Full Text of HB6845 93rd General Assembly
HB6845 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB6845
Introduced 02/09/04, by Jack McGuire SYNOPSIS AS INTRODUCED: |
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New Act |
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20 ILCS 105/4.03 |
from Ch. 23, par. 6104.03 |
305 ILCS 5/5-5.3a new |
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Creates the Long-Term Care Consultation Services Act and amends the Illinois Act on the Aging and the Illinois Public Aid Code. Provides for a program of long-term care consultation services, to be provided by the Department on Aging and the departments of Public Aid and Human Services, to assist persons with long-term or chronic care needs in making decisions and selecting options in relation to care. Provides for screening of individuals before admission to a Medicaid-certified nursing home, and makes the Department on Aging's nursing home prescreening program subject to the Long-Term Care Consultation Services Act. Provides for exemptions from preadmission screening requirements, including emergency admissions. Makes preadmission screening a condition of Medicaid reimbursement unless an exemption applies.
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A BILL FOR
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HB6845 |
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LRB093 15225 DRJ 47297 b |
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| AN ACT concerning long-term care.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the | 5 |
| Long-Term Care Consultation Services Act. | 6 |
| Section 5. Purpose and goal.
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| (a) The purpose of long-term care consultation services is | 8 |
| to assist persons with long-term or chronic care needs in | 9 |
| making long-term care decisions and selecting options that meet | 10 |
| their needs and
reflect their preferences. The availability of, | 11 |
| and access to,
information and other types of assistance is | 12 |
| also intended to
prevent or delay nursing facility placements | 13 |
| and to
provide transition assistance after admission to a | 14 |
| nursing facility. The goal of these services is to contain | 15 |
| costs associated with
unnecessary nursing facility admissions. | 16 |
| The
Department on Aging, the Department of Human Services, and | 17 |
| the Department of Public Aid shall cooperate in seeking to
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| maximize use of available federal and State funds and establish
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| the broadest program possible within the funding available. | 20 |
| (b) The services described in subsection (a) must be | 21 |
| provided by the Department on Aging, the Department of Human | 22 |
| Services, and the Department of Public Aid when applicable to | 23 |
| the population served by each agency. The services must be | 24 |
| coordinated with services
provided by other public and private | 25 |
| agencies in the community
to offer a variety of cost-effective | 26 |
| alternatives to persons
with disabilities and elderly persons. | 27 |
| The agency
providing long-term care consultation services | 28 |
| shall encourage
the use of volunteers from families, religious | 29 |
| organizations,
social clubs, and similar civic and service | 30 |
| organizations to
provide community-based services. | 31 |
| Section 10. Definitions. In this Act: |
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| "Department" means the the Department on Aging, the | 2 |
| Department of Human Services, or the Department of Public Aid, | 3 |
| as applicable. | 4 |
| "Long-term care consultation services" includes all of the | 5 |
| following: | 6 |
| (1) Providing information and education to the general
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| public regarding availability of the services authorized | 8 |
| under
this Act. | 9 |
| (2) An intake process that provides access to the | 10 |
| services
described in this Act. | 11 |
| (3) Assessing the health, psychological, and social
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| needs of referred persons. | 13 |
| (4) Assistance in identifying services needed to | 14 |
| maintain
an person in the least restrictive environment. | 15 |
| (5) Providing recommendations on cost-effective | 16 |
| community
services that are available to the person. | 17 |
| (6) Developing a person's community support plan. | 18 |
| (7) Providing information regarding eligibility for
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| Illinois health care programs. | 20 |
| (8) Preadmission screening to determine a person's | 21 |
| need for a
nursing facility level of care. | 22 |
| (9) Preliminary determination of a person's | 23 |
| eligibility for Illinois health care
programs for persons | 24 |
| who need a nursing facility
level of care, with appropriate | 25 |
| referrals for final
determination. | 26 |
| (10) Providing recommendations for nursing facility
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| placement when there are no cost-effective community | 28 |
| services
available. | 29 |
| (11) Assistance to transition people back to community
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| settings after admission to a nursing facility. | 31 |
| "Team" means a long-term care consultation team | 32 |
| established under this Act. | 33 |
| Section 15. Long-term care consultation team.
