Bill
SB 3555
Illinois expands Medicaid-supported supportive living facilities with data-driven site planning, market studies, and phased rate changes to broaden access to dementia-capable, non-
Title: MEDICAID-SUPPORTIVE LIVING
Jurisdiction: Illinois
Purpose
- To guide the selection, expansion, and operation of the Medicaid-supported “supportive living facilities” (SLF) program in Illinois.
- Aims to promote resident independence, dignity, and well-being in a cost-effective manner, expanding access to alternatives to nursing home care for Medicaid enrollees.
Key Provisions and Changes
1) Site Selection and Geographic Planning
- The Department of Healthcare and Family Services (HFS) must select SLF sites based on criteria such as:
- Geographic need for services
- Availability of funding
- Ability to meet program standards
- A statewide need assessment is required every 3 years using the most recently available statewide report, plus considerations of:
- Occupancy, vacancies, and waiting lists at surrounding SLF sites
- Public comments
- Based on need, the Department will designate geographic areas (county or ZIP-code based) within a rate-setting region to open a competitive application process.
2) Statewide Market Study and Expansion Rules
- Beginning January 1, 2027, and every 3 years thereafter, the Department must publish a statewide market study report to inform expansion decisions.
- The market study must define primary market areas, determine eligible populations (age, income, acuity), and apply a 20% capture rate to estimate eligible numbers.
- It must account for existing and approved-but-not-certified units, and consider current provider utilization.
- Expansion prioritization criteria include:
- Areas with no current SLF sites
- Counties and unit thresholds (e.g., Chicago and several listed counties with higher needs; other counties with defined unit thresholds)
- Existing providers with occupancy below 90% are ineligible for expansion in primary market areas
- Approved waiver capacity must be respected
- Public comments must be considered
- Rules implementing this section must be proposed within 180 days of the Act’s effective date.
3) Application and Construction Timeline
- Within 6 months of the first statewide market study publication, update on milestones or an application to change location must be submitted for approved-but-uncertified sites.
- Approved-but-uncertified sites must begin construction within 24 months of submission/approval.
- Applications for location changes may be accepted if the statewide market study demonstrates a need outside the original area; however, there are restrictions to avoid over-concentration and proximity to existing sites.
4) Dementia Care and Unit Conversion
- Existing SLFs may convert a limited number of conventional apartments (up to 20) into dementia care units if need is demonstrated and displacement of current residents is avoided.
- Dementia care unit conversions must meet applicable state certification criteria, with potential waivers if health and safety can be assured.
- For expansions approved before 2024, new non-dementia units may accompany dementia units under specific caps and distance requirements.
5) Rates, Compensation, and Funding
- Rates framework (subject to federal approval) includes phased adjustments:
- Rates from the 2014 baseline adjusted in various steps through 2025.
- From July 1, 2019 onward, SLF services must be at least 54.3% of the average total nursing facility per diem (including add-ons) in the geographic area, with dementia care rate maintained separately.
- From 2022 onward, aligns with the Patient-Driven Payment Model, still at ≥54.3% of average nursing per diem, with dementia care maintained.
- Beginning January 1, 2024, dementia care rate must be at least 1.5 times the non-dementia rate.
- By January 1, 2025, rates for SLF must be at least 54.75% of the average total nursing facility per diem (with add-ons).
- A 10% enhanced federal matching rate for SLF services under ARPA is authorized for a 12-month period (April 1, 2021 – March 31, 2022) with a supplemental $26 per diem payment to SLFs funded by enhanced federal participation, subject to federal approval and possible flexibilities on spending.
6) Eligibility, Participation, and Compliance
- SLF facilities must meet standards and may be exempt from certain state acts (Nursing Home Care Act, Illinois Health Facilities Planning Act) if they are selected and in good standing.
- Rules to implement these provisions will be developed by the Department, in consultation with aging, rehabilitation, mental health, and related departments.
7) Personal Needs and Services
- Beginning January 1, 2025, the monthly personal needs allowance for SLF residents is set at $120.
- From July 1, 2025, the Department must maintain a meal add-on of at least $6.15 per day (two meals per day) as per the home- and community-based waiver.
8) Medication Administration
- With federal approval, certified medication aides may administer medications in SLFs under supervision by a registered nurse, with Department rulemaking to implement.
Effective Date
- The act becomes law upon signing; specific provisions include immediate effect for some site-selection framework and ongoing rate/expansion changes in subsequent years.
Who is Affected
- Medicaid-eligible residents seeking alternatives to nursing home care.
- SLF operators and prospective developers.
- The Department of Healthcare and Family Services and related state agencies (Aging, Rehabilitation Services, Mental Health and Developmental Disabilities) involved in oversight, waivers, and rulemaking.
- Nursing facilities and associated per diem benchmarks due to rate setting.
Timeline Highlights
- 180 days after enactment: Department must propose implementing rules.
- 6 months after first statewide market study: deadlines for updates from approved-but-not-certified sites.
- 24 months after submission/approval: construction must begin for approved sites.
- 2025-2027: phased rate updates; dementia care rate adjustments; ongoing market studies every 3 years.
Notes
- The bill emphasizes data-driven expansion, geographic targeting, and ensuring adequate dementia care capacity while maintaining coordination with federal approvals and waivers.
Compiled from official sources — confirm details with the bill’s official record.
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