of long-term services and supports providers who provide approved services to eligible beneficiaries.

(3) The establishment of payment maximums for approved services consistent with actuarial soundness which may not be lower than Medicaid payments for comparable services. A service or supply may be limited by dollar amount, duration, or number of visits. The Commission shall engage affected stakeholders to develop this recommendation.

(4) Changes to rules or policies to improve the operation of the program.

(5) Providing a recommendation to the Council for the annual adjustment of the benefit unit as provided under this Act.

(6) Assisting the actuary contracted by the Department with the preparation of regular actuarial reports on the solvency and financial status of the program and advising the General Assembly on actions necessary to maintain trust solvency. The Commission shall provide the actuary with all actuarial reports for review. The actuary shall provide any recommendations to the Commission and the General Assembly on actions necessary to maintain trust solvency.

(7) Whether and how to extend coverage to individuals who became disabled before 18 years of age, including the impact on the financial status and solvency of the trust. The Commission shall engage affected stakeholders to develop this recommendation.

(8) Consultation with the actuary contracted by the Department on the development of an actuarial report of the projected solvency and financial status of the program. The actuary shall provide any recommendations to the Commission and the General Assembly on actions necessary to achieve trust solvency.

(g) Expenses. The Commission shall monitor Department administrative expenses over time. Beginning November 15, 2027, the Commission shall annually report to the Governor and the chairpersons and minority chairpersons of the Senate and House Revenue Committees on Department spending for administrative expenses and anticipated administrative expenses as the program shifts into different phases of implementation and operation. The November 15, 2030, report shall include recommendations for a method of calculating future Department administrative expenses to limit administrative expenses while providing sufficient money to adequately operate the program. The members under paragraphs (1), (2), (3), and (4) of subsection (b) may advise the Commission on the reports prepared under this subsection but must recuse themselves from the Commission's process for review, approval, and submission to the General Assembly.

(h) Investment strategy subcommittee. The Commission shall establish an investment strategy subcommittee consisting of the members under paragraphs (1), (2), (3), and (4) of subsection (b) as voting members of the subcommittee. In addition, 4 members appointed by the Governor who are considered experienced and qualified in the field of investment shall serve as nonvoting members. The subcommittee shall provide guidance and advice to the State Treasurer on investment strategies for the Trust Fund, including seeking counsel and advice on the types of investments that are constitutionally permitted.

Section 5. Long-Term Services and Supports Trust Council.

(a) Establishment. The Long-Term Services and Supports Trust Council is established.

(b) Membership. The Council shall include:

(1) The Director of Aging, or the Director's designee.

(2) The Director of Revenue, or the Director's designee.

(3) Two members of the Senate appointed by the President of the Senate.

(4) Two members of the House of Representatives appointed by the Speaker of the House of Representatives.

(5) A representative from the Governor's Office of Management and Budget.

(c) Adjustments to benefit unit. On an annual basis, the Council shall determine adjustments to the benefit unit to ensure benefit adequacy and solvency of the Trust Fund. The benefit unit shall be adjusted at a rate no greater than the Consumer Price Index, as determined by the Council. In determining adjustments to the benefit unit, the Council shall review the actuary's actuarial audit and valuation of the Trust Fund, any recommendations by the actuary and the Commission, data on relevant economic indicators and program costs and sustainability.

(d) Chair. The Director of Aging, or the Director's designee, shall serve as chair of the Council.

(e) Meetings and quorum. The Council shall meet at least once annually to determine adjustments to the benefit unit under subsection (c). Additional meetings of the Council shall be at the call of the chair. A majority of the voting members of the Council shall constitute a quorum for any votes of the Council. Approval of 60% of the members of the Council who are in attendance is required for the passage of any vote. The Council may adopt rules for the conduct of meetings, including provisions for meetings and voting to be conducted by telephonic, video, or other conferencing process.

Section 6. Qualifying beneficiaries.

(a) Determination. The Department of Revenue shall deem an individual to be a qualified individual as provided under this Act if the individual has paid the long-term services and supports premiums required under Section 9 for the equivalent of either:

(1) a total of 10 years without interruption of 5 or more consecutive years; or

(2) 3 years within the last 6 years.

(b) Requirements. When deeming an individual to be a qualified individual, the Department of Revenue shall require that the individual have worked at least 500 hours during each of the 10 years in paragraph (1) of subsection (a) and each of the 3 years in paragraph (2) of subsection (a).

Section 7. Disbursement of benefits.

(a) General rule. Beginning January 1, 2030, approved services shall be available and benefits payable to a registered long-term services and supports provider on behalf of an eligible beneficiary under this Section.

