Bill Amendment: IL HB3021 | 2023-2024 | 103rd General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: AGING-COMM CARE PROGRAM

Status: 2023-03-27 - House Floor Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB3021 Detail]

Download: Illinois-2023-HB3021-House_Amendment_001.html

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Rep. Lakesia Collins

Filed: 3/21/2023

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AMENDMENT TO HOUSE BILL 3021
AMENDMENT NO. ______. Amend House Bill 3021 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Act on the Aging is amended by
changing Section 4.02 as follows:
(20 ILCS 105/4.02) (from Ch. 23, par. 6104.02)
Sec. 4.02. Community Care Program. 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

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

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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.
Beginning January 1, 2008, the Department shall require as
a condition of eligibility that all new financially eligible
applicants apply for and enroll in medical assistance under
Article V of the Illinois Public Aid Code in accordance with
rules promulgated by the Department.
The Department shall, in conjunction with the Department
of Public Aid (now Department of Healthcare and Family
Services), 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 45 days

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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 45 day
notice period. The target 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 of the services together with the other
personal maintenance expenses of the persons are reasonably
related to the standards 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, Healthcare and Family Services, Public Health,
Veterans' Affairs, and Commerce and Economic Opportunity and
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 personal assistant and home care aide 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

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administrative and employee wage and benefits cost split as
defined in administrative rules. 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 Healthcare and Family Services,
to effect the following: (1) intake procedures and common
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 individuals 60 years of age or older shall
be conducted by the Department.
As part of the Department on Aging's routine training of
case managers and case manager supervisors, the Department may
include information on family futures planning for persons who
are age 60 or older and who are caregivers of their adult
children with developmental disabilities. The content of the
training shall be at the Department's discretion.
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
is equal to or less than the federal poverty standard shall not

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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.
The Department, or the Department's authorized
representative, may 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 or blind or who has a permanent and total
disability. This 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 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 Illinois Public Aid
Code, who precedes a person receiving services under this

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Section in death. All moneys for services 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 or relative, as defined
by the rules and regulations of the Department of Healthcare
and Family Services, regardless of the value of the property.
The Department shall increase the effectiveness of the
existing Community Care Program by:
(1) ensuring that in-home services included in the
care plan are available on evenings and weekends;
(2) ensuring that care plans contain the services that
eligible participants need based on the number of days in
a month, not limited to specific blocks of time, as
identified by the comprehensive assessment tool selected
by the Department for use statewide, not to exceed the
total monthly service cost maximum allowed for each
service; the Department shall develop administrative rules
to implement this item (2);
(3) ensuring that the participants have the right to
choose the services contained in their care plan and to
direct how those services are provided, based on
administrative rules established by the Department;
(4) ensuring that the determination of need tool is
accurate in determining the participants' level of need;
to achieve this, the Department, in conjunction with the

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Older Adult Services Advisory Committee, shall institute a
study of the relationship between the Determination of
Need scores, level of need, service cost maximums, and the
development and utilization of service plans no later than
May 1, 2008; findings and recommendations shall be
presented to the Governor and the General Assembly no
later than January 1, 2009; recommendations shall include
all needed changes to the service cost maximums schedule
and additional covered services;
(5) ensuring that homemakers can provide personal care
services that may or may not involve contact with clients,
including but not limited to:
(A) bathing;
(B) grooming;
(C) toileting;
(D) nail care;
(E) transferring;
(F) respiratory services;
(G) exercise; or
(H) positioning;
(6) ensuring that homemaker program vendors are not
restricted from hiring homemakers who are family members
of clients or recommended by clients; the Department may
not, by rule or policy, require homemakers who are family
members of clients or recommended by clients to accept
assignments in homes other than the client;

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(7) ensuring that the State may access maximum federal
matching funds by seeking approval for the Centers for
Medicare and Medicaid Services for modifications to the
State's home and community based services waiver and
additional waiver opportunities, including applying for
enrollment in the Balance Incentive Payment Program by May
1, 2013, in order to maximize federal matching funds; this
shall include, but not be limited to, modification that
reflects all changes in the Community Care Program
services and all increases in the services cost maximum;
(8) ensuring that the determination of need tool
accurately reflects the service needs of individuals with
Alzheimer's disease and related dementia disorders;
(9) ensuring that services are authorized accurately
and consistently for the Community Care Program (CCP); the
Department shall implement a Service Authorization policy
directive; the purpose shall be to ensure that eligibility
and services are authorized accurately and consistently in
the CCP program; the policy directive shall clarify
service authorization guidelines to Care Coordination
Units and Community Care Program providers no later than
May 1, 2013;
(10) working in conjunction with Care Coordination
Units, the Department of Healthcare and Family Services,
the Department of Human Services, Community Care Program
providers, and other stakeholders to make improvements to

