Illinois General Assembly - Full Text of HB5380
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Full Text of HB5380  98th General Assembly

HB5380ham001 98TH GENERAL ASSEMBLY

Rep. Rita Mayfield

Filed: 3/17/2014

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5380

2    AMENDMENT NO. ______. Amend House Bill 5380 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
 
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements. Such
14preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not

 

 

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1limited to, any or all of the following:
2        (a) (blank);
3        (b) (blank);
4        (c) home care aide services;
5        (d) personal assistant services;
6        (e) adult day services;
7        (f) home-delivered meals;
8        (g) education in self-care;
9        (h) personal care services;
10        (i) adult day health services;
11        (j) habilitation services;
12        (k) respite care;
13        (k-5) community reintegration services;
14        (k-6) flexible senior services;
15        (k-7) medication management;
16        (k-8) emergency home response;
17        (l) other nonmedical social services that may enable
18    the person to become self-supporting; or
19        (m) clearinghouse for information provided by senior
20    citizen home owners who want to rent rooms to or share
21    living space with other senior citizens.
22    The Department shall establish eligibility standards for
23such services. In determining the amount and nature of services
24for which a person may qualify, consideration shall not be
25given to the value of cash, property or other assets held in
26the name of the person's spouse pursuant to a written agreement

 

 

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1dividing marital property into equal but separate shares or
2pursuant to a transfer of the person's interest in a home to
3his spouse, provided that the spouse's share of the marital
4property is not made available to the person seeking such
5services.
6    Beginning January 1, 2008, the Department shall require as
7a condition of eligibility that all new financially eligible
8applicants apply for and enroll in medical assistance under
9Article V of the Illinois Public Aid Code in accordance with
10rules promulgated by the Department.
11    The Department shall, in conjunction with the Department of
12Public Aid (now Department of Healthcare and Family Services),
13seek appropriate amendments under Sections 1915 and 1924 of the
14Social Security Act. The purpose of the amendments shall be to
15extend eligibility for home and community based services under
16Sections 1915 and 1924 of the Social Security Act to persons
17who transfer to or for the benefit of a spouse those amounts of
18income and resources allowed under Section 1924 of the Social
19Security Act. Subject to the approval of such amendments, the
20Department shall extend the provisions of Section 5-4 of the
21Illinois Public Aid Code to persons who, but for the provision
22of home or community-based services, would require the level of
23care provided in an institution, as is provided for in federal
24law. Those persons no longer found to be eligible for receiving
25noninstitutional services due to changes in the eligibility
26criteria shall be given 45 days notice prior to actual

 

 

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1termination. Those persons receiving notice of termination may
2contact the Department and request the determination be
3appealed at any time during the 45 day notice period. The
4target population identified for the purposes of this Section
5are persons age 60 and older with an identified service need.
6Priority shall be given to those who are at imminent risk of
7institutionalization. The services shall be provided to
8eligible persons age 60 and older to the extent that the cost
9of the services together with the other personal maintenance
10expenses of the persons are reasonably related to the standards
11established for care in a group facility appropriate to the
12person's condition. These non-institutional services, pilot
13projects or experimental facilities may be provided as part of
14or in addition to those authorized by federal law or those
15funded and administered by the Department of Human Services.
16The Departments of Human Services, Healthcare and Family
17Services, Public Health, Veterans' Affairs, and Commerce and
18Economic Opportunity and other appropriate agencies of State,
19federal and local governments shall cooperate with the
20Department on Aging in the establishment and development of the
21non-institutional services. The Department shall require an
22annual audit from all personal assistant and home care aide
23vendors contracting with the Department under this Section. The
24annual audit shall assure that each audited vendor's procedures
25are in compliance with Department's financial reporting
26guidelines requiring an administrative and employee wage and

 

 

