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| Public Act 094-0048 |
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AN ACT concerning health.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. Short title. This Act may be cited as the FY2006 | ||||
Budget Implementation (Human Services) Act. | ||||
Section 5. Purpose. It is the purpose of this Act to | ||||
implement the Governor's FY2006 budget recommendations | ||||
concerning human services. | ||||
Section 10. The Illinois Administrative Procedure Act is | ||||
amended by changing Section 5-45 as follows:
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(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
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Sec. 5-45. Emergency rulemaking.
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(a) "Emergency" means the existence of any situation that | ||||
any agency
finds reasonably constitutes a threat to the public | ||||
interest, safety, or
welfare.
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(b) If any agency finds that an
emergency exists that | ||||
requires adoption of a rule upon fewer days than
is required by | ||||
Section 5-40 and states in writing its reasons for that
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finding, the agency may adopt an emergency rule without prior | ||||
notice or
hearing upon filing a notice of emergency rulemaking | ||||
with the Secretary of
State under Section 5-70. The notice | ||||
shall include the text of the
emergency rule and shall be | ||||
published in the Illinois Register. Consent
orders or other | ||||
court orders adopting settlements negotiated by an agency
may | ||||
be adopted under this Section. Subject to applicable | ||||
constitutional or
statutory provisions, an emergency rule | ||||
becomes effective immediately upon
filing under Section 5-65 or | ||||
at a stated date less than 10 days
thereafter. The agency's | ||||
finding and a statement of the specific reasons
for the finding | ||||
shall be filed with the rule. The agency shall take
reasonable | ||||
and appropriate measures to make emergency rules known to the
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persons who may be affected by them.
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(c) An emergency rule may be effective for a period of not | ||
longer than
150 days, but the agency's authority to adopt an | ||
identical rule under Section
5-40 is not precluded. No | ||
emergency rule may be adopted more
than once in any 24 month | ||
period, except that this limitation on the number
of emergency | ||
rules that may be adopted in a 24 month period does not apply
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to (i) emergency rules that make additions to and deletions | ||
from the Drug
Manual under Section 5-5.16 of the Illinois | ||
Public Aid Code or the
generic drug formulary under Section | ||
3.14 of the Illinois Food, Drug
and Cosmetic Act, (ii) | ||
emergency rules adopted by the Pollution Control
Board before | ||
July 1, 1997 to implement portions of the Livestock Management
| ||
Facilities Act, ; or (iii) emergency rules adopted by the | ||
Illinois Department of Public Health under subsections (a) | ||
through (i) of Section 2 of the Department of Public Health Act | ||
when necessary to protect the public's health. Two or more | ||
emergency rules having substantially the same
purpose and | ||
effect shall be deemed to be a single rule for purposes of this
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Section.
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(d) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 1999 budget, | ||
emergency rules to implement any
provision of Public Act 90-587 | ||
or 90-588
or any other budget initiative for fiscal year 1999 | ||
may be adopted in
accordance with this Section by the agency | ||
charged with administering that
provision or initiative, | ||
except that the 24-month limitation on the adoption
of | ||
emergency rules and the provisions of Sections 5-115 and 5-125 | ||
do not apply
to rules adopted under this subsection (d). The | ||
adoption of emergency rules
authorized by this subsection (d) | ||
shall be deemed to be necessary for the
public interest, | ||
safety, and welfare.
| ||
(e) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 2000 budget, | ||
emergency rules to implement any
provision of this amendatory | ||
Act of the 91st General Assembly
or any other budget initiative | ||
for fiscal year 2000 may be adopted in
accordance with this | ||
Section by the agency charged with administering that
provision | ||
or initiative, except that the 24-month limitation on the | ||
adoption
of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply
to rules adopted under this | ||
subsection (e). The adoption of emergency rules
authorized by | ||
this subsection (e) shall be deemed to be necessary for the
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public interest, safety, and welfare.
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(f) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 2001 budget, | ||
emergency rules to implement any
provision of this amendatory | ||
Act of the 91st General Assembly
or any other budget initiative | ||
for fiscal year 2001 may be adopted in
accordance with this | ||
Section by the agency charged with administering that
provision | ||
or initiative, except that the 24-month limitation on the | ||
adoption
of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply
to rules adopted under this | ||
subsection (f). The adoption of emergency rules
authorized by | ||
this subsection (f) shall be deemed to be necessary for the
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public interest, safety, and welfare.
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(g) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 2002 budget, | ||
emergency rules to implement any
provision of this amendatory | ||
Act of the 92nd General Assembly
or any other budget initiative | ||
for fiscal year 2002 may be adopted in
accordance with this | ||
Section by the agency charged with administering that
provision | ||
or initiative, except that the 24-month limitation on the | ||
adoption
of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply
to rules adopted under this | ||
subsection (g). The adoption of emergency rules
authorized by | ||
this subsection (g) shall be deemed to be necessary for the
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public interest, safety, and welfare.
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(h) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 2003 budget, | ||
emergency rules to implement any
provision of this amendatory | ||
Act of the 92nd General Assembly
or any other budget initiative | ||
for fiscal year 2003 may be adopted in
accordance with this | ||
Section by the agency charged with administering that
provision | ||
or initiative, except that the 24-month limitation on the | ||
adoption
of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply
to rules adopted under this | ||
subsection (h). The adoption of emergency rules
authorized by | ||
this subsection (h) shall be deemed to be necessary for the
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public interest, safety, and welfare.
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(i) In order to provide for the expeditious and timely | ||
implementation
of the State's fiscal year 2004 budget, | ||
emergency rules to implement any
provision of this amendatory | ||
Act of the 93rd General Assembly
or any other budget initiative | ||
for fiscal year 2004 may be adopted in
accordance with this | ||
Section by the agency charged with administering that
provision | ||
or initiative, except that the 24-month limitation on the | ||
adoption
of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply
to rules adopted under this | ||
subsection (i). The adoption of emergency rules
authorized by | ||
this subsection (i) shall be deemed to be necessary for the
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public interest, safety, and welfare.
| ||
(j) In order to provide for the expeditious and timely | ||
implementation of the provisions of the State's fiscal year | ||
2005 budget as provided under the Fiscal Year 2005 Budget | ||
Implementation (Human Services) Act, emergency rules to | ||
implement any provision of the Fiscal Year 2005 Budget | ||
Implementation (Human Services) Act may be adopted in | ||
accordance with this Section by the agency charged with | ||
administering that provision, except that the 24-month | ||
limitation on the adoption of emergency rules and the | ||
provisions of Sections 5-115 and 5-125 do not apply to rules | ||
adopted under this subsection (j). The Department of Public Aid | ||
may also adopt rules under this subsection (j) necessary to | ||
administer the Illinois Public Aid Code and the Children's | ||
Health Insurance Program Act. The adoption of emergency rules | ||
authorized by this subsection (j) shall be deemed to be | ||
necessary for the public interest, safety, and welfare.