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the Medicaid claiming processes and the Medicaid
enrollment procedures or requirements as needed,
including, but not limited to, specific policy changes or
rules to improve the up-front enrollment of participants
in the Medicaid program and specific policy changes or
rules to insure more prompt submission of bills to the
federal government to secure maximum federal matching
dollars as promptly as possible; the Department on Aging
shall have at least 3 meetings with stakeholders by
January 1, 2014 in order to address these improvements;
(11) requiring home care service providers to comply
with the rounding of hours worked provisions under the
federal Fair Labor Standards Act (FLSA) and as set forth
in 29 CFR 785.48(b) by May 1, 2013;
(12) implementing any necessary policy changes or
promulgating any rules, no later than January 1, 2014, to
assist the Department of Healthcare and Family Services in
moving as many participants as possible, consistent with
federal regulations, into coordinated care plans if a care
coordination plan that covers long term care is available
in the recipient's area; and
(13) maintaining fiscal year 2014 rates at the same
level established on January 1, 2013.
By January 1, 2009 or as soon after the end of the Cash and
Counseling Demonstration Project as is practicable, the
Department may, based on its evaluation of the demonstration

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project, promulgate rules concerning personal assistant
services, to include, but need not be limited to,
qualifications, employment screening, rights under fair labor
standards, training, fiduciary agent, and supervision
requirements. All applicants shall be subject to the
provisions of the Health Care Worker Background Check Act.
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
maximum established by the Department. Workers providing these
services shall be appropriately trained.
No Beginning on the effective date of this amendatory Act
of 1991, no person may perform in-home services
chore/housekeeping and home care aide services under a program
authorized by this Section unless that person has completed
required pre-service training. Thereafter, no person may
perform in-home services under a program authorized by this
Section unless that person remains current on the annual
in-service training. The employing agency is responsible for
ensuring the employee is appropriately trained. To promote
consistency in training and to meet these requirements of
pre-service training and annual in-service training, on and
after July 1, 2026, all pre-service and annual in-service
training must be approved in advance by the Department. The

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Department shall adopt rules, including, but not limited to,
rules on the topics to be covered in pre-service and annual
in-service training; the number of pre-service and annual
in-service training hours required; a process to evaluate and
approve training; and pre-service and annual in-service
training documentation and recordkeeping requirements. 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
employees.
The Department is required to develop a system to ensure
that persons working as home care aides and personal
assistants receive increases in their wages when the federal
minimum wage is increased by requiring vendors to certify that

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they are meeting the federal minimum wage statute for home
care aides and personal assistants. An employer that cannot
ensure that the minimum wage increase is being given to home
care aides and personal assistants shall be denied any
increase in reimbursement costs.
The Community Care Program Advisory Committee is created
in the Department on Aging. The Director shall appoint
individuals to serve in the Committee, who shall serve at
their own expense. Members of the Committee must abide by all
applicable ethics laws. The Committee shall advise the
Department on issues related to the Department's program of
services to prevent unnecessary institutionalization. The
Committee shall meet on a bi-monthly basis and shall serve to
identify and advise the Department on present and potential
issues affecting the service delivery network, including
strategies to recruit, retain, and train the workforce, the
program's clients, and the Department and to recommend
solution strategies. Persons appointed to the Committee shall
be appointed on, but not limited to, their own and their
agency's experience with the program, geographic
representation, and willingness to serve. The Director shall
appoint members to the Committee to represent provider,
advocacy, policy research, and other constituencies committed
to the delivery of high quality home and community-based
services to older adults. Representatives shall be appointed
to ensure representation from community care providers

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including, but not limited to, adult day service providers,
homemaker providers, case coordination and case management
units, emergency home response providers, statewide trade or
labor unions that represent home care aides and direct care
staff, area agencies on aging, adults over age 60, membership
organizations representing older adults, and other
organizational entities, providers of care, or individuals
with demonstrated interest and expertise in the field of home
and community care as determined by the Director.
Nominations may be presented from any agency or State
association with interest in the program. The Director, or his
or her designee, shall serve as the permanent co-chair of the
advisory committee. One other co-chair shall be nominated and
approved by the members of the committee on an annual basis.
Committee members' terms of appointment shall be for 4 years
with one-quarter of the appointees' terms expiring each year.
A member shall continue to serve until his or her replacement
is named. The Department shall fill vacancies that have a
remaining term of over one year, and this replacement shall
occur through the annual replacement of expiring terms. The
Director shall designate Department staff to provide technical
assistance and staff support to the committee. Department
representation shall not constitute membership of the
committee. All Committee papers, issues, recommendations,
reports, and meeting memoranda are advisory only. The
Director, or his or her designee, shall make a written report,

