Rep. Patricia R. Bellock

Filed: 4/7/2014

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5488

2    AMENDMENT NO. ______. Amend House Bill 5488 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1identical to the most current version required by the federal
2Centers for Medicare and Medicaid Services.
3    (b) "Department" means the Illinois Department of
4Healthcare and Family Services.
5    (c) "Discharge" means the release of a patient from
6hospital care for any discharge disposition other than a leave
7of absence, even if for Medicare payment purposes the discharge
8fits the definition of an interrupted stay.
9    (d) "FTE" means "full-time equivalent" or a person or
10persons employed in one full-time position.
11    (e) "Hospital" means an institution, place, building, or
12agency located in this State that is licensed as a general
13acute hospital by the Illinois Department of Public Health
14under the Hospital Licensing Act, whether public or private and
15whether organized for profit or not-for-profit.
16    (f) "ICU" means intensive care unit.
17    (g) "LTAC hospital" means an Illinois hospital that is
18designated by Medicare as a long term acute care hospital as
19described in Section 1886(d)(1)(B)(iv)(I) of the Social
20Security Act and has an average length of Medicaid inpatient
21stay greater than 25 days as reported on the hospital's 2008
22Medicaid cost report on file as of February 15, 2010, or a
23hospital that begins operations after January 1, 2009 and is
24designated by Medicare as a long term acute care hospital.
25    (h) "LTAC hospital criteria" means nationally recognized
26evidence-based evaluation criteria that have been publicly

 

 

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1tested and includes criteria specific to an LTAC hospital for
2admission, continuing stay, and discharge. The criteria cannot
3include criteria derived or developed by or for a specific
4hospital or group of hospitals. Criteria and tools developed by
5hospitals or hospital associations or hospital-owned
6organizations are not acceptable and do not meet the
7requirements of this subsection.
8    (i) "Patient" means an individual who is admitted to a
9hospital for an inpatient stay.
10    (j) "Program" means the Long Term Acute Care Hospital
11Quality Improvement Transfer Program established by this Act.
12    (k) "STAC hospital" means a hospital that is not an LTAC
13hospital as defined in this Act or a psychiatric hospital or a
14rehabilitation hospital.
15(Source: P.A. 96-1130, eff. 7-20-10; 97-662, eff. 1-13-12;
1697-667, eff. 1-13-12.)
 
17    (210 ILCS 155/15)
18    Sec. 15. Qualifying Hospitals.
19    (a) Beginning October 1, 2010, the Department shall
20establish the Long Term Acute Care Hospital Quality Improvement
21Transfer Program. Any hospital may participate in the program
22if it meets the requirements of this Section as determined by
23the Department.
24    (b) To participate in the program a hospital must do the
25following:

 

 

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1        (1) Operate as an LTAC hospital.
2        (2) Employ one-half of an FTE (designated for case
3    management) for every 15 patients admitted to the hospital.
4        (3) Maintain on-site physician coverage 24 hours a day,
5    7 days a week.
6        (4) Maintain on-site respiratory therapy coverage 24
7    hours a day, 7 days a week.
8    (c) A hospital must also execute a program participation
9agreement with the Department. The agreement must include:
10        (1) An attestation that the hospital complies with the
11    criteria in subsection (b) of this Section.
12        (2) A process for the hospital to report its continuing
13    compliance with subsection (b) of this Section. The
14    hospital must submit a compliance report at least annually.
15        (3) A requirement that the hospital complete and
16    electronically submit to the Department the CARE tool (the
17    most currently available version or an equivalent tool
18    designated and approved for use by the Department) for each
19    patient no later than 13 7 calendar days after discharge: .
20            (A) the CARE tool in the format required by the
21        federal Centers for Medicare and Medicaid Services;
22        and
23            (B) in an electronic format developed by the
24        Department, (i) whether the patient was successfully
25        weaned off invasive mechanical ventilation, (ii)
26        whether the patient, if the patient was a ventilator

 

 

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1        patient, acquired pneumonia, and (iii) whether the
2        patient fell and required an ancillary or surgical
3        procedure (e.g., x-ray, MRI, sutures, or surgery).
4        (4) A requirement that the hospital use a patient
5    satisfaction survey specifically designed for LTAC
6    hospital settings. The hospital must submit survey results
7    data to the Department at least annually.
8        (5) A requirement that the hospital accept all
9    clinically approved patients for admission or transfer
10    from a STAC hospital with the exception of STAC hospitals
11    identified in paragraphs (1) and (2) under subsection (a)
12    of Section 25 of this Act. The patient must be evaluated
13    using LTAC hospital criteria approved by the Department for
14    use in this program and meet the appropriate criteria.
15        (6) A requirement that the hospital report quality and
16    outcome measurement data, as described in Section 20 of
17    this Act, to the Department at least annually.
18        (7) A requirement that the hospital provide the
19    Department full access to patient data and other data
20    maintained by the hospital. Access must be in compliance
21    with State and federal law.
22        (8) A requirement that the hospital use LTAC hospital
23    criteria to evaluate patients that are admitted to the
24    hospital to determine that the patient is in the most
25    appropriate setting.
26(Source: P.A. 96-1130, eff. 7-20-10.)
 

