MEDICAID-SLF-DEMENTIA SETTINGS

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4723

Introduced , by Rep. Dagmara Avelar

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.01a

Amends the Medical Assistance Article of the Illinois Public Aid
Code. In provisions concerning the supportive living facilities program,
prohibits a supportive living dementia care setting from limiting a
resident's access to the sink, microwave, or refrigerator located within
the respective resident's room, provided a comprehensive safety assessment
deems the resident's use of the appliances safe. Requires the
comprehensive safety assessment to be conducted prior to any resident
moving in and at least once per quarter thereafter. Requires social and
recreational programming to be provided no less than 3 times daily,
including at least one time and location separate from a meal service.
Requires newly constructed supportive living dementia care settings to
provide no less than 300 square feet for a single occupancy apartment or no
less than 450 square feet for a double occupancy apartment, which may
include the closets and bathroom. Requires each apartment to include a
sink, microwave, and refrigerator within the unit. Provides that any newly
constructed supportive living dementia care setting shall provide a common
area completely separate from the dining area.
LRB104 17803 KTG 31236 b

A BILL FOR

HB4723
LRB104 17803 KTG 31236 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
changing Section 5-5.01a as follows:

6

(305 ILCS 5/5-5.01a)
7

Sec. 5-5.01a.
Supportive living facilities program.
8

(a) The Department shall establish and provide oversight
9
for a program of supportive living facilities that seek to
10
promote resident independence, dignity, respect, and
11
well-being in the most cost-effective manner.
12

A supportive living facility is (i) a free-standing
13
facility or (ii) a distinct physical and operational entity
14
within a mixed-use building that meets the criteria
15
established in subsection (d). A supportive living facility
16
integrates housing with health, personal care, and supportive
17
services and is a designated setting that offers residents
18
their own separate, private, and distinct living units.
19

Sites for the operation of the program shall be selected
20
by the Department based upon criteria that may include the
21
need for services in a geographic area, the availability of
22
funding, and the site's ability to meet the standards.
23

(b) Beginning July 1, 2014, subject to federal approval,

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LRB104 17803 KTG 31236 b
1
the Medicaid rates for supportive living facilities shall be
2
equal to the supportive living facility Medicaid rate
3
effective on June 30, 2014 increased by 8.85%. Once the
4
assessment imposed at Article V-G of this Code is determined
5
to be a permissible tax under Title XIX of the Social Security
6
Act, the Department shall increase the Medicaid rates for
7
supportive living facilities effective on July 1, 2014 by
8
9.09%. The Department shall apply this increase retroactively
9
to coincide with the imposition of the assessment in Article
10
V-G of this Code in accordance with the approval for federal
11
financial participation by the Centers for Medicare and
12
Medicaid Services.
13

The Medicaid rates for supportive living facilities
14
effective on July 1, 2017 must be equal to the rates in effect
15
for supportive living facilities on June 30, 2017 increased by
16
2.8%.
17

The Medicaid rates for supportive living facilities
18
effective on July 1, 2018 must be equal to the rates in effect
19
for supportive living facilities on June 30, 2018.
20

Subject to federal approval, the Medicaid rates for
21
supportive living services on and after July 1, 2019 must be at
22
least 54.3% of the average total nursing facility services per
23
diem for the geographic areas defined by the Department while
24
maintaining the rate differential for dementia care and must
25
be updated whenever the total nursing facility service per
26
diems are updated. Beginning July 1, 2022, upon the

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LRB104 17803 KTG 31236 b
1
implementation of the Patient Driven Payment Model, Medicaid
2
rates for supportive living services must be at least 54.3% of
3
the average total nursing services per diem rate for the
4
geographic areas. For purposes of this provision, the average
5
total nursing services per diem rate shall include all add-ons
6
for nursing facilities for the geographic area provided for in
7
Section 5-5.2. The rate differential for dementia care must be
8
maintained in these rates and the rates shall be updated
9
whenever nursing facility per diem rates are updated.
10

Subject to federal approval, beginning January 1, 2024,
11
the dementia care rate for supportive living services must be
12
no less than the non-dementia care supportive living services
13
rate multiplied by 1.5.
14

(b-5) Subject to federal approval, beginning January 1,
15
2025, Medicaid rates for supportive living services must be at
16
least 54.75% of the average total nursing facility per diem
17
rate for the geographic areas defined by the Department and
18
shall include all add-ons for nursing facilities for the
19
geographic area provided for in Section 5-5.2.
20

(c) The Department may adopt rules to implement this
21
Section. Rules that establish or modify the services,
22
standards, and conditions for participation in the program
23
shall be adopted by the Department in consultation with the
24
Department on Aging, the Department of Rehabilitation
25
Services, and the Department of Mental Health and
26
Developmental Disabilities (or their successor agencies).

