Long-Term Care - Illinois General Assembly

Terrance Sullivan
Illinois Council on Long Term Care
There is a consensus emerging through this Summit on Long-Term Care. Nursing home care
needs to be better-integrated and supportive of the continuum of home and community-based
care; and no one wants to see the quality of care in nursing homes go downhill. That is a good
two-pronged approach.
There is consensus that there should be a single source for case management and central
referral system; a consistent patient assessment system; a universal licensing system; and an
active, acuity-focused, patient-centered reimbursement system across the entire continuum of
care.
Wherever a person is placed, they should have the same accountability, the same funding
based on their needs, and the funding should follow the patient in whatever setting. The right
person should get the right amount of care in the right setting for the right funding.
The council provided a detailed statement at the regional meetings, a summary of which is
attached to this report.
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There's been considerable discussion about a provider assessment and how it's raised. If we
follow the federal limit, we're probably talking about raising 160 million from providers and
160 million federal matching funds, or about 320 million. There's been considerable discussion
on how to structure the tax, so that as few private pay providers as possible would not be
covered. If a facility accepts Medicaid residents, they would probably have to pay the tax, even
if they are 20% Medicaid and 80% private pay. So it's going to hit everybody.
In terms of the distribution of the assessment revenue, the heart of the discussion is about what
gets funded with the $320 million. I don't think anyone has decided that, yet. Nursing homes
would be asking for $320 million as a starting point, but there are different opinions on how that
might get spent.
The council would like to see increases in home care; increases for nursing home care; and
certainly restoration of the 5.9% cut in rates effective in state fiscal year 2003 before anything
else. The remainder could provide more home and community-based services. It could cover
the cost of the “MDS” (Minimum Data Set) reimbursement system. It could provide quality of
care incentive grants. It could be for career ladders. The advantage would be that these
improvements could be implemented without any additional cost to the state General Revenue
Fund. The details would have to be worked out by the legislature, including assurances that
this new money is not reallocated to supplant General Revenue.
In terms of cost shifting, whether it's a provider assessment or a rate cut, costs now get shifted
to private pay residents. When there is a rate cut, when state and federal funding is lost, there
is far more cost shifting to a private pay resident than if we have a provider assessment. A
provider assessment is the best way to bring in federal funding with the least amount of cost
shifting to private pay residents.
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