SB1324sam001 94TH GENERAL ASSEMBLY

Sen. M. Maggie Crotty

Filed: 5/5/2005

09400SB1324sam001 LRB094 05100 BDD 45479 a

AMENDMENT TO SENATE BILL 1324

AMENDMENT NO. ______. Amend Senate Bill 1324 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Community First Act.

Section 5. Purpose. It is the intent of the General Assembly to promote the civil rights of persons with disabilities by enabling those who want and who are determined appropriate for community services, as determined by the State, to receive them under the United States Supreme Court's decision in Olmstead v. L.C. 527 U.S. 581 (1999).

Therefore, the General Assembly's intent is to eliminate barriers that prevent or restrict the use of funds to allow the individual to remain in the community.

The General Assembly finds that increases in State long-term care expenditures for community services for people transitioning from institutions to the community under this Act must be offset by decreases in State long-term care expenditures for institutional care.

Section 10. Definitions. As used in this Act:

"Community service" means a service, aid, or benefit that is provided to a person with a disability as part of his or her long-term care that: (i) is available to a person living in their own home, family home, a facility with no more than 8 people, or assisted living as provided through the Supportive Living Facilities, as defined in Section 5-5.01a of the Illinois Public Aid Code, or Comprehensive Care in Residential Settings Demonstration Projects, as defined in Section 4.02c of the Illinois Act on the Aging, or other like settings; (ii) the State generally provides to people with disabilities; and (iii) is necessary for the person with a disability to live in the community, as determined by the State.

"Community service provider" means any person authorized by the State to provide community services and may include families, agencies, and other new providers who help to create a wider array of services.

"Departments" means the Department of Human Services, the Department on Aging, the Department of Public Health, and the Department of Public Aid.

"Home and Community Based Services waiver" or "HCBS waiver" means a Medicaid waiver granted under Section 1915c of Title XIX of the Social Security Act.

"Institution" or "institutional facility" means a skilled nursing or intermediate long-term care facility subject to licensure by the Department of Public Health under the Nursing Care Act, including any intermediate care facility for the mentally retarded, any institution for mental diseases, or any State-operated developmental center.

"Public funds" means any funds appropriated by the General Assembly to the Departments.

"Waiver" means a Home and Community Based Services waiver as defined above or a research and demonstration waiver granted under Section 1115 of the Social Security Act.

Section 15. Availability of public funds for community services.

(a) A person with a disability may have public funds that would otherwise have been expended for his or her services provided in an institution expended instead for any community service or support that the State generally offers to people with disabilities, provided the State determines that the service is necessary for the person to live in the community and further provided that the necessary services are available under Section 20, instituting the practice of "money follows the person" among other mechanisms to promote reintegration.

(b) The cost of community services provided under this Act may not exceed the cost of care in the institutional facility in the geographic area in which the person resides in the community. In the case of persons moving from an institutional facility to the community, transition costs and the cost of the first month of care are limited to the actual, individual cost of initially establishing the person in the community. Monthly expenditure for persons deflected from entering an institution and persons transferring out of institutions after the first month are limited to minimum cost of care determined necessary by the State to meet the person's long-term care service needs in the community under an existing waiver.

(c) Funding for persons under this Act shall remain available to the person as long as he or she remains eligible for services in an institution and wants community services and to the extent that such funding is available under Section 20.

Section 20. Implementation.

(a) In fiscal year 2006, the State shall provide additional funding to current reintegration programs administered by the Department of Human Services.

(b) As people with disabilities relocate from institutional facilities to the community, the Departments shall develop a model by which State funding appropriated to cover the costs of long-term care in institutions may be used to cover the cost of long-term care in the community. In conjunction with these efforts, the Departments shall strengthen efforts to divert people from going into institutions by addressing issues relating to: (i) home and community eligibility; (ii) preadmission screening and capacity in the institutional care system; and (iii) any other relevant issue to develop "money follows the person" or other mechanisms necessary to assure that, as expenditures for community services under this Act increase, there is a concomitant reduction in nursing facility costs.

(1) The Departments must collaborate on a survey of individuals who reside in institutions and are supported by public funds and as well as persons seeking long-term care to develop a survey tool to assess what these individuals and their family members perceive are the barriers for their remaining in a community-based setting. This survey must analyze the barriers for those over 65 years old and those who are persons with disability under the age of 65. The surveys must be completed by December 31, 2006.

(2) With the information gathered under item (1), the Departments must develop either modifications to current Home and Community Based Services (HCBS) waivers, so as to promote transition from a nursing home or other institution to a Home or Community Based Services (HCBS) setting, or develop new waivers that promote a return to home for seniors or younger persons with disabilities residing in institutions. Input from individuals with disabilities, families, providers, and other interested parties shall be included in the design, development, and evaluation of those modifications or new waivers. Requests for waiver modifications or new waivers must be submitted to the federal government no later than June 30, 2007.

(3) Services provided under item (2) are subject to federal approval of modification of an existing HCBS waivers or approval of new waivers.

(c) Programs under the waivers or HCBS waiver modifications developed under items (2) and (3) of subsection (b) must be piloted in such a manner that funding for the new services under these waivers does not exceed $2 million per year. The pilot programs shall commence no later than January 1, 2008.

(d) After 2 years of operation of such waivers, a report must be delivered to the General Assembly on the evaluation of the effectiveness of those waivers in promoting community reintegration.

The waivers or waiver modifications must be developed to address barriers experienced by all 4 categories of disability: (i) developmental; (ii) psychiatric; (iii) physical; and (iv) disabilities due to aging. Waiver or waiver modification programs found to be effective shall be continued subject to federal approval of those waivers.

Section 25. Information and dissemination.

(a) The State shall ensure that persons covered under this Act are informed of their opportunity to receive community services under this Act.

(1) The Departments shall work together to ensure that persons with disabilities and their families, guardians, and advocates are informed of their opportunities for services under this Act in a manner that is easily understandable and accessible to people with disabilities. The Departments shall ensure that appropriate methods of dissemination are employed and shall make all feasible efforts to inform people currently institutionalized, including at their individual team or program meetings.

(2) The Departments shall use organizations comprised of or representing people with disabilities to ensure that people with disabilities, particularly prospective residents of institutions covered under this Act, and their families, guardians, and advocates are informed of their opportunities for services under this Act.

(3) The Department of Public Health must ensure that, as a condition of licensing and certification, all institutions covered under this Act inform all residents prior to admission and annually thereafter of their opportunities to choose home and community alternatives under this Act. Additionally, the Department shall require each facility to post in a prominent location on each residential ward a notice containing information on services available under this Act.

Section 30. Effect of the Act on existing rights. This Act shall not alter or affect the manner in which persons with disabilities are determined eligible or appropriate for community services, except to the extent the determinations are based on the availability of community services. This Act shall not limit in any way the rights of people with disabilities under the U.S. Constitution, the American with Disabilities Act if 1990, Section 504 of the Rehabilitation Act, the Social Security Act, or any other federal or State law.

Section 40. Rules. The Department shall adopt any rules necessary for the implementation and administration of this Act.

Section 99. Effective date. This Act takes effect upon becoming law.".