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Public Act 095-0622


 

Public Act 0622 95TH GENERAL ASSEMBLY



 


 
Public Act 095-0622
 
HB0982 Enrolled LRB095 09864 DRJ 30075 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Department of Human Services Act is amended
by adding Section 10-55 as follows:
 
    (20 ILCS 1305/10-55 new)
    Sec. 10-55. Report; children with developmental
disabilities, severe mental illness, or severe emotional
disorders. On or before March 1, 2008, the Department shall
submit a report to the Governor and to the General Assembly
regarding the extent to which children (i) with developmental
disabilities, mental illness, severe emotional disorders, or
more than one of these disabilities, and (ii) who are currently
being provided services in an institution, could otherwise be
served in a less-restrictive community or home-based setting
for the same cost or for a lower cost. The Department shall
submit bi-annual updated reports to the Governor and the
General Assembly no later than March 1 of every even-numbered
year beginning in 2010.
 
    Section 10. The Illinois Public Aid Code is amended by
changing Sections 5-2.05 and 12-4.36 as follows:
 
    (305 ILCS 5/5-2.05)
    Sec. 5-2.05. Children with disabilities Disabled children.
    (a) The Department of Healthcare and Family Services, in
conjunction with the Department of Human Services, Public Aid
may offer, to children with developmental disabilities or
children with severe mental illness or severe emotional
disorders and severely mentally ill or emotionally disturbed
children who otherwise would not qualify for medical assistance
under this Article due to family income, home-based and
community-based services instead of institutional placement,
as allowed under paragraph 7 of Section 5-2.
    (b) The Department of Healthcare and Family Services Public
Aid, in conjunction with the Department of Human Services and
the Division of Specialized Care for Children, University of
Illinois-Chicago, shall submit a bi-annual also report to the
Governor and the General Assembly no later than January 1 of
every even-numbered year, beginning in 2008, 2004 regarding the
status of existing services offered under paragraph 7 of
Section 5-2. This report shall include, but not be limited to,
the following information:
        (1) The number of persons eligible for these services.
        (2) The number of persons who applied for these
    services.
        (1) (3) The number of persons who currently receive
    these services.
        (2) (4) The nature, scope, and cost of services
    provided under paragraph 7 of Section 5-2.
        (3) (5) The comparative cost of providing those
    services in a hospital, skilled nursing facility, or
    intermediate care facility.
        (4) (6) The funding sources for the provision of
    services, including federal financial participation.
        (5) (7) The qualifications, skills, and availability
    of caregivers for children receiving services.
        (6) The number of children who have aged out of the
    services offered under paragraph 7 of Section 5-2 during
    the 2 years immediately preceding the report.
    The report shall also include information regarding the
extent to which the existing programs could provide coverage
for mentally disabled children who are currently being provided
services in an institution who could otherwise be served in a
less-restrictive, community-based setting for the same or a
lower cost.
(Source: P.A. 93-599, eff. 8-26-03; revised 12-15-05.)
 
