Sen. M. Maggie Crotty

Filed: 3/23/2007





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2     AMENDMENT NO. ______. Amend Senate Bill 765 by replacing
3 everything after the enacting clause with the following:
4     "Section 5. The Disabilities Services Act of 2003 is
5 amended by adding a heading to Article 1 immediately before
6 Section 1 of the Act, by adding a heading to Article 2
7 immediately before Section 5 of the Act, by adding Article 3
8 and a heading to Article 99 immediately after Section 30 of the
9 Act as follows:
10     (20 ILCS 2407/Art. 1 heading new)

12     (20 ILCS 2407/Art. 2 heading new)




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1     (20 ILCS 2407/Art. 3 heading new)

3     (20 ILCS 2407/51 new)
4     Sec. 51. Legislative intent. It is the intent of the
5 General Assembly to promote the civil rights of persons with
6 disabilities by providing community-based services for persons
7 with disabilities when such services are determined
8 appropriate and desired by the affected persons, as required by
9 Title II of the Americans with Disabilities Act under the
10 United States Supreme Court's decision in Olmstead v. L.C., 527
11 U.S. 581 (1999). In accordance with Section 6071 of the Deficit
12 Reduction Act of 2005 (P.L. 109-171), the purpose of this Act
13 is: (i) to eliminate barriers or mechanisms, whether in State
14 law, the State Medicaid plan, the State budget, or otherwise,
15 that prevent or restrict the flexible use of funds to enable
16 individuals with disabilities to receive support for
17 appropriate and necessary long-term services in settings of
18 their choice; (ii) to increase the use of home and
19 community-based, rather than institutional, long-term care
20 services; (iii) to increase the ability of the State Medicaid
21 program to assure continued provision of home and
22 community-based long-term care service to eligible individuals
23 who choose to transition from an institutional to a community
24 setting; and (iv) to ensure that procedures are in place (at
25 least comparable to those required under the qualified HCB



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1 program) to provide quality assurance for eligible individuals
2 receiving Medicaid home and community-based long-term care
3 services and to provide for continuous quality improvement in
4 such services. More specifically, this Article amends the
5 Disabilities Services Act of 2003 (notwithstanding Section 30
6 of the Act) to mandate the creation of a flexible system of
7 financing for long-term services and supports in Illinois that
8 would allow available Medicaid funds to be spent on home and
9 community-based services when an individual residing in an
10 institution moves to the most appropriate and preferred
11 community-based setting of his or her choice.
12     (20 ILCS 2407/52 new)
13     Sec. 52. Applicability; definitions. In accordance with
14 section 6071 of the Deficit Reduction Act of 2005 (P.L.
15 109-171), as used in this Article:
16     "Home and community-based long-term care services". The
17 term "home and community-based long-term care services" means,
18 with respect to a State Medicaid program, a service aid, or
19 benefit, home and community-based services (including home
20 health and personal care services) that are provided to a
21 person with a disability (and are voluntarily accepted), as
22 part of his or her long-term care that: (i) is provided under
23 the State's qualified HCB program or that could be provided
24 under such a program but is otherwise provided under the
25 Medicaid program; (ii) is delivered in a qualified residence;



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1 and (iii) is necessary for the person with a disability to live
2 in the community.
3     "Departments". The term "Departments" means for the
4 purposes of this Act, the Department of Human Services, the
5 Department on Aging, Department of Children and Family
6 Services, Department of Healthcare and Family Services and
7 Department of Public Health, unless otherwise noted.
8     "Eligible Individual". The term "eligible individual"
9 means a person who (i) has resided, for a period of not less
10 than 6 months, in an inpatient facility; (ii) is receiving
11 Medicaid benefits for inpatient services furnished by the
12 inpatient facility; (iii) with respect to whom a determination
13 has been made that, but for the provision of home and
14 community-based long-term care services, the individual would
15 continue to require the level of care provided in an inpatient
16 facility; (iv) who is deemed appropriate by the
17 inter-disciplinary team for home or community-based services;
18 and (v) who wants to transfer from an inpatient facility to a
19 qualified residence. For the purposes of this Act, "eligible
20 individual" does not include a person with a disability
21 receiving acute care mental health treatment in a
22 State-operated mental health center for less than 30
23 consecutive days in a one-year period, or a person committed to
24 a State-operated mental health forensic program, or
25 developmental center forensic program.
26     "Inpatient facility". The term "inpatient facility" means