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(k) In order to provide for the expeditious and timely | ||
implementation of the provisions of the State's fiscal year | ||
2006 budget, emergency rules to implement any provision of this | ||
amendatory Act of the 94th General Assembly or any other budget | ||
initiative for fiscal year 2006 may be adopted in accordance | ||
with this Section by the agency charged with administering that | ||
provision or initiative, except that the 24-month limitation on | ||
the adoption of emergency rules and the provisions of Sections | ||
5-115 and 5-125 do not apply to rules adopted under this | ||
subsection (k). The Department of Public Aid may also adopt | ||
rules under this subsection (k) necessary to administer the | ||
Illinois Public Aid Code, the Senior Citizens and Disabled | ||
Persons Property Tax Relief and Pharmaceutical Assistance Act, | ||
the Senior Citizens and Disabled Persons Prescription Drug | ||
Discount Program Act, and the Children's Health Insurance | ||
Program Act. The adoption of emergency rules authorized by this | ||
subsection (k) shall be deemed to be necessary for the public | ||
interest, safety, and welfare.
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(Source: P.A. 92-10, eff. 6-11-01; 92-597, eff. 6-28-02; 93-20, | ||
eff. 6-20-03; 93-829, eff. 7-28-04; 93-841, eff. 7-30-04; | ||
revised 10-25-04.)
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Section 12. The Illinois Act on the Aging is amended by | ||
changing Section 4.02 as follows:
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(20 ILCS 105/4.02) (from Ch. 23, par. 6104.02)
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Sec. 4.02. The Department shall establish a program of | ||
services to
prevent unnecessary institutionalization of | ||
persons age 60 and older in
need of long term care or who are | ||
established as persons who suffer from
Alzheimer's disease or a | ||
related disorder under the Alzheimer's Disease
Assistance Act, | ||
thereby enabling them
to remain in their own homes or in other | ||
living arrangements. Such
preventive services, which may be | ||
coordinated with other programs for the
aged and monitored by | ||
area agencies on aging in cooperation with the
Department, may | ||
include, but are not limited to, any or all of the following:
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(a) home health services;
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(b) home nursing services;
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(c) homemaker services;
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(d) chore and housekeeping services;
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(e) day care services;
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(f) home-delivered meals;
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(g) education in self-care;
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(h) personal care services;
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(i) adult day health services;
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(j) habilitation services;
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(k) respite care;
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(k-5) community reintegration services;
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(l) other nonmedical social services that may enable | ||
the person
to become self-supporting; or
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(m) clearinghouse for information provided by senior | ||
citizen home owners
who want to rent rooms to or share | ||
living space with other senior citizens.
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The Department shall establish eligibility standards for | ||
such
services taking into consideration the unique economic and | ||
social needs
of the target population for whom they are to be | ||
provided. Such eligibility
standards shall be based on the | ||
recipient's ability to pay for services;
provided, however, | ||
that in determining the amount and nature of services
for which | ||
a person may qualify, consideration shall not be given to the
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value of cash, property or other assets held in the name of the | ||
person's
spouse pursuant to a written agreement dividing | ||
marital property into equal
but separate shares or pursuant to | ||
a transfer of the person's interest in a
home to his spouse, | ||
provided that the spouse's share of the marital
property is not | ||
made available to the person seeking such services.
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Beginning July 1, 2002, the Department shall require as a | ||
condition of
eligibility that all financially eligible | ||
applicants and recipients apply
for medical assistance
under | ||
Article V of the Illinois Public Aid Code in accordance with | ||
rules
promulgated by the Department.
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The Department shall, in conjunction with the Department of | ||
Public Aid,
seek appropriate amendments under Sections 1915 and | ||
1924 of the Social
Security Act. The purpose of the amendments | ||
shall be to extend eligibility
for home and community based | ||
services under Sections 1915 and 1924 of the
Social Security | ||
Act to persons who transfer to or for the benefit of a
spouse | ||
those amounts of income and resources allowed under Section | ||
1924 of
the Social Security Act. Subject to the approval of | ||
such amendments, the
Department shall extend the provisions of | ||
Section 5-4 of the Illinois
Public Aid Code to persons who, but | ||
for the provision of home or
community-based services, would | ||
require the level of care provided in an
institution, as is | ||
provided for in federal law. Those persons no longer
found to | ||
be eligible for receiving noninstitutional services due to | ||
changes
in the eligibility criteria shall be given 60 days | ||
notice prior to actual
termination. Those persons receiving | ||
notice of termination may contact the
Department and request | ||
the determination be appealed at any time during the
60 day | ||
notice period. With the exception of the lengthened notice and | ||
time
frame for the appeal request, the appeal process shall | ||
follow the normal
procedure. In addition, each person affected | ||
regardless of the
circumstances for discontinued eligibility | ||
shall be given notice and the
opportunity to purchase the | ||
necessary services through the Community Care
Program. If the | ||
individual does not elect to purchase services, the
Department | ||
shall advise the individual of alternative services. The target
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population identified for the purposes of this Section are | ||
persons age 60
and older with an identified service need. | ||
Priority shall be given to those
who are at imminent risk of | ||
institutionalization. The services shall be
provided to | ||
eligible persons age 60 and older to the extent that the cost
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of the services together with the other personal maintenance
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expenses of the persons are reasonably related to the standards
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established for care in a group facility appropriate to the | ||
person's
condition. These non-institutional services, pilot | ||
projects or
experimental facilities may be provided as part of | ||
or in addition to
those authorized by federal law or those | ||
funded and administered by the
Department of Human Services. | ||
The Departments of Human Services, Public Aid,
Public Health, | ||
Veterans' Affairs, and Commerce and Economic Opportunity and
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other appropriate agencies of State, federal and local | ||
governments shall
cooperate with the Department on Aging in the | ||
establishment and development
of the non-institutional | ||
services. The Department shall require an annual
audit from all | ||
chore/housekeeping and homemaker vendors contracting with
the | ||
Department under this Section. The annual audit shall assure | ||
that each
audited vendor's procedures are in compliance with | ||
Department's financial
reporting guidelines requiring an | ||
administrative and employee wage and benefits cost split as | ||
defined in administrative rules
a 27% administrative cost split | ||
and a 73%
employee wages and benefits cost split. The audit is | ||
a public record under
the Freedom of Information Act. The | ||
Department shall execute, relative to
the nursing home | ||
prescreening project, written inter-agency
agreements with the | ||
Department of Human Services and the Department
of Public Aid, | ||
to effect the following: (1) intake procedures and common
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eligibility criteria for those persons who are receiving | ||
non-institutional
services; and (2) the establishment and | ||
development of non-institutional
services in areas of the State | ||
where they are not currently available or are
undeveloped. On | ||
and after July 1, 1996, all nursing home prescreenings for
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individuals 60 years of age or older shall be conducted by the | ||
Department.