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| (a) The Department shall establish, through the network of | 35 |
| area agencies on aging established under the Illinois Act on |
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| the Aging, a long-term care consultation team in each | 2 |
| designated service region of the State. Each team
shall consist | 3 |
| of at least one social worker and at least one
public health | 4 |
| nurse. The area agency on aging may designate and contract with | 5 |
| a local public health or social services agency as the lead
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| agency for long-term care consultation services. If a region
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| does not have a public health nurse available, it may request
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| approval from the Department to assign a registered
nurse with | 9 |
| at least one year experience in home care to
participate on the | 10 |
| team. A joint local consultation team or teams may serve 2 or | 11 |
| more regions. | 12 |
| (b) The team is responsible for providing long-term care
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| consultation services to all persons located in the service | 14 |
| region or regions who request the services, regardless of a | 15 |
| person's eligibility for any Illinois health care or human | 16 |
| services program. | 17 |
| Section 20. Assessment and support planning. | 18 |
| (a) Persons requesting assessment, services planning, or | 19 |
| other
assistance intended to support community-based living | 20 |
| must be
visited by a long-term care consultation team within 10 | 21 |
| working
days after the date on which an assessment was | 22 |
| requested or
recommended. Assessments must be conducted in | 23 |
| accordance with this Section. | 24 |
| (b) A service region may utilize a long-term care | 25 |
| consultation team of either the social worker or the public | 26 |
| health nurse, or both, to conduct the assessment in a | 27 |
| face-to-face interview. The team
members must confer regarding | 28 |
| the most appropriate care for each
person screened or assessed. | 29 |
| The team must assess the
health and social needs of the person, | 30 |
| using an assessment form
provided by the Department. The team | 31 |
| must conduct the assessment in a face-to-face interview with | 32 |
| the person being assessed and the person's legal | 33 |
| representative, if applicable. | 34 |
| (c) The team must provide the person, or the person's legal
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| representative, with written recommendations for |
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| facility-based or
community-based services. The team must | 2 |
| document that the most
cost-effective alternatives available | 3 |
| were offered to the
person. For purposes of this requirement, | 4 |
| "cost-effective
alternatives" means community services and | 5 |
| living arrangements
that cost the same as or less than nursing | 6 |
| facility care. | 7 |
| (d) If a person chooses to use community-based services,
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| the team must provide the person or the person's legal
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| representative with a written community support plan, | 10 |
| regardless
of whether the person is eligible for any Illinois
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| health care or human services program. The person may request | 12 |
| assistance in developing a community support plan without | 13 |
| participating in a complete assessment. | 14 |
| (e) The team must give the person receiving an assessment | 15 |
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support planning, or the person's legal representative,
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| materials supplied by the Department containing the following
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| information: | 18 |
| (1) The purpose of preadmission screening and | 19 |
| assessment. | 20 |
| (2) Information about Illinois health care programs. | 21 |
| (3) The person's freedom to accept or reject the | 22 |
| recommendations of the team. | 23 |
| (4) The person's right to confidentiality. | 24 |
| (5) The person's right to appeal the decision regarding | 25 |
| the
need for nursing facility level of care or the | 26 |
| Department's final
decisions regarding public programs | 27 |
| eligibility.
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| Section 25. Transition assistance. | 29 |
| (a) A long-term care consultation team shall provide | 30 |
| assistance to persons residing in a nursing facility, hospital, | 31 |
| regional treatment
center, or intermediate care facility for | 32 |
| persons with mental
retardation who request or are referred for | 33 |
| assistance.
