HB2555 104TH GENERAL ASSEMBLY

LRB104 09368 KTG 19427 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB2555

Introduced 2/4/2025, by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

New Act

Creates the Support for Family Home Health Aides and Caregivers Act. Requires the Director of Healthcare and Family Services to establish, no later than one year after the effective date of the Act, a Family Home Health Aide Program for the purposes of training a family caregiver of an eligible relative on the provision of qualified home health services to supplement home health and private duty nursing services in the State. Provides that under the program, the Director must certify a family caregiver of an eligible relative who has successfully completed the approved training for family home health aides, and meets all other applicable requirements established by the State, and is determined to be in compliance with any federal law concerning family home health aides. Provides that, subject to federal approval by the Centers for Medicare and Medicaid Services, a certified family home health aide shall be eligible to provide qualified home health services to an eligible relative under any home and community-based services waiver program authorized under the Social Security Act. Contains provisions concerning the development of training requirements for family home health aides; certification requirements for family home health aides; employment opportunities; the different types of home health services; a requirement to triage services based on clinical acuity; the development of a clinical acuity tool to assist in determining the care needs of medically fragile individuals; the establishment of a respite program for family home health aides and other nursing professionals; reimbursement rates for home health aide services; utilization of the Department of Healthcare and Family Services' electronic verification system; reporting requirements; and rulemaking.

A BILL FOR

AN ACT concerning health care.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Support for Family Home Health Aides and Caregivers Act.

Section 5. Purpose. The home health workforce is facing a significant shortage of direct care workers, including home health aides, personal care aides, and private duty nurses. In addition to a shortage of direct care workers, the demand for private duty nursing services remains high due to an increasing desire for individuals to receive care in their community rather than in an institutionalized setting. As a result of fewer available workers and long waitlists because of a high demand for services, many families are turning to parent caregivers to fill the gap in care, who play a crucial role in providing care for loved ones who are medically frail. While parent and family caregivers serve an important role in providing needed care, private duty nursing services require nurses with proper education, licensing, and credentials that allow for the highest standard of care in the home.

The purpose of this Act is to establish a Family Home Health Aide Program to train a parent, guardian, or family member in providing certain home health aide and private duty nursing services to relatives, by consanguinity or affiliation, to ensure access to high-quality care for medically frail Medicaid beneficiaries who choose to receive such services in their community. Importantly, the Family Home Health Aide Program is intended to supplement the State's existing private duty nursing workforce and increase access to private duty nursing services for medically frail individuals of any age who require a higher acuity of care than what may be safely provided by a parent or family caregiver. This Act outlines requirements that the State will follow in:

(1) establishing the training and certification of parent or family caregivers, known as family home health aides;

(2) defining the services that family home health aides may provide under the State's Medicaid program;

(3) establishing competitive reimbursement rates while ensuring that residents of the State are not deterred from pursuing careers in private duty nursing or as a home health aide;

(4) establishing clinical supervision requirements for medically frail Medicaid beneficiaries receiving qualified home health services by ensuring they receive such services from family members employed by the same agency to ensure continuity of care;

(5) developing a respite program; and

(6) establishing electronic visit verification and reporting requirements to deter fraud, waste, and abuse, as well as collect metrics on the success of the Family Home Health Aide Program.

Section 10. Definitions. As used in this Act:

"Approved training" means a course of training approved by the Department of Healthcare and Family Services, in consultation with, independent and State providers of private duty nursing services, other private duty nursing agencies, home care providers, patient advocacy groups, and other relevant stakeholders, to train a family caregiver as a family home health aide.

"Department" means the Department of Healthcare and Family Services.

"Designated home care provider" means a private duty nursing or home care provider who has been approved by the Department to participate in the Family Home Health Aide Program.

"Eligible relative" means an individual of any age who has an underlying physical, mental, or cognitive impairment that prevents such individual from safely living independently, is eligible to receive skilled care or respite care services under the State's Medicaid program, and is related to his or her family caregiver.

"Family caregiver" means any parent, guardian, or family member related by consanguinity to the eligible relative, who:

(i) is able to provide appropriate and consistent care to an eligible relative based on physical proximity to the eligible relative; and

(ii) has the necessary physical and mental capacity to assist the eligible relative with services provided under the Family Home Health Aide Program.

"Family home health aide" means any family caregiver who meets the training and certification requirements described in paragraphs (2) and (3) of subsection (a) of Section 15 to provide services as a family home health aide under the State's Medicaid program.

"Home care provider" means a private duty nursing or home care provider who has been approved by the Department to participate in the Family Home Health Aide Program.

"Program" means the Family Home Health Aide Program.

