Aging population requires ‘bold leadership’ to protect human dignity: LeadingAge to House Speaker

Nursing Homes’ Letter to CMS Calls Out Lack of Teeth – and Clarity – in Final Rule’s Medicare Advantage Reform

Nursing home staffing rule finds scant political support

February 21: Governor’s Budget and State of the State Address

March 19: Primary Election



May 17: House and Senate Third Reading Deadline for Bills in the Opposite Chamber

May 24: Adjournment

As we move closer to ushering in 2024, several legislative changes await us. Here is a look at some of the laws taking effect January 1, 2024 that you should know about:

Public Act 101-0001

Illinois minimum wage was increased two General Assemblies ago. On January 1, 2024, it will increase to $14 an hour.

SB208

Paid Leave for All Workers Act

• Staff are eligible for a minimum of 40 hours of paid leave per year.
• Effective January 1, 2024, or when employment begins (whichever is later), covered employees must accrue at least one hour of paid leave for every 40 hours worked, for up to 40 hours of paid leave for every 12-month period. For accrual calculation, overtime exempt employees are generally deemed to work 40 hours each work week, unless their regular work week is under 40 hours.
• Employees are eligible to begin taking leave after 90 days of employment with the employer, or 90 days after January 1, 2024, whichever is later.
• Eligible employees may determine when they use leave and how much they choose to use, but employers may set a minimum leave increment of up to two hours per day
• Employers must allow employees to earn and use up to 40 hours of leave during a 12-month period.
• See also the Chicago Paid Leave Ordinance. 

HB1156 (Meier)

Posting Ombudsman Information on Website

• Requires postings of Long Term Care Ombudsman Program information.
• All licensed Assisted Living and Nursing Homes as well as Life Care Communities shall post on the home page of the establishment's website the Long Term Care Ombudsman Program's statewide toll-free telephone number and a link to the Long Term Care Ombudsman Program's website.
• An establishment may comply by posting the required information on the website of the establishment's parent company if the establishment does not maintain a unique website and is not required to comply if the establishment and any parent company do not maintain a website, and is not required to comply in instances where the parent company operates in multiple states and the establishment does not maintain a unique website.
• Effective January 1, 2024. 

HB1558 (Hirschauer)

Medicaid Fees

Removes language in law requiring the Illinois Department of Public Health (IDPH) to establish, by rule, and charge a fee to any facility or program applying to be certified to participate in the Medicare program or in the Medicaid program to cover the costs associated with the application, inspection, and survey of the facility or program and processing of the application. Effective January 1, 2024. 

HB2039 (Moeller)

General Public Health Data

The Illinois Department of Public Health (IDPH), at the request of local health departments, can make any and all public health data related to residents of that jurisdiction available for purposes of preventing or controlling disease.

HB2068 (Mah)

Transportation Benefit Program

• Employers with at least 50 employees in Chicago and other towns and counties (see second bullet), to allow employees to use pre-tax dollars for the purchase of a transit pass through payroll deductions.
• Cook County; Warren Township in Lake County; Grant Township in Lake County; Frankfort Township in Will County; Wheatland Township in Will County; Addison Township; Bloomingdale Township; York Township; Milton Township; Winfield Township; Downers Grove Township; Lisle Township; Naperville Township; Dundee Township; Elgin Township; St. Charles Township; Geneva Township; Batavia Township; Aurora Township; Zion Township; Benton Township; Waukegan Township; Avon Township; Libertyville Township; Shields Township; Vernon Township; West Deerfield Township; Deerfield Township; McHenry Township; Nunda Township; Algonquin Township; DuPage Township; Homer Township; Lockport Township; Plainfield Township; New Lenox Township; Joliet Township; or Troy Township.

HB2102 (Costa Howard)

Background Checks - FBI

• Amends the Health Care Worker Background Check Act in the section about a health care employer or long-term care facility hiring individuals convicted of committing or attempting to commit various offenses.
• It adds substantially equivalent offenses under the laws of any other state or of the laws of the United States, as verified by court records, records from a state agency, or an Federal Bureau of Investigation (FBI) criminal history records check.
• Fingerprints shall be checked against the Illinois State Police and FBI criminal history records databases now and hereafter filed, including, but not limited to, civil, criminal, and latent fingerprint databases.
• Illinois State Police shall furnish, pursuant to positive identification, records of Illinois convictions and shall forward the national criminal history record information to the department or agency.
• Illinois State Police shall forward the applicant's fingerprints to the FBI and request that they conduct a national criminal history pertaining to the applicant.
• Effective January 1, 2024. Rules will be written to implement the changes. They are currently in first notice. 

