Full Text of HB6602 093rd General Assembly
HB6602 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB6602
Introduced 02/09/04, by Dan Reitz SYNOPSIS AS INTRODUCED: |
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30 ILCS 105/5.625 new |
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305 ILCS 5/Art. V-F heading new |
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305 ILCS 5/5F-5 new |
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305 ILCS 5/5F-10 new |
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305 ILCS 5/5F-15 new |
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305 ILCS 5/5F-20 new |
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Amends the Illinois Public Aid Code. Provides that by the end of FY 2005, the Department of Public Aid must estimate a reduction in Medicaid nursing home expenditures based on the average annual expenditure for nursing home beds and estimated reductions in occupancy from FY 2000 through FY 2004. Provides that the Department, in cooperation with the nursing home industry and other affected parties, may reduce Medicaid nursing home expenditures for FY 2006 through FY 2010 based on that estimate. Provides for a redirection of Medicaid nursing home expenditures to expenditures for home and community-based services. Provides that any general funds that are redirected but not spent during any fiscal year shall be transferred to the Long-Term Care Special Administration Fund. Provides that moneys received from or generated to the fund shall be spent only for home and community-based services or for mechanisms that reduce the number of nursing home beds. Provides that up to $100,000 of the redirected funds in fiscal year 2006 shall be directed to the Illinois Independence Fund to be used for grants that have matching funds equivalent to that of Medicaid and are consistent with the purposes of and the time frame of the new provisions. Amends the State Finance Act by including the Long-Term Care Special Administration Fund as a special fund.
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A BILL FOR
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HB6602 |
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LRB093 15230 DRJ 47298 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The State Finance Act is amended by adding | 5 |
| Section 5.625 as follows: | 6 |
| (30 ILCS 105/5.625 new)
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| Sec. 5.625. The Long-Term Care Special Administration | 8 |
| Fund. | 9 |
| Section 10. The Illinois Public Aid Code is amended by | 10 |
| adding the heading of Article V-F and Sections 5F-5, 5F-10, | 11 |
| 5F-15, and 5F-20 as follows: | 12 |
| (305 ILCS 5/Art. V-F heading new) | 13 |
| ARTICLE V-F. FINANCING OF LONG-TERM | 14 |
| CARE SERVICES
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| (305 ILCS 5/5F-5 new) | 16 |
| Sec. 5F-5. Definitions. In this Article: | 17 |
| "Long-term care services" means the range of services, | 18 |
| other than acute care services that provide time-limited | 19 |
| curative or restorative treatment, that are delivered in the | 20 |
| home, the community, or an institution to persons with | 21 |
| functional or cognitive limitations who require assistance | 22 |
| with performing activities of daily living. The term includes | 23 |
| services provided in a nursing home or in an individual's home | 24 |
| by a nurse, health aide, or personal attendant.
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| "Home and community-based services" means long-term care | 26 |
| services that are designed to assist older Illinoisans and | 27 |
| people with disabilities to remain independent and avoid | 28 |
| inappropriate institutionalization. Home and community-based | 29 |
| services include, but are not limited to, the following:
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LRB093 15230 DRJ 47298 b |
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| (1) Home and community-based waiver.
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| (2) Traumatic brain injury waiver.
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| (3) Residential care homes.
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| (4) Personal care attendant services.
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| (5) Chore and homemaker services.
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| (6) Older Americans Act-funded services.
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| (7) Adult day services and home health services.
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| (8) Respite care to provide support to family | 9 |
| caregivers.
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| (9) Any other long-term care support services.
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| (305 ILCS 5/5F-10 new) | 12 |
| Sec. 5F-10. Redistribution of long-term care expenditures. | 13 |
| (a) By the end of fiscal year 2005, the Department of | 14 |
| Public Aid shall estimate a reduction in Medicaid nursing home | 15 |
| expenditures based on the average annual expenditure for | 16 |
| nursing home beds and estimated reductions in occupancy from | 17 |
| State fiscal years 2000 through 2004. For fiscal years 2006 | 18 |
| through 2010, the Department, in cooperation with the nursing | 19 |
| home industry and other affected parties, may reduce Medicaid | 20 |
| nursing home expenditures in each fiscal year based on that | 21 |
| estimate. | 22 |
| (b) If the agency determines that it is necessary to reduce | 23 |
| the number of nursing home beds in each fiscal year in order to | 24 |
| reduce nursing home expenditures pursuant to the estimate | 25 |
| prepared under subsection (a), the Department shall develop a | 26 |
| plan that reduces the number of beds certified for | 27 |
| participation in the medical assistance program under Article V | 28 |
| while ensuring that the supply and distribution of long-term | 29 |
| care services are not diminished in any community in which one | 30 |
| or more nursing home beds may be eliminated, to the extent that | 31 |
| the need for such services cannot be met. No nursing home beds | 32 |
| may be decertified for participation under the medical | 33 |
| assistance program under this Section by the Department until | 34 |
| February 1, 2006. The requirements of this subsection shall not | 35 |
| impede the Department's authority to reduce nursing home |
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| expenditures effective July 1, 2005 pursuant to subsection (a) | 2 |
| and to redirect those expenditures to fund home and | 3 |
| community-based services pursuant to subsection (d).
