(320 ILCS 35/1)

(from Ch. 23, par. 6801‑1)

Sec. 1.

Short title.

This Act may be cited as the

Partnership for Long‑Term Care Act.

(Source: P.A. 87‑163.)

(320 ILCS 35/10)

(from Ch. 23, par. 6801‑10)

Sec. 10.

Definitions.

"Program" means the long‑term care insurance partnership program established under this Act.

(Source: P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/15)

(from Ch. 23, par. 6801‑15)

Sec. 15.

Program.

(a) The Department on Aging, in cooperation with the Department of Insurance, and the Department of Public Aid, shall administer the program.

(b) The Departments shall seek any federal waivers and approvals necessary to accomplish the purposes of this Act.

(Source: P.A. 88‑328; 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/20)

(from Ch. 23, par. 6801‑20)

Sec. 20.

Program participant eligibility for Medicaid.

(a) Individuals who participate in the program and have resources above the eligibility levels for receipt of medical assistance under Title XIX of the Social Security Act (Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code) shall be eligible to receive in‑home supportive service benefits and Medicaid benefits through the Department of Public Aid if, before becoming eligible for benefits, they have purchased a long‑term care insurance policy covering long‑term care that has been certified by the Department of Insurance under Section 30 of this Act.

(b) Individuals may purchase certified long‑term care insurance policies which cover long‑term care services in amounts equal to the resources they wish to protect.

(b‑5) An individual may purchase a certified long‑term care insurance policy which protects an individual's total assets. To be eligible for total asset protection, an amount equal to the average cost of 4 years of long‑term care services in a nursing facility must be purchased.

(b‑7) Although a resource has been protected by the Partnership Policy, income is to be applied to the cost of care when the insured becomes Medicaid eligible.

(c) The resource protection provided by this Act shall be effective only for long‑term care policies which cover long‑term care services, that are delivered, issued for delivery, or renewed on or after July 1, 1992.

(d) When an individual purchases a certified long‑term care insurance policy, the issuer must notify the purchaser of the benefits of purchasing inflation protection for the long‑term care insurance policy.

(e) An insurance company may offer for sale a policy as described in paragraph (b) of this Section or paragraph (b‑5) of this Section or both types of policies.

(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff. 7‑1‑97.)

(320 ILCS 35/25)

(from Ch. 23, par. 6801‑25)

Sec. 25.

Protection of resources.

(a) Notwithstanding any other provision of law, the resources, to the extent described in subsection (b), of an individual who (i) purchases a certified long‑term care insurance policy which covers long‑term care services and (ii) has received all the benefit payments that are payable under that policy or contract for items described in subsection (b) shall not be considered in determining:

(1) Medicaid eligibility.

(2) The amount of any Medicaid payment.

(3) The amount of any subsequent recovery by the

State of payments made for medical services to the extent federal law permits.

(4) Eligibility for in‑home supportive services.

(5) The amount of any payment for in‑home supportive

services.

(b) Benefit payments described in subsection (a) must be for one or more of the following:

(1) In‑home supportive service benefits and Medicaid

long‑term care services specified in regulations by the Department of Public Aid.

(2) Long‑term care services delivered to insured

individuals in a community setting as part of an individual assessment and case management program provided by coordinating entities designated or approved by the Department on Aging.

(3) Services the insured individual received while

meeting the disability criteria for eligibility for long‑term care benefits established by the Departments.

(Source: P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/30)

(from Ch. 23, par. 6801‑30)

Sec. 30.

Certification of policies and contracts.

The Department of Insurance shall certify only long‑term care insurance policies which cover long‑term care that provide all of the following:

(1) Individual case management by a coordinating

entity designated or approved by the Department on Aging.

(2) The levels and durations of benefits that meet

minimum standards set by the Department of Insurance.

(3) A record keeping system including an explanation

of benefit reports on insurance payments or benefits that count toward Medicaid resource exclusion.

(4) Approval of the insurance policy by the

Department of Insurance.

(5) Compliance with any other requirements imposed

by the Departments through regulations consistent with the purposes of this Act.

(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff. 7‑1‑97.)

(320 ILCS 35/35)

(from Ch. 23, par. 6801‑35)

Sec. 35.

(Repealed).

(Source: P.A. 87‑163. Repealed by P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/40)

(from Ch. 23, par. 6801‑40)

Sec. 40.

Program.

(a) The program shall be designed so that the estimated aggregate State expenditures for long‑term care services for individuals participating in the program do not exceed the aggregate expenditures that would be made for these services under the Medicaid program in effect prior to the implementation of the program.

(b) The Department of Insurance shall provide advice and counseling through a Health Insurance Counseling and Advocacy Program to individuals interested in purchasing long‑term care insurance that cover long‑term care services certified under this Act.

(c) Insurers shall make available to the insureds the opportunity to purchase any traditional long‑term care policy offered by the insurer which has benefits comparable to the benefits provided by a certified long‑term care insurance policy provided for under this amendatory Act of 1996. The insurer shall make these policies available without requiring evidence of insurability in the event of the termination of the program.

(Source: P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/45)

(from Ch. 23, par. 6801‑45)

Sec. 45.

Agency powers; regulations.

(a) The Departments shall adopt regulations to implement this Act, including, but not limited to the following:

(1) The population and age groups that are eligible

to participate in the program.

(2) The minimum level of long‑term care insurance

that must be purchased to meet the requirement of subsection (b) of Section 20 of this Act.

(3) The amount and types of services that a

long‑term care insurance policy that includes long‑term care services must cover to meet the requirements of Section 30 of this Act.

