Full Text of SB0765 95th General Assembly
SB0765sam003 95TH GENERAL ASSEMBLY
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Sen. M. Maggie Crotty
Filed: 3/27/2007
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| AMENDMENT TO SENATE BILL 765
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| AMENDMENT NO. ______. Amend Senate Bill 765, AS AMENDED, by | 3 |
| replacing everything after the enacting clause with the | 4 |
| following:
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| "Section 5. The Disabilities Services Act of 2003 is | 6 |
| amended by adding a heading to Article 1 immediately before | 7 |
| Section 1 of the Act, by adding a heading to Article 2 | 8 |
| immediately before Section 5 of the Act, by adding Article 3 | 9 |
| and a heading to Article 99 immediately after Section 30 of the | 10 |
| Act as follows: | 11 |
| (20 ILCS 2407/Art. 1 heading new) | 12 |
| ARTICLE 1. SHORT TITLE | 13 |
| (20 ILCS 2407/Art. 2 heading new) | 14 |
| ARTICLE 2. DISABILITIES SERVICES ACT of 2003 |
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| (20 ILCS 2407/Art. 3 heading new) | 2 |
| ARTICLE 3. OLMSTEAD IMPLEMENTATION ACT | 3 |
| (20 ILCS 2407/51 new)
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| Sec. 51. Legislative intent. It is the intent of the | 5 |
| General Assembly to promote the civil rights of persons with | 6 |
| disabilities by providing community-based services for persons | 7 |
| with disabilities when such services are determined | 8 |
| appropriate and desired by the affected persons, as required by | 9 |
| Title II of the Americans with Disabilities Act under the | 10 |
| United States Supreme Court's decision in Olmstead v. L.C., 527 | 11 |
| U.S. 581 (1999). In accordance with Section 6071 of the Deficit | 12 |
| Reduction Act of 2005 (P.L. 109-171), the purpose of this Act | 13 |
| is: (i) to eliminate barriers or mechanisms, whether in State | 14 |
| law, the State Medicaid plan, the State budget, or otherwise, | 15 |
| that prevent or restrict the flexible use of funds to enable | 16 |
| individuals with disabilities to receive support for | 17 |
| appropriate and necessary long-term services in settings of | 18 |
| their choice; (ii) to increase the use of home and | 19 |
| community-based, rather than institutional, long-term care | 20 |
| services; (iii) to increase the ability of the State Medicaid | 21 |
| program to assure continued provision of home and | 22 |
| community-based long-term care service to eligible individuals | 23 |
| who choose to transition from an institutional to a community | 24 |
| setting; and (iv) to ensure that procedures are in place to |
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| provide quality assurance for eligible individuals receiving | 2 |
| Medicaid home and community-based long-term care services and | 3 |
| to provide for continuous quality improvement in such services. | 4 |
| More specifically, this Article amends the Disabilities | 5 |
| Services Act of 2003 (notwithstanding Section 30 of the Act) to | 6 |
| mandate the creation of a flexible system of financing for | 7 |
| long-term services and supports in Illinois that would allow | 8 |
| available Medicaid funds to be spent on home and | 9 |
| community-based services when an individual residing in an | 10 |
| institution moves to the most appropriate and preferred | 11 |
| community-based setting of his or her choice. | 12 |
| (20 ILCS 2407/52 new)
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| Sec. 52. Applicability; definitions. In accordance with | 14 |
| section 6071 of the Deficit Reduction Act of 2005 (P.L. | 15 |
| 109-171), as used in this Article: | 16 |
| "Home and community-based long-term care services". The | 17 |
| term "home and community-based long-term care services" means, | 18 |
| with respect to a State Medicaid program, a service aid, or | 19 |
| benefit, home and community-based services (including home | 20 |
| health and personal care services) that are provided to a | 21 |
| person with a disability (and are voluntarily accepted), as | 22 |
| part of his or her long-term care that: (i) is provided under | 23 |
| the State's qualified HCB program or that could be provided | 24 |
| under such a program but is otherwise provided under the | 25 |
| Medicaid program; (ii) is delivered in a qualified residence; |
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| and (iii) is necessary for the person with a disability to live | 2 |
| in the community. | 3 |
| "Departments". The term "Departments" means for the | 4 |
| purposes of this Act, the Department of Human Services, the | 5 |
| Department on Aging, Department of Children and Family | 6 |
| Services, Department of Healthcare and Family Services and | 7 |