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1 a skilled nursing or intermediate long-term care facility
2 subject to licensure by the Department of Public Health under
3 the Nursing Home Care Act, an intermediate care facility for
4 the developmentally disabled (ICF-DDs), an institution for
5 mental diseases, child care institutions licensed by the
6 Department of Children and Family Services, any community
7 living facility as defined in the Community Living Facilities
8 Licensing Act (210 ILCS 35), any community residential
9 alternative as defined in the Community Residential
10 Alternatives Licensing Act (405 ILCS 30), any Supportive Living
11 Facility as provided in the Public Aid Code (305 ILCS
12 5/5-5.01a), and a State-operated developmental center or
13 mental health center, whether publicly or privately owned.
14     "Interdisciplinary team" means a group of persons that
15 represents those professions, disciplines, or service areas
16 that are relevant to identifying an individual's strengths and
17 needs, and designs a program to meet those needs. This team
18 shall include at least a physician, a social worker, and other
19 professionals. In intermediate care facilities for the
20 developmentally disabled (ICF/DDs) at least one member of the
21 team shall be a qualified mental retardation professional. The
22 interdisciplinary team includes the individual, the
23 individual's guardian, the individual's authorized
24 representative, the individual's primary service providers,
25 including staff most familiar with the individual's needs. The
26 individual or his or her guardian may also invite other



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1 individuals to meet with the interdisciplinary team and
2 participate in the process of identifying the individual's
3 strengths and needs.
4     "Qualified residence". The term "qualified residence"
5 means, with respect to an eligible individual: (i) a home owned
6 or leased by the individual or the individual's authorized
7 representative (as defined by P.L. 109-171); (ii) an apartment
8 with an individual lease, with lockable access and egress, and
9 which includes living, sleeping, bathing, and cooking areas
10 over which the individual or the individual's family has domain
11 and control; and (iii) a residence, in a community-based
12 residential setting, in which no more than 4 unrelated
13 individuals reside.
14     "Self-directed services". The term "self-directed
15 services" means, with respect to home and community-based
16 long-term care services for an eligible individual, those
17 services for the individual that are planned and purchased
18 under the direction and control of the individual or the
19 individual's authorized representative, including the amount,
20 duration, scope, provider, and location of such services, under
21 the State Medicaid program consistent with the following
22 requirements:
23         (a) Assessment: there is an assessment of the needs,
24     capabilities, and preferences of the individual with
25     respect to such services.
26         (b) Service plan: based on the assessment, there is



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1     developed jointly with such individual or the individual's
2     authorized representative, a plan for such services for the
3     individual that is approved by the State and that (i)
4     specifies those services, if any, that the individual or
5     the individual's authorized representative would be
6     responsible for directing; (ii) identifies the methods by
7     which the individual or the individual's authorized
8     representative or an agency designated by an individual or
9     representative will select, manage, and dismiss providers
10     of such services.
11     "Public Funds" means any funds appropriated by the General
12 Assembly to the Department of Human Services, the Department on
13 Aging, the Department of Children and Family Services, or the
14 Department of Healthcare and Family Services.
15     (20 ILCS 2407/53 new)
16     Sec. 53. Allocation of public funds.
17     (a) Any eligible individual, as defined in Section 52, has
18 the right to have an amount equal to the amount of public funds
19 that are, or would have been, expended for his or her care in
20 an inpatient facility available to pay for his or her home and
21 community-based long-term care services in a qualified
22 residence.
23     (b) In accordance with Sections 15(2) and 20(b)(2) of this
24 Act, all eligible individuals under this Act shall have an
25 individual service or treatment plan that is reviewed by the



