093_HB3225

 
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 1        AN ACT concerning health care.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  1.   Short  title.  This Act may be cited as the
 5    Illinois Consumer-Directed Care Act.

 6        Section 5.  Legislative findings.  The  General  Assembly
 7    finds  that  alternatives  to  institutional  care,  such  as
 8    in-home  and  community-based care, should be encouraged. The
 9    General Assembly finds that giving recipients of in-home  and
10    community-based   services  the  opportunity  to  select  the
11    services they need and the  providers  they  want,  including
12    family  and  friends,  enhances  their  sense  of dignity and
13    autonomy. The General  Assembly  also  finds  that  providing
14    consumers  choice  and control, as tested in current research
15    and demonstration projects, has been beneficial and should be
16    developed further and implemented statewide.

17        Section 10.  Legislative intent.  It is the intent of the
18    General Assembly to nurture the autonomy of those citizens of
19    the State, of all ages, who have  disabilities  by  providing
20    the   long-term   care   services  they  need  in  the  least
21    restrictive and appropriate setting. It is the intent of  the
22    General  Assembly  to  give these individuals more choices in
23    and  greater  control  over  the  purchased  long-term   care
24    services that they receive.

25        Section 15.  Definitions.  In this Act
26        "Budget   allowance"  means  the  amount  of  money  made
27    available  each  month  to  a  consumer  to  purchase  needed
28    long-term care services, based on the results of a functional
29    needs assessment.
 
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 1        "Consultant" means an individual who  provides  technical
 2    assistance  to  consumers  in  meeting their responsibilities
 3    under this Act.
 4        "Consumer" means a person who has chosen  to  participate
 5    in  the program, has met the enrollment requirements, and has
 6    received an approved budget allowance.
 7        "Department" means the Illinois Department on Aging.
 8        "Fiscal intermediary" means an  entity  approved  by  the
 9    Department  that  helps  the  consumer  manage the consumer's
10    budget allowance, retains  the  funds,  processes  employment
11    information,  if any, and tax information, reviews records to
12    ensure  correctness,  writes  paychecks  to  providers,   and
13    delivers  paychecks  to  the  consumer  for  distribution  to
14    providers and caregivers.
15        "Provider"  means  (i)  a  person  licensed  or otherwise
16    permitted to render services eligible for reimbursement under
17    this Act for whom the consumer is not the employer of  record
18    or  (ii)  a consumer-employed caregiver for whom the consumer
19    is the employer of record.
20        "Representative"  means   an   uncompensated   individual
21    designated   by  the  consumer  to  assist  in  managing  the
22    consumer's budget allowance and needed services.

23        Section 20.   Program  established.   Beginning  July  1,
24    2004,  the  Department,  in  conjunction  with  the  Illinois
25    Department  of  Public Aid, the Illinois Department of Public
26    Health, and the Illinois Department of Human Services,  shall
27    establish  as  a  demonstration program the consumer-directed
28    care program, which shall  be  based  on  the  principles  of
29    consumer  choice  and control. The Department shall implement
30    the demonstration program upon federal approval.  The program
31    shall allow enrolled  persons  to  choose  the  providers  of
32    services and to direct the delivery of services, to best meet
33    their  long-term  care needs. The program must operate within
 
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 1    the funds appropriated.

 2        Section 25.  Eligibility and enrollment.  Persons who are
 3    enrolled  in  a  Medicaid  home  and  community-based  waiver
 4    program and are who able to  direct  their  own  care  or  to
 5    designate   an   eligible   representative   may   choose  to
 6    participate in the consumer-directed care program.

 7        Section 30.  Budget allowances.   Consumers  enrolled  in
 8    the  program  shall be given a monthly budget allowance based
 9    on the results of their assessed  functional  needs  and  the
10    financial  resources  of the program. Consumers shall receive
11    the budget  allowance  directly  from  a  Department-approved
12    fiscal  intermediary.  Each  participating State agency shall
13    develop purchasing guidelines to assist  consumers  in  using
14    the  budget  allowance  to purchase needed and cost-effective
15    services.  The  Department  shall  approve  all    purchasing
16    guidelines.