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The Department is authorized to establish a system of | ||
recipient copayment
for services provided under this Section, | ||
such copayment to be based upon
the recipient's ability to pay | ||
but in no case to exceed the actual cost of
the services | ||
provided. Additionally, any portion of a person's income which
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is equal to or less than the federal poverty standard shall not | ||
be
considered by the Department in determining the copayment. | ||
The level of
such copayment shall be adjusted whenever | ||
necessary to reflect any change
in the officially designated | ||
federal poverty standard.
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The Department, or the Department's authorized | ||
representative, shall
recover the amount of moneys expended for | ||
services provided to or in
behalf of a person under this | ||
Section by a claim against the person's
estate or against the | ||
estate of the person's surviving spouse, but no
recovery may be | ||
had until after the death of the surviving spouse, if
any, and | ||
then only at such time when there is no surviving child who
is | ||
under age 21, blind, or permanently and totally disabled. This
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paragraph, however, shall not bar recovery, at the death of the | ||
person, of
moneys for services provided to the person or in | ||
behalf of the person under
this Section to which the person was | ||
not entitled;
provided that such recovery shall not be enforced | ||
against any real estate while
it is occupied as a homestead by | ||
the surviving spouse or other dependent, if no
claims by other | ||
creditors have been filed against the estate, or, if such
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claims have been filed, they remain dormant for failure of | ||
prosecution or
failure of the claimant to compel administration | ||
of the estate for the purpose
of payment. This paragraph shall | ||
not bar recovery from the estate of a spouse,
under Sections | ||
1915 and 1924 of the Social Security Act and Section 5-4 of the
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Illinois Public Aid Code, who precedes a person receiving | ||
services under this
Section in death. All moneys for services
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paid to or in behalf of the person under this Section shall be | ||
claimed for
recovery from the deceased spouse's estate. | ||
"Homestead", as used
in this paragraph, means the dwelling | ||
house and
contiguous real estate occupied by a surviving spouse
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or relative, as defined by the rules and regulations of the | ||
Illinois Department
of Public Aid, regardless of the value of | ||
the property.
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The Department shall develop procedures to enhance | ||
availability of
services on evenings, weekends, and on an | ||
emergency basis to meet the
respite needs of caregivers. | ||
Procedures shall be developed to permit the
utilization of | ||
services in successive blocks of 24 hours up to the monthly
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maximum established by the Department. Workers providing these | ||
services
shall be appropriately trained.
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Beginning on the effective date of this Amendatory Act of | ||
1991, no person
may perform chore/housekeeping and homemaker | ||
services under a program
authorized by this Section unless that | ||
person has been issued a certificate
of pre-service to do so by | ||
his or her employing agency. Information
gathered to effect | ||
such certification shall include (i) the person's name,
(ii) | ||
the date the person was hired by his or her current employer, | ||
and
(iii) the training, including dates and levels. Persons | ||
engaged in the
program authorized by this Section before the | ||
effective date of this
amendatory Act of 1991 shall be issued a | ||
certificate of all pre- and
in-service training from his or her | ||
employer upon submitting the necessary
information. The | ||
employing agency shall be required to retain records of
all | ||
staff pre- and in-service training, and shall provide such | ||
records to
the Department upon request and upon termination of | ||
the employer's contract
with the Department. In addition, the | ||
employing agency is responsible for
the issuance of | ||
certifications of in-service training completed to their
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employees.
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The Department is required to develop a system to ensure | ||
that persons
working as homemakers and chore housekeepers | ||
receive increases in their
wages when the federal minimum wage | ||
is increased by requiring vendors to
certify that they are | ||
meeting the federal minimum wage statute for homemakers
and | ||
chore housekeepers. An employer that cannot ensure that the | ||
minimum
wage increase is being given to homemakers and chore | ||
housekeepers
shall be denied any increase in reimbursement | ||
costs.
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The Department on Aging and the Department of Human | ||
Services
shall cooperate in the development and submission of | ||
an annual report on
programs and services provided under this | ||
Section. Such joint report
shall be filed with the Governor and | ||
the General Assembly on or before
September 30 each year.
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The requirement for reporting to the General Assembly shall | ||
be satisfied
by filing copies of the report with the Speaker, | ||
the Minority Leader and
the Clerk of the House of | ||
Representatives and the President, the Minority
Leader and the | ||
Secretary of the Senate and the Legislative Research Unit,
as | ||
required by Section 3.1 of the General Assembly Organization | ||
Act and
filing such additional copies with the State Government | ||
Report Distribution
Center for the General Assembly as is | ||
required under paragraph (t) of
Section 7 of the State Library | ||
Act.
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Those persons previously found eligible for receiving | ||
non-institutional
services whose services were discontinued | ||
under the Emergency Budget Act of
Fiscal Year 1992, and who do | ||
not meet the eligibility standards in effect
on or after July | ||
1, 1992, shall remain ineligible on and after July 1,
1992. | ||
Those persons previously not required to cost-share and who | ||
were
required to cost-share effective March 1, 1992, shall | ||
continue to meet
cost-share requirements on and after July 1, | ||
1992. Beginning July 1, 1992,
all clients will be required to | ||
meet
eligibility, cost-share, and other requirements and will | ||
have services
discontinued or altered when they fail to meet | ||
these requirements.
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(Source: P.A. 92-597, eff. 6-28-02; 93-85, eff. 1-1-04; 93-902, | ||
eff. 8-10-04.)
