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Disability Services Committee
Adopted in House Comm. on Mar 14, 2007
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LRB095 09864 DRJ 33392 a |
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| AMENDMENT TO HOUSE BILL 982
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| AMENDMENT NO. ______. Amend House Bill 982 by replacing |
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| everything after the enacting clause with the following:
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| "Section 5. The Illinois Public Aid Code is amended by |
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| 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 |
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| conjunction with the Department of Human Services,
Public Aid
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| may offer, to children with developmental
disabilities or |
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| children with severe mental illness or severe emotional |
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| disorders
and severely mentally ill or emotionally disturbed |
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| children who
otherwise would not qualify for medical assistance |
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| under this Article due to
family income, home-based and |
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| community-based services instead of institutional
placement, |
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| as allowed under paragraph 7 of Section 5-2.
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LRB095 09864 DRJ 33392 a |
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| (b) The Department of Healthcare and Family Services
Public |
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| Aid , in conjunction with the Department of
Human Services and |
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| the Division of Specialized Care for Children, University of
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| Illinois-Chicago, shall submit a bi-annual
also
report to the |
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| Governor and the General Assembly no
later than January 1 of |
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| every even-numbered year beginning in 2008 , 2004 regarding the |
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| 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, |
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| 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 |
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| services.
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| (1)
(3) The number of persons who currently receive |
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| these services.
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| (2)
(4) The nature, scope, and cost of services |
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| provided under paragraph 7 of
Section 5-2 .
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| (3)
(5) The comparative cost of providing those |
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| services in a hospital,
skilled nursing facility, or |
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| intermediate care facility.
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| (4)
(6) The funding sources for the provision of |
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| services, including federal
financial participation.
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| (5)
(7) The qualifications, skills, and availability |
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| of caregivers for
children receiving services. |
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| (6) The number of children who have aged out of the |
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| services offered under paragraph 7 of Section 5-2 during |
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| the 2 years immediately preceding the report.
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LRB095 09864 DRJ 33392 a |
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| The report shall also include information regarding the |
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| extent to which the
existing programs could provide coverage |
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| for children with developmental disabilities or children with |
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| severe mental illness or severe emotional disorders
mentally |
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| disabled children who are
currently being provided services in |
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| an institution who could otherwise be
served in a |
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| 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 |
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| required by subsection (e) of Section 12-4.36 of this Code |
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| during the existence of the pilot program authorized by that |
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| 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) |
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| Sec. 12-4.36. Pilot program for persons who are medically |
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| fragile and technology-dependent. |
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| (a) Subject to appropriations for the first fiscal year of |
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| the pilot program beginning July 1, 2006, the Department of |
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| Human Services, in cooperation with the Department of |
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| Healthcare and Family Services, shall adopt rules to initiate a |
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| 3-year pilot program to (i) test a standardized assessment tool |
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| for persons who are medically fragile and technology-dependent |
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| who may be provided home and community-based services to meet |
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| their medical needs rather than be provided care in an |
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| institution not solely because of a severe mental or |
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| developmental impairment and (ii) provide appropriate home and |
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LRB095 09864 DRJ 33392 a |
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| community-based medical services for such persons as provided |
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| in subsection (c) of this Section. The Department of Human |
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| Services may administer the pilot program until June 30, 2010
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| 2009 if the General Assembly annually appropriates funds for |
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| this purpose. |
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| (b) Notwithstanding any other provisions of this Code, the |
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| rules implementing the pilot program shall provide for |
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| criteria, standards, procedures, and reimbursement for |
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| services that are not otherwise being provided in scope, |
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| duration, or amount through any other program administered by |
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| any Department of Human Services or any other agency of the |
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| State for these medically fragile, technology-dependent |
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| persons. At a minimum, the rules shall include the following: |
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| (1) A requirement that a pilot program participant be |
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| eligible for medical assistance under this Code, a citizen |
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| of the United States, or an individual who is lawfully |
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| residing permanently in the United States, and a resident |
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| of Illinois. |
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| (2) A requirement that a standardized assessment for |
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| medically fragile, technology-dependent persons will |
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| establish the level of care and the service-cost maximums. |
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| (3) A requirement for a determination by a physician |
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| licensed to practice medicine in all its branches (i) that, |
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| except for the provision of home and community-based care, |
