SB3554 104TH GENERAL ASSEMBLY

LRB104 19789 KTG 33239 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3554

Introduced 2/5/2026, by Sen. David Koehler

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-70 new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after January 1, 2027, certain services shall be eligible for reimbursement at approved programs through the Brain Injury waiver for eligible individuals over the age of 21, including, but not limited to: (1) case management; (2) nursing services; (3) medical oversight by consulting medical director; (4) physical therapy; and (5) occupational therapy. Requires the Department of Human Services to reimburse approved programs at the rates in effect for the Home and Community-Based Services Waiver program most recently approved. Effective January 1, 2027.

A BILL FOR

AN ACT concerning State government.

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

Section 5. The Illinois Public Aid Code is amended by adding Section 5-70 as follows:

(305 ILCS 5/5-70 new)

Sec. 5-70. Brain injury waiver services.

(a) Findings. The General Assembly finds that:

(1) Annually, over 141,000 new brain injuries are sustained by children and adult Illinois residents.

(2) The State provides services and support for individuals with brain injuries through the Persons with Brain Injury waiver, which is part of the Home and Community-Based Services Waiver and is operated by the Department of Human Services' Division of Rehabilitation Services. This program is administered by the Department of Healthcare and Family Services. Day-to-day operations are managed by the Department of Human Services' Division of Rehabilitation Services. These services are offered for individuals who are at risk of being placed in a nursing facility for care due to functional limitations caused by a brain injury.

(3) Individuals are eligible for Brain Injury waivers if, among other requirements, they have an acquired brain injury as documented by a physician or neurologist. This includes traumatic brain injuries, infections, anoxia, stroke, aneurysm, electrical injury, malignant or benign tumors, neoplasm of the brain, and toxic encephalopathy.

(4) Twenty-two states currently offer care in the community funding options for adults with brain injury who require residential supports and services.

(5) Illinois does not currently offer reimbursement for care to programs providing brain injury care services for individuals over the age of 21. As a result, these individuals must stop receiving care abruptly in their current programs when they age out of eligibility for reimbursement and must be transferred to a nursing home at age 21, or transferred to another state that can seek reimbursement from the State of Illinois for the provision of services for this age group. This causes a disruption in care and separation of families. Illinois Medicaid funds are used to support these individuals in accessing out-of-state care, resulting in funding going to out-of-state providers and being paid at higher out-of-state rates.

(b) As used in this Section, "approved programs" includes programs authorized to provide care under the Medicaid Home and Community-Based Services Waiver program.

(c) Notwithstanding any other provision of this Code to the contrary, on and after January 1, 2027, the following services shall be eligible for reimbursement at approved programs through the Brain Injury waiver for eligible individuals over the age of 21:

(1) Case management.

(2) Nursing services.

(3) Medical oversight by consulting medical director.

(4) Physical therapy.

(5) Occupational therapy.

(6) Speech language therapy.

(7) Behavioral intervention and therapy.

(8) Individual and family counseling.

(9) Life skills training, including community re-access training.

(10) Residential habilitation.

(11) Day habilitation.

(d) The Department of Human Services shall reimburse approved programs at the rates in effect for the Home and Community-Based Services Waiver program most recently approved under authority of Section 1915(c) of the Social Security Act.

Section 99. Effective date. This Act takes effect January 1, 2027.