Full Text of SB0354 100th General Assembly
SB0354sam001 100TH GENERAL ASSEMBLY | Sen. Daniel Biss Filed: 4/18/2018
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| 1 | | AMENDMENT TO SENATE BILL 354
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 354 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Affordable Long-Term Services and Supports for Illinois | 6 | | Families Act. | 7 | | Section 5. Purpose. The purpose of this Act is to provide | 8 | | security for Illinois families by pooling resources to create a | 9 | | benefit to assist with long-term care costs that otherwise can | 10 | | be an impossible burden for families or become costs to the | 11 | | State's Medical Assistance Program. This Act will also serve to | 12 | | support the State's effort to rebalance long-term care toward | 13 | | investing in home-based and community-based services and | 14 | | supports. | 15 | | Section 10. Definitions. As used in this Act: |
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| 1 | | "Commission" means the Long-Term Services and Supports | 2 | | Trust Commission created in Section 25. | 3 | | "Consumer direction" means an orientation to the delivery | 4 | | of home-based and community-based services under which | 5 | | informed individuals make choices about the services they | 6 | | receive. Individuals can consider their own needs, determine | 7 | | how and by whom these needs should be met, and monitor the | 8 | | quality of services received. Individuals can also | 9 | | independently make all decisions and manage services directly. | 10 | | The unifying principle in consumer-directed long-term services | 11 | | and supports arrangements is that individuals have the primary | 12 | | authority to make choices that work best for them. | 13 | | "Eligible beneficiary" means an Illinois resident with a | 14 | | long-term care need, as established in an assessment by a needs | 15 | | assessor, who is not receiving long-term care services and | 16 | | supports under the State's Medical Assistance Program and, if | 17 | | using Medicare-paid rehabilitation services, has unmet needs | 18 | | under Medicare. | 19 | | "Existing long-term care programs" includes the following | 20 | | programs existing on the effective date of this Act: the | 21 | | Community Care Program, the Home Services Program, the | 22 | | Home-Based Support Services Program, and any other long-term | 23 | | care provided by the State under the Medical Assistance | 24 | | Program. | 25 | | "Home-based and community-based services" includes | 26 | | long-term services and supports that meet the requirements set |
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| 1 | | forth in the Centers for Medicare and Medicaid Services' Home | 2 | | and Community-Based Services Settings Final Rule (CMS | 3 | | 2249-F/2296-F), published in the Federal Register on
January | 4 | | 16, 2014. | 5 | | "Medical assistance" means medical assistance coverage | 6 | | under the Medical Assistance Program. | 7 | | "Medical Assistance Program" means the medical assistance | 8 | | program administered by the Department of Healthcare and Family | 9 | | Services under Article V of the Illinois Public Aid Code. | 10 | | "Long-term care need" means an assessment indicating the | 11 | | need for ongoing assistance in routine life activities | 12 | | consistent with the eligibility threshold for long-term | 13 | | services and supports set in accordance with this Act, on the | 14 | | universal assessment tool procured by the State and described | 15 | | in Section 25 of the Older Adult Services Act. | 16 | | "Long-term services and supports benefit" or "benefit" | 17 | | means an amount available to eligible beneficiaries in a dollar | 18 | | amount per day to pay for the services of a qualified long-term | 19 | | services and supports provider from the Long-Term Services and | 20 | | Supports Trust Fund created in Section 35. | 21 | | "Needs assessor" means an organization employing | 22 | | individuals trained to assess needs using the universal | 23 | | assessment tool described in Section 25 of the Older Adult | 24 | | Services Act. "Needs assessor" includes care coordination | 25 | | units as described in the Illinois Act on the Aging and | 26 | | organizations led by and for people with disabilities such as |
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| 1 | | the Centers for Independent Living. | 2 | | "Person-centered" means delivery of care in which | 3 | | individuals' values and preferences are elicited and, once | 4 | | expressed, guide all aspects of their care, supporting their | 5 | | realistic health and life goals. Person-centered care requires | 6 | | sustained collaboration among individuals, others who are | 7 | | important to them, and relevant care providers, which informs | 8 | | decision-making to the extent that the individual desires. | 9 | | "Qualified long-term services and supports provider" means | 10 | | a provider of one of the types listed in Section 30 that are | 11 | | participating providers in the existing long-term care | 12 | | programs and in accordance with the process set forth in | 13 | | Section 30 have been deemed by the Long-Term Services and | 14 | | Supports Trust Commission to provide safe, consumer-directed | 15 | | or person-centered, and cost-effective long-term services and | 16 | | supports. | 17 | | "Trust Fund" means the Long-Term Services and Supports | 18 | | Trust Fund created in Section 35. | 19 | | "Universal assessment tool" means the universal assessment | 20 | | tool described in Section 25 of the Older Adult Services Act. | 21 | | Section 15. Affordable long-term care services and | 22 | | supports benefit or program; benchmark. | 23 | | (a) By January 1, 2020, Illinois shall have in place a | 24 | | long-term services and supports benefit or program for at least | 25 | | those who have a long-term care need consistent with the level |
