HB5488 EngrossedLRB098 19022 RPS 55261 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Long Term Acute Care Hospital Quality
5Improvement Transfer Program Act is amended by changing
6Sections 10, 15, 20, and 50 as follows:
 
7    (210 ILCS 155/10)
8    Sec. 10. Definitions. As used in this Act:
9    (a) "CARE tool" means the Continuity and Record Evaluation
10(CARE) tool. It is a patient assessment instrument that has
11been developed to document the medical, cognitive, functional,
12and discharge status of persons receiving health care services
13in acute and post-acute care settings. The data collected is
14able to document provider-level quality of care (patient
15outcomes) and characterize the clinical complexity of
16patients. For the purposes of this Act, the CARE tool must be
17identical to the most current version required by the federal
18Centers for Medicare and Medicaid Services.
19    (b) "Department" means the Illinois Department of
20Healthcare and Family Services.
21    (c) "Discharge" means the release of a patient from
22hospital care for any discharge disposition other than a leave
23of absence, even if for Medicare payment purposes the discharge

 

 

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1fits the definition of an interrupted stay.
2    (d) "FTE" means "full-time equivalent" or a person or
3persons employed in one full-time position.
4    (e) "Hospital" means an institution, place, building, or
5agency located in this State that is licensed as a general
6acute hospital by the Illinois Department of Public Health
7under the Hospital Licensing Act, whether public or private and
8whether organized for profit or not-for-profit.
9    (f) "ICU" means intensive care unit.
10    (g) "LTAC hospital" means an Illinois hospital that is
11designated by Medicare as a long term acute care hospital as
12described in Section 1886(d)(1)(B)(iv)(I) of the Social
13Security Act and has an average length of Medicaid inpatient
14stay greater than 25 days as reported on the hospital's 2008
15Medicaid cost report on file as of February 15, 2010, or a
16hospital that begins operations after January 1, 2009 and is
17designated by Medicare as a long term acute care hospital.
18    (h) "LTAC hospital criteria" means nationally recognized
19evidence-based evaluation criteria that have been publicly
20tested and includes criteria specific to an LTAC hospital for
21admission, continuing stay, and discharge. The criteria cannot
22include criteria derived or developed by or for a specific
23hospital or group of hospitals. Criteria and tools developed by
24hospitals or hospital associations or hospital-owned
25organizations are not acceptable and do not meet the
26requirements of this subsection.

 

 

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1    (i) "Patient" means an individual who is admitted to a
2hospital for an inpatient stay.
3    (j) "Program" means the Long Term Acute Care Hospital
4Quality Improvement Transfer Program established by this Act.
5    (k) "STAC hospital" means a hospital that is not an LTAC
6hospital as defined in this Act or a psychiatric hospital or a
7rehabilitation hospital.
8(Source: P.A. 96-1130, eff. 7-20-10; 97-662, eff. 1-13-12;
997-667, eff. 1-13-12.)
 
10    (210 ILCS 155/15)
11    Sec. 15. Qualifying Hospitals.
12    (a) Beginning October 1, 2010, the Department shall
13establish the Long Term Acute Care Hospital Quality Improvement
14Transfer Program. Any hospital may participate in the program
15if it meets the requirements of this Section as determined by
16the Department.
17    (b) To participate in the program a hospital must do the
18following:
19        (1) Operate as an LTAC hospital.
20        (2) Employ one-half of an FTE (designated for case
21    management) for every 15 patients admitted to the hospital.
22        (3) Maintain on-site physician coverage 24 hours a day,
23    7 days a week.
24        (4) Maintain on-site respiratory therapy coverage 24
25    hours a day, 7 days a week.

 

 

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1    (c) A hospital must also execute a program participation
2agreement with the Department. The agreement must include:
3        (1) An attestation that the hospital complies with the
4    criteria in subsection (b) of this Section.
5        (2) A process for the hospital to report its continuing
6    compliance with subsection (b) of this Section. The
7    hospital must submit a compliance report at least annually.
8        (3) A requirement that the hospital complete and
9    electronically submit to the Department the CARE tool (the
10    most currently available version or an equivalent tool
11    designated and approved for use by the Department) for each
12    patient no later than 13 7 calendar days after discharge: .
13            (A) the CARE tool in the format required by the
14        federal Centers for Medicare and Medicaid Services;
15        and
16            (B) in an electronic format developed by the
17        Department, (i) whether the patient was successfully
18        weaned off invasive mechanical ventilation, (ii)
19        whether the patient, if the patient was a ventilator
20        patient, acquired pneumonia, and (iii) whether the
21        patient fell and required an ancillary or surgical
22        procedure (e.g., x-ray, MRI, sutures, or surgery).
23        (4) A requirement that the hospital use a patient
24    satisfaction survey specifically designed for LTAC
25    hospital settings. The hospital must submit survey results
26    data to the Department at least annually.

 

 

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1        (5) A requirement that the hospital accept all
2    clinically approved patients for admission or transfer
3    from a STAC hospital with the exception of STAC hospitals
4    identified in paragraphs (1) and (2) under subsection (a)
5    of Section 25 of this Act. The patient must be evaluated
6    using LTAC hospital criteria approved by the Department for
7    use in this program and meet the appropriate criteria.
8        (6) A requirement that the hospital report quality and
9    outcome measurement data, as described in Section 20 of
10    this Act, to the Department at least annually.
11        (7) A requirement that the hospital provide the
12    Department full access to patient data and other data
13    maintained by the hospital. Access must be in compliance
14    with State and federal law.
15        (8) A requirement that the hospital use LTAC hospital
16    criteria to evaluate patients that are admitted to the
17    hospital to determine that the patient is in the most
18    appropriate setting.
19(Source: P.A. 96-1130, eff. 7-20-10.)
 