"Respite care" means planned or emergency care provided to a medically fragile child or adult to provide temporary relief to the family caregiver of such child or adult.

"State's Medicaid program" means the medical assistance program established and administered in Article V of the Illinois Public Aid Code as authorized under Section 1902 of the Social Security Act.

Section 15. Family Home Health Aide Program.

(a) Establishment.

(1) In general. Not later than one year after the effective date of this Act, the Director of Healthcare and Family Services shall establish a Family Home Health Aide Program for the purposes of training a family caregiver of an eligible relative on the provision of qualified home health services to supplement home health and private duty nursing services in the State. Under the Family Home Health Aide Program, the Director must certify a family caregiver of an eligible relative who has successfully completed the approved training for family home health aides, and meets all other applicable requirements established by the State, and is determined to be in compliance with any federal law concerning family home health aides. Subject to federal approval by the Centers for Medicare and Medicaid Services, a certified family home health aide shall be eligible to provide qualified home health services to an eligible relative under any home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act.

(2) Training.

(A) The Department, in consultation with independent and State home care providers of private duty nursing services, other private duty nursing agencies, patient advocacy groups, and other relevant stakeholders, shall develop requirements to train a family caregiver as a family home health aide to provide qualified home health services to an eligible relative pursuant to the relative's plan of care. A family caregiver shall be required to be trained in skills that are relevant or necessary to the eligible relative pursuant to the relative's plan of care and clinical acuity to become a family home health aide. Such training and instruction may include:

(i) patient care transfers;

(ii) assistance with activities of daily living;

(iii) normal range of motion and position;

(iv) adequate nutrition and fluid intake;

(v) basic infection prevention and control procedures;

(vi) observation and reporting of a patient's vital signs, blood pressure, and general patient status;

(vii) urinary catheterization and ostomy care;

(viii) ambulation;

(ix) adequate nutrition and fluid intake;

(x) wound care;

(xi) enteral care;

(xii) medication administration; and

(xiii) any additional requirements, including mandated reporter responsibilities, determined by the Department.

(B) The Department shall offer the training, including hands-on experience through the relevant State agency, or may select designated home care providers to provide the training described in paragraph (A) to family caregivers of eligible relatives for the purposes of becoming certified as a family home health aide. If the Department selects the option of utilizing designated home care providers to provide the training, the Department must adequately reimburse such designated providers for providing the training to family caregivers of eligible relatives.

(3) Certification. The Department shall certify a family caregiver of an eligible relative as a family home health aide if the family caregiver:

(A) is at least 18 years of age;

(B) has demonstrated a minimum capacity to read and write;

(C) has successfully completed the training described in paragraph (2) and any additional education or competency requirements established by the Department; and

(D) has successfully fulfilled any additional requirements as established by the Department.

(b) Employment.

(1) In general. A home care provider may employ a family home health aide to provide qualified home health services to an eligible relative under the program. However, the State shall not require a home care provider to participate in the program.

(2) Supervision. The home care provider shall ensure that a family home health aide employed by the provider receives appropriate clinical supervision, at least every 90 days or in accordance with State law, and based on the acuity level of the eligible relative, which may be determined using the optional acuity tool developed under subsection (e).

(c) Services.

(1) In general. Subject to federal approval by the Centers for Medicare and Medicaid Services and the limitations described in paragraph (2) of this subsection, the family caregiver qualified as a family home health aide under this program shall be eligible to provide qualified home health services to eligible relatives under Illinois' Medicaid State Plan or any home and community-based services waiver program. Such services shall include care relating to:

(A) activities of daily living, including personal care;

(B) mobility;

(C) nutrition and hydration;

(D) toileting and elimination;

(E) assistive devices;

(F) safety and cleanliness;

(G) reporting abnormal signs and symptoms;

(H) cardiopulmonary resuscitation and emergency care;

(I) infection control;

(J) hygiene, grooming, skin care, and pressure sore prevention;

(K) wound care;

(L) portable oxygen use and safety and other respiratory procedures;

(M) enteral care and therapy; and

(N) any other services appropriate for low acuity eligible relatives.

(2) Limitation on services.

(A) A family home health aide shall only provide qualified home health services to an eligible relative pursuant to the relative's plan of care and only while actively employed by a home care provider. A family home health aide may not provide qualified home health services to an eligible relative under this program unless such family caregiver has been certified and received the state-required training in such services.

(B) The services received under this program by an eligible relative from a home health aide shall not exceed 40 hours per week. Nothing in this subparagraph shall restrict unpaid services provided as part of the family caregiver's familial or household relationship to the eligible relative.

