Full Text of HB0982 95th General Assembly
HB0982eng 95TH GENERAL ASSEMBLY
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| AN ACT concerning public aid.
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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 5. The Illinois Public Aid Code is amended by | 5 |
| changing Sections 5-2.05 and 12-4.36 as follows:
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| (305 ILCS 5/5-2.05)
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| Sec. 5-2.05. Children with disabilities
Disabled children .
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| (a) The Department of Healthcare and Family Services, in | 9 |
| conjunction with the Department of Human Services,
Public Aid
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| may offer, to children with developmental
disabilities or | 11 |
| children with severe mental illness or severe emotional | 12 |
| disorders
and severely mentally ill or emotionally disturbed | 13 |
| children who
otherwise would not qualify for medical assistance | 14 |
| under this Article due to
family income, home-based and | 15 |
| community-based services instead of institutional
placement, | 16 |
| as allowed under paragraph 7 of Section 5-2.
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| (b) The Department of Healthcare and Family Services
Public | 18 |
| Aid , in conjunction with the Department of
Human Services and | 19 |
| the Division of Specialized Care for Children, University of
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| Illinois-Chicago, shall submit a bi-annual
also
report to the | 21 |
| Governor and the General Assembly no
later than January 1 of | 22 |
| every even-numbered year beginning in 2008 , 2004 regarding the | 23 |
| status of existing services offered
under paragraph 7
of |
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| Section 5-2. This report shall include, but not be limited to, | 2 |
| the following
information:
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| (1) The number of persons eligible for these services.
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| (2) The number of persons who applied for these | 5 |
| services.
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| (1)
(3) The number of persons who currently receive | 7 |
| these services.
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| (2)
(4) The nature, scope, and cost of services | 9 |
| provided under paragraph 7 of
Section 5-2 .
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| (3)
(5) The comparative cost of providing those | 11 |
| services in a hospital,
skilled nursing facility, or | 12 |
| intermediate care facility.
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| (4)
(6) The funding sources for the provision of | 14 |
| services, including federal
financial participation.
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| (5)
(7) The qualifications, skills, and availability | 16 |
| of caregivers for
children receiving services. | 17 |
| (6) The number of children who have aged out of the | 18 |
| services offered under paragraph 7 of Section 5-2 during | 19 |
| the 2 years immediately preceding the report.
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| The report shall also include information regarding the | 21 |
| extent to which the
existing programs could provide coverage | 22 |
| for children with developmental disabilities or children with | 23 |
| severe mental illness or severe emotional disorders
mentally | 24 |
| disabled children who are
currently being provided services in | 25 |
| an institution who could otherwise be
served in a | 26 |
| less-restrictive, community-based setting for the same or a |
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| lower
cost. The report may be submitted as part of the report | 2 |
| required by subsection (e) of Section 12-4.36 of this Code | 3 |
| during the existence of the pilot program authorized by that | 4 |
| Section.
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| (Source: P.A. 93-599, eff. 8-26-03; revised 12-15-05.)
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| (305 ILCS 5/12-4.36) | 7 |
| Sec. 12-4.36. Pilot program for persons who are medically | 8 |
| fragile and technology-dependent. | 9 |
| (a) Subject to appropriations for the first fiscal year of | 10 |
| the pilot program beginning July 1, 2006, the Department of | 11 |
| Human Services, in cooperation with the Department of | 12 |
| Healthcare and Family Services, shall adopt rules to initiate a | 13 |
| 3-year pilot program to (i) test a standardized assessment tool | 14 |
| for persons who are medically fragile and technology-dependent | 15 |
| who may be provided home and community-based services to meet | 16 |
| their medical needs rather than be provided care in an | 17 |
| institution not solely because of a severe mental or | 18 |
| developmental impairment and (ii) provide appropriate home and | 19 |
| community-based medical services for such persons as provided | 20 |
| in subsection (c) of this Section. The Department of Human | 21 |
| Services may administer the pilot program until June 30, 2010
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| 2009 if the General Assembly annually appropriates funds for | 23 |
| this purpose. | 24 |
| (b) Notwithstanding any other provisions of this Code, the | 25 |
| rules implementing the pilot program shall provide for |
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| criteria, standards, procedures, and reimbursement for | 2 |
| services that are not otherwise being provided in scope, | 3 |
| duration, or amount through any other program administered by | 4 |
| any Department of Human Services or any other agency of the | 5 |
| State for these medically fragile, technology-dependent | 6 |
| persons. At a minimum, the rules shall include the following: | 7 |
| (1) A requirement that a pilot program participant be | 8 |
| eligible for medical assistance under this Code, a citizen | 9 |
| of the United States, or an individual who is lawfully | 10 |
