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SB 3144

MEDICAID-SLF-DEMENTIA CARE

104th Regular Session Introduced by Christopher Belt

Illinois SB 3144 refines Medicaid-supported supportive living facilities, prioritizing dementia care, adjusting rates to nursing benchmarks, and expanding controlled mixed-use site

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Bill Summary · SB 3144

Overview

SB 3144, introduced in the 104th Illinois General Assembly, amends the Public Aid Code to govern the Medicaid-supported supportive living facilities (SLF) program, with a focus on dementia care settings, rate structures, site approvals, and related services.

Main purpose and intent

  • To clarify and modify how the state administers and finances supportive living facilities, particularly those providing dementia care.
  • To adjust reimbursement rates, eligibility criteria, and expansion provisions to reflect federal guidance and program objectives.
  • To set conditions for accepting certain mixed-use sites and to preserve targeted dementia care capacity within SLFs.

Key provisions and changes

  • SLF program framework (Section 5-5.01a):

    • The Department of Healthcare and Family Services (HFS) must oversee an SLF program that promotes resident independence, dignity, and well-being in a cost-effective manner.
    • An SLF is either a free-standing facility or a distinct part of a mixed-use building with private living units and integrated housing, health, personal care, and supportive services.

  • Rate and funding provisions (a and related subsections):

    • Several historical rate adjustments are codified, with directive increases tied to specific dates and federal approvals. Highlights include:
    • Initial rate changes in 2014 and subsequent steps through 2018, and further adjustments linked to statewide rate benchmarks and the Patient-Driven Payment Model (PDPM) implementation.
    • By 2019 onward, SLF rates are to be at least 54.3% of the average total nursing facility per diem in geographic areas, with the dementia care rate differential maintained.
    • Starting 2022, PDPM implementation requires 54.3% of the average nursing per diem, maintaining dementia care differentials and updating rates with nursing facility per diem updates.
    • Beginning 2024, dementia care rates for SLFs must be at least 1.5 times the non-dementia SLF rate, subject to federal approval.
    • A b-5 provision (further rate target) arriving in 2025- whenever federal approval is in place, sets SLF rates at least 54.75% of the average nursing per diem with all add-ons included.

  • Expansion and site considerations (d and g):

    • Subsection (d) allows HFS to accept applications for certification of sites or buildings where distinct parts are designated for non-SLF uses, provided:
    • The non-SLF portion is not designed for assisted living per the Assisted Living and Shared Housing Act.
    • The non-SLF portion is physically distinct with separate entrances, no shared spaces, and separate staffing from the SLF portion.
    • Subsection (g) addresses applications for expansion of dementia care settings that were not approved by January 1, 2024. It allows limited addition of elderly non-dementia units alongside dementia units under strict constraints:
    • No more than one non-dementia unit for each dementia unit.
    • The site must not be within 4 miles of an existing SLF site in Cook County (including Chicago), and must meet distance requirements from other counties as specified.

  • Exemptions and waivers (e):

    • Facilities or distinct parts selected as SLFs and in good standing with HFS rules are exempt from the Nursing Home Care Act and the Illinois Health Facilities Planning Act.

  • Federal relief and temporary enhancements (f):

    • Recitals related to the ARP Act enhanced FMAP (10% for SLFs) historically applicable from April 1, 2021, to March 31, 2022. The bill provides that, for a 12-month period, the Department must pay a supplemental $26 per diem to all SLFs using the enhanced federal funds, with department flexibility on spend parameters and to align with any federal changes.

  • Resident supports and services (h, i, j):

    • January 1, 2025, the monthly personal needs allowance for SLF residents increases to $120.
    • Ongoing SLF home and community-based service waiver requirements include provisions ensuring at least 2 meals per day, with a daily add-on rate not less than $6.15 (starting July 1, 2023, per the waiver terms).
    • Beginning July 1, 2029 (per the bill’s sequencing), the Department may authorize a certified medication aide to administer medications within SLFs under supervision of a registered nurse, with rules to be developed.

  • Administration and rules (c):

    • The Department may adopt rules to implement these provisions, in consultation with the Department of Aging, Department of Rehabilitation Services, and the Department of Mental Health and Developmental Disabilities (or successor agencies).

Affected parties and entities

  • Eligible residents of supportive living facilities in Illinois, especially those in dementia care settings.
  • SLFs seeking certification or expansion, including mixed-use sites with distinct non-SLF portions.
  • Operators and administrators of SLFs, who must comply with revised rate structures, staffing, and service requirements.
  • State agencies: Department of Healthcare and Family Services (primary), with involvement from aging, rehabilitation services, and mental health/developmental disabilities departments for rulemaking and program oversight.
  • Healthcare providers staffing SLFs (e.g., certified medication aides and supervision by licensed RNs).

Procedural and timeline aspects

  • Rate structure references begin as early as 2014, with ongoing updates through 2025 and beyond, contingent on federal approvals and PDPM implementation.
  • Dementia care rate adjustments are set to take effect subject to federal approval, with explicit milestones for 2024 and 2025.
  • Expansion provisions and restrictions around January 1, 2024, and the siting distance requirements apply to prior and new proposals.
  • Personal needs allowance increase to $120/month starts January 1, 2025.
  • Meals add-on and per diem requirements tie to the approved SLF waiver, with ongoing updates as federal and state rates change.
  • Authorized use of certified medication aides begins once federal and state rule processes are completed (contemplated for July 1, 2029, subject to implementation and rulemaking).

Bottom line

SB 3144 aims to refine the Illinois SLF program, emphasizing dementia care, ensuring adequate and progress-based Medicaid reimbursement aligned with nursing facility benchmarks, expanding permissible mixed-use sites under controlled conditions, and enhancing resident supports (e.g., personal needs allowances, meals, and medication administration) while maintaining compliance with federal requirements.

Compiled from official sources — confirm details with the bill’s official record.

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