SB216 (Edly-Allen)

The guardianship training program shall include content regarding Alzheimer's disease and dementia. Requires a public guardian to complete a one-hour course on Alzheimer's disease and dementia within 6 months of appointment and annually thereafter. Effective January 1, 2024. 

SB1497 (Villa)

Nursing Home Restraints / Psychotropics 

• Names Section 2-106. Restraints. Devices used for positioning, including, but not limited to, bed rails and gait belts, shall not be considered to be physical restraints for purposes of this Act unless the device is used to restrain or otherwise limit the patient's freedom to move. A device used for positioning must be requested by the resident or, if the resident is unable to consent, the resident's guardian or authorized representative, or the need for that device must be physically demonstrated by the resident and documented in the resident's care plan. The physically demonstrated need of the resident for a device used for positioning must be revisited in every comprehensive assessment of the resident.
• Adds to the definition of “emergency" means a situation, physical condition, or one or more practices, methods, or operations which present imminent danger of death or serious physical or mental harm to residents of a facility and are clinically documented in the resident's medical record.
• Adds to Section 2-106.1. Drug treatment: State laws, regulations, and policies related to psychotropic medication are intended to ensure psychotropic medications are used only when the medication is appropriate to treat a resident's specific, diagnosed, and documented condition and the medication is beneficial to the resident, as demonstrated by monitoring and documentation of the resident's response to the medication.
• Further adds that psychotropic medication shall only be given in both emergency and nonemergency situations if the diagnosis of the resident supports the benefit of the medication and clinical documentation in the resident's medical record supports the benefit of the medication over the contraindications related to other prescribed medications.
• Effective January 1, 2024. 

SB1814 (Holmes)

Assisted Living Advisory Board

Requires the Governor to establish an Assisted Living and Shared Housing Advisory Board that shall be provided copies of any additions or changes to the Assisted Living and Shared Housing Establishment Code for review and comment prior to notice being given to the public. Effective January 1, 2024.

SB2271 (Aquino)

Home Care Fees/Licenses/Violations

• Amends the Home Health, Home Services, and Home Nursing Agency Licensing Act.
• A professional license shall be valid for a period of 240 days (rather than 120 days) unless sooner suspended or revoked
• Illinois Department of Public Health (IDPH) may renew a provisional license once for a period not to exceed 90 days (rather than 120 days) from the expiration date of the initial provisional license
• The fee for each single home health agency license or any renewal shall be $1,500 (rather than $25).
• Home Health and Home Services Advisory Committee shall be composed of 15 voting members and one nonvoting member (rather than just 15 members).
• 2 (rather than one) of the voting members shall be individuals who represent an organization that advocates for consumers, and the nonvoting member shall be a home services worker.
• If the Department finds that a violation does not pose a substantial risk to the health or safety of an agency's clients or patients, the Department may choose to request a plan of correction for the Department's approval prior to issuing a notice of violation to the agency.
• If the agency fails to submit an acceptable plan of correction or fails to implement a Department-approved plan of correction within the time provided by the Department, the Department shall then issue the notice of violation.

If you have any questions, please contact Jason Speaks, director of government relations.

The Illinois Department of Public Health (IDPH) has updated the Assisted Living and Shared Housing Establishments Code, implementing their amendments made late this summer.

As you recall, LeadingAge Illinois and other associations negotiated with the Department for a number of months on their proposed rules and, through the meetings and advocating with legislators, we were able to stop the Department from tripling the fees/fines from taking away the provider opportunity for a statement of dispute. We also were successful and changing their proposed language on "potential for harm."

Here are the Code updates now in effect:

Section 295.200 Definitions:

Adds a definition of “Existing Establishment”: Existing establishment – any establishment initially licensed as a health care facility or approved for construction by the Department, or any establishment initially licensed or operated by any other agency of the State of Illinois, prior to September 1, 2023. Existing establishments shall meet the design and construction standards for existing establishments.

Adds definition of “New Establishment”: New establishment - any establishment initially licensed as a health care facility or approved for construction by the Department, or any establishment initially licensed or operated by any other agency of the State of Illinois, on or after September 1, 2023. New establishments shall meet the design and construction standards for new establishments.