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Section 15. The Children's Health Insurance Program Act is | ||
amended by changing Section 30 as follows:
| ||
(215 ILCS 106/30)
| ||
Sec. 30. Cost sharing.
| ||
(a) Children enrolled in a health benefits program pursuant | ||
to subdivision
(a)(2) of Section 25 and persons enrolled in a | ||
health benefits waiver program pursuant to Section 40 shall be | ||
subject to the following cost sharing
requirements:
| ||
(1) There shall be no co-payment required for well-baby | ||
or well-child
care, including age-appropriate | ||
immunizations as required under
federal law.
| ||
(2) Health insurance premiums for family members, | ||
either children or adults, in families whose household
| ||
income is above 150% of the federal poverty level shall be | ||
payable
monthly, subject to rules promulgated by the | ||
Department for grace periods and
advance payments, and | ||
shall be as follows:
| ||
(A) $15 per month for one family member
child.
| ||
(B) $25 per month for 2 family members
children.
| ||
(C) $30 per month for 3 family members
or more | ||
children. | ||
(D) $35 per month for 4 family members. | ||
(E) $40 per month for 5 or more family members.
| ||
(3) Co-payments for children or adults in families | ||
whose income is at or below
150% of the federal poverty | ||
level, at a minimum and to the extent permitted
under | ||
federal law, shall be $2 for all medical visits and | ||
prescriptions
provided under this Act.
| ||
(4) Co-payments for children or adults in families | ||
whose income is above 150%
of the federal poverty level, at | ||
a minimum and to the extent permitted under
federal law | ||
shall be as follows:
| ||
(A) $5 for medical visits.
| ||
(B) $3 for generic prescriptions and $5 for brand | ||
name
prescriptions.
| ||
(C) $25 for emergency room use for a non-emergency
| ||
situation as defined by the Department by rule.
| ||
(5) The maximum amount of out-of-pocket expenses for | ||
co-payments shall be
$100 per family per year.
| ||
(b) Individuals enrolled in a privately sponsored health | ||
insurance plan
pursuant to subdivision (a)(1) of Section 25 | ||
shall be subject to the cost
sharing provisions as stated in | ||
the privately sponsored health insurance plan.
| ||
(Source: P.A. 90-736, eff. 8-12-98; 91-266, eff. 7-23-99.)
| ||
Section 20. The Illinois Public Aid Code is amended by | ||
changing Sections 5-5.4, 5-5.12, 5-11, and 12-4.35 as follows: | ||
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
| ||
Sec. 5-5.4. Standards of Payment - Department of Public | ||
Aid.
The Department of Public Aid shall develop standards of | ||
payment of skilled
nursing and intermediate care services in | ||
facilities providing such services
under this Article which:
| ||
(1) Provide for the determination of a facility's payment
| ||
for skilled nursing and intermediate care services on a | ||
prospective basis.
The amount of the payment rate for all | ||
nursing facilities certified by the
Department of Public Health | ||
under the Nursing Home Care Act as Intermediate
Care for the | ||
Developmentally Disabled facilities, Long Term Care for Under | ||
Age
22 facilities, Skilled Nursing facilities, or Intermediate | ||
Care facilities
under the
medical assistance program shall be | ||
prospectively established annually on the
basis of historical, | ||
financial, and statistical data reflecting actual costs
from | ||
prior years, which shall be applied to the current rate year | ||
and updated
for inflation, except that the capital cost element | ||
for newly constructed
facilities shall be based upon projected | ||
budgets. The annually established
payment rate shall take | ||
effect on July 1 in 1984 and subsequent years. No rate
increase | ||
and no
update for inflation shall be provided on or after July | ||
1, 1994 and before
July 1, 2006
2005, unless specifically | ||
provided for in this
Section.
The changes made by this | ||
amendatory Act of the 93rd General Assembly extending the | ||
duration of the prohibition against a rate increase or update | ||
for inflation are effective retroactive to July 1, 2004.
| ||
For facilities licensed by the Department of Public Health | ||
under the Nursing
Home Care Act as Intermediate Care for the | ||
Developmentally Disabled facilities
or Long Term Care for Under | ||
Age 22 facilities, the rates taking effect on July
1, 1998 | ||
shall include an increase of 3%. For facilities licensed by the
| ||
Department of Public Health under the Nursing Home Care Act as | ||
Skilled Nursing
facilities or Intermediate Care facilities, | ||
the rates taking effect on July 1,
1998 shall include an | ||
increase of 3% plus $1.10 per resident-day, as defined by
the | ||
Department.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on July 1, 1999 | ||
shall include an increase of 1.6% plus $3.00 per
resident-day, | ||
as defined by the Department. For facilities licensed by the
| ||
Department of Public Health under the Nursing Home Care Act as | ||
Skilled Nursing
facilities or Intermediate Care facilities, | ||
the rates taking effect on July 1,
1999 shall include an | ||
increase of 1.6% and, for services provided on or after
October | ||
1, 1999, shall be increased by $4.00 per resident-day, as | ||
defined by
the Department.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on July 1, 2000 | ||
shall include an increase of 2.5% per resident-day,
as defined | ||
by the Department. For facilities licensed by the Department of
| ||
Public Health under the Nursing Home Care Act as Skilled | ||
Nursing facilities or
Intermediate Care facilities, the rates | ||
taking effect on July 1, 2000 shall
include an increase of 2.5% | ||
per resident-day, as defined by the Department.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as skilled nursing facilities | ||
or intermediate care
facilities, a new payment methodology must | ||
be implemented for the nursing
component of the rate effective | ||
July 1, 2003. The Department of Public Aid
shall develop the | ||
new payment methodology using the Minimum Data Set
(MDS) as the | ||
instrument to collect information concerning nursing home
| ||
resident condition necessary to compute the rate. The | ||
Department of Public Aid
shall develop the new payment | ||
methodology to meet the unique needs of
Illinois nursing home | ||
residents while remaining subject to the appropriations
| ||
provided by the General Assembly.