    (305 ILCS 5/12-4.36)
    Sec. 12-4.36. Pilot program for persons who are medically
fragile and technology-dependent.
    (a) Subject to appropriations for the first fiscal year of
the pilot program beginning July 1, 2006, the Department of
Human Services, in cooperation with the Department of
Healthcare and Family Services, shall adopt rules to initiate a
3-year pilot program to (i) test a standardized assessment tool
for persons who are medically fragile and technology-dependent
who may be provided home and community-based services to meet
their medical needs rather than be provided care in an
institution not solely because of a severe mental or
developmental impairment and (ii) provide appropriate home and
community-based medical services for such persons as provided
in subsection (c) of this Section. The Department of Human
Services may administer the pilot program until June 30, 2010
2009 if the General Assembly annually appropriates funds for
this purpose.
    (b) Notwithstanding any other provisions of this Code, the
rules implementing the pilot program shall provide for
criteria, standards, procedures, and reimbursement for
services that are not otherwise being provided in scope,
duration, or amount through any other program administered by
any Department of Human Services or any other agency of the
State for these medically fragile, technology-dependent
persons. At a minimum, the rules shall include the following:
        (1) A requirement that a pilot program participant be
    eligible for medical assistance under this Code, a citizen
    of the United States, or an individual who is lawfully
    residing permanently in the United States, and a resident
    of Illinois.
        (2) A requirement that a standardized assessment for
    medically fragile, technology-dependent persons will
    establish the level of care and the service-cost maximums.
        (3) A requirement for a determination by a physician
    licensed to practice medicine in all its branches (i) that,
    except for the provision of home and community-based care,
    these individuals would require the level of care provided
    in an institutional setting and (ii) that the necessary
    level of care can be provided safely in the home and
    community through the provision of medical support
    services.
        (4) A requirement that the services provided be
    medically necessary and appropriate for the level of
    functioning of the persons who are participating in the
    pilot program.
        (5) Provisions for care coordination and family
    support services that will enable the person to receive
    services in the most integrated setting possible
    appropriate to his or her medical condition and level of
    functioning.
        (6) The frequency of assessment and plan-of-care
    reviews.
        (7) The family or guardian's active participation as
    care givers in meeting the individual's medical needs.
        (8) The estimated cost to the State for in-home care,
    as compared to the institutional level of care appropriate
    to the individual's medical needs, may not exceed 100% of
    the institutional care as indicated by the standardized
    assessment tool.
        (9) When determining the hours of medically necessary
    support services needed to maintain the individual at home,
    consideration shall be given to the availability of other
    services, including direct care provided by the
    individual's family or guardian that can reasonably be
    expected to meet the medical needs of the individual.
    (c) During the pilot program, an individual who has
received services pursuant to paragraph 7 of Section 5-2 of
this Code, but who no longer receives receive such services
because he or she has reached the age of 21, may be provided
additional services pursuant to rule if the Department of Human
Services, Division of Rehabilitation Services, determines from
completion of the assessment tool for that individual that the
exceptional care rate established by the Department of
Healthcare and Family Services under Section 5-5.8a of this
Code is not sufficient to cover the medical needs of the
individual under the home and community-based services (HCBS)
waivers for persons with disabilities.
    (d) The Department of Human Services is authorized to lower
the payment levels established under this Section or take such
other actions, including, without limitation, cessation of
enrollment, reduction of available medical services, and
changing standards for eligibility, that are deemed necessary
by the Department during a State fiscal year to ensure that
payments under this Section do not exceed available funds.
These changes may be accomplished by emergency rulemaking under
Section 5-45 of the Illinois Administrative Procedure Act,
except that the limitation on the number of emergency rules
that may be adopted in a 24-month period shall not apply.
    (e) The Department of Human Services must make an annual
report to the Governor and the General Assembly with respect to
the persons eligible for medical assistance under this pilot
program. The report must cover the State fiscal year ending on
June 30 of the preceding year. The first report is due by
January 1, 2008. The report must include the following
information for the fiscal year covered by the report:
        (1) The number of persons who were evaluated through
    the assessment tool under this pilot program.
        (2) The number of persons who received services not
    available under the home and community-based services
    (HCBS) waivers for persons with disabilities under this
    pilot program.
        (3) The number of persons whose services were reduced
    under this pilot program.
        (4) The nature, scope, and cost of services provided
    under this pilot program.
        (5) The comparative costs of providing those services
    in other institutions.
        (6) The Department's progress in establishing an
    objective, standardized assessment tool for the HCBS
    waiver that assesses the medical needs of medically
    fragile, technology-dependent adults.
        (7) Recommendations for the funding needed to expand
    this pilot program to all medically fragile,
    technology-dependent individuals in HCBS waivers.
        (8) Subject to appropriation or the availability of
    other funds for this purpose, participant experience
    survey information for persons with disabilities who are
    participating in this pilot program and for persons with
    disabilities who are not participating in the pilot program
    but who are currently receiving services under the home and
    community-based services (HCBS) waiver and who have
    received services under paragraph 7 of Section 5-2 of this
    Code.
    This report may be submitted as part of the report required
by subsection (b) of section 5-2.05 of this Code.
(Source: P.A. 94-838, eff. 6-6-06.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 9/17/2007