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| these individuals would require the level of care provided |
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| in an institutional setting and (ii) that the necessary |
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LRB095 09864 DRJ 33392 a |
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| level of care can be provided safely in the home and |
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| community through the provision of medical support |
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| services. |
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| (4) A requirement that the services provided be |
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| medically necessary and appropriate for the level of |
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| functioning of the persons who are participating in the |
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| pilot program. |
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| (5) Provisions for care coordination and family |
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| support services that will enable the person to receive |
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| services in the most integrated setting possible |
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| appropriate to his or her medical condition and level of |
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| functioning. |
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| (6) The frequency of assessment and plan-of-care |
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| reviews. |
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| (7) The family or guardian's active participation as |
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| care givers in meeting the individual's medical needs. |
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| (8) The estimated cost to the State for in-home care, |
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| as compared to the institutional level of care appropriate |
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| to the individual's medical needs, may not exceed 100% of |
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| the institutional care as indicated by the standardized |
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| assessment tool. |
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| (9) When determining the hours of medically necessary |
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| support services needed to maintain the individual at home, |
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| consideration shall be given to the availability of other |
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| services, including direct care provided by the |
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| individual's family or guardian that can reasonably be |
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| expected to meet the medical needs of the individual. |
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| (c) During the pilot program, an individual who has |
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| received services pursuant to paragraph 7 of Section 5-2 of |
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| this Code, but who no longer receives
receive such services |
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| because he or she has reached the age of 21, may be provided |
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| additional services pursuant to rule if the Department of Human |
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| Services, Division of Rehabilitation Services, determines from |
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| completion of the assessment tool for that individual that the |
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| exceptional care rate established by the Department of |
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| Healthcare and Family Services under Section 5-5.8a of this |
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| Code is not sufficient to cover the medical needs of the |
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| individual under the home and community-based services (HCBS) |
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| waivers for persons with disabilities. |
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| (d) The Department of Human Services is authorized to lower |
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| the payment levels established under this Section or take such |
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| other actions, including, without limitation, cessation of |
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| enrollment, reduction of available medical services, and |
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| changing standards for eligibility, that are deemed necessary |
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| by the Department during a State fiscal year to ensure that |
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| payments under this Section do not exceed available funds. |
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| These changes may be accomplished by emergency rulemaking under |
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| Section 5-45 of the Illinois Administrative Procedure Act, |
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| except that the limitation on the number of emergency rules |
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| that may be adopted in a 24-month period shall not apply. |
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| (e) The Department of Human Services must make an annual |
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| report to the Governor and the General Assembly with respect to |
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LRB095 09864 DRJ 33392 a |
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| the persons eligible for medical assistance under this pilot |
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| program. The report must cover the State fiscal year ending on |
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| June 30 of the preceding year. The first report is due by |
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| January 1, 2008.
The report must include the following |
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| information for the fiscal year covered by the report: |
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| (1) The number of persons who were evaluated through |
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| the assessment tool under this pilot program. |
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| (2) The number of persons who received services not |
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| available under the home and community-based services |
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| (HCBS) waivers for persons with disabilities under this |
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| pilot program. |
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| (3) The number of persons whose services were reduced |
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| under this pilot program. |
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| (4) The nature, scope, and cost of services provided |
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| under this pilot program. |
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| (5) The comparative costs of providing those services |
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| in other institutions. |
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| (6) The Department's progress in establishing an |
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| objective, standardized assessment tool for the HCBS |
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| waiver that assesses the medical needs of medically |
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| fragile, technology-dependent adults. |
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| (7) Recommendations for the funding needed to expand |
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| this pilot program to all medically fragile, |
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| technology-dependent individuals in HCBS waivers.
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| (8) Participant experience survey information for |
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| persons with disabilities who are participating in this |
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LRB095 09864 DRJ 33392 a |
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| pilot program and for persons with disabilities who are not |
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| participating in this pilot program but who are currently |
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| receiving services under the home and community-based |
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| services (HCBS) waiver and who have received services under |
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| 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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