(b) Eligible beneficiary. A qualified individual may become an eligible beneficiary by filing an application with the Department and undergoing an eligibility determination which includes an evaluation that the qualified individual requires assistance with at least 3 activities of daily living. The Department shall engage a qualified assessor so that the determination may be made within 45 days from receipt of the application by the qualified individual to use a benefit.

(c) Receipt of services and benefits. An eligible beneficiary:

(1) May receive approved services and benefits through the program in the form of a benefit unit payable to a registered long-term services and supports provider.

(2) May not receive more than the dollar equivalent of 365 benefit units over the course of the eligible beneficiary's lifetime.

(d) Reimbursements. If the Department reimburses a long-term services and supports provider for approved services provided to an eligible beneficiary and the payment is less than the benefit unit, only the portion of the benefit unit that is used shall be taken into consideration when calculating the individual's remaining lifetime limit on receipt of benefits.

(e) Combination of benefit units. Eligible beneficiaries may combine benefit units to receive more approved services per day as long as the total number of lifetime benefit units has not been exceeded.

Section 8. Benefits.

(a) Payment. Benefits provided under this Act shall be paid periodically and promptly to registered long-term services and supports providers.

(b) Qualified family members. Qualified family members may be paid for approved personal care services in the same way as individual providers, through a licensed home care agency or through a third option if recommended by the Commission and adopted by the Department.

Section 9. Payroll premium.

(a) General rule. Beginning January 1, 2027, the Department of Revenue shall assess for each individual in employment with an employer a premium based on the amount of the individual's wages. The initial premium rate shall be 0.58% of the individual's wages. Beginning January 1, 2029, and biennially thereafter, the premium rate shall be set by the Illinois Commission on Government Forecasting and Accountability at a rate no greater than 0.58%. In addition, the Illinois Commission on Government Forecasting and Accountability shall set the premium rate at the lowest amount necessary to maintain the actuarial solvency of the Trust Fund in accordance with recognized insurance principles and designed to attempt to limit fluctuations in the premium rate. To facilitate the premium rate setting the actuary contracted by the Department shall perform a biennial actuarial audit and valuation of the Trust Fund and make recommendations to the Illinois Commission on Government Forecasting and Accountability.

(b) Duties of employers. An employer shall:

(1) Collect from employees the premiums provided under subsection (a) through payroll deductions and remit the amounts collected to the Department of Revenue.

(2) In collecting employee premiums through payroll deductions, act as the agent of the employees and shall remit the amounts to the Department of Revenue as required by this Act.

(c) Collective bargaining agreements. Nothing in this Act shall require a party to a collective bargaining agreement taking effect within 24 months or less of the effective date of this Act to reopen negotiations of the agreement or to apply any of the responsibilities under this Act unless and until the existing agreement is reopened or renegotiated by the parties or expires.

(d) Collection. Premiums shall be collected in the manner and at such intervals as provided by the Department of Revenue.

(e) Deposit of premiums. The Department of Revenue shall deposit all premiums collected under this Section into the Trust Fund.

(f) Increase of premiums. If the premiums under this Section are increased, the Department of Revenue shall notify each qualified individual by mail that the individual's premiums have been increased, describe the reason for increasing the premiums and describe the plan for restoring the money so that premiums are returned to 0.58% of the individual's wages.

(g) Exemption. An employee who demonstrates that the employee has long-term care insurance is exempt from the premium assessment under this Section.

Section 10. Self-employed individuals.

(a) Electing coverage. Beginning January 1, 2027, a self-employed individual, including a sole proprietor, independent contractor, partner, or joint venturer may elect coverage under this Act. An individual electing coverage under this subsection is responsible for payment of all premiums assessed to an employee under Section 9. The individual shall file a notice of election in writing with the Department of Revenue, in a manner prescribed by the Department of Revenue. The individual shall be eligible for benefits after paying the long-term services and supports premium for the time required under Section 6.

(b) Withdraw from coverage. A self-employed individual who has elected coverage may withdraw from coverage at times prescribed by the Department of Revenue by filing a notice of withdrawal in writing with the Department of Revenue, with the withdrawal to take effect no sooner than 30 days after filing the notice with the Department of Revenue.

(c) Cancellation. The Department of Revenue may cancel elective coverage if the self-employed individual fails to make required payments or file reports. The Department of Revenue may collect due and unpaid premiums and may levy an additional premium for the remainder of the period of coverage. The cancellation shall be effective no later than 30 days from the date of the notice in writing advising the self-employed individual of the cancellation.

(d) Rules. The Department of Revenue shall adopt rules for determining the hours worked and the wages of individuals who elect coverage under this Section and for the enforcement of this Section.

Section 11. Long-Term Services and Supports Trust Fund.