| Department of Public Health, unless otherwise noted. | 8 |
| "Eligible Individual". The term "eligible individual" | 9 |
| means a person of any age in Illinois who (i) has resided, for | 10 |
| a period of not less than 6 months, in an inpatient facility; | 11 |
| (ii) is receiving Medicaid benefits for inpatient services | 12 |
| furnished by the inpatient facility; (iii) with respect to whom | 13 |
| a determination has been made that, but for the provision of | 14 |
| home and community-based long-term care services, the | 15 |
| individual would continue to require the level of care provided | 16 |
| in an inpatient facility; (iv) who is deemed appropriate by the | 17 |
| inter-disciplinary team for home or community-based services; | 18 |
| and (v) who wants to transfer from an inpatient facility to a | 19 |
| qualified residence. For the purposes of this Act, "eligible | 20 |
| individual" does not include a person with a disability | 21 |
| receiving acute care mental health treatment in a | 22 |
| State-operated mental health center for less than 30 | 23 |
| consecutive days in a one-year period, or a person committed to | 24 |
| a State-operated mental health forensic program, or | 25 |
| developmental center forensic program. | 26 |
| "Inpatient facility". The term "inpatient facility" means |
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| a skilled nursing or intermediate long-term care facility | 2 |
| subject to licensure by the Department of Public Health under | 3 |
| the Nursing Home Care Act, an intermediate care facility for | 4 |
| the developmentally disabled (ICF-DDs), an institution for | 5 |
| mental diseases, child care institutions licensed by the | 6 |
| Department of Children and Family Services, any community | 7 |
| living facility as defined in the Community Living Facilities | 8 |
| Licensing Act (210 ILCS 35), any community residential | 9 |
| alternative as defined in the Community Residential | 10 |
| Alternatives Licensing Act (405 ILCS 30), any Supportive Living | 11 |
| Facility as provided in the Public Aid Code (305 ILCS | 12 |
| 5/5-5.01a), and a State-operated developmental center or | 13 |
| mental health center, whether publicly or privately owned. | 14 |
| "Interdisciplinary team" means a group of persons that | 15 |
| represents those professions, disciplines, or service areas | 16 |
| that are relevant to identifying an individual's strengths and | 17 |
| needs, and designs a program to meet those needs. This team | 18 |
| shall include at least a physician, a social worker, other | 19 |
| professionals, and the individual. In intermediate care | 20 |
| facilities for the developmentally disabled (ICF/DDs) at least | 21 |
| one member of the team shall be a qualified mental retardation | 22 |
| professional. The interdisciplinary team includes the | 23 |
| individual, the individual's guardian, the individual's | 24 |
| authorized representative, the individual's primary service | 25 |
| providers, including staff most familiar with the individual's | 26 |
| needs. The individual or his or her guardian may also invite |
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| other individuals to meet with the interdisciplinary team and | 2 |
| participate in the process of identifying the individual's | 3 |
| strengths and needs. | 4 |
| "Qualified residence". The term "qualified residence" | 5 |
| means, with respect to an eligible individual: (i) a home owned | 6 |
| or leased by the individual or the individual's authorized | 7 |
| representative (as defined by P.L. 109-171); (ii) an apartment | 8 |
| with an individual lease, with lockable access and egress, and | 9 |
| which includes living, sleeping, bathing, and cooking areas | 10 |
| over which the individual or the individual's family has domain | 11 |
| and control; and (iii) a residence, in a community-based | 12 |
| residential setting, in which no more than 4 unrelated | 13 |
| individuals reside. | 14 |
| "Self-directed services". The term "self-directed | 15 |
| services" means, with respect to home and community-based | 16 |
| long-term care services for an eligible individual, those | 17 |
| services for the individual that are planned and purchased | 18 |
| under the direction and control of the individual or the | 19 |
| individual's authorized representative, including the amount, | 20 |
| duration, scope, provider, and location of such services, under | 21 |
| the State Medicaid program consistent with the following | 22 |
| requirements: | 23 |
| (a) Assessment: there is an assessment of the needs,
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| capabilities, and preferences of the individual with | 25 |
| respect to such services.