Transition assistance must include assessment, | 34 |
| community support
plan development, referrals to Illinois | 35 |
| health care programs,
and referrals to programs that provide |
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| assistance with housing. | 2 |
| (b) The area agency on aging shall develop transition | 3 |
| processes with
institutional social workers and discharge | 4 |
| planners to ensure
that: | 5 |
| (1) Persons admitted to facilities receive information
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| about transition assistance that is available. | 7 |
| (2) The assessment is completed for persons within 10
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| working days after the date of the request or | 9 |
| recommendation for
assessment. | 10 |
| (3) There is a plan for transition and follow-up for | 11 |
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person's return to the community. The plan must require
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| notification of other local agencies when a person who may
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| require transition assistance is screened in one service | 14 |
| region for admission to a facility located in another | 15 |
| service region. | 16 |
| (c) If a person who is eligible for an Illinois health care
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| program is admitted to a nursing facility, the nursing facility
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| must include a long-term care consultation team member or the | 19 |
| case manager in the discharge planning process. | 20 |
| Section 30. Preadmission screening. | 21 |
| (a) Every applicant to a Medicaid-certified nursing | 22 |
| facility must be screened before admission to the facility, | 23 |
| regardless of the applicant's income, assets, or funding | 24 |
| sources for nursing facility care, except as described in | 25 |
| Section 35. The purpose of the
screening is to determine the | 26 |
| applicant's need for nursing facility level of care as | 27 |
| described in subsection (e) and to complete activities
required | 28 |
| under federal law related to mental illness and mental
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| retardation as described in subsection (b). | 30 |
| (b) A person who has a diagnosis or possible diagnosis of
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| mental illness, mental retardation, or a related condition must
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| receive a preadmission screening before admission to a nursing | 33 |
| facility, regardless of the exemptions described in subsection | 34 |
| (b) of Section 35, to identify the need for further evaluation | 35 |
| and specialized
services, unless the admission before |
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| screening is authorized
by the local mental health authority or | 2 |
| the local developmental
disabilities case manager, or unless | 3 |
| authorized by the Department.
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| (c) The following criteria apply to the preadmission | 5 |
| screening: | 6 |
| (1) the screening must use forms and criteria developed | 7 |
| by the
Department to identify persons who require referral | 8 |
| for
further evaluation and determination of the need for | 9 |
| specialized
services. | 10 |
| (2) The evaluation and determination of the need for
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| specialized services must be done by: | 12 |
| (A) a qualified independent mental health | 13 |
| professional, for
persons with a primary or secondary | 14 |
| diagnosis of a serious
mental illness; or | 15 |
| (B) a qualified mental retardation professional, | 16 |
| for
persons with a primary or secondary diagnosis of | 17 |
| mental
retardation or related conditions. For purposes | 18 |
| of this
requirement, a qualified mental retardation | 19 |
| professional must
meet the standards for a qualified | 20 |
| mental retardation
professional under 42 CFR 483.430. | 21 |
| (d) The local mental health authority or State mental | 22 |
| retardation authority under Public Law 100-203 and Public Law | 23 |
| 101-508 may prohibit admission to a nursing facility if the | 24 |
| person seeking admission does not meet the nursing facility | 25 |
| level of care criteria or needs specialized services as defined | 26 |
| in Public Law
100-203 and Public Law 101-508. For purposes of | 27 |
| this subsection,
"specialized services" for a person with | 28 |
| mental retardation or a
related condition means active | 29 |
| treatment as that term is defined
in 42 CFR 483.440. | 30 |
| (e) The determination of a person's need for nursing | 31 |
| facility
level of care must be made according to criteria | 32 |
| developed by
the Department. In assessing a person's needs, | 33 |
| team members must have a physician available for consultation | 34 |
| and must consider the assessment of the person's attending | 35 |
| physician, if any. The person's physician must be included if | 36 |
| the physician chooses to participate. Other personnel may be |
