Bill Text: IL SB2147 | 2011-2012 | 97th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Health Facilities Planning Act. In provisions concerning an application for a permit, provides that members of the public and the permit applicant shall have until 10 days before the meeting of the Health Facilities and Services Review Board to submit any written response concerning the Board staff's written review or findings regarding the permit application. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Passed) 2011-11-14 - Public Act . . . . . . . . . 97-0619 [SB2147 Detail]

Download: Illinois-2011-SB2147-Amended.html

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Rep. Lou Lang

Filed: 5/28/2011

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AMENDMENT TO SENATE BILL 2147
AMENDMENT NO. ______. Amend Senate Bill 2147 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 agreement

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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 notice prior to actual

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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 administrative and employee wage and

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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
be considered by the Department in determining the copayment.

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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, blind, or permanently and totally disabled. 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 Section in death. All moneys for services
paid to or in behalf of the person under this Section shall be

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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 Older
Adult Services Advisory Committee, shall institute a study

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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;
(7) ensuring that the State may access maximum federal

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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 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; and
(8) ensuring that the determination of need tool
accurately reflects the service needs of individuals with
Alzheimer's disease and related dementia disorders.
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
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

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services shall be appropriately trained.
Beginning on the effective date of this Amendatory Act of
1991, no person may perform chore/housekeeping and home care
aide 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
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 they are
meeting the federal minimum wage statute for home care aides
and personal assistants. An employer that cannot ensure that

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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, 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 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

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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, 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

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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 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.
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.
The Department shall pay an enhanced rate under the

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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.
Notwithstanding any other eligibility rules in effect or
subsequently promulgated by the Department, and consistent
with the mandates of Public Act 95-713, vendors who receive or
did receive an enhanced rate payment for the purpose of
providing health insurance coverage to their employees by
contributing to a Taft-Hartley welfare plan or other qualified
self-funded health plan will be allowed to have such plans
accumulate or have accumulated up to 6 months of enhanced rate
payments prior to the actual provision of health insurance
coverage to their direct service worker employees in order to
be able to pay premiums, benefits, claims, or other attendant
costs of such health coverage.
For the purposes of this Section, "flexible senior
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.
(Source: P.A. 95-298, eff. 8-20-07; 95-473, eff. 8-27-07;
95-565, eff. 6-1-08; 95-876, eff. 8-21-08; 96-918, eff. 6-9-10;
96-1129, eff. 7-20-10; revised 9-2-10.)
Section 10. The Nursing Home Care Act is amended by

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

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General Assembly, in a form and manner prescribed by the
Department, of the staffing ratios in effect on the effective
date of this amendatory Act of the 96th General Assembly for
both intermediate and skilled care and the number of residents
receiving each level of care.
(d)(1) Effective July 1, 2010, for each resident needing
skilled care, a minimum staffing ratio of 2.5 hours of nursing
and personal care each day must be provided; for each resident
needing intermediate care, 1.7 hours of nursing and personal
care each day must be provided.
(2) Effective January 1, 2011, the minimum staffing ratios
shall be increased to 2.7 hours of nursing and personal care
each day for a resident needing skilled care and 1.9 hours of
nursing and personal care each day for a resident needing
intermediate care.
(3) Effective January 1, 2012, the minimum staffing ratios
shall be increased to 3.0 hours of nursing and personal care
each day for a resident needing skilled care and 2.1 hours of
nursing and personal care each day for a resident needing
intermediate care.
(4) Effective January 1, 2013, the minimum staffing ratios
shall be increased to 3.4 hours of nursing and personal care
each day for a resident needing skilled care and 2.3 hours of
nursing and personal care each day for a resident needing
intermediate care.
(5) Effective January 1, 2014, the minimum staffing ratios

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