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1 individual treatment professionals at least annually that is
2 consistent with the requirements under subparts (A) and (B) of
3 item 8 of subsection (b) of the Deficit Reduction Act of 2005
4 (P.L. 109-171), and that includes an individualized budget that
5 identifies the dollar value of the services consistent with the
6 requirements under subsection (b)(8)(C) of section 6071 and
7 supports under the control and direction of the individual or
8 the individual's authorized representative. The service or
9 treatment plan must contain assurances that each eligible
10 individual has been provided the opportunity to make an
11 informed choice regarding their right under subsection (a).
12     (c) In accordance with any disability services plan or plan
13 update under this Act and section 6071 of the Deficit Reduction
14 Act of 2005 (P.L. 109-171), the Departments shall develop
15 appropriate fiscal payment mechanisms and methodologies, by
16 December 1, 2008, that effectively support choice and eliminate
17 any legal, budgetary, or other barriers to flexibility in the
18 availability of Medicaid funds to pay for long-term care
19 services for individuals in the appropriate home and
20 community-based long-term care settings of their choice,
21 including costs to transition from an inpatient facility to a
22 qualified residence. With respect to the individualized
23 budgets described in subsection (b), the fiscal payment
24 mechanisms and methodologies must: (i) describe the method for
25 calculating the dollar values in such budgets based on reliable
26 costs and service utilization; (ii) define a process for making



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1 adjustments in such dollar values to reflect changes in
2 individual assessments and service plans; and (iii) provide a
3 procedure to evaluate expenditures under such budgets.
4     (d) The cost of home and community-based long-term care
5 services provided under this Act shall be funded in accordance
6 with the individual service or treatment plan, but shall not
7 exceed 60% of the weighted average (weighted by Medicaid
8 patient days) inpatient facility rates for the geographic
9 grouping, by licensure category. Each qualified residence
10 shall be paid 60% of the weighted average inpatient facility
11 geographic group rate, based upon the inpatient facility
12 geographic group in which it is located. The rates paid to
13 qualified residences shall be reviewed semi-annually, and
14 adjusted, if necessary, on April 1 and October 1 to assure that
15 the rates coincide with 60% of weighted average inpatient
16 facility geographic group's rates.
17     (e) In addition to Section 4.4 of the Community Services
18 Act of 2004 (P.L. 094-0498), to the extent that savings are
19 realized, those moneys must be deposited into the Olmstead
20 Implementation Fund, created as a special fund in the State
21 treasury, and shall be used to expand the availability,
22 quality, or stability of home and community-based long-term
23 care services and supports for persons with disabilities (such
24 as in-home consumer/family supports; integrated, accessible,
25 and affordable housing options and home modifications; etc.).
26 Any portion of the Olmstead Implementation Fund for a fiscal



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1 year under this Section remaining at the end of such fiscal
2 year shall remain available for the next 4 years
3     (f) The allocation of public funds for home and
4 community-based long-term care services shall not have the
5 effect of: (i) diminishing or reducing the quality of services
6 available to residents of inpatient facilities; or (ii) forcing
7 any residents of inpatient facilities to involuntarily accept
8 home and community-based long-term care services, or causing
9 any residents of inpatient facilities to be involuntarily
10 transferred or discharged; (iii) causing reductions in
11 inpatient facility reimbursement rates in effect as of July 1,
12 2008; or (iv) causing any delay of inpatient facility payments.
13     (g) Funding for eligible individuals under this Act shall
14 remain available to the eligible individual, in accordance with
15 the individual service or treatment plan, as long as he or she
16 remains eligible for services in an inpatient facility and
17 prefers home and community-based long-term care services.
18     (20 ILCS 2407/54 new)
19     Sec. 54. Quality assurance and quality improvement.
20     (a) In accordance with subsection (c) (11) of section 6071
21 of the Deficit Reduction Act of 2005 (P.L. 109-171), the
22 Departments shall develop a plan for quality assurance and
23 quality improvement for home and community-based long-term
24 care services under the State Medicaid program, including a
25 regulatory plan to assure the health and welfare of eligible