Section 295.1050 Violations:

The underlined language was added and is new. We were able to successfully oppose the Department’s initial proposed language that stated “potential for harm.” In speaking with counsel, potential and substantial probability do have legal differences. This new language is not as detrimental as “potential for harm.” 

Type 2 violation – an act or omission by the establishment or its staff that causes harm to a resident or creates a substantial probability of harm to a resident or residents.

Type 1 violation – an act or omission by the establishment or its staff that causes severe harm or the death of a resident or creates a substantial probability of severe harm to a resident or residents.

Section 295.1060 Remedies and Sanctions:

In addition to other remedies, the Department may conduct, at their discretion, a consultative conference with administrative staff who oversee the daily operations of the establishment to identify remedial actions to address a violation.

Fines. Changes “may” impose fines to “will” impose fines. 

Adds to the regulation language concerning actions preventing the Department from carrying out its duties could result in your license revoked or suspended and be subject to a fine of not more than $250 per day for each day the Department is prevented from carrying out its duties.

Also, each day a violation continues shall be deemed a separate violation.

Section 295.1070 Annual On-Site Review and Complaint Investigation Procedures:

Statement of Findings and Violations. The Department will provide the establishment with a written statement of findings and violations via U.S. mail or other electronic means within 10 business days (instead of 20 days) after exiting the on-site inspection.

Statements of Correction. Each statement of correction shall be based on an assessment by the establishment of the conditions or occurrences that are the basis for the violation and evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences. Evidence of such assessment and evaluation shall be maintained by the establishment. Each statement of correction shall include:

A description of the specific corrective action the facility is taking, or plans to take, to abate, eliminate, or correct the violation cited in the notice;

A description of the steps that will be taken to avoid future occurrences of the same and similar violations; and

A specific date by which the corrective action will be completed.

• The Department will review each statement of correction to ensure it provides for the abatement, elimination, or correction of the finding or violation. The Department will reject a submitted plan if it finds any of the following deficiencies:
• 1) The plan does not appear to address the conditions or occurrences that are the basis of the finding or violation and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences.
• 2) The plan is not specific enough to indicate the actual actions the establishment will be taking to abate, eliminate, or correct the finding or violation.
• 3) The plan does not provide for measures that will abate or eliminate or correct the finding or violation.
• 4) The plan does not provide steps that will avoid future occurrences of the same and similar findings or violations.
• 5) The plan does not provide for timely completion of the corrective action, considering the seriousness of the violation, any possible harm to the residents, and the extent and complexity of the corrective action.

• When the Department rejects a submitted statement of correction, it will notify the establishment in writing and will specify the reason for the rejection. The establishment must submit an acceptable plan of correction within 30 days following notice of rejection. Failure to submit a revised acceptable plan of correction may result in suspension or loss of license.

Section 295.1090 Complaints:

The Department will conduct an on-site review and evaluation of an assisted living or shared housing establishment found to be in violation within a specified period of time based on the gravity and severity of the violation and any pervasive pattern of occurrences of the same or similar violations.

Complaints, other than abuse and neglect, will be investigated within 30 days after the receipt of the complaint.

Deleted from the Code: The Department shall conduct an on-site review and evaluation of an assisted living or shared housing establishment found to be in violation of the Act within a specified period of time based on the gravity and severity of the violation and any pervasive pattern of occurrences of the same or similar violations.

Section 295.2050 Incident and Accident Reporting:

New language: An establishment shall report to the Department any serious incident or accident. For the purposes of this Section, "serious" means any incident or accident that causes physical or emotional harm or injury to a resident. A change in an individual's (resident's) condition that is due to health or medical decline is not a reportable incident or accident.

Reports made now by email at DPH.LTCAL@illinois.gov rather than fax. 

Section 295.3050 Employee Assistance Programs (NEW):

An "employee assistance program" is a program that supports individual physical and mental well-being and that is provided by the establishment or through an insurance or employee benefits program offered by the establishment.

 Employee assistance programs may include, but are not limited to programs that offer professional counseling, stress management, mental wellness support, smoking cessation, and other support services.

An establishment shall ensure that nurses employed by the establishment are aware of employee assistance programs or other like programs available for the physical and mental well-being of the employee.

 The establishment shall provide information on these programs, no less than at the time of employment, during any benefit open enrollment period, by an information form about the respective programs that a nurse shall sign during onboarding at the establishment, and upon request of the employee.