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| (b) Service plan: based on the assessment, there is |
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| developed
jointly with such individual or the individual's | 2 |
| authorized representative, a plan for such services for the | 3 |
| individual that is approved by the State and that (i) | 4 |
| specifies those services, if any, that the individual or | 5 |
| the individual's authorized representative would be | 6 |
| responsible for directing; (ii) identifies the methods by | 7 |
| which the individual or the individual's authorized | 8 |
| representative or an agency designated by an individual or | 9 |
| representative will select, manage, and dismiss providers | 10 |
| of such services.
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| "Public Funds" means any funds appropriated by the General | 12 |
| Assembly to
the Department of Human Services, the Department on | 13 |
| Aging, the Department of Children and Family Services, or the | 14 |
| Department of Healthcare and Family Services. | 15 |
| (20 ILCS 2407/53 new)
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| Sec. 53. Allocation of public funds. | 17 |
| (a) Any eligible individual, as defined in Section 52, has | 18 |
| the right to have
an amount equal to the amount of public funds | 19 |
| that are, or would have been, expended for his or her care in | 20 |
| an inpatient facility available to pay for his or her home and | 21 |
| community-based long-term care services in a qualified | 22 |
| residence. | 23 |
| (b) In accordance with Sections 15(2) and 20(b)(2) of this | 24 |
| Act, all eligible individuals under this Act shall have an | 25 |
| individual service or treatment plan that is reviewed by the |
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| individual treatment professionals at least annually that is | 2 |
| consistent with the requirements under subparts (A) and (B) of | 3 |
| item 8 of subsection (b) of the Deficit Reduction Act of 2005 | 4 |
| (P.L. 109-171), and that includes an individualized budget that | 5 |
| identifies the dollar value of the services consistent with the | 6 |
| requirements under subsection (b)(8)(C) of section 6071 and | 7 |
| supports under the control and direction of the individual or | 8 |
| the individual's authorized representative. The service or | 9 |
| treatment plan must contain assurances that each eligible | 10 |
| individual has been provided the opportunity to make an | 11 |
| informed choice regarding their right under subsection (a). | 12 |
| (c) In accordance with any disability services plan or plan | 13 |
| update under
this Act and section 6071 of the Deficit Reduction | 14 |
| Act of 2005 (P.L. 109-171), the Departments shall develop | 15 |
| appropriate fiscal payment mechanisms and methodologies, by | 16 |
| December 1, 2008, that effectively support choice and eliminate | 17 |
| any legal, budgetary, or other barriers to flexibility in the | 18 |
| availability of Medicaid funds to pay for long-term care | 19 |
| services for individuals in the appropriate home and | 20 |
| community-based long-term care settings of their choice, | 21 |
| including costs to transition from an inpatient facility to a | 22 |
| qualified residence. As part of this process, the Department of | 23 |
| Human Services, Division of Developmental Disabilities shall | 24 |
| review its Intermediate Care Facility for Developmental | 25 |
| Disabilities (ICF/DD) downsizing rate methodology. During its | 26 |
| review, the Division shall confer and consult with community |
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| stakeholders including individuals and entities who utilize or | 2 |
| provide ICF/DD, CILA, and other services alternatives, those | 3 |
| who advocate for individuals with developmental disabilities, | 4 |
| and other State agencies having financial or regulatory roles | 5 |
| involving these facilities. The Division shall consider and | 6 |
| develop proposals and strategies that could provide incentives | 7 |
| to reduction, downsizing, closure, or conversion of ICFs/DDs, | 8 |
| such as changes in formulas and methodology, changes in the | 9 |
| provider tax, funding levels, procedures for the determination | 10 |
| of downsizing rates, and financing opportunities and programs | 11 |
| to support conversions, or alternative uses, or both, of | 12 |
| facilities. The Division shall develop a report by December 1, | 13 |
| 2007. As appropriate, the Division shall develop estimates of | 14 |
| the implementation costs of proposed strategies and | 15 |
