HB6602 93RD GENERAL ASSEMBLY

LRB093 15230 DRJ 47298 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB6602

Introduced 02/09/04, by Dan Reitz

SYNOPSIS AS INTRODUCED:

30 ILCS 105/5.625 new
305 ILCS 5/Art. V-F heading new
305 ILCS 5/5F-5 new
305 ILCS 5/5F-10 new
305 ILCS 5/5F-15 new
305 ILCS 5/5F-20 new

Amends the Illinois Public Aid Code. Provides that by the end of FY 2005, the Department of Public Aid must estimate a reduction in Medicaid nursing home expenditures based on the average annual expenditure for nursing home beds and estimated reductions in occupancy from FY 2000 through FY 2004. Provides that the Department, in cooperation with the nursing home industry and other affected parties, may reduce Medicaid nursing home expenditures for FY 2006 through FY 2010 based on that estimate. Provides for a redirection of Medicaid nursing home expenditures to expenditures for home and community-based services. Provides that any general funds that are redirected but not spent during any fiscal year shall be transferred to the Long-Term Care Special Administration Fund. Provides that moneys received from or generated to the fund shall be spent only for home and community-based services or for mechanisms that reduce the number of nursing home beds. Provides that up to $100,000 of the redirected funds in fiscal year 2006 shall be directed to the Illinois Independence Fund to be used for grants that have matching funds equivalent to that of Medicaid and are consistent with the purposes of and the time frame of the new provisions. Amends the State Finance Act by including the Long-Term Care Special Administration Fund as a special fund.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The State Finance Act is amended by adding Section 5.625 as follows:

(30 ILCS 105/5.625 new)

Sec. 5.625. The Long-Term Care Special Administration Fund.

Section 10. The Illinois Public Aid Code is amended by adding the heading of Article V-F and Sections 5F-5, 5F-10, 5F-15, and 5F-20 as follows:

(305 ILCS 5/Art. V-F heading new)

ARTICLE V-F. FINANCING OF LONG-TERM CARE SERVICES

(305 ILCS 5/5F-5 new)

Sec. 5F-5. Definitions. In this Article:

"Long-term care services" means the range of services, other than acute care services that provide time-limited curative or restorative treatment, that are delivered in the home, the community, or an institution to persons with functional or cognitive limitations who require assistance with performing activities of daily living. The term includes services provided in a nursing home or in an individual's home by a nurse, health aide, or personal attendant.

"Home and community-based services" means long-term care services that are designed to assist older Illinoisans and people with disabilities to remain independent and avoid inappropriate institutionalization. Home and community-based services include, but are not limited to, the following:

(1) Home and community-based waiver.

(2) Traumatic brain injury waiver.

(3) Residential care homes.

(4) Personal care attendant services.

(5) Chore and homemaker services.

(6) Older Americans Act-funded services.

(7) Adult day services and home health services.

(8) Respite care to provide support to family caregivers.

(9) Any other long-term care support services.

(305 ILCS 5/5F-10 new)

Sec. 5F-10. Redistribution of long-term care expenditures.

(a) By the end of fiscal year 2005, the Department of Public Aid shall estimate a reduction in Medicaid nursing home expenditures based on the average annual expenditure for nursing home beds and estimated reductions in occupancy from State fiscal years 2000 through 2004. For fiscal years 2006 through 2010, the Department, in cooperation with the nursing home industry and other affected parties, may reduce Medicaid nursing home expenditures in each fiscal year based on that estimate.

(b) If the agency determines that it is necessary to reduce the number of nursing home beds in each fiscal year in order to reduce nursing home expenditures pursuant to the estimate prepared under subsection (a), the Department shall develop a plan that reduces the number of beds certified for participation in the medical assistance program under Article V while ensuring that the supply and distribution of long-term care services are not diminished in any community in which one or more nursing home beds may be eliminated, to the extent that the need for such services cannot be met. No nursing home beds may be decertified for participation under the medical assistance program under this Section by the Department until February 1, 2006. The requirements of this subsection shall not impede the Department's authority to reduce nursing home expenditures effective July 1, 2005 pursuant to subsection (a) and to redirect those expenditures to fund home and community-based services pursuant to subsection (d).

(c) The reductions required in subsection (a) shall not have the effect of doing any of the following:

(1) Diminishing or reducing the quality of services available to nursing home residents.

(2) Forcing any nursing home resident to involuntarily accept home and community-based services instead of nursing home services.

(3) Causing any nursing home resident to be involuntarily transferred or discharged as the result of a change in the resident's method of payment for nursing home services or exhaustion of the resident's personal financial resources.

(d) The reductions required in subsection (a) shall be redirected in fiscal year 2006 to fund home and community-based services. For fiscal year 2006 and thereafter, the reductions estimated under subsection (a) shall be redirected in that fiscal year to fund both home and community-based services and any programs designed to reduce the number of nursing home beds. Any general funds that are redirected but not spent during any fiscal year shall be transferred to the Long-Term Care Special Administration Fund, which is hereby created as a special fund in the State treasury. Interest earned on moneys in the fund shall be retained in the fund. All moneys received from or generated to the fund shall be spent only for home and community-based services or for mechanisms that reduce the number of nursing home beds.

(e) The long-term care funds generated by the reductions in nursing home expenditures required in subsection (a) shall be distributed among the following categories of consumers:

(1) Nursing home residents who desire transfer to a home and community-based setting and for whom such a transfer is medically appropriate and cost effective.

(2) People on waiting lists for publicly funded programs as of July 1, 2005 and at the highest risk of nursing home placement.

(3) People at the highest risk of nursing home admission.

(4) People with the greatest social and economic need.

(305 ILCS 5/5F-15 new)

Sec. 5F-15. Implementation.