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1benefits cost split as defined in administrative rules. The
2audit is a public record under the Freedom of Information Act.
3The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department of Healthcare
6and Family Services, to effect the following: (1) intake
7procedures and common eligibility criteria for those persons
8who are receiving non-institutional services; and (2) the
9establishment and development of non-institutional services in
10areas of the State where they are not currently available or
11are undeveloped. On and after July 1, 1996, all nursing home
12prescreenings for individuals 60 years of age or older shall be
13conducted by the Department.
14    As part of the Department on Aging's routine training of
15case managers and case manager supervisors, the Department may
16include information on family futures planning for persons who
17are age 60 or older and who are caregivers of their adult
18children with developmental disabilities. The content of the
19training shall be at the Department's discretion.
20    The Department is authorized to establish a system of
21recipient copayment for services provided under this Section,
22such copayment to be based upon the recipient's ability to pay
23but in no case to exceed the actual cost of the services
24provided. Additionally, any portion of a person's income which
25is equal to or less than the federal poverty standard shall not
26be considered by the Department in determining the copayment.

 

 

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1The level of such copayment shall be adjusted whenever
2necessary to reflect any change in the officially designated
3federal poverty standard.
4    The Department, or the Department's authorized
5representative, may recover the amount of moneys expended for
6services provided to or in behalf of a person under this
7Section by a claim against the person's estate or against the
8estate of the person's surviving spouse, but no recovery may be
9had until after the death of the surviving spouse, if any, and
10then only at such time when there is no surviving child who is
11under age 21, blind, or permanently and totally disabled. This
12paragraph, however, shall not bar recovery, at the death of the
13person, of moneys for services provided to the person or in
14behalf of the person under this Section to which the person was
15not entitled; provided that such recovery shall not be enforced
16against any real estate while it is occupied as a homestead by
17the surviving spouse or other dependent, if no claims by other
18creditors have been filed against the estate, or, if such
19claims have been filed, they remain dormant for failure of
20prosecution or failure of the claimant to compel administration
21of the estate for the purpose of payment. This paragraph shall
22not bar recovery from the estate of a spouse, under Sections
231915 and 1924 of the Social Security Act and Section 5-4 of the
24Illinois Public Aid Code, who precedes a person receiving
25services under this Section in death. All moneys for services
26paid to or in behalf of the person under this Section shall be

 

 

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1claimed for recovery from the deceased spouse's estate.
2"Homestead", as used in this paragraph, means the dwelling
3house and contiguous real estate occupied by a surviving spouse
4or relative, as defined by the rules and regulations of the
5Department of Healthcare and Family Services, regardless of the
6value of the property.
7    The Department shall increase the effectiveness of the
8existing Community Care Program by:
9        (1) ensuring that in-home services included in the care
10    plan are available on evenings and weekends;
11        (2) ensuring that care plans contain the services that
12    eligible participants need based on the number of days in a
13    month, not limited to specific blocks of time, as
14    identified by the comprehensive assessment tool selected
15    by the Department for use statewide, not to exceed the
16    total monthly service cost maximum allowed for each
17    service; the Department shall develop administrative rules
18    to implement this item (2);
19        (3) ensuring that the participants have the right to
20    choose the services contained in their care plan and to
21    direct how those services are provided, based on
22    administrative rules established by the Department;
23        (4) ensuring that the determination of need tool is
24    accurate in determining the participants' level of need; to
25    achieve this, the Department, in conjunction with the Older
26    Adult Services Advisory Committee, shall institute a study

 

 

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1    of the relationship between the Determination of Need
2    scores, level of need, service cost maximums, and the
3    development and utilization of service plans no later than
4    May 1, 2008; findings and recommendations shall be
5    presented to the Governor and the General Assembly no later
6    than January 1, 2009; recommendations shall include all
7    needed changes to the service cost maximums schedule and
8    additional covered services;
9        (5) ensuring that homemakers can provide personal care
10    services that may or may not involve contact with clients,
11    including but not limited to:
12            (A) bathing;
13            (B) grooming;
14            (C) toileting;
15            (D) nail care;
16            (E) transferring;
17            (F) respiratory services;
18            (G) exercise; or
19            (H) positioning;
20        (6) ensuring that homemaker program vendors are not
21    restricted from hiring homemakers who are family members of
22    clients or recommended by clients; the Department may not,
23    by rule or policy, require homemakers who are family
24    members of clients or recommended by clients to accept
25    assignments in homes other than the client;
26        (7) ensuring that the State may access maximum federal