20    (210 ILCS 155/20)
21    Sec. 20. Quality and outcome measurement data.
22    (a) For proper evaluation and monitoring of the program,
23each LTAC hospital must provide quality and outcome measurement
24data ("measures") identical to Medicare as specified in
25Medicare's LTCH Quality Reporting Program Manual (version 2.0)

 

 

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1and any subsequent revisions subsections (c) through (h) of
2this Section to the Department for patients treated under this
3program. The Department may develop measures in addition to the
4minimum measures required under this Section.
5    (b) Two sets of measures must be calculated. The first set
6should only use data for medical assistance patients, and the
7second set should include all patients of the LTAC hospital
8regardless of payer.
9    (c) (Blank). Average LTAC hospital length of stay for
10patients discharged during the reporting period.
11    (d) (Blank). Adverse outcomes rates: Percent of patients
12who expired or whose condition worsens and requires treatment
13in a STAC hospital.
14    (e) (Blank). Ventilator weaning rate: Percent of patients
15discharged during the reporting period who have been
16successfully weaned off invasive mechanical ventilation.
17    (f) (Blank). Central Line Infection Rate per 1000 central
18line days: Number of patients discharged from an LTAC hospital
19during the reporting period that had a central line in place
20and developed a bloodstream infection 48 hours or more after
21admission to the LTAC hospital.
22    (g) (Blank). Acquired pressure ulcers per 1000 patient
23days.
24    (h) (Blank). Falls with injury per 1000 patient days:
25Number of falls among discharged LTAC hospital patients
26discharged during the reporting period, who fell during the

 

 

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1LTAC hospital stay, regardless of distance fallen, that
2required an ancillary or surgical procedure (i.e. x-ray, MRI,
3sutures, surgery, etc.)
4(Source: P.A. 96-1130, eff. 7-20-10.)
 
5    (210 ILCS 155/50)
6    Sec. 50. Duties of the Department.
7    (a) The Department is responsible for implementing,
8monitoring, and evaluating the program. This includes but is
9not limited to:
10        (1) Collecting data required under Section 15 and data
11    necessary to calculate the measures under Section 20 of
12    this Act. The Department must make every effort to collect
13    this data with the minimal amount of administrative burden
14    to participating LTAC hospitals.
15        (2) Setting annual benchmarks or targets for the
16    measures in Section 20 of this Act or other measures beyond
17    the minimum required under Section 20. The Department must
18    consult participating LTAC hospitals when setting these
19    benchmarks and targets.
20        (3) Monitoring compliance with all requirements of
21    this Act.
22    (b) The Department shall include specific information on
23the Program in its annual medical programs report.
24    (c) The Department must establish monitoring procedures
25that ensure the LTAC supplemental payment is only paid for

 

 

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1patients who upon admission meet the LTAC hospital criteria.
2The Department must notify qualified LTAC hospitals of the
3procedures and establish an appeals process as part of those
4procedures. The Department must recoup any LTAC supplemental
5payments that are identified as being paid for patients who do
6not meet the LTAC hospital criteria.
7    (d) The Department must implement the program by October 1,
82010.
9    (e) The Department must create and distribute to LTAC
10hospitals the agreement required under subsection (c) of
11Section 15 no later than September 1, 2010.
12    (f) The Department must notify Illinois hospitals which
13LTAC hospital criteria are approved for use under the program.
14The Department may limit LTAC hospital criteria to the most
15strict criteria that meet the definitions of this Act.
16    (g) (Blank). The Department must identify discharge tools
17that are considered equivalent to the CARE tool and approved
18for use under the program. The Department must notify LTAC
19hospitals which tools are approved for use under the program.
20    (h) The Department must notify Illinois LTAC hospitals of
21the program and inform them how to apply for qualification and
22what the qualification requirements are as described under
23Section 15 of this Act.
24    (i) The Department must notify Illinois STAC hospitals
25about the operation and implementation of the program
26established by this Act. The Department must also notify LTAC

 

 

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1hospitals that accepting transfers from the STAC hospitals
2identified in paragraphs (1) and (2) under subsection (a) of
3Section 25 of this Act are not required under paragraph (5) of
4subsection (c) of Section 15 of this Act. The Department must
5notify LTAC hospitals that accepting transfers from the STAC
6hospitals identified in paragraphs (1) and (2) under subsection
7(a) of Section 25 of this Act shall negatively impact the
8savings calculations under the Program evaluation required by
9Section 40 of this Act and shall in turn require the Department
10to initiate the penalty described in subsection (d) of Section
1140 of this Act.
12    (j) The Department shall deem LTAC hospitals qualified
13under Section 15 of this Act as qualifying for expedited
14payments.
15    (k) The Department may use up to $500,000 of funds
16contained in the Public Aid Recoveries Trust Fund per State
17fiscal year to operate the program under this Act. The
18Department may expand existing contracts, issue new contracts,
19issue personal service contracts, or purchase other services,
20supplies, or equipment.
21    (l) The Department may promulgate rules as allowed by the
22Illinois Administrative Procedure Act to implement this Act;
23however, the requirements under this Act shall be implemented
24by the Department even if the Department's proposed rules are
25not yet adopted by the implementation date of October 1, 2010.
26(Source: P.A. 96-1130, eff. 7-20-10.)
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.