17        Section 35.  Services.   Consumers  may  use  the  budget
18    allowance  to  pay only for home and community-based services
19    that meet the consumer's long-term care needs and that are  a
20    cost-efficient  use of funds. These services may include, but
21    are not limited to, the following:
22             (1)  Personal care.
23             (2)  Homemaking  and  chores,  including  housework,
24        meals, shopping, and transportation.
25             (3)  Home modifications and assistive  devices  that
26        may  increase  the  consumer's  independence  or  make it
27        possible to avoid institutional placement.
28             (4)  Assistance    in    taking    self-administered
29        medication.
30             (5)  Day care and respite care  services,  including
31        those provided by nursing home facilities or by adult day
 
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 1        care facilities.
 2             (6)  Personal  care and support services provided in
 3        an assisted living facility.

 4        Section 40.  Consumer roles and responsibilities.
 5        (a)  Consumers shall be allowed to choose  the  providers
 6    of  services,  as  well  as  when  and  how  the services are
 7    provided.  Providers  may  include  a  consumer's   neighbor,
 8    friend, spouse, or relative.
 9        (b)  In cases where a consumer is the employer of record,
10    the  consumer's  roles  and responsibilities include, but are
11    not limited to, the following:
12             (1)  Developing a job description.
13             (2)  Selecting caregivers and submitting information
14        for the background screening as required by law.
15             (3)  Communicating    needs,    preferences,     and
16        expectations about services being purchased.
17             (4)  Providing  the  fiscal  intermediary  with  all
18        information  necessary  for  provider  payments  and  tax
19        requirements.
20             (5)  Ending  the  employment  of  an  unsatisfactory
21        caregiver.
22        (c)  In  cases  where  a  consumer is not the employer of
23    record, the consumer's roles  and  responsibilities  include,
24    but are not limited to, the following:
25             (1)  Communicating     needs,    preferences,    and
26        expectations about services being purchased.
27             (2)  Ending  the  services  of   an   unsatisfactory
28        provider.
29             (3)  Providing the fiscal agent with all information
30        necessary for provider payments and tax requirements.

31        Section    45.    Agency   and   Department   roles   and
32    responsibilities.    The   Department's   and    the    other
 
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 1    participating  State  agencies'  roles  and  responsibilities
 2    include, but are not limited to, the following:
 3             (1)  Assessing  each  consumer's  functional  needs,
 4        helping  with  the  service  plan,  and providing ongoing
 5        assistance with the service plan.
 6             (2)  Offering the services of consultants to provide
 7        training,  technical  assistance,  and  support  to   the
 8        consumer.
 9             (3)  Completing   the   background   screening   for
10        providers.
11             (4)  Approving fiscal intermediaries.
12             (5)  Establishing the minimum qualifications for all
13        caregivers  and  providers and being the final arbiter of
14        the fitness of  any  individual  to  be  a  caregiver  or
15        provider.

16        Section    50.     Fiscal    intermediary    roles    and
17    responsibilities.    The   fiscal  intermediary's  roles  and
18    responsibilities  include,  but  are  not  limited  to,   the
19    following:
20             (1)  Providing recordkeeping services.
21             (2)  Retaining  the  consumer-directed  care  funds,
22        processing   employment  and  tax  information,  if  any,
23        reviewing  records   to   ensure   correctness,   writing
24        paychecks  to  providers, and delivering paychecks to the
25        consumer for distribution.

26        Section  55.   Background  screening  requirements.   All
27    persons who render care under this Act must comply  with  the
28    requirements of the Health Care Worker Background Check Act.

29        Section  60.  Rules; federal waivers.  The Department and
30    the other participating State agencies may adopt and  enforce
31    rules  concerning  the  consumer-directed  care program.  The
 
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 1    Department shall take all necessary action  to  ensure  State
 2    compliance  with  federal  regulations.  The Department shall
 3    apply for any necessary federal waivers or waiver  amendments
 4    needed to implement the program.

 5        Section 65.  Reviews and reports.  The Department and all
 6    other  participating State agencies shall each, on an ongoing
 7    basis,  review  and  assess   the   implementation   of   the
 8    consumer-directed  care  program. By January 15 of each year,
 9    beginning in 2004, the  Department  shall  submit  a  written
10    report to the General Assembly that includes the Department's
11    and  all  other  State  agencies'  review  of the program and
12    recommendations for improvements to the program.

13        Section 70.  Repeal.  The Illinois Consumer-Directed Care
14    Act is repealed on January 1, 2008.