Illinois General Assembly - Full Text of SB2147
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Full Text of SB2147  97th General Assembly


Rep. Lou Lang

Filed: 5/28/2011





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2    AMENDMENT NO. ______. Amend Senate Bill 2147 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements. Such
14preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not



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1limited to, any or all of the following:
2        (a) (blank);
3        (b) (blank);
4        (c) home care aide services;
5        (d) personal assistant services;
6        (e) adult day services;
7        (f) home-delivered meals;
8        (g) education in self-care;
9        (h) personal care services;
10        (i) adult day health services;
11        (j) habilitation services;
12        (k) respite care;
13        (k-5) community reintegration services;
14        (k-6) flexible senior services;
15        (k-7) medication management;
16        (k-8) emergency home response;
17        (l) other nonmedical social services that may enable
18    the person to become self-supporting; or
19        (m) clearinghouse for information provided by senior
20    citizen home owners who want to rent rooms to or share
21    living space with other senior citizens.
22    The Department shall establish eligibility standards for
23such services. In determining the amount and nature of services
24for which a person may qualify, consideration shall not be
25given to the value of cash, property or other assets held in
26the name of the person's spouse pursuant to a written agreement



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1dividing marital property into equal but separate shares or
2pursuant to a transfer of the person's interest in a home to
3his spouse, provided that the spouse's share of the marital
4property is not made available to the person seeking such
6    Beginning January 1, 2008, the Department shall require as
7a condition of eligibility that all new financially eligible
8applicants apply for and enroll in medical assistance under
9Article V of the Illinois Public Aid Code in accordance with
10rules promulgated by the Department.
11    The Department shall, in conjunction with the Department of
12Public Aid (now Department of Healthcare and Family Services),
13seek appropriate amendments under Sections 1915 and 1924 of the
14Social Security Act. The purpose of the amendments shall be to
15extend eligibility for home and community based services under
16Sections 1915 and 1924 of the Social Security Act to persons
17who transfer to or for the benefit of a spouse those amounts of
18income and resources allowed under Section 1924 of the Social
19Security Act. Subject to the approval of such amendments, the
20Department shall extend the provisions of Section 5-4 of the
21Illinois Public Aid Code to persons who, but for the provision
22of home or community-based services, would require the level of
23care provided in an institution, as is provided for in federal
24law. Those persons no longer found to be eligible for receiving
25noninstitutional services due to changes in the eligibility
26criteria shall be given 45 days notice prior to actual



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1termination. Those persons receiving notice of termination may
2contact the Department and request the determination be
3appealed at any time during the 45 day notice period. The
4target population identified for the purposes of this Section
5are persons age 60 and older with an identified service need.
6Priority shall be given to those who are at imminent risk of
7institutionalization. The services shall be provided to
8eligible persons age 60 and older to the extent that the cost
9of the services together with the other personal maintenance
10expenses of the persons are reasonably related to the standards
11established for care in a group facility appropriate to the
12person's condition. These non-institutional services, pilot
13projects or experimental facilities may be provided as part of
14or in addition to those authorized by federal law or those
15funded and administered by the Department of Human Services.
16The Departments of Human Services, Healthcare and Family
17Services, Public Health, Veterans' Affairs, and Commerce and
18Economic Opportunity and other appropriate agencies of State,
19federal and local governments shall cooperate with the
20Department on Aging in the establishment and development of the
21non-institutional services. The Department shall require an
22annual audit from all personal assistant and home care aide
23vendors contracting with the Department under this Section. The
24annual audit shall assure that each audited vendor's procedures
25are in compliance with Department's financial reporting
26guidelines requiring an administrative and employee wage and



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1benefits cost split as defined in administrative rules. The
2audit is a public record under the Freedom of Information Act.
3The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department of Healthcare
6and Family Services, to effect the following: (1) intake
7procedures and common eligibility criteria for those persons
8who are receiving non-institutional services; and (2) the
9establishment and development of non-institutional services in
10areas of the State where they are not currently available or
11are undeveloped. On and after July 1, 1996, all nursing home
12prescreenings for individuals 60 years of age or older shall be
13conducted by the Department.
14    As part of the Department on Aging's routine training of
15case managers and case manager supervisors, the Department may
16include information on family futures planning for persons who
17are age 60 or older and who are caregivers of their adult
18children with developmental disabilities. The content of the
19training shall be at the Department's discretion.
20    The Department is authorized to establish a system of
21recipient copayment for services provided under this Section,
22such copayment to be based upon the recipient's ability to pay
23but in no case to exceed the actual cost of the services
24provided. Additionally, any portion of a person's income which
25is equal to or less than the federal poverty standard shall not
26be considered by the Department in determining the copayment.