 

 

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1    matching funds by seeking approval for the Centers for
2    Medicare and Medicaid Services for modifications to the
3    State's home and community based services waiver and
4    additional waiver opportunities, including applying for
5    enrollment in the Balance Incentive Payment Program by May
6    1, 2013, in order to maximize federal matching funds; this
7    shall include, but not be limited to, modification that
8    reflects all changes in the Community Care Program services
9    and all increases in the services cost maximum;
10        (8) ensuring that the determination of need tool
11    accurately reflects the service needs of individuals with
12    Alzheimer's disease and related dementia disorders;
13        (9) ensuring that services are authorized accurately
14    and consistently for the Community Care Program (CCP); the
15    Department shall implement a Service Authorization policy
16    directive; the purpose shall be to ensure that eligibility
17    and services are authorized accurately and consistently in
18    the CCP program; the policy directive shall clarify service
19    authorization guidelines to Care Coordination Units and
20    Community Care Program providers no later than May 1, 2013;
21        (10) working in conjunction with Care Coordination
22    Units, the Department of Healthcare and Family Services,
23    the Department of Human Services, Community Care Program
24    providers, and other stakeholders to make improvements to
25    the Medicaid claiming processes and the Medicaid
26    enrollment procedures or requirements as needed,

 

 

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1    including, but not limited to, specific policy changes or
2    rules to improve the up-front enrollment of participants in
3    the Medicaid program and specific policy changes or rules
4    to insure more prompt submission of bills to the federal
5    government to secure maximum federal matching dollars as
6    promptly as possible; the Department on Aging shall have at
7    least 3 meetings with stakeholders by January 1, 2014 in
8    order to address these improvements;
9        (11) requiring home care service providers to comply
10    with the rounding of hours worked provisions under the
11    federal Fair Labor Standards Act (FLSA) and as set forth in
12    29 CFR 785.48(b) by May 1, 2013;
13        (12) implementing any necessary policy changes or
14    promulgating any rules, no later than January 1, 2014, to
15    assist the Department of Healthcare and Family Services in
16    moving as many participants as possible, consistent with
17    federal regulations, into coordinated care plans if a care
18    coordination plan that covers long term care is available
19    in the recipient's area; and
20        (13) maintaining fiscal year 2014 rates at the same
21    level established on January 1, 2013.
22    By January 1, 2009 or as soon after the end of the Cash and
23Counseling Demonstration Project as is practicable, the
24Department may, based on its evaluation of the demonstration
25project, promulgate rules concerning personal assistant
26services, to include, but need not be limited to,

 

 

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1qualifications, employment screening, rights under fair labor
2standards, training, fiduciary agent, and supervision
3requirements. All applicants shall be subject to the provisions
4of the Health Care Worker Background Check Act.
5    The Department shall develop procedures to enhance
6availability of services on evenings, weekends, and on an
7emergency basis to meet the respite needs of caregivers.
8Procedures shall be developed to permit the utilization of
9services in successive blocks of 24 hours up to the monthly
10maximum established by the Department. Workers providing these
11services shall be appropriately trained.
12    Beginning on the effective date of this Amendatory Act of
131991, no person may perform chore/housekeeping and home care
14aide services under a program authorized by this Section unless
15that person has been issued a certificate of pre-service to do
16so by his or her employing agency. Information gathered to
17effect such certification shall include (i) the person's name,
18(ii) the date the person was hired by his or her current
19employer, and (iii) the training, including dates and levels.
20Persons engaged in the program authorized by this Section
21before the effective date of this amendatory Act of 1991 shall
22be issued a certificate of all pre- and in-service training
23from his or her employer upon submitting the necessary
24information. The employing agency shall be required to retain
25records of all staff pre- and in-service training, and shall
26provide such records to the Department upon request and upon

