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
3everything after the enacting clause with the following:
 
4    "Section 1. Short title. This Act may be cited as the
5Affordable Long-Term Services and Supports for Illinois
6Families Act.
 
7    Section 5. Purpose. The purpose of this Act is to provide
8security for Illinois families by pooling resources to create a
9benefit to assist with long-term care costs that otherwise can
10be an impossible burden for families or become costs to the
11State's Medical Assistance Program. This Act will also serve to
12support the State's effort to rebalance long-term care toward
13investing in home-based and community-based services and
14supports.
 
15    Section 10. Definitions. As used in this Act:

 

 

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1    "Commission" means the Long-Term Services and Supports
2Trust Commission created in Section 25.
3    "Consumer direction" means an orientation to the delivery
4of home-based and community-based services under which
5informed individuals make choices about the services they
6receive. Individuals can consider their own needs, determine
7how and by whom these needs should be met, and monitor the
8quality of services received. Individuals can also
9independently make all decisions and manage services directly.
10The unifying principle in consumer-directed long-term services
11and supports arrangements is that individuals have the primary
12authority to make choices that work best for them.
13    "Eligible beneficiary" means an Illinois resident with a
14long-term care need, as established in an assessment by a needs
15assessor, who is not receiving long-term care services and
16supports under the State's Medical Assistance Program and, if
17using Medicare-paid rehabilitation services, has unmet needs
18under Medicare.
19    "Existing long-term care programs" includes the following
20programs existing on the effective date of this Act: the
21Community Care Program, the Home Services Program, the
22Home-Based Support Services Program, and any other long-term
23care provided by the State under the Medical Assistance
24Program.
25    "Home-based and community-based services" includes
26long-term services and supports that meet the requirements set

 

 

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1forth in the Centers for Medicare and Medicaid Services' Home
2and Community-Based Services Settings Final Rule (CMS
32249-F/2296-F), published in the Federal Register on January
416, 2014.
5    "Medical assistance" means medical assistance coverage
6under the Medical Assistance Program.
7    "Medical Assistance Program" means the medical assistance
8program administered by the Department of Healthcare and Family
9Services under Article V of the Illinois Public Aid Code.
10    "Long-term care need" means an assessment indicating the
11need for ongoing assistance in routine life activities
12consistent with the eligibility threshold for long-term
13services and supports set in accordance with this Act, on the
14universal assessment tool procured by the State and described
15in Section 25 of the Older Adult Services Act.
16    "Long-term services and supports benefit" or "benefit"
17means an amount available to eligible beneficiaries in a dollar
18amount per day to pay for the services of a qualified long-term
19services and supports provider from the Long-Term Services and
20Supports Trust Fund created in Section 35.
21    "Needs assessor" means an organization employing
22individuals trained to assess needs using the universal
23assessment tool described in Section 25 of the Older Adult
24Services Act. "Needs assessor" includes care coordination
25units as described in the Illinois Act on the Aging and
26organizations led by and for people with disabilities such as

 

 

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1the Centers for Independent Living.
2    "Person-centered" means delivery of care in which
3individuals' values and preferences are elicited and, once
4expressed, guide all aspects of their care, supporting their
5realistic health and life goals. Person-centered care requires
6sustained collaboration among individuals, others who are
7important to them, and relevant care providers, which informs
8decision-making to the extent that the individual desires.
9    "Qualified long-term services and supports provider" means
10a provider of one of the types listed in Section 30 that are
11participating providers in the existing long-term care
12programs and in accordance with the process set forth in
13Section 30 have been deemed by the Long-Term Services and
14Supports Trust Commission to provide safe, consumer-directed
15or person-centered, and cost-effective long-term services and
16supports.
17    "Trust Fund" means the Long-Term Services and Supports
18Trust Fund created in Section 35.
19    "Universal assessment tool" means the universal assessment
20tool described in Section 25 of the Older Adult Services Act.
 
21    Section 15. Affordable long-term care services and
22supports benefit or program; benchmark.
23    (a) By January 1, 2020, Illinois shall have in place a
24long-term services and supports benefit or program for at least
25those who have a long-term care need consistent with the level

 

 