| residing permanently in the United States, and a resident | 11 |
| of Illinois. | 12 |
| (2) A requirement that a standardized assessment for | 13 |
| medically fragile, technology-dependent persons will | 14 |
| establish the level of care and the service-cost maximums. | 15 |
| (3) A requirement for a determination by a physician | 16 |
| licensed to practice medicine in all its branches (i) that, | 17 |
| except for the provision of home and community-based care, | 18 |
| these individuals would require the level of care provided | 19 |
| in an institutional setting and (ii) that the necessary | 20 |
| level of care can be provided safely in the home and | 21 |
| community through the provision of medical support | 22 |
| services. | 23 |
| (4) A requirement that the services provided be | 24 |
| medically necessary and appropriate for the level of | 25 |
| functioning of the persons who are participating in the | 26 |
| pilot program. |
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| (5) Provisions for care coordination and family | 2 |
| support services that will enable the person to receive | 3 |
| services in the most integrated setting possible | 4 |
| appropriate to his or her medical condition and level of | 5 |
| functioning. | 6 |
| (6) The frequency of assessment and plan-of-care | 7 |
| reviews. | 8 |
| (7) The family or guardian's active participation as | 9 |
| care givers in meeting the individual's medical needs. | 10 |
| (8) The estimated cost to the State for in-home care, | 11 |
| as compared to the institutional level of care appropriate | 12 |
| to the individual's medical needs, may not exceed 100% of | 13 |
| the institutional care as indicated by the standardized | 14 |
| assessment tool. | 15 |
| (9) When determining the hours of medically necessary | 16 |
| support services needed to maintain the individual at home, | 17 |
| consideration shall be given to the availability of other | 18 |
| services, including direct care provided by the | 19 |
| individual's family or guardian that can reasonably be | 20 |
| expected to meet the medical needs of the individual. | 21 |
| (c) During the pilot program, an individual who has | 22 |
| received services pursuant to paragraph 7 of Section 5-2 of | 23 |
| this Code, but who no longer receives
receive such services | 24 |
| because he or she has reached the age of 21, may be provided | 25 |
| additional services pursuant to rule if the Department of Human | 26 |
| Services, Division of Rehabilitation Services, determines from |
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| completion of the assessment tool for that individual that the | 2 |
| exceptional care rate established by the Department of | 3 |
| Healthcare and Family Services under Section 5-5.8a of this | 4 |
| Code is not sufficient to cover the medical needs of the | 5 |
| individual under the home and community-based services (HCBS) | 6 |
| waivers for persons with disabilities. | 7 |
| (d) The Department of Human Services is authorized to lower | 8 |
| the payment levels established under this Section or take such | 9 |
| other actions, including, without limitation, cessation of | 10 |
| enrollment, reduction of available medical services, and | 11 |
| changing standards for eligibility, that are deemed necessary | 12 |
| by the Department during a State fiscal year to ensure that | 13 |
| payments under this Section do not exceed available funds. | 14 |
| These changes may be accomplished by emergency rulemaking under | 15 |
| Section 5-45 of the Illinois Administrative Procedure Act, | 16 |
| except that the limitation on the number of emergency rules | 17 |
| that may be adopted in a 24-month period shall not apply. | 18 |
| (e) The Department of Human Services must make an annual | 19 |
| report to the Governor and the General Assembly with respect to | 20 |
| the persons eligible for medical assistance under this pilot | 21 |
| program. The report must cover the State fiscal year ending on | 22 |
| June 30 of the preceding year. The first report is due by | 23 |
| January 1, 2008.
The report must include the following | 24 |
| information for the fiscal year covered by the report: | 25 |
| (1) The number of persons who were evaluated through | 26 |
| the assessment tool under this pilot program. |
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| (2) The number of persons who received services not | 2 |
| available under the home and community-based services | 3 |
| (HCBS) waivers for persons with disabilities under this | 4 |
| pilot program. | 5 |
| (3) The number of persons whose services were reduced | 6 |
| under this pilot program. | 7 |
| (4) The nature, scope, and cost of services provided | 8 |
| under this pilot program. | 9 |
| (5) The comparative costs of providing those services | 10 |
| in other institutions. | 11 |
| (6) The Department's progress in establishing an | 12 |
| objective, standardized assessment tool for the HCBS | 13 |
| waiver that assesses the medical needs of medically | 14 |
| fragile, technology-dependent adults. | 15 |
| (7) Recommendations for the funding needed to expand | 16 |
| this pilot program to all medically fragile, | 17 |
| technology-dependent individuals in HCBS waivers.
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| (8) Participant experience survey information for | 19 |
| persons with disabilities who are participating in this | 20 |
| pilot program and for persons with disabilities who are not | 21 |
| participating in this pilot program but who are currently | 22 |
| receiving services under the home and community-based | 23 |
| services (HCBS) waiver and who have received services under | 24 |
| paragraph 7 of Section 5-2 of this Code.
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| (Source: P.A. 94-838, eff. 6-6-06.)
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| Section 99. Effective date. This Act takes effect upon |
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| becoming law.
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