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| included on the team as deemed appropriate by the Department. | 2 |
| Section 35. Persons exempt from prescreening requirements. | 3 |
| (a) Persons exempt from the federal screening requirements | 4 |
| described in subsections (b), (c), and (d) of Section 30 are | 5 |
| limited to the following: | 6 |
| (1) A person who, having entered an acute care facility
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| from a Medicaid-certified nursing facility, is returning | 8 |
| to a Medicaid-certified
nursing facility. | 9 |
| (2) A person transferring from one Medicaid-certified | 10 |
| nursing
facility in Illinois to another Medicaid-certified | 11 |
| nursing facility in
Illinois. | 12 |
| (3) A person, 21 years of age or older, who satisfies | 13 |
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following criteria, as specified in 42 CFR 106(b)(2): | 14 |
| (A) the person is admitted to a nursing facility | 15 |
| directly
from a hospital after receiving acute | 16 |
| inpatient care at the
hospital; | 17 |
| (B) the person requires nursing facility services | 18 |
| for the
same condition for which care was provided in | 19 |
| the hospital; and | 20 |
| (C) the attending physician has certified before | 21 |
| the person's
admission to the nursing facility that the | 22 |
| person is likely to receive
less than 30 days of | 23 |
| nursing facility services. | 24 |
| A nursing facility must provide a written notice to a
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| person who satisfies the criteria in paragraph (3)
regarding | 26 |
| the person's right to request and receive long-term
care | 27 |
| consultation services as defined in this Act. The
notice must | 28 |
| be provided before the person's discharge from the
facility and | 29 |
| in a format specified by the Department. | 30 |
| (b) Persons who are exempt from preadmission screening for
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| purposes of level-of-care determination include the following: | 32 |
| (1) Persons described in subsection (a). | 33 |
| (2) A person who has a contractual right to have
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| nursing facility care paid for indefinitely by the | 35 |
| Veterans'
Administration. |
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| (3) A person currently being served under the | 2 |
| alternative care program or under a home and | 3 |
| community-based services waiver authorized under Section | 4 |
| 1915(c) of the Social Security Act.
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| (4) Persons admitted to a Medicaid-certified nursing | 6 |
| facility
for a short-term stay, which is expected to be 14 | 7 |
| days or less
in duration based on a physician's | 8 |
| certification, and who have
been assessed and approved for | 9 |
| nursing facility admission within
the previous 6 months. | 10 |
| This exemption applies only if the long-term care | 11 |
| consultation team member determines at the time of the | 12 |
| initial
assessment of the 6-month period that it is | 13 |
| appropriate to use
the nursing facility for short-term | 14 |
| stays and that there is an
adequate plan of care for return | 15 |
| to the home or community-based
setting. If a stay exceeds | 16 |
| 14 days, the person must be
referred no later than the | 17 |
| first working day following
the 14th resident day for a | 18 |
| screening, which must be completed
within 5 working days | 19 |
| after the referral.
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| Section 40. Emergency admission to a nursing facility. | 21 |
| (a) Persons admitted to a Medicaid-certified nursing
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| facility from the community on an emergency basis as described
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| in subsection (b) or from an acute care facility on a day other | 24 |
| than a working day must be screened on the first working day | 25 |
| after admission. | 26 |
| (b) Emergency admission to a nursing facility before
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| screening is permitted when all of the following conditions are
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| met: | 29 |
| (1) The person is admitted from the community to a | 30 |
| certified
nursing facility during county
nonworking hours. | 31 |
| (2) A physician has determined that delaying admission
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| until preadmission screening is completed would adversely | 33 |
| affect
the person's health and safety. | 34 |
| (3) There is a recent precipitating event that | 35 |
| precludes
the person from living safely in the community, |
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| such as the person
sustaining an injury, the sudden onset | 2 |
| of an acute illness, or a
caregiver's inability to continue | 3 |
| to provide care. | 4 |
| (4) The person's attending physician has authorized | 5 |
| the emergency
placement and has documented the reason that | 6 |
| the emergency
placement is recommended. | 7 |
| (5) The Department is contacted on the first working | 8 |
| day
