SB0470 95TH GENERAL ASSEMBLY

LRB095 10789 HLH 31119 b

95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
SB0470

Introduced 2/8/2007, by Sen. M. Maggie Crotty

SYNOPSIS AS INTRODUCED:

See Index

Amends the Disability Services Act of 2005. Adds a new Article to the Act. Provides that certain disabled persons have the right to have the amount of public funds that are, or would have been, expended for their care in an institution transferred to pay for their community-based services in a qualified residence. Requires the Departments of Human Services, Aging, Children and Family Services, Healthcare and Family Services, and Public Aid to develop appropriate fiscal payment mechanisms and methodologies that support choice. Provides that the cost of community-based services provided under the Act may not exceed the cost of care in the institutional facility in which the individual most recently resided. Requires the Department of Human Services, the Department on Aging, the Department of Public Health, and the Department of Healthcare and Family Services to work together with organizations composed of or representing persons with disabilities to ensure that persons with disabilities and their families, guardians, and advocates are informed of their rights under the Act in a manner that is easily understandable and accessible to persons with disabilities. Requires the Department of Healthcare and Family Services and the Department of Public Health to make annual reports. Effective July 1, 2007.

FISCAL NOTE ACT MAY APPLY

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 Disabilities Services Act of 2003 is amended by adding a heading to of Article 1 immediately before Section 1 of the Act, by adding a heading to Article 2 immediately before Section 5 of the Act, by adding Article 3 and a heading to Article 99 immediately after Section 30 of the Act as follows:

(20 ILCS 2407/Art. 1 heading heading new)

ARTICLE 1 heading. SHORT TITLE

(20 ILCS 2407/Art. 2 heading heading new)

ARTICLE 2 heading. DISABILITIES SERVICES ACT of 2003

(20 ILCS 2407/Art. 3 heading heading new)

ARTICLE 3 heading. OLMSTEAD IMPLEMENTATION ACT

(20 ILCS 2407/51 new)

Sec. 51. Legislative intent. It is the intent of the General Assembly to promote the civil rights of persons with disabilities by providing community-based services for persons with disabilities when such services are determined appropriate and desired by the affected persons, as required by Title II of the 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 eliminate barriers or mechanisms, whether in State law, the State Medicaid plan, the State budget, or otherwise, that prevent or restrict the flexible use of funds to enable individuals with disabilities to receive support for appropriate and necessary long-term services in the community settings of their choice; (ii) to increase the use of home and community-based, rather than institutional, long-term care services; (iii) to increase the ability of the State Medicaid program to ensure continued provision of home and community-based long-term care service to eligible individuals who choose to transition from an institutional to a community setting; and (iv) to ensure that procedures are in place that are at least comparable to those required under the qualified HCB 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. More specifically, this Article amends the Illinois Disability Services Act of 2003 (notwithstanding Section 30 of the Act) to mandate the creation of a flexible system of financing for long-term services and supports in Illinois that would allow available Medicaid funds budgeted for nursing homes and institutional services to be spent on home and community-based services when an individual residing in an institution moves to the most appropriate and preferred community-based setting of his or her choice.

(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:

"Home and community-based long-term care services". The term "home and community-based long-term care services" means, with respect to a State Medicaid program, a service, aid, or benefit that is provided to a person with a disability (and is voluntarily accepted) as part of his or her long-term care that: (i) is provided under the State's qualified HCB 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.

"Eligible individual". The term "eligible individual" means a person with a disability of any age in Illinois: (i) who is receiving Medicaid benefits for inpatient services furnished by an inpatient facility; (ii) with respect to whom a determination has been made that, but for the provision of home and community-based long-term care services, the individual would continue to require the level of care provided in an inpatient facility; (iii) who is deemed appropriate by the State's treatment professionals for home or community-based services; and (iv) who wants to transfer from an inpatient facility to a qualified residence. For the purposes of this Act, "eligible individual" does not include a person with a disability receiving acute care mental health treatment in a State-operated mental health center for less than 30 consecutive days in a one-year period.

"Inpatient facility". The term "inpatient facility" means a skilled nursing or intermediate long-term care facility subject to licensure by the Department of Public Health under the Nursing Care Act, an intermediate care facility for the mentally retarded (ICF-DDs), an institution for mental diseases, child care institutions licensed by the Department of Children and Family Services, and a State-operated developmental center or mental health center, whether publicly or privately owned.

"Qualified HCB program". The term "qualified HCB program" means a program providing home and community-based long-term care services operating under Medicaid, whether or not operating under waiver authority.

"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; and (iii) a residence, in a community-based residential setting, in which no more than 4 unrelated individuals reside.

"Self-directed services". The term "self-directed services" means, with respect to home and community-based long-term care services for an eligible individual, such services for the individual that are planned and purchased under the direction and control of such individual or the individual's authorized representative, including the amount, duration, scope, provider, and location of such services, as described in the individual service or treatment plan.

"Public funds" means any funds appropriated by the General Assembly to the Department of Human Services, the Department on Aging, the Department of Children and Family Services, or the Department of Healthcare and Family Services.

(20 ILCS 2407/53 new)

Sec. 53. Redistribution of public funds for community services.

(a) Any eligible individual, as defined in Section 52, has the right to have public funds that are, or would have been, expended for his or her care in an inpatient facility transferred to pay for his or her home and community-based long-term care services in a qualified residence.

(b) In accordance with Sections 15(2) and 20(b)(2) of this Act, all eligible individuals under this Act shall have an individual service or treatment plan that is reviewed at least annually that is consistent with the requirements under subsection (b)(8)(A) of section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), and that includes an individualized budget that identifies the dollar value of the services and supports under the control and direction of the individual or the individual's authorized representative. The service or treatment plan must contain assurances that each eligible individual has been provided the opportunity to make an informed choice regarding their right under subsection (a).