A transition period from the | ||
payment methodology in effect on June 30, 2003
to the payment | ||
methodology in effect on July 1, 2003 shall be provided for a
| ||
period not exceeding 2 years after implementation of the new | ||
payment
methodology as follows:
| ||
(A) For a facility that would receive a lower
nursing | ||
component rate per patient day under the new system than | ||
the facility
received
effective on the date immediately | ||
preceding the date that the Department
implements the new | ||
payment methodology, the nursing component rate per | ||
patient
day for the facility
shall be held at
the level in | ||
effect on the date immediately preceding the date that the
| ||
Department implements the new payment methodology until a | ||
higher nursing
component rate of
reimbursement is achieved | ||
by that
facility.
| ||
(B) For a facility that would receive a higher nursing | ||
component rate per
patient day under the payment | ||
methodology in effect on July 1, 2003 than the
facility | ||
received effective on the date immediately preceding the | ||
date that the
Department implements the new payment | ||
methodology, the nursing component rate
per patient day for | ||
the facility shall be adjusted.
| ||
(C) Notwithstanding paragraphs (A) and (B), the | ||
nursing component rate per
patient day for the facility | ||
shall be adjusted subject to appropriations
provided by the | ||
General Assembly.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on March 1, 2001 | ||
shall include a statewide increase of 7.85%, as
defined by the | ||
Department.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as Intermediate Care for the | ||
Developmentally Disabled
facilities or Long Term Care for Under | ||
Age 22 facilities, the rates taking
effect on April 1, 2002 | ||
shall include a statewide increase of 2.0%, as
defined by the | ||
Department.
This increase terminates on July 1, 2002;
beginning | ||
July 1, 2002 these rates are reduced to the level of the rates
| ||
in effect on March 31, 2002, as defined by the Department.
| ||
For facilities licensed by the Department of Public Health | ||
under the
Nursing Home Care Act as skilled nursing facilities | ||
or intermediate care
facilities, the rates taking effect on | ||
July 1, 2001 shall be computed using the most recent cost | ||
reports
on file with the Department of Public Aid no later than | ||
April 1, 2000,
updated for inflation to January 1, 2001. For | ||
rates effective July 1, 2001
only, rates shall be the greater | ||
of the rate computed for July 1, 2001
or the rate effective on | ||
June 30, 2001.
| ||
Notwithstanding any other provision of this Section, for | ||
facilities
licensed by the Department of Public Health under | ||
the Nursing Home Care Act
as skilled nursing facilities or | ||
intermediate care facilities, the Illinois
Department shall | ||
determine by rule the rates taking effect on July 1, 2002,
| ||
which shall be 5.9% less than the rates in effect on June 30, | ||
2002.
| ||
Notwithstanding any other provision of this Section, for | ||
facilities
licensed by the Department of Public Health under | ||
the Nursing Home Care Act as
skilled nursing
facilities or | ||
intermediate care facilities, if the payment methodologies | ||
required under Section 5A-12 and the waiver granted under 42 | ||
CFR 433.68 are approved by the United States Centers for | ||
Medicare and Medicaid Services, the rates taking effect on July | ||
1, 2004 shall be 3.0% greater than the rates in effect on June | ||
30, 2004. These rates shall take
effect only upon approval and
| ||
implementation of the payment methodologies required under | ||
Section 5A-12.
| ||
Notwithstanding any other provisions of this Section, for | ||
facilities licensed by the Department of Public Health under | ||
the Nursing Home Care Act as skilled nursing facilities or | ||
intermediate care facilities, the rates taking effect on | ||
January 1, 2005 shall be 3% more than the rates in effect on | ||
December 31, 2004.
| ||
For facilities
licensed
by the
Department of Public Health | ||
under the Nursing Home Care Act as Intermediate
Care for
the | ||
Developmentally Disabled facilities or as long-term care | ||
facilities for
residents under 22 years of age, the rates | ||
taking effect on July 1,
2003 shall
include a statewide | ||
increase of 4%, as defined by the Department.
| ||
Notwithstanding any other provision of this Section, for | ||
facilities licensed by the Department of Public Health under | ||
the Nursing Home Care Act as skilled nursing facilities or | ||
intermediate care facilities, effective January 1, 2005, | ||
facility rates shall be increased by the difference between (i) | ||
a facility's per diem property, liability, and malpractice | ||
insurance costs as reported in the cost report filed with the | ||
Department of Public Aid and used to establish rates effective | ||
July 1, 2001 and (ii) those same costs as reported in the | ||
facility's 2002 cost report. These costs shall be passed | ||
through to the facility without caps or limitations, except for | ||
adjustments required under normal auditing procedures.
| ||
Rates established effective each July 1 shall govern | ||
payment
for services rendered throughout that fiscal year, | ||
except that rates
established on July 1, 1996 shall be | ||
increased by 6.8% for services
provided on or after January 1, | ||
1997. Such rates will be based
upon the rates calculated for | ||
the year beginning July 1, 1990, and for
subsequent years | ||
thereafter until June 30, 2001 shall be based on the
facility | ||
cost reports
for the facility fiscal year ending at any point | ||
in time during the previous
calendar year, updated to the | ||
midpoint of the rate year. The cost report
shall be on file | ||
with the Department no later than April 1 of the current
rate | ||
year. Should the cost report not be on file by April 1, the | ||
Department
shall base the rate on the latest cost report filed | ||
by each skilled care
facility and intermediate care facility, | ||
updated to the midpoint of the
current rate year. In | ||
determining rates for services rendered on and after
July 1, | ||
1985, fixed time shall not be computed at less than zero. The
| ||
Department shall not make any alterations of regulations which | ||
would reduce
any component of the Medicaid rate to a level | ||
below what that component would
have been utilizing in the rate | ||
effective on July 1, 1984.
| ||
(2) Shall take into account the actual costs incurred by | ||
facilities
in providing services for recipients of skilled | ||
nursing and intermediate
care services under the medical | ||
assistance program.
| ||
(3) Shall take into account the medical and psycho-social
| ||
characteristics and needs of the patients.
| ||
(4) Shall take into account the actual costs incurred by | ||
facilities in
meeting licensing and certification standards | ||
imposed and prescribed by the
State of Illinois, any of its | ||
political subdivisions or municipalities and by
the U.S. | ||
Department of Health and Human Services pursuant to Title XIX | ||
of the
Social Security Act.
| ||
The Department of Public Aid shall develop precise | ||
standards for
payments to reimburse nursing facilities for any | ||
utilization of
appropriate rehabilitative personnel for the | ||
provision of rehabilitative
services which is authorized by | ||
federal regulations, including
reimbursement for services | ||
provided by qualified therapists or qualified
assistants, and | ||
which is in accordance with accepted professional
practices. | ||
Reimbursement also may be made for utilization of other
| ||
supportive personnel under appropriate supervision.
| ||
(Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | ||
eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | ||
eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; 93-841, | ||
eff. 7-30-04; 93-1087, eff. 2-28-05.)
| ||
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
| ||
Sec. 5-5.12. Pharmacy payments.
| ||
(a) Every request submitted by a pharmacy for reimbursement | ||
under this
Article for prescription drugs provided to a | ||
recipient of aid under this
Article shall include the name of | ||
the prescriber or an acceptable
identification number as | ||
established by the Department.
| ||
(b) Pharmacies providing prescription drugs under
this | ||
Article shall be reimbursed at a rate which shall include
a | ||
professional dispensing fee as determined by the Illinois
| ||
Department, plus the current acquisition cost of the | ||
prescription
drug dispensed. The Illinois Department shall | ||
update its
information on the acquisition costs of all | ||
prescription drugs
no less frequently than every 30 days. | ||
However, the Illinois
Department may set the rate of | ||
reimbursement for the acquisition
cost, by rule, at a | ||
percentage of the current average wholesale
acquisition cost.
| ||
(c) (Blank).