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as requested by the Committee, regarding issues before the
Committee.
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.
The requirement for reporting to the General Assembly
shall be satisfied by filing copies of the report 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.
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.
For the purposes of this Section, "flexible senior

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services" refers to services that require one-time or periodic
expenditures including, but not limited to, respite care, home
modification, assistive technology, housing assistance, and
transportation.
The Department shall implement an electronic service
verification based on global positioning systems or other
cost-effective technology for the Community Care Program no
later than January 1, 2014.
The Department shall require, as a condition of
eligibility, enrollment in the medical assistance program
under Article V of the Illinois Public Aid Code (i) beginning
August 1, 2013, if the Auditor General has reported that the
Department has failed to comply with the reporting
requirements of Section 2-27 of the Illinois State Auditing
Act; or (ii) beginning June 1, 2014, if the Auditor General has
reported that the Department has not undertaken the required
actions listed in the report required by subsection (a) of
Section 2-27 of the Illinois State Auditing Act.
The Department shall delay Community Care Program services
until an applicant is determined eligible for medical
assistance under Article V of the Illinois Public Aid Code (i)
beginning August 1, 2013, if the Auditor General has reported
that the Department has failed to comply with the reporting
requirements of Section 2-27 of the Illinois State Auditing
Act; or (ii) beginning June 1, 2014, if the Auditor General has
reported that the Department has not undertaken the required

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actions listed in the report required by subsection (a) of
Section 2-27 of the Illinois State Auditing Act.
The Department shall implement co-payments for the
Community Care Program at the federally allowable maximum
level (i) beginning August 1, 2013, if the Auditor General has
reported that the Department has failed to comply with the
reporting requirements of Section 2-27 of the Illinois State
Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
General has reported that the Department has not undertaken
the required actions listed in the report required by
subsection (a) of Section 2-27 of the Illinois State Auditing
Act.
The Department shall continue to provide other Community
Care Program reports as required by statute.
The Department shall conduct a quarterly review of Care
Coordination Unit performance and adherence to service
guidelines. The quarterly review shall be reported to the
Speaker of the House of Representatives, the Minority Leader
of the House of Representatives, the President of the Senate,
and the Minority Leader of the Senate. The Department shall
collect and report longitudinal data on the performance of
each care coordination unit. Nothing in this paragraph shall
be construed to require the Department to identify specific
care coordination units.
In regard to community care providers, failure to comply
with Department on Aging policies shall be cause for

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disciplinary action, including, but not limited to,
disqualification from serving Community Care Program clients.
Each provider, upon submission of any bill or invoice to the
Department for payment for services rendered, shall include a
notarized statement, under penalty of perjury pursuant to
Section 1-109 of the Code of Civil Procedure, that the
provider has complied with all Department policies.
The Director of the Department on Aging shall make
information available to the State Board of Elections as may
be required by an agreement the State Board of Elections has
entered into with a multi-state voter registration list
maintenance system.
Within 30 days after July 6, 2017 (the effective date of
Public Act 100-23), rates shall be increased to $18.29 per
hour, for the purpose of increasing, by at least $.72 per hour,
the wages paid by those vendors to their employees who provide
homemaker services. The Department shall pay an enhanced rate
under the Community Care Program to those in-home service
provider agencies that offer health insurance coverage as a
benefit to their direct service worker employees consistent
with the mandates of Public Act 95-713. For State fiscal years
2018 and 2019, the enhanced rate shall be $1.77 per hour. The
rate shall be adjusted using actuarial analysis based on the
cost of care, but shall not be set below $1.77 per hour. The
Department shall adopt rules, including emergency rules under
subsections (y) and (bb) of Section 5-45 of the Illinois

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Administrative Procedure Act, to implement the provisions of
this paragraph.
The General Assembly finds it necessary to authorize an
aggressive Medicaid enrollment initiative designed to maximize
federal Medicaid funding for the Community Care Program which
produces significant savings for the State of Illinois. The
Department on Aging shall establish and implement a Community
Care Program Medicaid Initiative. Under the Initiative, the
Department on Aging shall, at a minimum: (i) provide an
enhanced rate to adequately compensate care coordination units
to enroll eligible Community Care Program clients into
Medicaid; (ii) use recommendations from a stakeholder
committee on how best to implement the Initiative; and (iii)
establish requirements for State agencies to make enrollment
in the State's Medical Assistance program easier for seniors.
The Community Care Program Medicaid Enrollment Oversight
Subcommittee is created as a subcommittee of the Older Adult
Services Advisory Committee established in Section 35 of the
Older Adult Services Act to make recommendations on how best
to increase the number of medical assistance recipients who
are enrolled in the Community Care Program. The Subcommittee
shall consist of all of the following persons who must be
appointed within 30 days after the effective date of this
amendatory Act of the 100th General Assembly:
(1) The Director of Aging, or his or her designee, who
shall serve as the chairperson of the Subcommittee.