| incentives. With respect to the individualized budgets | 16 |
| described in subsection (b), the fiscal payment mechanisms and | 17 |
| methodologies must: (i) describe the method for calculating the | 18 |
| dollar values in such budgets based on reliable costs and | 19 |
| service utilization; (ii) define a process for making | 20 |
| adjustments in such dollar values to reflect changes in | 21 |
| individual assessments and service plans; and (iii) provide a | 22 |
| procedure to evaluate expenditures under such budgets. | 23 |
| (d) The cost of home and community-based long-term care | 24 |
| services provided under this Act shall be funded in accordance | 25 |
| with the individual service or treatment plan, but shall not | 26 |
| exceed 60% of the weighted average (weighted by Medicaid |
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| patient days) inpatient facility rates for the geographic | 2 |
| grouping, by licensure category. Each qualified residence | 3 |
| shall be paid 60% of the weighted average inpatient facility | 4 |
| geographic group rate, based upon the inpatient facility | 5 |
| geographic group in which it is located. The rates paid to | 6 |
| qualified residences shall be reviewed semi-annually, and | 7 |
| adjusted, if necessary, on April 1 and October 1 to assure that | 8 |
| the rates coincide with 60% of weighted average inpatient | 9 |
| facility geographic group's rates. | 10 |
| (e) In addition to Section 4.4 of the Community Services | 11 |
| Act of 2004 (P.A. 094-0498), whenever any appropriation, or any | 12 |
| portion of any appropriation, for any fiscal year related to | 13 |
| the funding of an inpatient facility is reduced due to the | 14 |
| redistribution of funds under this Act, to the extent that | 15 |
| savings are realized, those moneys must be deposited into the | 16 |
| Olmstead Implementation Fund, created as a special fund in the | 17 |
| State treasury, and shall be used to expand the availability, | 18 |
| quality, or stability of home and community-based long-term | 19 |
| care services and supports for persons with disabilities (such | 20 |
| as in-home consumer/family supports; integrated, accessible, | 21 |
| and affordable housing options and home modifications; etc.). | 22 |
| (f) The allocation of public funds for home and | 23 |
| community-based long-term care services shall not have the | 24 |
| effect of: (i) diminishing or reducing the quality of services | 25 |
| available to residents of inpatient facilities; (ii) forcing | 26 |
| any residents of inpatient facilities to involuntarily accept |
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| home and community-based long-term care services, or causing | 2 |
| any residents of inpatient facilities to be involuntarily | 3 |
| transferred or discharged; (iii) causing reductions in | 4 |
| inpatient facility reimbursement rates in effect as of July 1, | 5 |
| 2008; or (iv) causing any delay of inpatient facility payments. | 6 |
| If an eligible individual moves to a qualified residence and | 7 |
| determines it is not the appropriate or preferred setting, they | 8 |
| remain entitled to return to an inpatient facility under Title | 9 |
| XIX of the Social Security Act (42 U.S.C §1396a(a)(10)(A), | 10 |
| §1396d(a)(15), §1396a(a)(1). | 11 |
| (g) Funding for eligible individuals under this Act shall | 12 |
| remain available to the eligible individual, in accordance with | 13 |
| the individual service or treatment plan, as long as he or she | 14 |
| remains eligible for services in an inpatient facility and | 15 |
| prefers home and community-based long-term care services.
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| (20 ILCS 2407/54 new)
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| Sec. 54. Quality assurance and quality improvement. | 18 |
| (a) In accordance with subsection (c) (11) of section 6071 | 19 |
| of the Deficit Reduction Act of 2005 (P.L. 109-171), the | 20 |
| Departments shall develop a plan for quality assurance and | 21 |
| quality improvement for home and community-based long-term | 22 |
| care services under the State Medicaid program, including a | 23 |
| regulatory plan to assure the health and welfare of eligible | 24 |
| individuals under this Act. | 25 |
| (b) This plan shall require the Departments to apply for |
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| any available federal strategic planning and implementation | 2 |
| funding to carry out the intent of this legislation, and to | 3 |
| seek any appropriate Federal Medicaid waivers to maximize | 4 |
| Federal financial participation.