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1of care criteria in place on the effective date of this Act for
2existing long-term care programs.
3    (b) Illinois shall create a long-term services and supports
4benefit for eligible beneficiaries. The benefit shall be a
5dollar amount available in an amount per day to pay for the
6services of a qualified long-term services and supports
7provider. A dedicated Trust Fund for this purpose is created in
8Section 35.
9    (c) The long-term services and supports benefit is not
10intended to replace the Community Care Program, Home Services
11Program, the Home-Based Support Services Program, or any other
12long-term services and supports provided by the State through
13the Medical Assistance Program. Maintenance of existing
14long-term care programs shall help to fulfill the requirement
15under subsection (a). The long-term services and supports
16benefit is intended to improve investment in home-based and
17community-based services in Illinois, including those
18described in the State's Medicaid waivers and other existing
19long-term care programs. The existing long-term care programs
20and the benefit described in this Act may not be used
21concurrently, but may be used sequentially.
22    (d) No later than January 1, 2025, the long-term services
23and supports benefit shall be available for eligible
24beneficiaries. The Long-Term Services and Supports Trust
25Commission may set an earlier date for the initial availability
26of 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
3commission a comprehensive study of long-term care trends,
4future projections, and actuarial analysis of a new long-term
5services and supports benefit. Upon completion of the study,
6the Department shall prepare a report on the study that
7includes 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
15configurations the numbers of persons covered year over year,
16utilization rates, total spending, and the Trust Fund's ratio
17balance and solvency. The Trust Fund must initially be
18structured to be solvent for 75 years. The report must detail
19the sensitivity of these projections to the level of care
20criteria that define long-term care need and examine the
21feasibility of setting a lower threshold, based on a lower need
22for ongoing assistance in routine life activities.
23     The report must also detail the amount of out-of-pocket
24costs avoided, the number of persons who delayed or avoided
25utilization of medical assistance benefits, an analysis on the
26projected increased utilization of home-based and

 

 

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1community-based services over skilled nursing facilities and
2savings therewith, and savings to the existing long-term care
3programs due to the new long-term services and supports
4benefit.
5    (b) The financing options to be studied in the actuarial
6analysis shall conform to the main benchmarks listed in Section
715.
8    (c) The entity chosen to conduct the actuarial analysis
9shall be a nationally-recognized organization with experience
10modeling public and private long-term care financing programs.
11    (d) The study shall be completed before April 1, 2019. Upon
12completion, the report on the study shall to be delivered to
13the Long-Term Services and Supports Trust Commission
14established in Section 25.
 
15    Section 25. Long-Term Services and Supports Trust
16Commission.
17    (a) The Long-Term Services and Supports Trust Commission is
18created on April 1, 2019. The Commission shall include the
19following 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
18of 2 years, except that the Governor shall appoint the initial
19members identified in paragraphs (6), (7), and (8) of
20subsection (a) to staggered terms not to exceed 4 years.
21Appointments by the Governor shall be subject to the advice and
22consent of the Senate.
23    (c) On April 1, 2019, the Commission shall receive a report
24on the completed study of long-term services and supports needs
25and actuarial modeling. The Commission shall use the study
26results to set the initial per-day long-term services and

 

 

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1supports benefit, the benefit's duration, the formula for an
2annual adjustment of the benefit amount, the start date for
3payouts, and other terms as may be necessary, and shall
4identify a funding mechanism, inclusive of rates of tax, that
5is consistent with these terms and in a manner that is
6actuarially sound. The Commission may set the eligibility
7threshold that defines long-term care need for the new benefit
8lower, but not higher, than the level of care criteria in place
9on the effective date of this Act for existing long-term care
10programs. In setting the initial per-day benefit, the
11Commission shall primarily consider the cost of home-based and
12community-based services, and shall address deficiencies in
13current rates of payment and workers' wages for those services
14identified as contributing to weaknesses in the system of
15long-term care services and supports. Within 30 days after the
16Commission receives the report, the Commission shall submit a
17separate report to the General Assembly with its recommendation
18for a funding mechanism for the long-term services and supports
19benefit.
20    (d) The Commission member from the Department of Healthcare
21and Family Services shall convene the first meeting. The
22members shall elect a chair at the first meeting. Meetings of
23the Commission shall be at the call of the chair, but shall
24occur 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
2provide administrative support to the Commission.
 
3    Section 30. Long-term services and supports providers.
4    (a) The provider types that may become qualified providers
5by decision of the Commission are: home care or homemaker
6services providers participating in the Community Care Program
7or Home Services Program; personal assistants or other
8independent providers participating in the Home Services
9Program; adult day programs participating in the Community Care
10Program or Home Services Program; respite care providers
11participating in the Home Services Program; home modification
12or environmental accessibility modification providers
13participating in the Home Services Program; personal support
14providers participating as waiver providers in the Medical
15Assistance Program; community-integrated living arrangements
16participating as waiver providers in the Medical Assistance
17Program; supportive living facilities participating in the
18Medical Assistance Program; and nursing facilities
19participating as providers in the Medical Assistance Program.
20    (b) Participating providers described in subsection (a)
21shall be qualified long-term services and supports providers if
22their provider type is deemed by the Commission to provide
23safe, consumer-directed or person-centered, and cost-effective
24long-term services and supports. In making these decisions, the
25Commission shall evaluate whether home-based and