(C) A family home health aide is not permitted to provide tracheostomy and ventilation therapy and care regardless of the clinical acuity of the eligible relative. Nothing in this Section shall prohibit a family home health aide who is a clinical nursing specialist, a registered nurse, a registered nurse practitioner, licensed practical nurse, or licensed vocational nurse licensed in this State from providing tracheostomy, ventilation therapy, and qualified home health aide services to an eligible relative.

(D) A family home health aide shall not provide qualified home health aide services to an eligible relative unless the plan of care for the eligible relative is recertified by the provider at least every 180 calendar days.

(d) Triaging services based on acuity. To ensure continuity of care, the Department must ensure the following:

(1) an eligible relative receiving qualified home health aide services, who is also eligible for home health and private duty nursing services, remains eligible and enrolled in such programs regardless of clinical acuity, as may be determined utilizing the optional State acuity tool described in subsection (e) or in a manner described by the Department;

(2) an eligible relative requiring a higher clinical acuity of care, including those who require tracheostomy and ventilation therapy and care, have timely access to private duty nursing services; and

(3) the home care provider employing the family home health aide be given preference to provide any other necessary home health and private duty nursing services to the eligible relative, beyond those provided as part of the Family Home Health Aide Program, to the extent practicable.

(e) Optional clinical acuity tool.

(1) In general. The Department may develop a State clinical acuity tool to assist in determining the care needs of medically fragile individuals to ensure that such individuals receive access to high-quality, clinically appropriate home health services, private duty nursing services, and qualified family home health aide services. If the Department develops such a clinical acuity tool, the Department shall convene a working group that includes representatives of independent and national home care providers of private duty nursing services under the State's Medicaid program, other private duty nursing agencies, full-benefit dual eligible individuals, Medicaid beneficiaries, patient advocacy groups, and other relevant stakeholders to assist the Department in developing such a clinical acuity tool to determine the appropriate level of care for medically fragile individuals, including eligible relatives.

(2) Use of optional clinical acuity tool. The Department may create a program to require the use of the State clinical acuity tool described in subparagraph (A) to conduct an assessment to determine whether the services described under subsection (c) are clinically appropriate for such medically fragile individuals and eligible relatives consistent with their plan of care prior to the provision of such services. Under such program, the Department shall ensure that the assessment conducted using the State clinical acuity tool is independent and not conducted by a home health agency or facility.

(f) Respite program. In developing the Family Home Health Aid Program, the Department shall establish a respite program to provide respite care for family home health aides, private duty nurses, and home health aides. To ensure continuity of high quality of care, the Department shall ensure that the respite program:

(1) is operated and managed by the same home care provider that employs the family home health aide as described in subsection (b); and

(2) provides respite hours in totality on a biannual or annual basis.

(g) Reimbursement. In consultation with representatives of independent and State providers of private duty nursing services under the State's Medicaid program, other private duty nursing agencies, home care providers, patient advocacy groups, and other relevant stakeholders, the Department shall establish a payment rate to reimburse home care providers for the provision of qualified home health aide services that are adequate to provide efficient, economical, and effective administration of the Family Home Health Aide Program and Illinois' Medicaid State Plan. In establishing such a rate, the Department shall ensure:

(1) compliance with State and federal minimum wage requirements;

(2) when establishing such payment rates, that the rates take into consideration any clinical supervision that home health agencies or private duty nursing providers must provide to family home health aides in the provision of qualified home health aide services to eligible relatives; and

(3) that payment rates are not set at a level that would deter individuals from pursuing other opportunities in alternate clinical care settings.

(h) Electronic visit verification. The Department shall require family home health aides providing qualified home health aide services under the State's Medicaid program to utilize the State's electronic visit verification system established in accordance with federal law.

(i) Reporting requirements. To track clinical outcomes and operational challenges with the Family Home Health Aide Program, the Department shall issue, within 2 years after the establishment of the program, and every 2 years thereafter, a report to the Governor and make such report publicly available on the Department's official website. The report shall include the following:

(1) the number of hospitalizations and emergency room visits of eligible relatives participating in the program;

(2) the number of private duty nursing hours each eligible relative participating in the program has received and an analysis of whether such hours have increased or decreased since the eligible relative's participation the program;

(3) the number of qualified home health aide services that were provided by family home health aides to each eligible relative enrolled in the program;

(4) the number of overpayments made to each provider employing family home health aides and other metrics determined by the State that may be used to determine the amount of fraud, waste, and abuse in the program; and

(5) an analysis of whether the State's waitlist for private duty nursing services or other home and community-based services under the State's Medicaid program has improved or declined since the introduction of the Family Home Health Aide Program.

(j) Rulemaking. The Department may adopt rules to implement this Act.