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| 1 | | of care criteria in place on the effective date of this Act for | 2 | | existing long-term care programs. | 3 | | (b) Illinois shall create a long-term services and supports | 4 | | benefit for eligible beneficiaries. The benefit shall be a | 5 | | dollar amount available in an amount per day to pay for the | 6 | | services of a qualified long-term services and supports | 7 | | provider. A dedicated Trust Fund for this purpose is created in | 8 | | Section 35. | 9 | | (c) The long-term services and supports benefit is not | 10 | | intended to replace the Community Care Program, Home Services | 11 | | Program, the Home-Based Support Services Program, or any other | 12 | | long-term services and supports provided by the State through | 13 | | the Medical Assistance Program. Maintenance of existing | 14 | | long-term care programs shall help to fulfill the requirement | 15 | | under subsection (a). The long-term services and supports | 16 | | benefit is intended to improve investment in home-based and | 17 | | community-based services in Illinois, including those | 18 | | described in the State's Medicaid waivers and other existing | 19 | | long-term care programs. The existing long-term care programs | 20 | | and the benefit described in this Act may not be used | 21 | | concurrently, but may be used sequentially. | 22 | | (d) No later than January 1, 2025, the long-term services | 23 | | and supports benefit shall be available for eligible | 24 | | beneficiaries. The Long-Term Services and Supports Trust | 25 | | Commission may set an earlier date for the initial availability | 26 | | of the benefit described in Section 25. |
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| 1 | | Section 20. Comprehensive study and actuarial modeling. | 2 | | (a) The Department of Healthcare and Family Services shall | 3 | | commission a comprehensive study of long-term care trends, | 4 | | future projections, and actuarial analysis of a new long-term | 5 | | services and supports benefit. Upon completion of the study, | 6 | | the Department shall prepare a report on the study that | 7 | | includes the following: | 8 | | (1) an extensive analysis of long-term care trends in | 9 | | Illinois, including the number of Illinoisans needing | 10 | | long-term care, the number of paid and unpaid caregivers, | 11 | | the existing long-term care programs' utilization and | 12 | | impact on the State budget; out-of-pocket spending and | 13 | | spend-down to qualify for medical assistance coverage, the | 14 | | financial and health impacts of caregiving on the family, | 15 | | wages of paid caregivers and the effects of compensation on | 16 | | the availability of this workforce, the current market for | 17 | | private long-term care insurance, and a brief assessment of | 18 | | the existing system of long-term services and supports in | 19 | | terms of health, well-being, and the ability of | 20 | | participants to continue living in their communities; | 21 | | (2) an analysis of: long-term care costs and | 22 | | utilization projections through at least 2050 and the | 23 | | estimated impact of such costs and utilization projections | 24 | | on the State budget; increases in the senior population; | 25 | | projections of the number of paid and unpaid caregivers in |
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| 1 | | relation to demand for services; and projections of the | 2 | | impact of housing cost burdens and a lack of affordable | 3 | | housing on seniors and people with disabilities; | 4 | | (3) an actuarial analysis of a new long-term services | 5 | | and supports benefit program, including an analysis of | 6 | | potential tax sources and necessary levels, a vesting | 7 | | period, the maximum daily benefit dollar amount, the total | 8 | | maximum dollar amount of the benefit, and the duration of | 9 | | the benefit; and | 10 | | (4) a qualitative analysis of a new benefit's impact on | 11 | | seniors and people with disabilities, including their | 12 | | families and caregivers, public and private long-term care | 13 | | services, and the State budget. | 14 | | The report must project under multiple possible | 15 | | configurations the numbers of persons covered year over year, | 16 | | utilization rates, total spending, and the Trust Fund's ratio | 17 | | balance and solvency. The Trust Fund must initially be | 18 | | structured to be solvent for 75 years. The report must detail | 19 | | the sensitivity of these projections to the level of care | 20 | | criteria that define long-term care need and examine the | 21 | | feasibility of setting a lower threshold, based on a lower need | 22 | | for ongoing assistance in routine life activities. | 23 | | The report must also detail the amount of out-of-pocket | 24 | | costs avoided, the number of persons who delayed or avoided | 25 | | utilization of medical assistance benefits, an analysis on the | 26 | | projected increased utilization of home-based and |