 

 

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1community-based services are consumer-directed, and shall
2evaluate whether other institutional provider types provide
3services in a person-centered fashion.
4    (c) Family caregivers may deliver services under this Act
5if the arrangement complies with the requirements for a type of
6provider that is a qualified provider as set forth in
7subsections (a) and (b). If, after the effective date of this
8Act, the requirements for any type of qualified providers
9become more restrictive with regard to family caregivers, the
10Commission shall review whether these changes diminish the
11ability of the long-term services and support benefit to
12support family caregiving, in accordance with paragraph (6) of
13subsection (e) of Section 25.
14    (d) An eligible beneficiary seeking to use the long-term
15services and supports benefit to pay a qualified provider that
16is a nursing facility, and nursing facilities seeking payment
17from the long-term services and supports benefit for services
18to an eligible beneficiary, shall be subject to additional
19requirements. An eligible beneficiary seeking to use the
20long-term services and supports benefit to pay a nursing
21facility must have an assessment consistent with a
22determination of need score of 37 or higher or an assessment
23indicating the same level of need for ongoing assistance in
24routine life activities on the universal assessment tool. An
25eligible beneficiary must also secure an exception documented
26by his or her needs assessor, and approved by the Department of

 

 

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1Healthcare and Family Services, that it is not possible for the
2eligible beneficiary to use the benefit to live at home with
3home-based and community-based supports. An eligible
4beneficiary may not use more than 75% of the cumulative total
5value of the benefit over its duration to pay a nursing
6facility. In arranging payment, nursing facilities shall
7submit information on actual costs of direct-care labor being
8charged, capital costs being charged, and all other costs being
9charged. The long-term services and supports benefit shall not
10be 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
13created as a special fund in the State treasury for the purpose
14of receiving funds dedicated to paying the long-term services
15and supports benefit created under this Act. Dedicated funds
16shall come from a tax set at rates deemed to be actuarially
17sound as set forth in subsection (b). All receipts under
18subsection (b) must be deposited into the Trust Fund. These
19funds shall be held separate and apart from all public moneys
20or funds of the State, as provided in this Section, and shall
21be administered as set forth in Section 40 exclusively for the
22purposes of this Act. Expenditures from the Trust Fund may be
23used solely for payment of long-term services and supports
24benefits and for necessary administrative activities.
25    (b) The benefit shall be paid for through a tax, the nature

 

 

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1of which shall be determined by the actuarial study set forth
2in paragraph (3) of subsection (a) of Section 20. The
3Commission shall recommend tax rates that are actuarially sound
4in its report to the General Assembly as required under
5subsection (c) of Section 25.
6    (c) Funds deposited into the Trust Fund may be used only
7for the purposes set forth in this Act, and shall not be
8subject to administrative charges or chargebacks unless
9otherwise authorized by this Act. The Trust Fund is exempt from
10any sweep, transfer, or other budgetary maneuver that may
11result in the use of the Trust Fund's moneys for a purpose
12other than the purposes set forth in this Act.
13    (d) This Section shall not become operative until
14legislation is enacted into law by the General Assembly that
15imposes or authorizes a new tax for the purposes set forth in
16this Act.
 
17    Section 40. Administration.
18    (a) The Department of Healthcare and Family Services shall
19maintain rolls of eligible beneficiaries based in part on
20assessments of long-term care need performed by needs
21assessors. The Department of Healthcare and Family Services
22shall be responsible for making payments from benefits to
23qualified long-term services and supports providers on behalf
24of eligible beneficiaries for the provision of services to
25those beneficiaries.

 

 

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1    (b) The Department of Healthcare and Family Services shall
2maintain a list of qualified long-term services and supports
3providers. This list shall conform to determinations made by
4the Commission as to which types of providers appear on the
5list. Within each type of provider, the particular providers
6that qualify shall be those participating in the existing
7long-term care programs.
8    (c) The Department of Healthcare and Family Services shall
9assist the Commission in monitoring the solvency and financial
10status of the Trust Fund.
11    (d) The Department of Healthcare and Family Services shall
12prepare and distribute written or electronic materials to
13eligible beneficiaries, family caregivers, seniors, and the
14public at large as necessary to inform or update them regarding
15the long-term services and supports benefit.
16    (e) The Department on Aging shall maintain a statewide
17network of needs assessors and shall be charged with
18reimbursing the needs assessors for eligibility assessment
19services.
20    (f) This Section shall not become operative until (i)
21legislation is enacted into law by the General Assembly that
22imposes or authorizes a new tax for the purposes set forth in
23this Act and (ii) the Trust Fund in Section 35 has been
24created.
 
25    Section 45. The State Finance Act is amended by adding

 

 

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1Section 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
5becoming law.".