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| (20 ILCS 2407/55 new)
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| Sec. 55. Dissemination of information; reports. | 7 |
| (a) The State shall ensure that all eligible individuals | 8 |
| are informed of their right to receive home and community-based | 9 |
| long-term care services under this Act. The Departments shall | 10 |
| work together with organizations comprised of, or representing | 11 |
| people with disabilities and providers of Medicaid acute and | 12 |
| long-term care services, to ensure that persons with | 13 |
| disabilities and their families, guardians, and advocates are | 14 |
| informed of their rights under this Act in a manner that is | 15 |
| easily understandable and accessible to people with | 16 |
| disabilities. The Departments shall ensure that multiple | 17 |
| methods of dissemination are employed and shall make concerted | 18 |
| efforts to inform people currently in inpatient facilities, | 19 |
| including at their individual team or program meetings. The | 20 |
| Department of Public Health shall ensure that, as a condition | 21 |
| of licensing and certification, all inpatient facilities | 22 |
| covered under this Act shall inform all residents annually of | 23 |
| their opportunities to choose home and community alternatives | 24 |
| under this Act. Additionally, the Department shall require each | 25 |
| inpatient facility to post in a prominent location a notice |
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| containing information on rights and services available under | 2 |
| this Act. Notices posted shall comply with the accessibility | 3 |
| standards of the Americans with Disabilities Act. | 4 |
| (b) On or before April 1 of each year, in conjunction with | 5 |
| their annual reports, the Departments shall report to the | 6 |
| Governor and the General Assembly on the implementation of this | 7 |
| Act and include, at a minimum, the following data; (i) a | 8 |
| description of the fiscal payment mechanisms and methodologies | 9 |
| developed under this Act that effectively support choice (money | 10 |
| follows the person); (ii) an accounting of the savings realized | 11 |
| under this Act and the ways in which these savings were spent; | 12 |
| (iii) information concerning the dollar amounts of State | 13 |
| Medicaid expenditures for fiscal years 2006 and 2007, for | 14 |
| long-term care services and the percentage of such expenditures | 15 |
| that were for institutional long-term care services or were for | 16 |
| home and community-based long-term care services; (iv) a | 17 |
| description of the Departments' efforts to inform all eligible | 18 |
| individuals of their rights under this Act; (v) the number of | 19 |
| eligible individuals referred or identified under this Act in | 20 |
| the previous fiscal year, the number of eligible individuals | 21 |
| who applied to transfer to home and community-based long-term | 22 |
| care services in the previous fiscal year, and the number of | 23 |
| eligible individuals who, in fact, transferred from an | 24 |
| inpatient facility to a qualified residence in the previous | 25 |
| fiscal year; (vi) documentation that the Departments have met | 26 |
| the requirements under Section 5 to assure the health and |
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| welfare of eligible individuals receiving home and | 2 |
| community-based long-term care services; and (vii) any | 3 |
| obstacles the Departments confronted in assisting residents of | 4 |
| inpatient facilities to make the transition to a qualified | 5 |
| residence, and the Departments' recommendations for removing | 6 |
| those obstacles. This report must be made available to the | 7 |
| general public, including via the Departments' websites.
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| (20 ILCS 2407/56 new)
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| Sec. 56. Effect on existing rights. | 10 |
| (a) This Article does not alter or affect the manner in | 11 |
| which persons with disabilities are determined eligible or | 12 |
| appropriate for home and community-based long-term care | 13 |
| services, except to the extent the determinations are based on | 14 |
| the availability of community services. | 15 |
| (b) This Article shall not be read to limit in any way the | 16 |
| rights of people with disabilities under the U.S. Constitution, | 17 |
| the Americans with Disabilities Act, Section 504 of the | 18 |
| Rehabilitation Act, the Social Security Act, or any other | 19 |
| federal or State law.
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| (20 ILCS 2407/57 new)
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| Sec. 57. Rules. The Departments shall adopt any rules | 22 |
| necessary for the implementation and administration of this Act | 23 |
| within 6 months of the effective date of this Act. |
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| (20 ILCS 2407/58 new)
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| Sec. 58. Service provider cost reporting and | 3 |
| accountability. The Departments shall adopt any rules | 4 |
| necessary for the implementation of service provider cost | 5 |
| reporting to ensure accountability under this Act within 6 | 6 |
| months of the effective date of this Act.
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| (20 ILCS 2407/Art. 99 heading new)
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| ARTICLE 99. AMENDATORY PROVISIONS; EFFECTIVE DATE
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| Section 90. The State Finance Act is amended by adding | 10 |
| Section 5.675 as follows: | 11 |
| (30 ILCS 105/5.675 new) | 12 |
| Sec. 5.675. The Olmstead Implementation Fund.
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| Section 99. Effective date. This Act takes effect July 1, | 14 |
| 2008.".
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