(a) Establishment. The Long-Term Services and Supports Trust Fund is created as a trust fund in the State treasury. The Trust Fund shall be held separate and apart from all public moneys or funds of this State. The Trust Fund shall consist of all receipts from employers as provided under Section 9 as well as any moneys appropriated to the Department for the purposes of this Act. Interest earned on moneys in the Trust Fund shall be deposited into the Trust Fund.

(b) Trust Fund Administration.

(1) All receipts from employers under Section 9 shall be deposited into the Trust Fund.

(2) Expenditures from the Trust Fund may be used for the administrative activities of the Department and the Department of Revenue.

(3) Benefits associated with the program shall be disbursed from the Trust Fund by the Department. Only the Director of Aging, or the Director's designee, may authorize disbursements from the Trust Fund.

(4) The Trust Fund shall provide reimbursement of any amounts from other sources that may have been used for the initial establishment of the program.

(c) Utilization of revenue. The revenue generated under this Act shall be utilized to expand long-term care in this State. The money may not be used either in whole or in part to supplant existing State or county money for programs that meet the definition of approved services.

(d) Money expended for other purposes. Money deposited into the Trust Fund shall remain in the Trust Fund until expended in accordance with the requirements of this Act. If money is expended for any purpose other than supporting the long-term services and supports program, the Department of Revenue shall notify each qualified individual by mail that the individual's premiums have been expended for an alternate use, describe the alternate use and state the Department of Revenue's plan for restoring the money so that premiums are not increased and benefits are not reduced.

Section 12. Management of Trust Fund.

(a) Investment of money in Trust Fund. The Department shall have the State Treasurer invest the money in the Trust Fund. The State Treasurer shall have full power to invest, reinvest, manage, contract, sell, or exchange investment money in the Trust Fund.

(b) Investment policy. All investments made by the State Treasurer shall be made with the degree of judgment and care required and the investment policy established by the State Treasury.

(c) Investment with other funds. As deemed appropriate by the State Treasurer, money in the Trust Fund may be commingled for investment with other funds subject to investment by the State Treasurer.

(d) Policies. The Department shall establish all policies relating to the Trust Fund, other than the investment policies as provided under this Section.

(e) Disbursement. With the exception of expenses of the State Treasurer under this Section, disbursements from the Trust Fund shall be made only on the authorization of the Director of Aging, or the Director's designee, and money in the Trust Fund may be spent only for the purposes specified under this Act.

(f) Consultation. The State Treasurer shall routinely consult and communicate with the Department on the investment policy, earnings of the Trust Fund, and related needs of the program.

Section 13. Appeals. Determinations made by the Department under this Act, including determinations regarding functional eligibility or related to registration of long-term services and support providers, are subject to judicial review in accordance with the provisions of the Administrative Review Law. In addition, the standards and procedures adopted for judicial review under this Section shall address the following:

(1) Timelines.

(2) Eligibility and benefit determination.

(3) Fees.

Section 14. Information sharing. The Department shall:

(1) Seek access to Medicare data from the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to analyze the potential savings in Medicare expenditures due to the operation of the program.

(2) Apply for a demonstration waiver from the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to allow for the State to share in the savings generated in the federal match for Medicaid long-term services and supports and Medicare due to the operation of the program.

(3) Submit a report on the status of the waiver to General Assembly by December 1, 2027.

Section 15. Report. Beginning December 1, 2031, and annually thereafter, the Commission shall report to the General Assembly on the program, including:

(1) Projected and actual program participation.

(2) Adequacy of premium rates.

(3) Trust Fund balances.

(4) Benefits paid.

(5) Demographic information on program participants, including age, gender, race, ethnicity, geographic distribution by county, legislative district, and employment sector.

(6) The extent to which the operation of the program has resulted in savings to the State's Medicaid program by avoiding costs that would have otherwise been the responsibility of the State.

Section 16. Auditor General audits. By December 1, 2031, the Auditor General must conduct, in accordance with the Illinois State Auditing Act, a financial, compliance, and performance audit of the Long-Term Services and Supports Trust Program and deliver a report, including a conclusion and recommendations for improvement to the General Assembly regarding:

(1) Program operations, including the performance of the Commission established in Section 4;

(2) Program financial status, including solvency, the value of the benefit provided, and the financial balance of program benefits to costs.

(3) The overall efficacy of the program, based on the established goals under this Act including, but not limited to:

(i) delaying middle class families' need to spend to poverty to receive Medicaid-funded long-term care;

(ii) strengthening the State economy through improving workforce participation;

(iii) reducing the caseload and expenditures of the State Medicaid program on long-term care; and

(iv) obtaining shared savings through a Medicaid demonstration waiver.

Section 17. Exclusions. Any benefits used by an individual under this Act are not income or resources for any determinations of eligibility for any other State program or benefit, Medicaid, a State-federal program, or for any other means-tested program.

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