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1The level of such copayment shall be adjusted whenever
2necessary to reflect any change in the officially designated
3federal poverty standard.
4    The Department, or the Department's authorized
5representative, may recover the amount of moneys expended for
6services provided to or in behalf of a person under this
7Section by a claim against the person's estate or against the
8estate of the person's surviving spouse, but no recovery may be
9had until after the death of the surviving spouse, if any, and
10then only at such time when there is no surviving child who is
11under age 21, blind, or permanently and totally disabled. This
12paragraph, however, shall not bar recovery, at the death of the
13person, of moneys for services provided to the person or in
14behalf of the person under this Section to which the person was
15not entitled; provided that such recovery shall not be enforced
16against any real estate while it is occupied as a homestead by
17the surviving spouse or other dependent, if no claims by other
18creditors have been filed against the estate, or, if such
19claims have been filed, they remain dormant for failure of
20prosecution or failure of the claimant to compel administration
21of the estate for the purpose of payment. This paragraph shall
22not bar recovery from the estate of a spouse, under Sections
231915 and 1924 of the Social Security Act and Section 5-4 of the
24Illinois Public Aid Code, who precedes a person receiving
25services under this Section in death. All moneys for services
26paid to or in behalf of the person under this Section shall be



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1claimed for recovery from the deceased spouse's estate.
2"Homestead", as used in this paragraph, means the dwelling
3house and contiguous real estate occupied by a surviving spouse
4or relative, as defined by the rules and regulations of the
5Department of Healthcare and Family Services, regardless of the
6value of the property.
7    The Department shall increase the effectiveness of the
8existing Community Care Program by:
9        (1) ensuring that in-home services included in the care
10    plan are available on evenings and weekends;
11        (2) ensuring that care plans contain the services that
12    eligible participants need based on the number of days in a
13    month, not limited to specific blocks of time, as
14    identified by the comprehensive assessment tool selected
15    by the Department for use statewide, not to exceed the
16    total monthly service cost maximum allowed for each
17    service; the Department shall develop administrative rules
18    to implement this item (2);
19        (3) ensuring that the participants have the right to
20    choose the services contained in their care plan and to
21    direct how those services are provided, based on
22    administrative rules established by the Department;
23        (4) ensuring that the determination of need tool is
24    accurate in determining the participants' level of need; to
25    achieve this, the Department, in conjunction with the Older
26    Adult Services Advisory Committee, shall institute a study



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1    of the relationship between the Determination of Need
2    scores, level of need, service cost maximums, and the
3    development and utilization of service plans no later than
4    May 1, 2008; findings and recommendations shall be
5    presented to the Governor and the General Assembly no later
6    than January 1, 2009; recommendations shall include all
7    needed changes to the service cost maximums schedule and
8    additional covered services;
9        (5) ensuring that homemakers can provide personal care
10    services that may or may not involve contact with clients,
11    including but not limited to:
12            (A) bathing;
13            (B) grooming;
14            (C) toileting;
15            (D) nail care;
16            (E) transferring;
17            (F) respiratory services;
18            (G) exercise; or
19            (H) positioning;
20        (6) ensuring that homemaker program vendors are not
21    restricted from hiring homemakers who are family members of
22    clients or recommended by clients; the Department may not,
23    by rule or policy, require homemakers who are family
24    members of clients or recommended by clients to accept
25    assignments in homes other than the client;
26        (7) ensuring that the State may access maximum federal



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1    matching funds by seeking approval for the Centers for
2    Medicare and Medicaid Services for modifications to the
3    State's home and community based services waiver and
4    additional waiver opportunities in order to maximize
5    federal matching funds; this shall include, but not be
6    limited to, modification that reflects all changes in the
7    Community Care Program services and all increases in the
8    services cost maximum; and
9        (8) ensuring that the determination of need tool
10    accurately reflects the service needs of individuals with
11    Alzheimer's disease and related dementia disorders.
12    By January 1, 2009 or as soon after the end of the Cash and
13Counseling Demonstration Project as is practicable, the
14Department may, based on its evaluation of the demonstration
15project, promulgate rules concerning personal assistant
16services, to include, but need not be limited to,
17qualifications, employment screening, rights under fair labor
18standards, training, fiduciary agent, and supervision
19requirements. All applicants shall be subject to the provisions
20of the Health Care Worker Background Check Act.
21    The Department shall develop procedures to enhance
22availability of services on evenings, weekends, and on an
23emergency basis to meet the respite needs of caregivers.
24Procedures shall be developed to permit the utilization of
25services in successive blocks of 24 hours up to the monthly
26maximum established by the Department. Workers providing these