(4) Which coordinating entities are designated or

approved to deliver individual assessment and case management services to individuals in a community setting as required by subdivision (b)(2) of Section 25 of this Act.

(5) The disability criteria for eligibility for

long‑term care benefits as required by subdivision (b)(3) of Section 25 of this Act.

(6) The specific eligibility requirements for

receipt of the Medicaid benefits provided for by the program, and the Medicaid benefits for which participants in the program shall be eligible.

(b) The Departments shall also adopt regulations to implement this Act, including, but not limited to, regulations which establish the following:

(1) The specific eligibility requirements for

in‑home supportive service benefits.

(2) Those in‑home supportive service benefits for

which participants in the programs shall be eligible.

(c) (Blank).

(Source: P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/5)

(from Ch. 23, par. 6801‑5)

Sec. 5.

The Legislature finds that chronic long‑term care illnesses threaten the health and welfare of millions of families. Furthermore, most families have no private or public insurance to help pay the catastrophic expenses of an extended chronic episode requiring home, community, or institutional long‑term care. The costs of care during an extended chronic illness are high and force tens of thousands of Illinoisans annually to spend‑down their income and savings of a lifetime and become dependent upon public assistance programs.

The State cannot continue as the insurer of last resort for increasing numbers of middle‑income Illinoisans while at the same time meeting its obligations to the poor who have no other means of caring for themselves.

The Legislature declares it is in the interest of the people of Illinois that individuals be encouraged to anticipate their potential long‑term care needs by purchasing quality private long‑term care insurance policies.

It is the intent of the Legislature that the State establish a private‑public long‑term care insurance partnership program in which individuals who purchase private long‑term care insurance that meets State standards and who sustain extended episodes of chronic illnesses that exhaust all the benefits of their private insurance be eligible for continued care by in‑home supportive services and by the Medicaid program on the basis of specific resource eligibility requirements.

(Source: P.A. 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/50)

(from Ch. 23, par. 6801‑50)

Sec. 50.

Task force.

(a) An executive and legislative advisory task force shall be created to provide advice and assistance in designing and implementing the Partnership for Long‑term Care Program. The task force shall be composed of representatives, designated by the director of each of the following agencies or departments:

(1) The Department on Aging.

(2) The Department of Public Aid.

(3) (Blank).

(4) The Department of Insurance.

(5) The Department of Commerce and Community Affairs.

(6) The Legislative Research Unit.

(b) The task force shall consult with persons knowledgeable of and concerned with long‑term care, including, but not limited to the following:

(1) Consumers.

(2) Health care providers.

(3) Representatives of long‑term care insurance

companies and administrators of health care service plans that cover long‑term care services.

(4) Providers of long‑term care.

(5) Private employers.

(6) Academic specialists in long‑term care and aging.

(7) Representatives of the public employees' and

teachers' retirement systems.

(c) The task force shall be established, and its members designated, not later than March 1, 1993. The task force shall make recommendations to the Department on Aging concerning the policy components of the program on or before September 1, 1993.

(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff. 7‑1‑97.)

(320 ILCS 35/55)

(from Ch. 23, par. 6801‑55)

Sec. 55.

The Director of Aging shall annually report to the General Assembly regarding the progress of the pilot program established under Public Act 87‑163 and the permanent program established under this amendatory Act of 1996. The report regarding the pilot program shall be provided by January 1 of each year, commencing with 1993 and ending with 1996. The report regarding the permanent program shall be provided by January 1 of each year, commencing with 1997. The report shall include the following:

(a) The success in implementing the public and

private partnership.

(b) The number and type of insurers and health care

service plans with policies or contracts certified by the Departments.

(c) The number, age, and financial circumstances of

participants in the pilot or permanent program who have purchased certified long‑term care insurance policies which cover long‑term care services.

(d) The number of individuals seeking consumer

information services and advice from the Department on Aging under subsection (b) of Section 40 of this Act.

(e) The number of participants actually receiving

long‑term care services, Medicaid benefits, and in‑home supportive services provided by the program, and the type of benefits paid under certified policies which cover long‑term care that could count toward Medicaid resource protection.

(f) Estimates of the impact on present and future

Medicaid expenditures.

(g) The cost effectiveness of the program.

(h) A recommendation regarding the continuation of

the program.

The Director of Aging shall report the following information to the General Assembly on or before March 31, 1998:

(1) For each department or agency set forth in

subsection (a) of Section 50, the costs of implementing the program and the savings generated by the program.

(2) The details of the program proposed by the

Department on Aging and Department of Insurance.

(3) The nature of any federal waivers or approvals

sought by the Department on Aging, including any changes in the Medicaid State Plan proposed to the federal Health Care Finance Administration.

(Source: P.A. 88‑328; 89‑525, eff. 7‑19‑96.)

(320 ILCS 35/60)

(from Ch. 23, par. 6801‑60)

Sec. 60.

Administrative costs.

(a) The Department on Aging, in conjunction with the Department of Public Aid, the Department of Insurance, and the Department of Commerce and Community Affairs, shall submit applications for State or federal grants or federal waivers, or funding from nationally distributed private foundation grants, or insurance reimbursements to be used to pay the administrative expenses of implementation of the program. The Department on Aging, in conjunction with those other departments, also shall seek moneys from these same sources for the purpose of implementing the program, including moneys appropriated for that purpose.

(b) In implementing this Act, the Department on Aging may negotiate contracts, on a nonbid basis, with long‑term care insurers, health care insurers, health care service plans, or both, for the provision of coverage for long‑term care services that will meet the certification requirements set forth in Section 30 and the other requirements of this Act.

(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff. 7‑1‑97.)