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1 individuals under this Act.
2     (b) This plan shall require the Departments to apply for
3 any available federal strategic planning and implementation
4 funding to carry out the intent of this legislation, and to
5 seek any appropriate Federal Medicaid waivers to maximize
6 Federal financial participation.
7     (20 ILCS 2407/55 new)
8     Sec. 55. Dissemination of information; reports.
9     (a) The State shall ensure that all eligible individuals
10 are informed of their right to receive home and community-based
11 long-term care services under this Act. The Departments shall
12 work together with organizations comprised of, or representing
13 people with disabilities, to ensure that persons with
14 disabilities and their families, guardians, and advocates are
15 informed of their rights under this Act in a manner that is
16 easily understandable and accessible to people with
17 disabilities. The Departments shall ensure that multiple
18 methods of dissemination are employed and shall make concerted
19 efforts to inform people currently in inpatient facilities,
20 including at their individual team or program meetings. The
21 Department of Public Health shall ensure that, as a condition
22 of licensing and certification, all inpatient facilities
23 covered under this Act shall inform all residents annually of
24 their opportunities to choose home and community alternatives
25 under this Act. Additionally, the Department shall require each



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1 inpatient facility to post in a prominent location a notice
2 containing information on rights and services available under
3 this Act. Notices posted shall comply with the accessibility
4 standards of the Americans with Disabilities Act.
5     (b) On or before April 1 of each year, in conjunction with
6 their annual reports, the Departments shall report to the
7 Governor and the General Assembly on the implementation of this
8 Act and include, at a minimum, the following data; (i) a
9 description of the fiscal payment mechanisms and methodologies
10 developed under this Act that effectively support choice (money
11 follows the person); (ii) an accounting of the savings realized
12 under this Act and the ways in which these savings were spent;
13 (iii) information concerning the dollar amounts of State
14 Medicaid expenditures for fiscal years 2006 and 2007, for
15 long-term care services and the percentage of such expenditures
16 that were for institutional long-term care services or were for
17 home and community-based long-term care services; (iv) a
18 description of the Departments' efforts to inform all eligible
19 individuals of their rights under this Act; (v) the number of
20 eligible individuals referred or identified under this Act in
21 the previous fiscal year, the number of eligible individuals
22 who applied to transfer to home and community-based long-term
23 care services in the previous fiscal year, and the number of
24 eligible individuals who, in fact, transferred from an
25 inpatient facility to a qualified residence in the previous
26 fiscal year; (vi) documentation that the Departments have met



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1 the requirements under Section 5 to assure the health and
2 welfare of eligible individuals receiving home and
3 community-based long-term care services; and (vii) any
4 obstacles the Departments confronted in assisting residents of
5 inpatient facilities to make the transition to a qualified
6 residence, and the Departments' recommendations for removing
7 those obstacles. This report must be made available to the
8 general public, including via the Departments' websites.
9     (20 ILCS 2407/56 new)
10     Sec. 56. Effect on existing rights.
11     (a) This Article does not alter or affect the manner in
12 which persons with disabilities are determined eligible or
13 appropriate for home and community-based long-term care
14 services, except to the extent the determinations are based on
15 the availability of community services.
16     (b) This Article shall not be read to limit in any way the
17 rights of people with disabilities under the U.S. Constitution,
18 the Americans with Disabilities Act, Section 504 of the
19 Rehabilitation Act, the Social Security Act, or any other
20 federal or State law.
21     (20 ILCS 2407/57 new)
22     Sec. 57. Rules. The Departments shall adopt any rules
23 necessary for the implementation and administration of this Act
24 within 6 months of the effective date of this Act.



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1     (20 ILCS 2407/58 new)
2     Sec. 58. Service provider cost reporting and
3 accountability. The Departments shall adopt any rules
4 necessary for the implementation of service provider cost
5 reporting to ensure accountability under this Act within 6
6 months of the effective date of this Act.
7     (20 ILCS 2407/Art. 99 heading new)

9     Section 90. The State Finance Act is amended by adding
10 Section 5.675 as follows:
11     (30 ILCS 105/5.675 new)
12     Sec. 5.675. The Olmstead Implementation Fund.
13     Section 99. Effective date. This Act takes effect July 1,
14 2008.".