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| (c) The reductions required in subsection (a) shall not | 5 |
| have the effect of doing any of the following:
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| (1) Diminishing or reducing the quality of services | 7 |
| available to nursing home residents.
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| (2) Forcing any nursing home resident to involuntarily | 9 |
| accept home and community-based services instead of | 10 |
| nursing home services.
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| (3) Causing any nursing home resident to be | 12 |
| involuntarily transferred or discharged as the result of a | 13 |
| change in the resident's method of payment for nursing home | 14 |
| services or exhaustion of the resident's personal | 15 |
| financial resources.
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| (d) The reductions required in subsection (a) shall be | 17 |
| redirected in fiscal year 2006 to fund home and community-based | 18 |
| services. For fiscal year 2006 and thereafter, the reductions | 19 |
| estimated under subsection (a) shall be redirected in that | 20 |
| fiscal year to fund both home and community-based services and | 21 |
| any programs designed to reduce the number of nursing home | 22 |
| beds. Any general funds that are redirected but not spent | 23 |
| during any fiscal year shall be transferred to the Long-Term | 24 |
| Care Special Administration Fund, which is hereby created as a | 25 |
| special fund in the State treasury. Interest earned on moneys | 26 |
| in the fund shall be retained in the fund. All moneys received | 27 |
| from or generated to the fund shall be spent only for home and | 28 |
| community-based services or for mechanisms that reduce the | 29 |
| number of nursing home beds.
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| (e) The long-term care funds generated by the reductions in | 31 |
| nursing home expenditures required in subsection (a) shall be | 32 |
| distributed among the following categories of consumers:
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| (1) Nursing home residents who desire transfer to a | 34 |
| home and community-based setting and for whom such a | 35 |
| transfer is medically appropriate and cost effective.
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| (2) People on waiting lists for publicly funded |
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| programs as of July 1, 2005 and at the highest risk of | 2 |
| nursing home placement.
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| (3) People at the highest risk of nursing home | 4 |
| admission.
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| (4) People with the greatest social and economic need.
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| (305 ILCS 5/5F-15 new) | 7 |
| Sec. 5F-15. Implementation. | 8 |
| (a) The Department shall document and verify the amount of | 9 |
| funding transferred from nursing home services to home and | 10 |
| community-based services and any additional home and | 11 |
| community-based services that are provided or enhanced from | 12 |
| this transfer of funds. This documentation shall be submitted | 13 |
| to the General Assembly no later than January 1, 2006, and on | 14 |
| each January 1 thereafter until January 1, 2010. | 15 |
| (b) By July 1, 2005, the Department shall complete the | 16 |
| following:
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| (1) Implementation of the initial phase of a | 18 |
| comprehensive data system that tracks long-term care | 19 |
| expenditures, services, consumer profiles, and consumer | 20 |
| preferences.
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| (2) Implementation, in cooperation with the Department | 22 |
| on Aging, the Department of Human Services, and the | 23 |
| Department of Public Health, of a system of statewide | 24 |
| long-term care service coordination and case management to | 25 |
| minimize administrative costs, improve access to services, | 26 |
| and minimize obstacles to the delivery of long-term care | 27 |
| services to people in need. At a minimum, the system shall | 28 |
| include the following:
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| (A) A request for proposal process by which the | 30 |
| Department may authorize local entities to administer | 31 |
| long-term care services.
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| (B) A comprehensive assessment system by which all | 33 |
| individuals shall be evaluated before receiving | 34 |
| long-term care services and may be evaluated | 35 |
| periodically, as needed, while long-term care services |
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| are being provided to ensure that an individual | 2 |
| receives appropriate long-term care services.
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| (C) Coordination of all of the long-term care | 4 |
| services administered by the Department on Aging, the | 5 |
| Department of Public Aid, and the Department of Human | 6 |
| Services.
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| (D) Completion of consumer information about all | 8 |
| of the long-term care services that are available.
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| (E) Consumer participation and oversight at the | 10 |
| State and local levels in the planning and delivery of | 11 |
| long-term care services.
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| (F) Long-term care service models that are | 13 |
| alternatives to nursing home models, provided that the | 14 |
| alternative models are comparable in cost or are more | 15 |
| cost effective than the nursing home models that | 16 |
| provide equivalent services. Any such alternative | 17 |
| long-term care service models must be financially | 18 |
| viable, must be cost effective, and must promote | 19 |
| consumer independence, participation, and | 20 |
| noninstitutionalization and, when appropriate, | 21 |
| consumer direction; in addition, they may include a | 22 |
| service or a combination of services such as assisted | 23 |
| living, adult foster care, attendant care, and | 24 |
| modifications of the residential care home system.
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| (G) Proposals for legislation to create | 26 |
| alternative long-term care service models.
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| (3) In consultation with the nursing home industry, | 28 |
| consumer advocates, consumers, and other long-term service | 29 |
| providers, the proposal and implementation of methods to | 30 |
| contain costs and encourage the reduction of Medicaid | 31 |
| nursing home expenditures. These methods may include the | 32 |
| following:
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| (A) Maximizing Medicare billing to pay for nursing | 34 |
| home care.