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1services shall be appropriately trained.
2    Beginning on the effective date of this Amendatory Act of
31991, no person may perform chore/housekeeping and home care
4aide services under a program authorized by this Section unless
5that person has been issued a certificate of pre-service to do
6so by his or her employing agency. Information gathered to
7effect such certification shall include (i) the person's name,
8(ii) the date the person was hired by his or her current
9employer, and (iii) the training, including dates and levels.
10Persons engaged in the program authorized by this Section
11before the effective date of this amendatory Act of 1991 shall
12be issued a certificate of all pre- and in-service training
13from his or her employer upon submitting the necessary
14information. The employing agency shall be required to retain
15records of all staff pre- and in-service training, and shall
16provide such records to the Department upon request and upon
17termination of the employer's contract with the Department. In
18addition, the employing agency is responsible for the issuance
19of certifications of in-service training completed to their
21    The Department is required to develop a system to ensure
22that persons working as home care aides and personal assistants
23receive increases in their wages when the federal minimum wage
24is increased by requiring vendors to certify that they are
25meeting the federal minimum wage statute for home care aides
26and personal assistants. An employer that cannot ensure that



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1the minimum wage increase is being given to home care aides and
2personal assistants shall be denied any increase in
3reimbursement costs.
4    The Community Care Program Advisory Committee is created in
5the Department on Aging. The Director shall appoint individuals
6to serve in the Committee, who shall serve at their own
7expense. Members of the Committee must abide by all applicable
8ethics laws. The Committee shall advise the Department on
9issues related to the Department's program of services to
10prevent unnecessary institutionalization. The Committee shall
11meet on a bi-monthly basis and shall serve to identify and
12advise the Department on present and potential issues affecting
13the service delivery network, the program's clients, and the
14Department and to recommend solution strategies. Persons
15appointed to the Committee shall be appointed on, but not
16limited to, their own and their agency's experience with the
17program, geographic representation, and willingness to serve.
18The Director shall appoint members to the Committee to
19represent provider, advocacy, policy research, and other
20constituencies committed to the delivery of high quality home
21and community-based services to older adults. Representatives
22shall be appointed to ensure representation from community care
23providers including, but not limited to, adult day service
24providers, homemaker providers, case coordination and case
25management units, emergency home response providers, statewide
26trade or labor unions that represent home care aides and direct



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1care staff, area agencies on aging, adults over age 60,
2membership organizations representing older adults, and other
3organizational entities, providers of care, or individuals
4with demonstrated interest and expertise in the field of home
5and community care as determined by the Director.
6    Nominations may be presented from any agency or State
7association with interest in the program. The Director, or his
8or her designee, shall serve as the permanent co-chair of the
9advisory committee. One other co-chair shall be nominated and
10approved by the members of the committee on an annual basis.
11Committee members' terms of appointment shall be for 4 years
12with one-quarter of the appointees' terms expiring each year. A
13member shall continue to serve until his or her replacement is
14named. The Department shall fill vacancies that have a
15remaining term of over one year, and this replacement shall
16occur through the annual replacement of expiring terms. The
17Director shall designate Department staff to provide technical
18assistance and staff support to the committee. Department
19representation shall not constitute membership of the
20committee. All Committee papers, issues, recommendations,
21reports, and meeting memoranda are advisory only. The Director,
22or his or her designee, shall make a written report, as
23requested by the Committee, regarding issues before the
25    The Department on Aging and the Department of Human
26Services shall cooperate in the development and submission of



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1an annual report on programs and services provided under this
2Section. Such joint report shall be filed with the Governor and
3the General Assembly on or before September 30 each year.
4    The requirement for reporting to the General Assembly shall
5be satisfied by filing copies of the report with the Speaker,
6the Minority Leader and the Clerk of the House of
7Representatives and the President, the Minority Leader and the
8Secretary of the Senate and the Legislative Research Unit, as
9required by Section 3.1 of the General Assembly Organization
10Act and filing such additional copies with the State Government
11Report Distribution Center for the General Assembly as is
12required under paragraph (t) of Section 7 of the State Library
14    Those persons previously found eligible for receiving
15non-institutional services whose services were discontinued
16under the Emergency Budget Act of Fiscal Year 1992, and who do
17not meet the eligibility standards in effect on or after July
181, 1992, shall remain ineligible on and after July 1, 1992.
19Those persons previously not required to cost-share and who
20were required to cost-share effective March 1, 1992, shall
21continue to meet cost-share requirements on and after July 1,
221992. Beginning July 1, 1992, all clients will be required to
23meet eligibility, cost-share, and other requirements and will
24have services discontinued or altered when they fail to meet
25these requirements.
26    The Department shall pay an enhanced rate under the