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| 1 | | community-based services over skilled nursing facilities and | 2 | | savings therewith, and savings to the existing long-term care | 3 | | programs due to the new long-term services and supports | 4 | | benefit. | 5 | | (b) The financing options to be studied in the actuarial | 6 | | analysis shall conform to the main benchmarks listed in Section | 7 | | 15. | 8 | | (c) The entity chosen to conduct the actuarial analysis | 9 | | shall be a nationally-recognized organization with experience | 10 | | modeling public and private long-term care financing programs. | 11 | | (d) The study shall be completed before April 1, 2019. Upon | 12 | | completion, the report on the study shall to be delivered to | 13 | | the Long-Term Services and Supports Trust Commission | 14 | | established in Section 25. | 15 | | Section 25. Long-Term Services and Supports Trust | 16 | | Commission. | 17 | | (a) The Long-Term Services and Supports Trust Commission is | 18 | | created on April 1, 2019. The Commission shall include the | 19 | | following members: | 20 | | (1) One member of the Senate appointed by the President | 21 | | of the Senate, and one member of the Senate appointed by | 22 | | the Minority Leader of the Senate. | 23 | | (2) One member of the House of Representatives | 24 | | appointed by the Speaker of the House of Representatives, | 25 | | and one member of the House of Representatives appointed by |
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| 1 | | the Minority Leader of the House of Representatives. | 2 | | (3) The Director of Healthcare and Family Services, or | 3 | | his or her designee. | 4 | | (4) The Director of Aging, or his or her designee. | 5 | | (5) The Secretary of Human Services, or his or her | 6 | | designee. | 7 | | (6) Two individuals who receive long-term services and | 8 | | supports. | 9 | | (7) Two representatives from organizations | 10 | | representing the population receiving long-term services | 11 | | and supports, one of whom is from an organization | 12 | | representing seniors and one of whom is from an | 13 | | organization representing people with disabilities. | 14 | | (8) Two representatives of caregivers, one of whom is a | 15 | | representative of a union representing long-term care | 16 | | workers and one of whom is a family caregiver. | 17 | | (b) Members of the Commission shall be appointed for terms | 18 | | of 2 years, except that the Governor shall appoint the initial | 19 | | members identified in paragraphs (6), (7), and (8) of | 20 | | subsection (a) to staggered terms not to exceed 4 years. | 21 | | Appointments by the Governor shall be subject to the advice and | 22 | | consent of the Senate. | 23 | | (c) On April 1, 2019, the Commission shall receive a report | 24 | | on the completed study of long-term services and supports needs | 25 | | and actuarial modeling. The Commission shall use the study | 26 | | results to set the initial per-day long-term services and |
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| 1 | | supports benefit, the benefit's duration, the formula for an | 2 | | annual adjustment of the benefit amount, the start date for | 3 | | payouts, and other terms as may be necessary, and shall | 4 | | identify a funding mechanism, inclusive of rates of tax, that | 5 | | is consistent with these terms and in a manner that is | 6 | | actuarially sound. The Commission may set the eligibility | 7 | | threshold that defines long-term care need for the new benefit | 8 | | lower, but not higher, than the level of care criteria in place | 9 | | on the effective date of this Act for existing long-term care | 10 | | programs. In setting the initial per-day benefit, the | 11 | | Commission shall primarily consider the cost of home-based and | 12 | | community-based services, and shall address deficiencies in | 13 | | current rates of payment and workers' wages for those services | 14 | | identified as contributing to weaknesses in the system of | 15 | | long-term care services and supports. Within 30 days after the | 16 | | Commission receives the report, the Commission shall submit a | 17 | | separate report to the General Assembly with its recommendation | 18 | | for a funding mechanism for the long-term services and supports | 19 | | benefit. | 20 | | (d) The Commission member from the Department of Healthcare | 21 | | and Family Services shall convene the first meeting. The | 22 | | members shall elect a chair at the first meeting. Meetings of | 23 | | the Commission shall be at the call of the chair, but shall | 24 | | occur no less frequently than annually. | 25 | | (e) Regular duties of the Commission shall include: | 26 | | (1) establishing and following a process for annual |