HB4723
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LRB104 17803 KTG 31236 b
1

(d) Subject to federal approval by the Centers for
2
Medicare and Medicaid Services, the Department shall accept
3
for consideration of certification under the program any
4
application for a site or building where distinct parts of the
5
site or building are designated for purposes other than the
6
provision of supportive living services, but only if:
7

(1) those distinct parts of the site or building are
8

not designated for the purpose of providing assisted
9

living services as required under the Assisted Living and
10

Shared Housing Act;
11

(2) those distinct parts of the site or building are
12

completely separate from the part of the building used for
13

the provision of supportive living program services,
14

including separate entrances;
15

(3) those distinct parts of the site or building do
16

not share any common spaces with the part of the building
17

used for the provision of supportive living program
18

services; and
19

(4) those distinct parts of the site or building do
20

not share staffing with the part of the building used for
21

the provision of supportive living program services.
22

(e) Facilities or distinct parts of facilities which are
23
selected as supportive living facilities and are in good
24
standing with the Department's rules are exempt from the
25
provisions of the Nursing Home Care Act and the Illinois
26
Health Facilities Planning Act.

HB4723
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LRB104 17803 KTG 31236 b
1

(f) Section 9817 of the American Rescue Plan Act of 2021
2
(Public Law 117-2) authorizes a 10% enhanced federal medical
3
assistance percentage for supportive living services for a
4
12-month period from April 1, 2021 through March 31, 2022.
5
Subject to federal approval, including the approval of any
6
necessary waiver amendments or other federally required
7
documents or assurances, for a 12-month period the Department
8
must pay a supplemental $26 per diem rate to all supportive
9
living facilities with the additional federal financial
10
participation funds that result from the enhanced federal
11
medical assistance percentage from April 1, 2021 through March
12
31, 2022. The Department may issue parameters around how the
13
supplemental payment should be spent, including quality
14
improvement activities. The Department may alter the form,
15
methods, or timeframes concerning the supplemental per diem
16
rate to comply with any subsequent changes to federal law,
17
changes made by guidance issued by the federal Centers for
18
Medicare and Medicaid Services, or other changes necessary to
19
receive the enhanced federal medical assistance percentage.
20

(g) All applications for the expansion of supportive
21
living dementia care settings involving sites not approved by
22
the Department by January 1, 2024 may allow new elderly
23
non-dementia units in addition to new dementia care units. The
24
Department may approve such applications only if the
25
application has: (1) no more than one non-dementia care unit
26
for each dementia care unit and (2) the site is not located

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LRB104 17803 KTG 31236 b
1
within 4 miles of an existing supportive living program site
2
in Cook County (including the City of Chicago), not located
3
within 12 miles of an existing supportive living program site
4
in Alexander, Bond, Boone, Calhoun, Champaign, Clinton,
5
DeKalb, DuPage, Fulton, Grundy, Henry, Jackson, Jersey,
6
Johnson, Kane, Kankakee, Kendall, Lake, Macon, Macoupin,
7
Madison, Marshall, McHenry, McLean, Menard, Mercer, Monroe,
8
Peoria, Piatt, Rock Island, Sangamon, Stark, St. Clair,
9
Tazewell, Vermilion, Will, Williamson, Winnebago, or Woodford
10
counties, or not located within 25 miles of an existing
11
supportive living program site in any other county.
12

(h) Beginning January 1, 2025, subject to federal
13
approval, for a person who is a resident of a supportive living
14
facility under this Section, the monthly personal needs
15
allowance shall be $120 per month.
16

(i) As stated in the supportive living program home and
17
community-based service waiver approved by the federal Centers
18
for Medicare and Medicaid Services, and beginning July 1,
19
2025, the Department must maintain the rate add-on implemented
20
on January 1, 2023 for the provision of 2 meals per day at no
21
less than $6.15 per day.
22

(j) Subject to federal approval, the Department shall
23
allow a certified medication aide to administer medication in
24
a supportive living facility. For purposes of this subsection,
25
"certified medication aide" means a person who has met the
26
qualifications for certification under Section 79 of the

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LRB104 17803 KTG 31236 b
1
Assisted Living and Shared Housing Act and assists with
2
medication administration while under the supervision of a
3
registered professional nurse as authorized by Section 50-75
4
of the Nurse Practice Act. The Department may adopt rules to
5
implement this subsection.
6

(k) A supportive living dementia care setting shall not
7
limit resident access to the sink, microwave, or refrigerator
8
located within the respective resident's room, provided a
9
comprehensive safety assessment deems the resident's use of
10
the appliances safe. This assessment shall be conducted prior
11
to any resident moving in and at least once per quarter
12
thereafter. Social and recreational programming shall be
13
provided no less than 3 times daily, including at least one
14
time and location separate from a meal service.
15

Any newly constructed supportive living dementia care
16
setting shall provide no less than 300 square feet for a single
17
occupancy apartment or no less than 450 square feet for a
18
double occupancy apartment. This requirement may include the
19
closets and bathroom. Each apartment shall include a sink,
20
microwave, and refrigerator within the unit.
21

Any newly constructed supportive living dementia care
22
setting shall provide a common area completely separate from
23
the dining area.

24
(Source: P.A. 103-102, Article 20, Section 20-5, eff. 1-1-24;
25
103-102, Article 100, Section 100-5, eff. 1-1-24; 103-593,
26
Article 15, Section 15-5, eff. 6-7-24; 103-593, Article 100,

HB4723
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LRB104 17803 KTG 31236 b
1
Section 100-5, eff. 6-7-24; 103-593, Article 165, Section
2
165-5, eff. 6-7-24; 103-605, eff. 7-1-24; 103-886, eff.
3
8-9-24; 104-9, eff. 6-16-25; 104-417, eff. 8-15-25; revised
4
9-12-25.)

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