following the emergency admission. | 9 |
| (c) Transfer of a patient from an acute care hospital to a | 10 |
| nursing
facility is not considered an emergency except for a | 11 |
| person who
has received hospital services in the following | 12 |
| situations:
hospital admission for observation, care in an | 13 |
| emergency room
without hospital admission, or following | 14 |
| hospital 24-hour bed care. | 15 |
| Section 45. Screening procedure. | 16 |
| (a) A person may be screened for nursing facility admission | 17 |
| by telephone or in a face-to-face screening interview. | 18 |
| Long-term care consultation team members must identify each | 19 |
| person's needs using one of the following categories: | 20 |
| (1) The person does not need a face-to-face screening | 21 |
| interview to
determine the need for nursing facility level | 22 |
| of care based on
information obtained from other health | 23 |
| care professionals. | 24 |
| (2) The person needs an immediate face-to-face | 25 |
| screening
interview to determine the need for nursing | 26 |
| facility level of
care and to complete activities required | 27 |
| under Section 30. | 28 |
| (3) The person may be exempt from screening | 29 |
| requirements as
described in Section 35 or 40 but will need | 30 |
| transitional
assistance after admission or in-person | 31 |
| follow-along after a
return home. | 32 |
| (b) Persons admitted on a nonemergency basis to a
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| Medicaid-certified nursing facility must be screened before
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| admission. | 35 |
| (c) The long-term care consultation team shall recommend a
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| case mix classification for persons admitted to a certified
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| nursing facility when sufficient information is received to | 3 |
| make
that classification. The nursing facility may
conduct all | 4 |
| case mix assessments for persons who have been
screened before | 5 |
| admission for whom the team did not
recommend a case mix | 6 |
| classification. The nursing facility may conduct all case mix | 7 |
| assessments for persons admitted to the facility before a | 8 |
| preadmission screening. | 9 |
| (d) The team's screening or intake activity must include
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| processes to identify persons who may require transition | 11 |
| assistance as described in Section 25. | 12 |
| Section 50. Preadmission screening of persons under age 65.
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| (a) It is the policy of the State of Illinois to ensure | 14 |
| that persons with disabilities or chronic illness are served in | 15 |
| the most integrated setting appropriate to their needs and have | 16 |
| the necessary information to make informed choices about home | 17 |
| and community-based service options. The Department of Public | 18 |
| Aid and the Department of Human Services shall administer this | 19 |
| Section. | 20 |
| (b) A person under 65 years of age who is admitted to a
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| nursing facility from a hospital must be screened before
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| admission as described in Sections 30, 35, 40, and 45. | 23 |
| (c) A person under 65 years of age who is admitted to a
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| nursing facility with only a telephone preadmission screening | 25 |
| must receive a face-to-face assessment from the long-term care | 26 |
| consultation
team member from the service region in which the | 27 |
| facility is located or from the person's case manager within 40 | 28 |
| calendar days
after admission. | 29 |
| (d) A person under 65 years of age who is admitted to a
| 30 |
| nursing facility without a preadmission screening in | 31 |
| accordance with subdivision (a)(3) of Section 35 and who | 32 |
| remains in the facility longer than 30 days must
receive a | 33 |
| face-to-face assessment within 40 days after admission. | 34 |
| (e) At the face-to-face assessment, the long-term care
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| consultation team member or case manager must perform the
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| activities required under Section 25. | 2 |
| (f) For a person under 21 years of age, a screening
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| interview that recommends nursing facility admission must be | 4 |
| conducted
face-to-face and must be approved by the Department | 5 |
| before the
person is admitted to the nursing facility. | 6 |
| (g) If a person under 65 years of age
is admitted to a | 7 |
| nursing facility on an emergency basis, the
Department must be | 8 |
| notified of the admission on the next working
day, and a | 9 |
| face-to-face assessment as described in subsection (c)
must be | 10 |
| conducted within 40 calendar days after admission. | 11 |
| (h) At the face-to-face assessment, the team member or the | 12 |
| case manager must present information about home and | 13 |
| community-based options so that the person can make informed | 14 |