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| 1 | | adjustment of the long-term services and supports benefit | 2 | | amount based primarily on increases in the cost of | 3 | | home-based and community-based services; | 4 | | (2) monitoring the fiscal condition of the Trust Fund; | 5 | | (3) establishing and monitoring outcomes of procedures | 6 | | for determining that an individual has a long-term care | 7 | | need as defined in this Act; | 8 | | (4) setting standards for qualifying long-term | 9 | | services and supports providers and deciding which types of | 10 | | providers that may qualify under Section 30 meet the | 11 | | definition of qualifying providers; | 12 | | (5) setting standards for organizations to be needs | 13 | | assessors; | 14 | | (6) monitoring the role of the long-term care services | 15 | | and supports benefit in supporting family caregivers, | 16 | | inclusive of reviewing the role of particular features of | 17 | | benefit design or administration and of proposing changes | 18 | | to ensure the benefit supports family caregivers | 19 | | appropriately; and | 20 | | (7) monitoring the role of the long-term care services | 21 | | and supports benefit in recruiting and retaining a | 22 | | caregiving workforce, inclusive of collecting information | 23 | | on the wages, benefits, and working conditions of paid | 24 | | caregivers, and of proposing changes to benefit design or | 25 | | administration to ensure the benefit supports this | 26 | | workforce appropriately. |
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| 1 | | (f) The Department of Healthcare and Family Services shall | 2 | | provide administrative support to the Commission. | 3 | | Section 30. Long-term services and supports providers. | 4 | | (a) The provider types that may become qualified providers | 5 | | by decision of the Commission are: home care or homemaker | 6 | | services providers participating in the Community Care Program | 7 | | or Home Services Program; personal assistants or other | 8 | | independent providers participating in the Home Services | 9 | | Program; adult day programs participating in the Community Care | 10 | | Program or Home Services Program; respite care providers | 11 | | participating in the Home Services Program; home modification | 12 | | or environmental accessibility modification providers | 13 | | participating in the Home Services Program; personal support | 14 | | providers participating as waiver providers in the Medical | 15 | | Assistance Program; community-integrated living arrangements | 16 | | participating as waiver providers in the Medical Assistance | 17 | | Program; supportive living facilities participating in the | 18 | | Medical Assistance Program; and nursing facilities | 19 | | participating as providers in the Medical Assistance Program. | 20 | | (b) Participating providers described in subsection (a) | 21 | | shall be qualified long-term services and supports providers if | 22 | | their provider type is deemed by the Commission to provide | 23 | | safe, consumer-directed or person-centered, and cost-effective | 24 | | long-term services and supports. In making these decisions, the | 25 | | Commission shall evaluate whether home-based and |
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| 1 | | community-based services are consumer-directed, and shall | 2 | | evaluate whether other institutional provider types provide | 3 | | services in a person-centered fashion. | 4 | | (c) Family caregivers may deliver services under this Act | 5 | | if the arrangement complies with the requirements for a type of | 6 | | provider that is a qualified provider as set forth in | 7 | | subsections (a) and (b). If, after the effective date of this | 8 | | Act, the requirements for any type of qualified providers | 9 | | become more restrictive with regard to family caregivers, the | 10 | | Commission shall review whether these changes diminish the | 11 | | ability of the long-term services and support benefit to | 12 | | support family caregiving, in accordance with paragraph (6) of | 13 | | subsection (e) of Section 25. | 14 | | (d) An eligible beneficiary seeking to use the long-term | 15 | | services and supports benefit to pay a qualified provider that | 16 | | is a nursing facility, and nursing facilities seeking payment | 17 | | from the long-term services and supports benefit for services | 18 | | to an eligible beneficiary, shall be subject to additional | 19 | | requirements. An eligible beneficiary seeking to use the | 20 | | long-term services and supports benefit to pay a nursing | 21 | | facility must have an assessment consistent with a | 22 | | determination of need score of 37 or higher or an assessment | 23 | | indicating the same level of need for ongoing assistance in | 24 | | routine life activities on the universal assessment tool. An | 25 | | eligible beneficiary must also secure an exception documented | 26 | | by his or her needs assessor, and approved by the Department of |