The signed information form shall be added to the nurse's personnel file. The establishment may provide this information to nurses electronically.

Section 295.9000 Physical Plant:

The establishment shall comply with the residential board and care occupancies chapter of the National Fire Protection Association's (NFPA) Life Safety Code (Life Safety Code) 101, Chapter 32 for new establishments and Chapter 33 for existing establishments.

All plumbing systems shall be designed and installed in accordance with the requirements of the Illinois Plumbing Code except that the number of resident-required water closets, lavatories, bathtubs, showers, and other fixtures shall be as required.

Kitchen Facilities housing 10 or more residents shall comply with the requirements of NFPA 96, Ventilation Control and Fire Protection of Commercial Cooking Operation.

Section 295.9010 Supplemental Physical Plant Requirements for Assisted Living

Establishments:

Each new establishment shall have a bathtub or shower. 

If you have any questions, please contact Jason Speaks, director of government relations.

Ask you federal representatives to cosponsor the Expanding Service Coordinators Act (H.R. 5177). Fewer than half of the multifamily housing communities assisted by the Department of Housing and Urban Development (HUD) have a service coordinator—and there is no national program to fund service coordinators in Housing Credit communities. Service coordinators fulfill a critical need to connect older adult residents of affordable housing communities to the services and supports they need to successfully age in the community. Please take action to urge representatives to cosponsor the Expanding Service Coordinators Act and support funding for new service coordinators.

In the Provider Notice Issued 04/29/2021 (illinois.gov), Long Term Care (LTC) providers were notified that the Department of Human Services (DHS) would be utilizing the Central Scanning Unit (CSU) Datacap for LTC providers as an option to upload documents to the resident’s case record via fax if they were unable to utilize the Application for Benefits Eligibility (ABE) Partner Portal.

Effective December 1, 2023, the address for the DHS CSU-LTC will be:

Illinois Department of Human Services

Central Scanning Unit - LTC

PO Box 34020

Chicago, IL 60634-0019

Utilizing the ABE Partner Portal is the preferred method for submitting documentation. However, if the LTC provider is not able to utilize the ABE Partner Portal, documents should be faxed to the DHS CSU-LTC at (217) 557-4965.

If the LTC provider is unable to utilize the ABE Partner Portal or the DHS CSU-LTC fax number, the documentation should be addressed and sent to the DHS CSU-LTC address provided above.

Please contact your DHS Medical Field Operations (MFO) Office with questions regarding this notice. To determine the correct DHS MFO Office that serves your facility, please reference the Provider Notice Issued 05/10/2017 (illinois.gov).

Pursuant to Public Act 102-1035, long term care providers are to be assessed per occupied bed day in an amount varying with the number of paid Medicaid resident days per annum in the facility with the following schedule of occupied bed tax amounts. This assessment is due and payable each month. The tax shall follow the schedule below effective July 1, 2022, and be rebased by the Department at the beginning of each calendar year.

Rate Tier based on number of paid Medicaid resident days per annum 4/1/2022-3/31/2023

a.)    $10.67 – 0-5,000 paid Medicaid resident days per annum

b.)    $19.20 – 5,001-15,000 paid Medicaid resident days per annum

c.)    $22.40 – 15,001-35,000 paid Medicaid resident days per annum

d.)    $19.20 – 35,001-55,000 paid Medicaid resident days per annum

e.)    $13.86 – 55,001-65,000 paid Medicaid resident days per annum

f.)     $10.67 – 65,001+ paid Medicaid resident days per annum

g.)    $ 7.00 – Any non-profit nursing facilities without Medicaid certified beds or any nursing facility owned and operated by a county government.

The published Rate Tier by facility can be found here.

An "occupied bed day" is defined as the sum of all beds multiplied by the number of days during the month on which each bed was occupied by a resident, other than a resident for whom Medicare Part A is the primary payer. By law, this assessment cannot be billed or passed on to any resident of a nursing home.

As a reminder, for a resident whose care is covered by the Medicare Medicaid Alignment Initiative (MMAI) demonstration, Medicare Part A is considered the primary payer. 

Enrollment of residents into MMAI are not expected to increase the tax burden on any nursing facility as these beds are counted as Medicare beds and will not be charged the per day assessment.

The department has established due dates for providers to file monthly assessment reports and make assessment payments for the reporting periods of October 2023 through September 2024 for assessment periods January 2024 through December 2024. Providers will be notified of any assessment deadline extensions via the website, and are encouraged to sign up for e-mail notifications regarding extensions of future due dates here.