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1Community Care Program to those in-home service provider
2agencies that offer health insurance coverage as a benefit to
3their direct service worker employees consistent with the
4mandates of Public Act 95-713.
5    Notwithstanding any other eligibility rules in effect or
6subsequently promulgated by the Department, and consistent
7with the mandates of Public Act 95-713, vendors who receive or
8did receive an enhanced rate payment for the purpose of
9providing health insurance coverage to their employees by
10contributing to a Taft-Hartley welfare plan or other qualified
11self-funded health plan will be allowed to have such plans
12accumulate or have accumulated up to 6 months of enhanced rate
13payments prior to the actual provision of health insurance
14coverage to their direct service worker employees in order to
15be able to pay premiums, benefits, claims, or other attendant
16costs of such health coverage.
17    For the purposes of this Section, "flexible senior
18services" refers to services that require one-time or periodic
19expenditures including, but not limited to, respite care, home
20modification, assistive technology, housing assistance, and
22(Source: P.A. 95-298, eff. 8-20-07; 95-473, eff. 8-27-07;
2395-565, eff. 6-1-08; 95-876, eff. 8-21-08; 96-918, eff. 6-9-10;
2496-1129, eff. 7-20-10; revised 9-2-10.)
25    Section 10. The Nursing Home Care Act is amended by



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1changing Section 3-202.05 as follows:
2    (210 ILCS 45/3-202.05)
3    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
5    (a) For the purpose of computing staff to resident ratios,
6direct care staff shall include:
7        (1) registered nurses;
8        (2) licensed practical nurses;
9        (3) certified nurse assistants;
10        (4) psychiatric services rehabilitation aides;
11        (5) rehabilitation and therapy aides;
12        (6) psychiatric services rehabilitation coordinators;
13        (7) assistant directors of nursing;
14        (8) 50% of the Director of Nurses' time; and
15        (9) 30% of the Social Services Directors' time.
16    The Department shall, by rule, allow certain facilities
17subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
18S) and 300.6000 and following (Subpart T) to utilize
19specialized clinical staff, as defined in rules, to count
20towards the staffing ratios.
21    (b) Beginning January 1, 2011, and thereafter, light
22intermediate care shall be staffed at the same staffing ratio
23as intermediate care.
24    (c) Facilities shall notify the Department within 60 days
25after the effective date of this amendatory Act of the 96th



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1General Assembly, in a form and manner prescribed by the
2Department, of the staffing ratios in effect on the effective
3date of this amendatory Act of the 96th General Assembly for
4both intermediate and skilled care and the number of residents
5receiving each level of care.
6    (d)(1) Effective July 1, 2010, for each resident needing
7skilled care, a minimum staffing ratio of 2.5 hours of nursing
8and personal care each day must be provided; for each resident
9needing intermediate care, 1.7 hours of nursing and personal
10care each day must be provided.
11    (2) Effective January 1, 2011, the minimum staffing ratios
12shall be increased to 2.7 hours of nursing and personal care
13each day for a resident needing skilled care and 1.9 hours of
14nursing and personal care each day for a resident needing
15intermediate care.
16    (3) Effective January 1, 2012, the minimum staffing ratios
17shall be increased to 3.0 hours of nursing and personal care
18each day for a resident needing skilled care and 2.1 hours of
19nursing and personal care each day for a resident needing
20intermediate care.
21    (4) Effective January 1, 2013, the minimum staffing ratios
22shall be increased to 3.4 hours of nursing and personal care
23each day for a resident needing skilled care and 2.3 hours of
24nursing and personal care each day for a resident needing
25intermediate care.
26    (5) Effective January 1, 2014, the minimum staffing ratios



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1shall be increased to 3.8 hours of nursing and personal care
2each day for a resident needing skilled care and 2.5 hours of
3nursing and personal care each day for a resident needing
4intermediate care.
5    (e) Staffing increases contained in paragraphs (3), (4),
6and (5) of subsection (d) shall be delayed for one year after
7the effective dates stated in the paragraphs, unless (i) the
8federal Centers for Medicare & Medicaid Services reviews and
9approves an appropriate State plan amendment containing the
10methodologies contained in Section 5-5.4 of the Illinois Public
11Aid Code and determines that the assessment imposed by Section
125B-2 of the Illinois Public Aid Code is a permissible tax under
13Title XIX of the Social Security Act or (ii) the State of
14Illinois identifies an alternative funding source, in which
15case the effective dates shall not be delayed. In the event
16that both this amendatory Act of the 97th General Assembly and
17Senate Bill 145 of the 97th General Assembly become law, the
18provisions under this subsection (e) shall not apply.
19(Source: P.A. 96-1372, eff. 7-29-10; 96-1504, eff. 1-27-11.)
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".