93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB6602

 

Introduced 02/09/04, by Dan Reitz

 

SYNOPSIS AS INTRODUCED:
 
30 ILCS 105/5.625 new
305 ILCS 5/Art. V-F heading new
305 ILCS 5/5F-5 new
305 ILCS 5/5F-10 new
305 ILCS 5/5F-15 new
305 ILCS 5/5F-20 new

    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.


LRB093 15230 DRJ 47298 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB6602 LRB093 15230 DRJ 47298 b

1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The State Finance Act is amended by adding
5 Section 5.625 as follows:
 
6     (30 ILCS 105/5.625 new)
7     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

 
15     (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.
25     "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:

 

 

HB6602 - 2 - LRB093 15230 DRJ 47298 b

1         (1) Home and community-based waiver.
2         (2) Traumatic brain injury waiver.
3         (3) Residential care homes.
4         (4) Personal care attendant services.
5         (5) Chore and homemaker services.
6         (6) Older Americans Act-funded services.
7         (7) Adult day services and home health services.
8         (8) Respite care to provide support to family
9     caregivers.
10         (9) Any other long-term care support services.
 
11     (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

 

 

HB6602 - 3 - LRB093 15230 DRJ 47298 b

1 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).
4     (c) The reductions required in subsection (a) shall not
5 have the effect of doing any of the following:
6         (1) Diminishing or reducing the quality of services
7     available to nursing home residents.
8         (2) Forcing any nursing home resident to involuntarily
9     accept home and community-based services instead of
10     nursing home services.
11         (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.
16     (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.
30     (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:
33         (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.
36         (2) People on waiting lists for publicly funded

 

 

HB6602 - 4 - LRB093 15230 DRJ 47298 b

1     programs as of July 1, 2005 and at the highest risk of
2     nursing home placement.
3         (3) People at the highest risk of nursing home
4     admission.
5         (4) People with the greatest social and economic need.
 
6     (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:
17         (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.
21         (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:
29             (A) A request for proposal process by which the
30         Department may authorize local entities to administer
31         long-term care services.
32             (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

 

 

HB6602 - 5 - LRB093 15230 DRJ 47298 b

1         are being provided to ensure that an individual
2         receives appropriate long-term care services.
3             (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.
7             (D) Completion of consumer information about all
8         of the long-term care services that are available.
9             (E) Consumer participation and oversight at the
10         State and local levels in the planning and delivery of
11         long-term care services.
12             (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.
25             (G) Proposals for legislation to create
26         alternative long-term care service models.
27         (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:
33             (A) Maximizing Medicare billing to pay for nursing
34         home care.
35             (B) Mechanisms to reduce the number of nursing home
36         beds, including a schedule for those reductions and

 

 

HB6602 - 6 - LRB093 15230 DRJ 47298 b

1         recommendations for various sources of funding for
2         payments to nursing homes to reduce the number of
3         licensed beds.
4             (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.
7             (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.
11             (E) Proposals for adoption of or changes in rules,
12         subject to the certificate of need review, that permit
13         the following:
14                 (i) Greater cooperation among long-term care
15             providers in such areas as discharge planning and
16             staff sharing during periods of transition.
17                 (ii) Greater cooperation between nursing homes
18             and providers of home care, respite care, adult day
19             care, and other long-term care services.
20                 (iii) The use of vacant nursing home beds as
21             respite beds.
22             (F) Changes in the State Medicaid plan to permit
23         Medicaid billing for community residential care homes.
24             (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:
31                 (i) Flexible use of reverse mortgages.
32                 (ii) Private insurance coverage for long-term
33             care.
34                 (iii) Tax credits or employment programs, such
35             as medical savings accounts for long-term care.
36                 (iv) Changes in Medicaid eligibility

 

 

HB6602 - 7 - LRB093 15230 DRJ 47298 b

1             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.
5                 (v) Social insurance models.
6                 (vi) Estate recovery options.
7                 (vii) Methods to supplement and support family
8             and community care giving.
9         (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:
18             (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.
29             (B) Mechanisms to ensure quality of service.
30             (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.
36             (D) The amount of any copayment to be made by the

 

 

HB6602 - 8 - LRB093 15230 DRJ 47298 b

1         consumer, based on income criteria.
2             (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.
9     (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).
 
12     (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.
20         (2) Home and community-based waiver.
21         (3) Traumatic brain injury waiver.
22         (4) Residential care home waiver.
23         (5) Personal care attendant services.
24         (6) Chore and homemaker services.
25         (7) Older Americans Act-funded services.
26         (8) Adult day services and home health services.
27         (9) Respite care to provide support to family
28     caregivers.
29         (10) Any other long-term care support services.