(a) The Department shall document and verify the amount of funding transferred from nursing home services to home and community-based services and any additional home and community-based services that are provided or enhanced from this transfer of funds. This documentation shall be submitted to the General Assembly no later than January 1, 2006, and on each January 1 thereafter until January 1, 2010.

(b) By July 1, 2005, the Department shall complete the following:

(1) Implementation of the initial phase of a comprehensive data system that tracks long-term care expenditures, services, consumer profiles, and consumer preferences.

(2) Implementation, in cooperation with the Department on Aging, the Department of Human Services, and the Department of Public Health, of a system of statewide long-term care service coordination and case management to minimize administrative costs, improve access to services, and minimize obstacles to the delivery of long-term care services to people in need. At a minimum, the system shall include the following:

(A) A request for proposal process by which the Department may authorize local entities to administer long-term care services.

(B) A comprehensive assessment system by which all individuals shall be evaluated before receiving long-term care services and may be evaluated periodically, as needed, while long-term care services are being provided to ensure that an individual receives appropriate long-term care services.

(C) Coordination of all of the long-term care services administered by the Department on Aging, the Department of Public Aid, and the Department of Human Services.

(D) Completion of consumer information about all of the long-term care services that are available.

(E) Consumer participation and oversight at the State and local levels in the planning and delivery of long-term care services.

(F) Long-term care service models that are alternatives to nursing home models, provided that the alternative models are comparable in cost or are more cost effective than the nursing home models that provide equivalent services. Any such alternative long-term care service models must be financially viable, must be cost effective, and must promote consumer independence, participation, and noninstitutionalization and, when appropriate, consumer direction; in addition, they may include a service or a combination of services such as assisted living, adult foster care, attendant care, and modifications of the residential care home system.

(G) Proposals for legislation to create alternative long-term care service models.

(3) In consultation with the nursing home industry, consumer advocates, consumers, and other long-term service providers, the proposal and implementation of methods to contain costs and encourage the reduction of Medicaid nursing home expenditures. These methods may include the following:

(A) Maximizing Medicare billing to pay for nursing home care.

(B) Mechanisms to reduce the number of nursing home beds, including a schedule for those reductions and recommendations for various sources of funding for payments to nursing homes to reduce the number of licensed beds.

(C) Elimination or modification of State nursing home rules that do not advance the quality of patient care and are not cost effective.

(D) Applications for exemption from federal nursing home regulations to improve the efficiency and reduce the cost and paperwork required to regulate the nursing home industry.

(E) Proposals for adoption of or changes in rules, subject to the certificate of need review, that permit the following:

(i) Greater cooperation among long-term care providers in such areas as discharge planning and staff sharing during periods of transition.

(ii) Greater cooperation between nursing homes and providers of home care, respite care, adult day care, and other long-term care services.

(iii) The use of vacant nursing home beds as respite beds.

(F) Changes in the State Medicaid plan to permit Medicaid billing for community residential care homes.

(G) Strategies to provide alternative financing of long-term care services by shifting the balance of the financial responsibility for payment for long-term care services from public to private sources by promoting public-private partnerships and personal responsibility for long-term care. These strategies may include the following:

(i) Flexible use of reverse mortgages.

(ii) Private insurance coverage for long-term care.

(iii) Tax credits or employment programs, such as medical savings accounts for long-term care.

(iv) Changes in Medicaid eligibility requirements that increase consumers' financial responsibility for their long-term care, such as revising the rules relating to the transfer of assets.

(v) Social insurance models.

(vi) Estate recovery options.

(vii) Methods to supplement and support family and community care giving.

(4) Designation and implementation of a voucher program that permits appropriate consumers to direct, manage, and pay for their home and community-based care services. The Department shall apply for any federal waivers required to implement this program. The cost of providing those services pursuant to the voucher program shall be limited to no more than 90% of the cost of providing similar services under the Medicaid program and shall be designed to provide the following:

(A) Program flexibility that permits consumers to design, manage, and pay for their own long-term care services, including hiring and firing their personal care assistants. The Department shall apply for available foundation grants to address barriers to recruitment and retention of caregivers. Policy and fiscal program design shall be based on input from consumers and caregivers. Support services, such as transportation, training, and personal assistance reimbursement, shall be provided to ensure such participation.

(B) Mechanisms to ensure quality of service.

(C) An eligibility determination procedure by which appropriate long-term care service needs are determined for each consumer by means of a self-evaluation of needs and abilities in combination with an objective evaluation of the consumer's ability to direct, coordinate, and manage such services.

(D) The amount of any copayment to be made by the consumer, based on income criteria.

(E) A payment system by which a consumer receives a voucher in the amount required to pay for his or her long-term care services on a regular, determined schedule. The amount of the voucher shall not be more than 90% of the cost of providing the same or comparable services under Medicaid, less the amount of any copayment to be paid by the consumer.

(c) No later than January 1, 2007, the Department shall report to the General Assembly regarding the progress made in complying with the requirements of subsection (b).

(305 ILCS 5/5F-20 new)

Sec. 5F-20. Long-term care budget. By January 1, 2006, and by January 1 of each year thereafter, the Department shall submit to the General Assembly a budget and budget management plan. The budget shall include all publicly financed long-term care services available to older Illinoisans and people with disabilities, including:

(1) Medicaid expenditures for nursing homes.

(2) Home and community-based waiver.

(3) Traumatic brain injury waiver.

(4) Residential care home waiver.

(5) Personal care attendant services.

(6) Chore and homemaker services.

(7) Older Americans Act-funded services.

(8) Adult day services and home health services.

(9) Respite care to provide support to family caregivers.

(10) Any other long-term care support services.