| choices. If the person chooses
home and community-based | 15 |
| services, the team member or case manager must complete a | 16 |
| written relocation plan within 20 working days after the | 17 |
| assessment. The plan must describe the services needed to | 18 |
| enable the person to move out of the facility and must include | 19 |
| a time line for the move that is designed to ensure a smooth | 20 |
| transition to the person's home and community. | 21 |
| (i) A person under 65 years of age residing in a
nursing | 22 |
| facility is entitled to a face-to-face assessment at
least | 23 |
| every 12 months to review the person's service choices and
| 24 |
| available alternatives unless the person indicates, in
| 25 |
| writing, that he or she does not desire annual assessments. In | 26 |
| this case, the person must receive a face-to-face assessment at | 27 |
| least every 36 months for the same purposes. | 28 |
| Section 55. Administration. The Department shall minimize | 29 |
| the number of forms required in the provision of long-term care | 30 |
| consultation services and shall limit the
screening document to | 31 |
| items necessary for community support plan
approval, | 32 |
| reimbursement, program planning, evaluation, and
policy | 33 |
| development. | 34 |
| Section 60. Medicaid reimbursement. |
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| (a) Reimbursement for a nursing facility under Article V of | 2 |
| the Illinois Public Aid Code shall be authorized for a | 3 |
| recipient of medical assistance under that Article V only if a | 4 |
| preadmission screening has been conducted before the | 5 |
| recipient's admission to the facility or the Department has | 6 |
| authorized an exemption from the preadmission screening | 7 |
| requirement as provided in this Act. Reimbursement under | 8 |
| Article V of the Illinois Public Aid Code shall not be provided | 9 |
| for any medical assistance recipient who, as determined by the | 10 |
| local screener, does not meet the level of care criteria for | 11 |
| nursing facility placement or, if indicated, has not had a | 12 |
| level II OBRA evaluation as required under the federal Omnibus | 13 |
| Budget Reconciliation Act of 1987 completed, unless an | 14 |
| admission for a recipient with mental illness is approved by | 15 |
| the local mental health authority or an admission for a | 16 |
| recipient with mental
retardation or a related condition is | 17 |
| approved by the State mental
retardation authority. | 18 |
| (b) A nursing facility must not bill a person who is not
a | 19 |
| medical assistance recipient for resident days that preceded
| 20 |
| the date of completion of screening activities as required | 21 |
| under
Sections 30, 35, 40, and 45. The nursing facility must | 22 |
| include
unreimbursed resident days in the nursing facility | 23 |
| resident day
totals reported to the Department. | 24 |
| (c) The Department shall make a request to the Centers
for | 25 |
| Medicare and Medicaid Services for a waiver allowing team
| 26 |
| approval of Medicaid payments for certified nursing facility
| 27 |
| care. A person has a choice and makes the final decision
| 28 |
| between nursing facility placement and community placement | 29 |
| after
the screening team's recommendation, except as provided | 30 |
| in
subsection (d) of Section 30.
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| Section 90. The Illinois Act on the Aging is amended by | 32 |
| changing Section 4.03 as follows:
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| (20 ILCS 105/4.03) (from Ch. 23, par. 6104.03)
| 34 |
| Sec. 4.03. Nursing home prescreening program.
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| (a) The Department on Aging, in cooperation with the Department | 2 |
| of
Human Services and any other appropriate State, local or
| 3 |
| federal agency, shall, without regard to income guidelines, | 4 |
| establish a
nursing home prescreening program to determine | 5 |
| whether Alzheimer's Disease
and related disorders victims, and | 6 |
| persons who are deemed as blind or
disabled as defined by the | 7 |
| Social Security Act and who are in need of long
term care, may | 8 |
| be satisfactorily cared for in their homes through the use
of | 9 |
| home and community based services. Case coordination units | 10 |
| under
contract with the Department may charge a fee for the | 11 |
| prescreening provided
under this Section and the fee shall be | 12 |
| no greater than the cost of such
services to the case | 13 |
| coordination unit.
| 14 |
| (b) The program established under this Section must comply | 15 |
| with the Long-Term Care Consultation Services Act.
| 16 |
| (Source: P.A. 89-21, eff. 7-1-95; 89-507, eff. 7-1-97.)
| 17 |
| Section 95. The Illinois Public Aid Code is amended by | 18 |
| adding Section 5-5.3a as follows: | 19 |
| (305 ILCS 5/5-5.3a new)
| 20 |
| Sec. 5-5.3a. Long-Term Care Consultation Services Act. | 21 |
| Payments to a nursing facility under this Article are subject | 22 |
| to preadmission screening requirements as provided in Section | 23 |
| 60 of the Long-Term Care Consultation Services Act.
|
|