Reimbursement under this Article for | ||
prescription drugs shall be
limited to reimbursement for 4 | ||
brand-name prescription drugs per patient per
month. This | ||
subsection applies only if (i) the brand-name drug was not
| ||
prescribed for an acute or urgent condition, (ii) the | ||
brand-name drug was not
prescribed for Alzheimer's disease, | ||
arthritis, diabetes, HIV/AIDS, a mental
health condition, or | ||
respiratory disease, and (iii) a therapeutically
equivalent | ||
generic medication has been approved by the federal Food and | ||
Drug
Administration.
| ||
(d) The Department shall not impose requirements for prior | ||
approval
based on a preferred drug list for anti-retroviral, | ||
anti-hemophilic factor
concentrates,
or
any atypical | ||
antipsychotics, conventional antipsychotics,
or | ||
anticonvulsants used for the treatment of serious mental
| ||
illnesses
until 30 days after it has conducted a study of the | ||
impact of such
requirements on patient care and submitted a | ||
report to the Speaker of the
House of Representatives and the | ||
President of the Senate.
| ||
(Source: P.A. 92-597, eff. 6-28-02; 92-825, eff. 8-21-02; | ||
93-106, eff.
7-8-03.)
| ||
(305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
| ||
Sec. 5-11. Co-operative arrangements; contracts with other | ||
State
agencies, health care and rehabilitation organizations, | ||
and fiscal
intermediaries.
| ||
(a) The Illinois Department may enter into co-operative | ||
arrangements
with
State agencies responsible for administering | ||
or supervising the
administration of health services and | ||
vocational rehabilitation services to
the end that there may be | ||
maximum utilization of such services in the
provision of | ||
medical assistance.
| ||
The Illinois Department shall, not later than June 30, | ||
1993, enter into
one or more co-operative arrangements with the | ||
Department of Mental Health
and Developmental Disabilities | ||
providing that the Department of Mental
Health and | ||
Developmental Disabilities will be responsible for | ||
administering
or supervising all programs for services to | ||
persons in community care
facilities for persons with | ||
developmental disabilities, including but not
limited to | ||
intermediate care facilities, that are supported by State funds | ||
or
by funding under Title XIX of the federal Social Security | ||
Act. The
responsibilities of the Department of Mental Health | ||
and Developmental
Disabilities under these agreements are | ||
transferred to the Department of
Human Services as provided in | ||
the Department of Human Services Act.
| ||
The Department may also contract with such State health and
| ||
rehabilitation agencies and other public or private health care | ||
and
rehabilitation organizations to act for it in supplying | ||
designated medical
services to persons eligible therefor under | ||
this Article. Any contracts
with health services or health | ||
maintenance organizations shall be
restricted to organizations | ||
which have been certified as being in
compliance with standards | ||
promulgated pursuant to the laws of this State
governing the | ||
establishment and operation of health services or health
| ||
maintenance organizations. The Department shall renegotiate | ||
the contracts with health maintenance organizations and | ||
managed care community
networks that took effect August 1, | ||
2003, so as to produce $70,000,000 savings to the Department | ||
net of resulting increases to the fee-for-service program for | ||
State fiscal year 2006. The Department may also contract with | ||
insurance
companies or other corporate entities serving as | ||
fiscal intermediaries in
this State for the Federal Government | ||
in respect to Medicare payments under
Title XVIII of the | ||
Federal Social Security Act to act for the Department in
paying | ||
medical care suppliers. The provisions of Section 9 of "An Act | ||
in
relation to State finance", approved June 10, 1919, as | ||
amended,
notwithstanding, such contracts with State agencies, | ||
other health care and
rehabilitation organizations, or fiscal | ||
intermediaries may provide for
advance payments.
| ||
(b) For purposes of this subsection (b), "managed care | ||
community
network" means an entity, other than a health | ||
maintenance organization, that
is owned, operated, or governed | ||
by providers of health care services within
this State and that | ||
provides or arranges primary, secondary, and tertiary
managed | ||
health care services under contract with the Illinois | ||
Department
exclusively to persons participating in programs | ||
administered by the Illinois
Department.
| ||
The Illinois Department may certify managed care community
| ||
networks, including managed care community networks owned, | ||
operated, managed,
or
governed by State-funded medical | ||
schools, as risk-bearing entities eligible to
contract with the | ||
Illinois Department as Medicaid managed care
organizations. | ||
The Illinois Department may contract with those managed
care | ||
community networks to furnish health care services to or | ||
arrange those
services for individuals participating in | ||
programs administered by the Illinois
Department. The rates for | ||
those provider-sponsored organizations may be
determined on a | ||
prepaid, capitated basis. A managed care community
network may | ||
choose to contract with the Illinois Department to provide only
| ||
pediatric
health care services.