 

 

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1termination of the employer's contract with the Department. In
2addition, the employing agency is responsible for the issuance
3of certifications of in-service training completed to their
4employees.
5    The Department is required to develop a system to ensure
6that persons working as home care aides and personal assistants
7receive increases in their wages when the federal minimum wage
8is increased by requiring vendors to certify that they are
9meeting the federal minimum wage statute for home care aides
10and personal assistants. An employer that cannot ensure that
11the minimum wage increase is being given to home care aides and
12personal assistants shall be denied any increase in
13reimbursement costs. On July 1, 2014, rates shall be increased
14to $18.84 for the purpose of increasing, by at least $1.00 per
15hour, the wages paid by those vendors to their employees who
16provide homemaker services. The Department shall pay an
17enhanced rate under the Community Care Program to those in-home
18service provider agencies that offer health insurance coverage
19as a benefit to their direct service worker employees
20consistent with the mandates of Public Act 95-713. For State
21fiscal year 2015, the enhanced rate shall be $1.77 per hour.
22    The Community Care Program Advisory Committee is created in
23the Department on Aging. The Director shall appoint individuals
24to serve in the Committee, who shall serve at their own
25expense. Members of the Committee must abide by all applicable
26ethics laws. The Committee shall advise the Department on

 

 

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1issues related to the Department's program of services to
2prevent unnecessary institutionalization. The Committee shall
3meet on a bi-monthly basis and shall serve to identify and
4advise the Department on present and potential issues affecting
5the service delivery network, the program's clients, and the
6Department and to recommend solution strategies. Persons
7appointed to the Committee shall be appointed on, but not
8limited to, their own and their agency's experience with the
9program, geographic representation, and willingness to serve.
10The Director shall appoint members to the Committee to
11represent provider, advocacy, policy research, and other
12constituencies committed to the delivery of high quality home
13and community-based services to older adults. Representatives
14shall be appointed to ensure representation from community care
15providers including, but not limited to, adult day service
16providers, homemaker providers, case coordination and case
17management units, emergency home response providers, statewide
18trade or labor unions that represent home care aides and direct
19care staff, area agencies on aging, adults over age 60,
20membership organizations representing older adults, and other
21organizational entities, providers of care, or individuals
22with demonstrated interest and expertise in the field of home
23and community care as determined by the Director.
24    Nominations may be presented from any agency or State
25association with interest in the program. The Director, or his
26or her designee, shall serve as the permanent co-chair of the

 

 

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1advisory committee. One other co-chair shall be nominated and
2approved by the members of the committee on an annual basis.
3Committee members' terms of appointment shall be for 4 years
4with one-quarter of the appointees' terms expiring each year. A
5member shall continue to serve until his or her replacement is
6named. The Department shall fill vacancies that have a
7remaining term of over one year, and this replacement shall
8occur through the annual replacement of expiring terms. The
9Director shall designate Department staff to provide technical
10assistance and staff support to the committee. Department
11representation shall not constitute membership of the
12committee. All Committee papers, issues, recommendations,
13reports, and meeting memoranda are advisory only. The Director,
14or his or her designee, shall make a written report, as
15requested by the Committee, regarding issues before the
16Committee.
17    The Department on Aging and the Department of Human
18Services shall cooperate in the development and submission of
19an annual report on programs and services provided under this
20Section. Such joint report shall be filed with the Governor and
21the General Assembly on or before September 30 each year.
22    The requirement for reporting to the General Assembly shall
23be satisfied by filing copies of the report with the Speaker,
24the Minority Leader and the Clerk of the House of
25Representatives and the President, the Minority Leader and the
26Secretary of the Senate and the Legislative Research Unit, as

 

 