The purpose of this notice is to provide information on the reporting and payment requirements for the 2024 calendar year monthly occupied bed assessments. Your facility’s provider notice packet has been mailed via USPS Attn: Chief Financial Officer. The packet should include the following material:

The Department has developed the electronic submission for the Monthly Assessment Report which can be accessed through the HFS MEDI website.

The Monthly Assessment Report must be submitted electronically or postmarked on or before the due date to be considered as received on time. A copy of the report must accompany the payment and must be postmarked on or before the due date for the payment to be considered as received on time.

Failure to pay the monthly assessment on or before the due date will result in the assessment of a 5% penalty. In addition, failure to file the Monthly Assessment Report will result in an additional penalty equal to 25% of the monthly assessment due.

Thanks to all who joined our last HUD Member Quarterly Meetingrecently as we had one of the biggest turnouts of the year. In addition to our regular guest, Gail Burks, chief, account executive branch at the HUD Multifamily Midwest Regional Center, we were joined by I-Sha Reeves, senior grants specialist

At HUDs Office of Multifamily Housing. We wanted to share the information discussed during the meeting. Please see below:

Annual Extensions

Annual Extension Instructions

Annual Extension Instructions & Renewal Guidance

Multifamily Service Coordinator Program: Getting in the “Know”

Annual Extensions Webinar Transcript

HUD Announces Energy Benchmarking Initiative for Multifamily Housing

LeadingAge Q&A with Jenny DeSilva: HOTMA Implementation for Mission-Driven Housing Providers

Our next meeting is set for Thursday, March 21, 2024 from 12-1 p.m. CST. Please make plans to join us. If there are items you would like discussed at the next meeting, please send them to Jason Speaks and Juliana Bilowich.

The LeadingAge Illinois Assisted Living and Skilled Nursing Facilities Boot Camps were held recently, packed with experts in the regulatory and legal arena and staff from the Illinois Department of Public Health (IDPH). The Assisted Living Boot Camp was held in Naperville while the Skilled Nursing Boot Camp was held in Springfield. It was the second Boot Camp for each setting this year.

There is still time to make an impact on Illinois legislators before the 2024 Spring Session begins in mid-January.

Every year, a number of legislative and regulatory proposals are introduced that have large impacts on older adult care and services. Your State Senators and Representatives (i.e.: legislators) are the deciding voters in Springfield on these important issues, let alone may sometimes be the authors of such legislation. As such, LeadingAge Illinois strongly encourages ALL members host your legislators to build and maintain a strong, beneficial relationship. LeadingAge Illinois works on your behalf to pass legislation that provides solutions to member challenges and defeat legislation that places undue burden on providers and residents. As a member, you play a vital role in helping us accomplish this work. You do this by participating in our email campaigns, advocacy day events, and by holding a legislative visit in your community as a part of the LeadingAge Illinois Partners in Quality program.

Click here to view our Legislative Visits toolkit and contact Jason Speaks, director of government relations to schedule your visit.

We must continue to leverage our PAC to educate legislators to reduce burdens and implement solutions that impact YOU. 

Each contribution, no matter how small, makes a difference. Like our voices, our contributions collectively make a significant difference in providing the ability to influence public policy related to aging services.

There are a number of ways to engage in the LeadingAge Illinois PAC.

• Monthly Contribution (most popular). You can contribute smaller amounts each month, spreading your total contribution over the year. Select “make this a monthly donation” when processing your payment. 

• Make a one-time contribution – Visit our webpage online to make a one-time contribution.  

• Chair’s Circle. Along with maintaining a sound presence for the LeadingAge Illinois PAC, an annual contribution of $500 qualifies you for our Chair’s Circle!! Chair Circle members receive special recognition at LeadingAge Illinois events as well as making our PAC the strongest ever. You can make your chair's circle contribution all at once or monthly by checking the box that says "make this a monthly donation." Contribute online now.

*Nonprofit 501c(3) organizations cannot by law fund the PAC with a corporate check. Donations must come from individual contributions. We recommend sharing this communication with your staff to encourage personal contributions.

**Contributions to PAC are not deductible as charitable contributions for tax purposes.

***A copy of our report filed with the State Board of Elections is available on the Board’s official website or for purchase from the State Board of Elections, Springfield, Illinois.