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| (B) Mechanisms to reduce the number of nursing home | 36 |
| beds, including a schedule for those reductions and |
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LRB093 15230 DRJ 47298 b |
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| recommendations for various sources of funding for | 2 |
| payments to nursing homes to reduce the number of | 3 |
| licensed beds.
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| (C) Elimination or modification of State nursing | 5 |
| home rules that do not advance the quality of patient | 6 |
| care and are not cost effective.
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| (D) Applications for exemption from federal | 8 |
| nursing home regulations to improve the efficiency and | 9 |
| reduce the cost and paperwork required to regulate the | 10 |
| nursing home industry.
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| (E) Proposals for adoption of or changes in rules, | 12 |
| subject to the certificate of need review, that permit | 13 |
| the following:
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| (i) Greater cooperation among long-term care | 15 |
| providers in such areas as discharge planning and | 16 |
| staff sharing during periods of transition.
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| (ii) Greater cooperation between nursing homes | 18 |
| and providers of home care, respite care, adult day | 19 |
| care, and other long-term care services.
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| (iii) The use of vacant nursing home beds as | 21 |
| respite beds.
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| (F) Changes in the State Medicaid plan to permit | 23 |
| Medicaid billing for community residential care homes.
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| (G) Strategies to provide alternative financing of | 25 |
| long-term care services by shifting the balance of the | 26 |
| financial responsibility for payment for long-term | 27 |
| care services from public to private sources by | 28 |
| promoting public-private partnerships and personal | 29 |
| responsibility for long-term care. These strategies | 30 |
| may include the following:
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| (i) Flexible use of reverse mortgages.
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| (ii) Private insurance coverage for long-term | 33 |
| care.
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| (iii) Tax credits or employment programs, such | 35 |
| as medical savings accounts for long-term care.
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| (iv) Changes in Medicaid eligibility |
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LRB093 15230 DRJ 47298 b |
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| requirements that increase consumers' financial | 2 |
| responsibility for their long-term care, such as | 3 |
| revising the rules relating to the transfer of | 4 |
| assets.
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| (v) Social insurance models.
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| (vi) Estate recovery options.
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| (vii) Methods to supplement and support family | 8 |
| and community care giving.
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| (4) Designation and implementation of a voucher | 10 |
| program that permits appropriate consumers to direct, | 11 |
| manage, and pay for their home and community-based care | 12 |
| services. The Department shall apply for any federal | 13 |
| waivers required to implement this program. The cost of | 14 |
| providing those services pursuant to the voucher program | 15 |
| shall be limited to no more than 90% of the cost of | 16 |
| providing similar services under the Medicaid program and | 17 |
| shall be designed to provide the following:
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| (A) Program flexibility that permits consumers to | 19 |
| design, manage, and pay for their own long-term care | 20 |
| services, including hiring and firing their personal | 21 |
| care assistants. The Department shall apply for | 22 |
| available foundation grants to address barriers to | 23 |
| recruitment and retention of caregivers. Policy and | 24 |
| fiscal program design shall be based on input from | 25 |
| consumers and caregivers. Support services, such as | 26 |
| transportation, training, and personal assistance | 27 |
| reimbursement, shall be provided to ensure such | 28 |
| participation.
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| (B) Mechanisms to ensure quality of service.
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| (C) An eligibility determination procedure by | 31 |
| which appropriate long-term care service needs are | 32 |
| determined for each consumer by means of a | 33 |
| self-evaluation of needs and abilities in combination | 34 |
| with an objective evaluation of the consumer's ability | 35 |
| to direct, coordinate, and manage such services.
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| (D) The amount of any copayment to be made by the |
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| consumer, based on income criteria.
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| (E) A payment system by which a consumer receives a | 3 |
| voucher in the amount required to pay for his or her | 4 |
| long-term care services on a regular, determined | 5 |
| schedule. The amount of the voucher shall not be more | 6 |
| than 90% of the cost of providing the same or | 7 |
| comparable services under Medicaid, less the amount of | 8 |
| any copayment to be paid by the consumer.
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| (c) No later than January 1, 2007, the Department shall | 10 |
| report to the General Assembly regarding the progress made in | 11 |
| complying with the requirements of subsection (b).
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| (305 ILCS 5/5F-20 new) | 13 |
| Sec. 5F-20. Long-term care budget. By January 1, 2006, and | 14 |
| by January 1 of each year thereafter, the Department shall | 15 |
| submit to the General Assembly a budget and budget management | 16 |
| plan. The budget shall include all publicly financed long-term | 17 |
| care services available to older Illinoisans and people with | 18 |
| disabilities, including: | 19 |
| (1) Medicaid expenditures for nursing homes.
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| (2) Home and community-based waiver.
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| (3) Traumatic brain injury waiver.
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| (4) Residential care home waiver.
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| (5) Personal care attendant services.
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| (6) Chore and homemaker services.
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| (7) Older Americans Act-funded services.
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| (8) Adult day services and home health services.
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| (9) Respite care to provide support to family | 28 |
| caregivers.
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| (10) Any other long-term care support services.
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