The
Illinois Department shall | ||
by rule adopt the criteria, standards, and procedures
by
which | ||
a managed care community network may be permitted to contract | ||
with
the Illinois Department and shall consult with the | ||
Department of Insurance in
adopting these rules.
| ||
A county provider as defined in Section 15-1 of this Code | ||
may
contract with the Illinois Department to provide primary, | ||
secondary, or
tertiary managed health care services as a | ||
managed care
community network without the need to establish a | ||
separate entity and shall
be deemed a managed care community | ||
network for purposes of this Code
only to the extent it | ||
provides services to participating individuals. A county
| ||
provider is entitled to contract with the Illinois Department | ||
with respect to
any contracting region located in whole or in | ||
part within the county. A
county provider is not required to | ||
accept enrollees who do not reside within
the county.
| ||
In order
to (i) accelerate and facilitate the development | ||
of integrated health care in
contracting areas outside counties | ||
with populations in excess of 3,000,000 and
counties adjacent | ||
to those counties and (ii) maintain and sustain the high
| ||
quality of education and residency programs coordinated and | ||
associated with
local area hospitals, the Illinois Department | ||
may develop and implement a
demonstration program from managed | ||
care community networks owned, operated,
managed, or
governed | ||
by State-funded medical schools. The Illinois Department shall
| ||
prescribe by rule the criteria, standards, and procedures for | ||
effecting this
demonstration program.
| ||
A managed care community network that
contracts with the | ||
Illinois Department to furnish health care services to or
| ||
arrange those services for enrollees participating in programs | ||
administered by
the Illinois Department shall do all of the | ||
following:
| ||
(1) Provide that any provider affiliated with the | ||
managed care community
network may also provide services on | ||
a
fee-for-service basis to Illinois Department clients not | ||
enrolled in such
managed care entities.
| ||
(2) Provide client education services as determined | ||
and approved by the
Illinois Department, including but not | ||
limited to (i) education regarding
appropriate utilization | ||
of health care services in a managed care system, (ii)
| ||
written disclosure of treatment policies and restrictions | ||
or limitations on
health services, including, but not | ||
limited to, physical services, clinical
laboratory tests, | ||
hospital and surgical procedures, prescription drugs and
| ||
biologics, and radiological examinations, and (iii) | ||
written notice that the
enrollee may receive from another | ||
provider those covered services that are not
provided by | ||
the managed care community network.
| ||
(3) Provide that enrollees within the system may choose | ||
the site for
provision of services and the panel of health | ||
care providers.
| ||
(4) Not discriminate in enrollment or disenrollment | ||
practices among
recipients of medical services or | ||
enrollees based on health status.
| ||
(5) Provide a quality assurance and utilization review | ||
program that
meets
the requirements established by the | ||
Illinois Department in rules that
incorporate those | ||
standards set forth in the Health Maintenance Organization
| ||
Act.
| ||
(6) Issue a managed care community network
| ||
identification card to each enrollee upon enrollment. The | ||
card
must contain all of the following:
| ||
(A) The enrollee's health plan.
| ||
(B) The name and telephone number of the enrollee's | ||
primary care
physician or the site for receiving | ||
primary care services.
| ||
(C) A telephone number to be used to confirm | ||
eligibility for benefits
and authorization for | ||
services that is available 24 hours per day, 7 days per
| ||
week.
| ||
(7) Ensure that every primary care physician and | ||
pharmacy in the managed
care community network meets the | ||
standards
established by the Illinois Department for | ||
accessibility and quality of care.
The Illinois Department | ||
shall arrange for and oversee an evaluation of the
| ||
standards established under this paragraph (7) and may | ||
recommend any necessary
changes to these standards.
| ||
(8) Provide a procedure for handling complaints that
| ||
meets the
requirements established by the Illinois | ||
Department in rules that incorporate
those standards set | ||
forth in the Health Maintenance Organization Act.
| ||
(9) Maintain, retain, and make available to the | ||
Illinois Department
records, data, and information, in a | ||
uniform manner determined by the Illinois
Department, | ||
sufficient for the Illinois Department to monitor | ||
utilization,
accessibility, and quality of care.
| ||
(10) Provide that the pharmacy formulary used by the | ||
managed care
community
network and its contract providers | ||
be no
more restrictive than the Illinois Department's | ||
pharmaceutical program on the
effective date of this | ||
amendatory Act of 1998 and as amended after that date.
| ||
The Illinois Department shall contract with an entity or | ||
entities to provide
external peer-based quality assurance | ||
review for the managed health care
programs administered by the | ||
Illinois Department. The entity shall be
representative of | ||
Illinois physicians licensed to practice medicine in all its
| ||
branches and have statewide geographic representation in all | ||
specialities of
medical care that are provided in managed | ||
health care programs administered by
the Illinois Department. | ||
The entity may not be a third party payer and shall
maintain | ||
offices in locations around the State in order to provide | ||
service and
continuing medical education to physician | ||
participants within those managed
health care programs | ||
administered by the Illinois Department. The review
process | ||
shall be developed and conducted by Illinois physicians | ||
licensed to
practice medicine in all its branches. In | ||
consultation with the entity, the
Illinois Department may | ||
contract with other entities for professional
peer-based | ||
quality assurance review of individual
categories of services | ||
other than services provided, supervised, or coordinated
by | ||
physicians licensed to practice medicine in all its branches. | ||
The Illinois
Department shall establish, by rule, criteria to | ||
avoid conflicts of interest in
the conduct of quality assurance | ||
activities consistent with professional
peer-review standards. | ||
All quality assurance activities shall be coordinated
by the | ||
Illinois Department.
| ||
Each managed care community network must demonstrate its | ||
ability to
bear the financial risk of serving individuals under | ||
this program.
The Illinois Department shall by rule adopt | ||
standards for assessing the
solvency and financial soundness of | ||
each managed care community network.
Any solvency and financial | ||
standards adopted for managed care community
networks
shall be | ||
no more restrictive than the solvency and financial standards | ||
adopted
under
Section 1856(a) of the Social Security Act for | ||
provider-sponsored
organizations under Part C of Title XVIII of | ||
the Social Security Act.
| ||
The Illinois
Department may implement the amendatory | ||
changes to this
Code made by this amendatory Act of 1998 | ||
through the use of emergency
rules in accordance with Section | ||
5-45 of the Illinois Administrative Procedure
Act. For purposes | ||
of that Act, the adoption of rules to implement these
changes | ||
is deemed an emergency and necessary for the public interest,
| ||
safety, and welfare.
| ||
(c) Not later than June 30, 1996, the Illinois Department | ||
shall
enter into one or more cooperative arrangements with the | ||
Department of Public
Health for the purpose of developing a | ||
single survey for
nursing facilities, including but not limited | ||
to facilities funded under Title
XVIII or Title XIX of the | ||
federal Social Security Act or both, which shall be
| ||
administered and conducted solely by the Department of Public | ||
Health.