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| 1 | | Healthcare and Family Services, that it is not possible for the | 2 | | eligible beneficiary to use the benefit to live at home with | 3 | | home-based and community-based supports. An eligible | 4 | | beneficiary may not use more than 75% of the cumulative total | 5 | | value of the benefit over its duration to pay a nursing | 6 | | facility. In arranging payment, nursing facilities shall | 7 | | submit information on actual costs of direct-care labor being | 8 | | charged, capital costs being charged, and all other costs being | 9 | | charged. The long-term services and supports benefit shall not | 10 | | be used to pay for nursing facility capital costs. | 11 | | Section 35. Long-Term Services and Supports Trust Fund. | 12 | | (a) The Long-Term Services and Supports Trust Fund is | 13 | | created as a special fund in the State treasury for the purpose | 14 | | of receiving funds dedicated to paying the long-term services | 15 | | and supports benefit created under this Act. Dedicated funds | 16 | | shall come from a tax set at rates deemed to be actuarially | 17 | | sound as set forth in subsection (b). All receipts under | 18 | | subsection (b) must be deposited into the Trust Fund. These | 19 | | funds shall be held separate and apart from all public moneys | 20 | | or funds of the State, as provided in this Section, and shall | 21 | | be administered as set forth in Section 40 exclusively for the | 22 | | purposes of this Act. Expenditures from the Trust Fund may be | 23 | | used solely for payment of long-term services and supports | 24 | | benefits and for necessary administrative activities. | 25 | | (b) The benefit shall be paid for through a tax, the nature |
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| 1 | | of which shall be determined by the actuarial study set forth | 2 | | in paragraph (3) of subsection (a) of Section 20. The | 3 | | Commission shall recommend tax rates that are actuarially sound | 4 | | in its report to the General Assembly as required under | 5 | | subsection (c) of Section 25. | 6 | | (c) Funds deposited into the Trust Fund may be used only | 7 | | for the purposes set forth in this Act, and shall not be | 8 | | subject to administrative charges or chargebacks unless | 9 | | otherwise authorized by this Act. The Trust Fund is exempt from | 10 | | any sweep, transfer, or other budgetary maneuver that may | 11 | | result in the use of the Trust Fund's moneys for a purpose | 12 | | other than the purposes set forth in this Act. | 13 | | (d) This Section shall not become operative until | 14 | | legislation is enacted into law by the General Assembly that | 15 | | imposes or authorizes a new tax for the purposes set forth in | 16 | | this Act. | 17 | | Section 40. Administration. | 18 | | (a) The Department of Healthcare and Family Services shall | 19 | | maintain rolls of eligible beneficiaries based in part on | 20 | | assessments of long-term care need performed by needs | 21 | | assessors. The Department of Healthcare and Family Services | 22 | | shall be responsible for making payments from benefits to | 23 | | qualified long-term services and supports providers on behalf | 24 | | of eligible beneficiaries for the provision of services to | 25 | | those beneficiaries. |
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| 1 | | (b) The Department of Healthcare and Family Services shall | 2 | | maintain a list of qualified long-term services and supports | 3 | | providers. This list shall conform to determinations made by | 4 | | the Commission as to which types of providers appear on the | 5 | | list. Within each type of provider, the particular providers | 6 | | that qualify shall be those participating in the existing | 7 | | long-term care programs. | 8 | | (c) The Department of Healthcare and Family Services shall | 9 | | assist the Commission in monitoring the solvency and financial | 10 | | status of the Trust Fund. | 11 | | (d) The Department of Healthcare and Family Services shall | 12 | | prepare and distribute written or electronic materials to | 13 | | eligible beneficiaries, family caregivers, seniors, and the | 14 | | public at large as necessary to inform or update them regarding | 15 | | the long-term services and supports benefit. | 16 | | (e) The Department on Aging shall maintain a statewide | 17 | | network of needs assessors and shall be charged with | 18 | | reimbursing the needs assessors for eligibility assessment | 19 | | services. | 20 | | (f) This Section shall not become operative until (i) | 21 | | legislation is enacted into law by the General Assembly that | 22 | | imposes or authorizes a new tax for the purposes set forth in | 23 | | this Act and (ii) the Trust Fund in Section 35 has been | 24 | | created. | 25 | | Section 45. The State Finance Act is amended by adding |
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| 1 | | Section 5.886 as follows: | 2 | | (30 ILCS 105/5.886 new) | 3 | | Sec. 5.886. The Long-Term Services and Supports Trust Fund.
| 4 | | Section 99. Effective date. This Act takes effect upon | 5 | | becoming law.".
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