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(2) One representative of the Department of Healthcare
and Family Services, appointed by the Director of
Healthcare and Family Services.
(3) One representative of the Department of Human
Services, appointed by the Secretary of Human Services.
(4) One individual representing a care coordination
unit, appointed by the Director of Aging.
(5) One individual from a non-governmental statewide
organization that advocates for seniors, appointed by the
Director of Aging.
(6) One individual representing Area Agencies on
Aging, appointed by the Director of Aging.
(7) One individual from a statewide association
dedicated to Alzheimer's care, support, and research,
appointed by the Director of Aging.
(8) One individual from an organization that employs
persons who provide services under the Community Care
Program, appointed by the Director of Aging.
(9) One member of a trade or labor union representing
persons who provide services under the Community Care
Program, appointed by the Director of Aging.
(10) One member of the Senate, who shall serve as
co-chairperson, appointed by the President of the Senate.
(11) One member of the Senate, who shall serve as
co-chairperson, appointed by the Minority Leader of the
Senate.

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(12) One member of the House of Representatives, who
shall serve as co-chairperson, appointed by the Speaker of
the House of Representatives.
(13) One member of the House of Representatives, who
shall serve as co-chairperson, appointed by the Minority
Leader of the House of Representatives.
(14) One individual appointed by a labor organization
representing frontline employees at the Department of
Human Services.
The Subcommittee shall provide oversight to the Community
Care Program Medicaid Initiative and shall meet quarterly. At
each Subcommittee meeting the Department on Aging shall
provide the following data sets to the Subcommittee: (A) the
number of Illinois residents, categorized by planning and
service area, who are receiving services under the Community
Care Program and are enrolled in the State's Medical
Assistance Program; (B) the number of Illinois residents,
categorized by planning and service area, who are receiving
services under the Community Care Program, but are not
enrolled in the State's Medical Assistance Program; and (C)
the number of Illinois residents, categorized by planning and
service area, who are receiving services under the Community
Care Program and are eligible for benefits under the State's
Medical Assistance Program, but are not enrolled in the
State's Medical Assistance Program. In addition to this data,
the Department on Aging shall provide the Subcommittee with

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plans on how the Department on Aging will reduce the number of
Illinois residents who are not enrolled in the State's Medical
Assistance Program but who are eligible for medical assistance
benefits. The Department on Aging shall enroll in the State's
Medical Assistance Program those Illinois residents who
receive services under the Community Care Program and are
eligible for medical assistance benefits but are not enrolled
in the State's Medicaid Assistance Program. The data provided
to the Subcommittee shall be made available to the public via
the Department on Aging's website.
The Department on Aging, with the involvement of the
Subcommittee, shall collaborate with the Department of Human
Services and the Department of Healthcare and Family Services
on how best to achieve the responsibilities of the Community
Care Program Medicaid Initiative.
The Department on Aging, the Department of Human Services,
and the Department of Healthcare and Family Services shall
coordinate and implement a streamlined process for seniors to
access benefits under the State's Medical Assistance Program.
The Subcommittee shall collaborate with the Department of
Human Services on the adoption of a uniform application
submission process. The Department of Human Services and any
other State agency involved with processing the medical
assistance application of any person enrolled in the Community
Care Program shall include the appropriate care coordination
unit in all communications related to the determination or

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status of the application.
The Community Care Program Medicaid Initiative shall
provide targeted funding to care coordination units to help
seniors complete their applications for medical assistance
benefits. On and after July 1, 2019, care coordination units
shall receive no less than $200 per completed application,
which rate may be included in a bundled rate for initial intake
services when Medicaid application assistance is provided in
conjunction with the initial intake process for new program
participants.
The Community Care Program Medicaid Initiative shall cease
operation 5 years after the effective date of this amendatory
Act of the 100th General Assembly, after which the
Subcommittee shall dissolve.
(Source: P.A. 101-10, eff. 6-5-19; 102-1071, eff. 6-10-22.)".