The Departments shall test the single survey process on | ||
a pilot basis, with
both the Departments of Public Aid and | ||
Public Health represented on the
consolidated survey team. The | ||
pilot will sunset June 30, 1997. After June 30,
1997, unless | ||
otherwise determined by the Governor, a single survey shall be
| ||
implemented by the Department of Public Health which would not | ||
preclude staff
from the Department of Public Aid from going | ||
on-site to nursing facilities to
perform necessary audits and | ||
reviews which shall not replicate the single State
agency | ||
survey required by this Act. This Section shall not apply to | ||
community
or intermediate care facilities for persons with | ||
developmental disabilities.
| ||
(d) Nothing in this Code in any way limits or otherwise | ||
impairs the
authority or power of the Illinois Department to | ||
enter into a negotiated
contract pursuant to this Section with | ||
a managed care community network or
a health maintenance | ||
organization, as defined in the Health Maintenance
| ||
Organization Act, that provides for
termination or nonrenewal | ||
of the contract without cause, upon notice as
provided in the | ||
contract, and without a hearing.
| ||
(Source: P.A. 92-370, eff. 8-15-01.)
| ||
(305 ILCS 5/12-4.35)
| ||
Sec. 12-4.35. Medical services for certain noncitizens.
| ||
(a) Notwithstanding
Subject to specific appropriation for | ||
this purpose, and notwithstanding
Section 1-11 of this Code or | ||
Section 20(a) of the Children's Health Insurance
Program Act, | ||
the Department of Public Aid may provide medical services to
| ||
noncitizens who have not yet attained 19 years of age and who | ||
are not eligible
for medical assistance under Article V of this | ||
Code or under the Children's
Health Insurance Program created | ||
by the Children's Health Insurance Program Act
due to their not | ||
meeting the otherwise applicable provisions of Section 1-11
of | ||
this Code or Section 20(a) of the Children's Health Insurance | ||
Program Act.
The medical services available, standards for | ||
eligibility, and other conditions
of participation under this | ||
Section shall be established by rule by the
Department; | ||
however, any such rule shall be at least as restrictive as the
| ||
rules for medical assistance under Article V of this Code or | ||
the Children's
Health Insurance Program created by the | ||
Children's Health Insurance Program
Act.
| ||
(b) The Department is authorized to take any action, | ||
including without
limitation cessation of enrollment, | ||
reduction of available medical services,
and changing | ||
standards for eligibility, that is deemed necessary by the
| ||
Department during a State fiscal year to assure that payments | ||
under this
Section do not exceed available funds
the amounts | ||
appropriated for this purpose.
| ||
(c) Continued
In the event that the appropriation in any | ||
fiscal year for the
Children's Health Insurance Program created | ||
by the Children's Health Insurance
Program Act is determined by | ||
the Department to be insufficient to continue
enrollment of | ||
otherwise eligible children under that Program during that | ||
fiscal
year, the Department is authorized to use funds | ||
appropriated for the purposes
of this Section to fund that | ||
Program and to take any other action necessary to
continue the | ||
operation of that Program. Furthermore, continued enrollment | ||
of
individuals into the program created under this Section in | ||
any fiscal year is
contingent upon continued enrollment of | ||
individuals into the Children's Health
Insurance Program | ||
during that fiscal year.
| ||
(d) (Blank).
The General Assembly finds that the adoption | ||
of rules to meet the
purposes of subsections (a), (b), and (c) | ||
is an emergency and necessary for
the public interest, safety, | ||
and welfare. The Department may adopt such rules
through the | ||
use of emergency rulemaking in accordance with 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.
| ||
(Source: P.A. 90-588, eff. 7-1-98.)
| ||
Section 25. The All-Inclusive Care for the Elderly Act is | ||
amended by changing Sections 10 and 15 as follows:
| ||
(320 ILCS 40/10) (from Ch. 23, par. 6910)
| ||
Sec. 10. Services for eligible persons. Within the context | ||
of the
PACE program established under this Act, the Illinois | ||
Department of Public
Aid may include any or all of the services | ||
in Article 5 of the Illinois
Public Aid Code.
| ||
An eligible person may elect to receive services from the | ||
PACE program.
If such an election is made, the eligible person | ||
shall not remain eligible
for payment through the regular | ||
Medicare or Medicaid program. All services
and programs | ||
provided through the PACE program shall be provided in
| ||
accordance with this Act. An eligible person may elect to | ||
disenroll from
the PACE program at any time.
| ||
For purposes of this Act, "eligible person" means a frail | ||
elderly
individual who voluntarily enrolls in the PACE program, | ||
whose income and
resources do not exceed limits established by | ||
the Illinois Department of
Public Aid and for whom a licensed | ||
physician certifies that such a program
provides an appropriate | ||
alternative to institutionalized care. The term
"frail | ||
elderly" means an individual who meets the age and functional | ||
eligibility
requirements, as established by the Illinois | ||
Department of Public Aid and
the Department on Aging for | ||
nursing home care, and who is 65 years of age
or older.
| ||
(Source: P.A. 87-411.)
| ||
(320 ILCS 40/15) (from Ch. 23, par. 6915)
| ||
Sec. 15. Program implementation.
| ||
(a) Upon receipt of federal approval
waivers, the Illinois | ||
Department of Public
Aid shall implement the PACE program | ||
pursuant to the provisions of the approved Title XIX State plan
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as a demonstration program to provide
the services set forth in | ||
Section 10 to eligible persons, as defined in
Section 10, for a | ||
period of 3 years. After the 3 year demonstration, the
General | ||
Assembly shall reexamine the PACE program and determine if the
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program should be implemented on a permanent basis.
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(b) Using a risk-based financing model, the nonprofit | ||
organization providing
the PACE program shall assume | ||
responsibility for all costs generated by
the PACE program | ||
participants, and it shall create and maintain a risk
reserve | ||
fund that will cover any cost overages for any participant. The
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PACE program is responsible for the entire range of services in | ||
the
consolidated service model, including hospital and nursing | ||
home care,
according to participant need as determined by a | ||
multidisciplinary team.
The nonprofit organization providing | ||
the PACE program is responsible for
the full financial risk at | ||
the conclusion of the demonstration period
and when permanent | ||
waivers from the federal Health Care Financing
Administration | ||
are granted. Specific arrangements of the risk-based
financing | ||
model shall be adopted and negotiated by the federal Centers | ||
for Medicare and Medicaid Services
Health Care
Financing | ||
Administration, the nonprofit organization providing the PACE
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program, and the Illinois Department of Public Aid.
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(Source: P.A. 87-411.)
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Section 99. Effective date. This Act takes effect July 1, | ||
2005.
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