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1required by Section 3.1 of the General Assembly Organization
2Act and filing such additional copies with the State Government
3Report Distribution Center for the General Assembly as is
4required under paragraph (t) of Section 7 of the State Library
5Act.
6    Those persons previously found eligible for receiving
7non-institutional services whose services were discontinued
8under the Emergency Budget Act of Fiscal Year 1992, and who do
9not meet the eligibility standards in effect on or after July
101, 1992, shall remain ineligible on and after July 1, 1992.
11Those persons previously not required to cost-share and who
12were required to cost-share effective March 1, 1992, shall
13continue to meet cost-share requirements on and after July 1,
141992. Beginning July 1, 1992, all clients will be required to
15meet eligibility, cost-share, and other requirements and will
16have services discontinued or altered when they fail to meet
17these requirements.
18    For the purposes of this Section, "flexible senior
19services" refers to services that require one-time or periodic
20expenditures including, but not limited to, respite care, home
21modification, assistive technology, housing assistance, and
22transportation.
23    The Department shall implement an electronic service
24verification based on global positioning systems or other
25cost-effective technology for the Community Care Program no
26later than January 1, 2014.

 

 

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1    The Department shall require, as a condition of
2eligibility, enrollment in the medical assistance program
3under Article V of the Illinois Public Aid Code (i) beginning
4August 1, 2013, if the Auditor General has reported that the
5Department has failed to comply with the reporting requirements
6of Section 2-27 of the Illinois State Auditing Act; or (ii)
7beginning June 1, 2014, if the Auditor General has reported
8that the Department has not undertaken the required actions
9listed in the report required by subsection (a) of Section 2-27
10of the Illinois State Auditing Act.
11    The Department shall delay Community Care Program services
12until an applicant is determined eligible for medical
13assistance under Article V of the Illinois Public Aid Code (i)
14beginning August 1, 2013, if the Auditor General has reported
15that the Department has failed to comply with the reporting
16requirements of Section 2-27 of the Illinois State Auditing
17Act; or (ii) beginning June 1, 2014, if the Auditor General has
18reported that the Department has not undertaken the required
19actions listed in the report required by subsection (a) of
20Section 2-27 of the Illinois State Auditing Act.
21    The Department shall implement co-payments for the
22Community Care Program at the federally allowable maximum level
23(i) beginning August 1, 2013, if the Auditor General has
24reported that the Department has failed to comply with the
25reporting requirements of Section 2-27 of the Illinois State
26Auditing Act; or (ii) beginning June 1, 2014, if the Auditor

 

 

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1General has reported that the Department has not undertaken the
2required actions listed in the report required by subsection
3(a) of Section 2-27 of the Illinois State Auditing Act.
4    The Department shall provide a bi-monthly report on the
5progress of the Community Care Program reforms set forth in
6this amendatory Act of the 98th General Assembly to the
7Governor, the Speaker of the House of Representatives, the
8Minority Leader of the House of Representatives, the President
9of the Senate, and the Minority Leader of the Senate.
10    The Department shall conduct a quarterly review of Care
11Coordination Unit performance and adherence to service
12guidelines. The quarterly review shall be reported to the
13Speaker of the House of Representatives, the Minority Leader of
14the House of Representatives, the President of the Senate, and
15the Minority Leader of the Senate. The Department shall collect
16and report longitudinal data on the performance of each care
17coordination unit. Nothing in this paragraph shall be construed
18to require the Department to identify specific care
19coordination units.
20    In regard to community care providers, failure to comply
21with Department on Aging policies shall be cause for
22disciplinary action, including, but not limited to,
23disqualification from serving Community Care Program clients.
24Each provider, upon submission of any bill or invoice to the
25Department for payment for services rendered, shall include a
26notarized statement, under penalty of perjury pursuant to

 

 

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1Section 1-109 of the Code of Civil Procedure, that the provider
2has complied with all Department policies.
3(Source: P.A. 97-333, eff. 8-12-11; 98-8, eff. 5-3-13.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.".