(c) In accordance with any Disability Services Plan or Plan update developed under this Act and section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), the Departments of Human Services, Aging, Children and Family Services, Department of Healthcare and Family Services, and Public Aid shall develop appropriate fiscal payment mechanisms and methodologies that effectively support choice (money follows the person) and eliminate any legal, budgetary, or other barriers to flexibility in the availability of Medicaid funds to pay for long-term care services for eligible individuals in the appropriate home and community-based long-term care settings of their choice, including costs to transition from an inpatient facility to a qualified residence. With respect to the individualized budgets described in subsection (b), the fiscal payment mechanisms and methodologies must: (i) describe the method for calculating the dollar values in such budgets based on reliable costs and service utilization; (ii) define a process for making adjustments in such dollar values to reflect changes in individual assessments and service plans; and (iii) provide a procedure to evaluate expenditures under such budgets.

(d) The cost of home and community-based long-term care services provided under this Act shall be funded in accordance with the individual service or treatment plan, but shall not exceed the cost of care in the inpatient facility in which the individual most recently resided.

(e) In accordance with Section 4.4 of the Community Services Act of 2004 (P.L. 094-0498), whenever any appropriation, or any portion of an appropriation, for any fiscal year related to the funding of an inpatient facility is reduced due to the redistribution of funds under this Act, to the extent that savings are realized, those moneys must be deposited into the Olmstead Implementation Fund, created as a special fund in the State treasury, and shall be used to expand the availability, quality, or stability of home and community-based long-term care services and supports for persons with disabilities (such as in-home consumer/family supports; integrated, accessible, and affordable housing options and home modifications, etc).

(f) The redistribution required in this Section shall not have the effect of: (i) diminishing or reducing the quality of services available to residents of inpatient facilities; or (ii) forcing any residents of inpatient facilities to involuntarily accept home and community-based long-term care services, or causing any residents of inpatient facilities to be involuntarily transferred or discharged.

(g) Funding for eligible individuals under this Act shall remain available to the eligible individual, in accordance with the individual service or treatment plan, as long as he or she remains eligible for services in an inpatient facility and prefers home and community-based long-term care services.

(20 ILCS 2407/54 new)

Sec. 54. Quality assurance and quality improvement. In accordance with subsection (11) of section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), the Departments of Human Services, Aging, Children and Family Services, Public Health, and Department of Healthcare and Family Services 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.

(20 ILCS 2407/55 new)

Sec. 55. Dissemination of information; reports.

(a) The State shall ensure that all eligible individuals are informed of their right to receive home and community-based long-term care services under this Act. The Departments of Human Services, Aging, Department of Healthcare and Family Services, and Public Aid shall work together with organizations comprised of, or representing people with disabilities, to ensure that persons with disabilities and their families, guardians, and advocates are informed of their rights under this Act in a manner that is easily understandable and accessible to people with disabilities. The Departments shall ensure that multiple methods of dissemination are employed and shall make concerted efforts to inform people currently in inpatient facilities, including at their individual team or program meetings. The Departments of Human Services, Aging, Department of Healthcare and Family Services, and Public Aid shall ensure that all nursing home residents listed under the Minimum Data Set (MDS) of the Centers for Medicare and Medicaid Services as preferring to live in the community are informed of and given the opportunity to exercise their rights under this Act. The Department of Public Health shall ensure that, as a condition of licensing and certification, all inpatient facilities covered under this Act shall inform all residents annually of their opportunities to choose home and community alternatives under this Act. Additionally, the Department shall require each inpatient facility to post in a prominent location on each residential ward a notice containing information on rights and services available under this Act. Signs posted on residential wards shall comply with the accessibility standards of the Americans with Disabilities Act.

(b) On or before January 1 of each year, the Department of Public Aid and the Department of Public Health 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 the fiscal payment mechanisms and methodologies developed under this Act that effectively support choice (money follows the person); (ii) an accounting of the savings realized under this Act and the ways in which these savings were spent; (iii) information concerning the dollar amounts of State Medicaid expenditures for fiscal years 2006 and 2007, for long-term care services 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; (iv) a description of the Departments' efforts to inform all eligible individuals of their rights under this Act; (v) the number of eligible individuals referred or identified under this Act in the previous fiscal year, the number of eligible individuals who applied to transfer to home and community-based long-term care services in the previous fiscal year, and the number of eligible individuals who, in fact, transferred from an inpatient facility to a qualified residence in the previous fiscal year; (vi) documentation that the Departments have met the requirements under Section 5 to assure the health and welfare of eligible individuals receiving home and community-based long-term care services; and (vii) Any obstacles the Department confronted in assisting residents of inpatient facilities to make the transition to a qualified residence, and the Department's recommendations for removing those obstacles. This report must be made available to the general public, including via the Departments' 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, except to the extent the determinations are based on the availability of community services.

(b) This Article shall not be read to limit in any way the rights of people 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, Aging, Children and Family Services, Department of Healthcare and Family Services, and Public Aid shall adopt any rules necessary for the implementation and administration of this Act.

Section 10. The Disabilities Services Act of 2003 is amended by adding the heading of Article 99 heading as follows:

(20 ILCS 2407/Art. 99 heading new)

ARTICLE 99 heading.

ARTICLE 99. AMENDATORY PROVISIONS; EFFECTIVE DATE

Section 15. The State Finance Act is amended by adding Section 5.675 as follows:

(30 ILCS 105/5.675 new)

Sec. 5.675. The Olmstead Implementation Fund.

Section 99. Effective date. This Act takes effect July 1, 2007.