 

 

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1    (210 ILCS 155/20)
2    Sec. 20. Quality and outcome measurement data.
3    (a) For proper evaluation and monitoring of the program,
4each LTAC hospital must provide quality and outcome measurement
5data ("measures") identical to Medicare as specified in
6Medicare's LTCH Quality Reporting Program Manual (version 2.0)
7and any subsequent revisions subsections (c) through (h) of
8this Section to the Department for patients treated under this
9program. The Department may develop measures in addition to the
10minimum measures required under this Section.
11    (b) Two sets of measures must be calculated. The first set
12should only use data for medical assistance patients, and the
13second set should include all patients of the LTAC hospital
14regardless of payer.
15    (c) (Blank). Average LTAC hospital length of stay for
16patients discharged during the reporting period.
17    (d) (Blank). Adverse outcomes rates: Percent of patients
18who expired or whose condition worsens and requires treatment
19in a STAC hospital.
20    (e) (Blank). Ventilator weaning rate: Percent of patients
21discharged during the reporting period who have been
22successfully weaned off invasive mechanical ventilation.
23    (f) (Blank). Central Line Infection Rate per 1000 central
24line days: Number of patients discharged from an LTAC hospital
25during the reporting period that had a central line in place

 

 

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1and developed a bloodstream infection 48 hours or more after
2admission to the LTAC hospital.
3    (g) (Blank). Acquired pressure ulcers per 1000 patient
4days.
5    (h) (Blank). Falls with injury per 1000 patient days:
6Number of falls among discharged LTAC hospital patients
7discharged during the reporting period, who fell during the
8LTAC hospital stay, regardless of distance fallen, that
9required an ancillary or surgical procedure (i.e. x-ray, MRI,
10sutures, surgery, etc.)
11(Source: P.A. 96-1130, eff. 7-20-10.)
 
12    (210 ILCS 155/50)
13    Sec. 50. Duties of the Department.
14    (a) The Department is responsible for implementing,
15monitoring, and evaluating the program. This includes but is
16not limited to:
17        (1) Collecting data required under Section 15 and data
18    necessary to calculate the measures under Section 20 of
19    this Act. The Department must make every effort to collect
20    this data with the minimal amount of administrative burden
21    to participating LTAC hospitals.
22        (2) Setting annual benchmarks or targets for the
23    measures in Section 20 of this Act or other measures beyond
24    the minimum required under Section 20. The Department must
25    consult participating LTAC hospitals when setting these

 

 

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1    benchmarks and targets.
2        (3) Monitoring compliance with all requirements of
3    this Act.
4    (b) The Department shall include specific information on
5the Program in its annual medical programs report.
6    (c) The Department must establish monitoring procedures
7that ensure the LTAC supplemental payment is only paid for
8patients who upon admission meet the LTAC hospital criteria.
9The Department must notify qualified LTAC hospitals of the
10procedures and establish an appeals process as part of those
11procedures. The Department must recoup any LTAC supplemental
12payments that are identified as being paid for patients who do
13not meet the LTAC hospital criteria.
14    (d) The Department must implement the program by October 1,
152010.
16    (e) The Department must create and distribute to LTAC
17hospitals the agreement required under subsection (c) of
18Section 15 no later than September 1, 2010.
19    (f) The Department must notify Illinois hospitals which
20LTAC hospital criteria are approved for use under the program.
21The Department may limit LTAC hospital criteria to the most
22strict criteria that meet the definitions of this Act.
23    (g) (Blank). The Department must identify discharge tools
24that are considered equivalent to the CARE tool and approved
25for use under the program. The Department must notify LTAC
26hospitals which tools are approved for use under the program.

 

 

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1    (h) The Department must notify Illinois LTAC hospitals of
2the program and inform them how to apply for qualification and
3what the qualification requirements are as described under
4Section 15 of this Act.
5    (i) The Department must notify Illinois STAC hospitals
6about the operation and implementation of the program
7established by this Act. The Department must also notify LTAC
8hospitals that accepting transfers from the STAC hospitals
9identified in paragraphs (1) and (2) under subsection (a) of
10Section 25 of this Act are not required under paragraph (5) of
11subsection (c) of Section 15 of this Act. The Department must
12notify LTAC hospitals that accepting transfers from the STAC
13hospitals identified in paragraphs (1) and (2) under subsection
14(a) of Section 25 of this Act shall negatively impact the
15savings calculations under the Program evaluation required by
16Section 40 of this Act and shall in turn require the Department
17to initiate the penalty described in subsection (d) of Section
1840 of this Act.
19    (j) The Department shall deem LTAC hospitals qualified
20under Section 15 of this Act as qualifying for expedited
21payments.
22    (k) The Department may use up to $500,000 of funds
23contained in the Public Aid Recoveries Trust Fund per State
24fiscal year to operate the program under this Act. The
25Department may expand existing contracts, issue new contracts,
26issue personal service contracts, or purchase other services,

 

 

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1supplies, or equipment.
2    (l) The Department may promulgate rules as allowed by the
3Illinois Administrative Procedure Act to implement this Act;
4however, the requirements under this Act shall be implemented
5by the Department even if the Department's proposed rules are
6not yet adopted by the implementation date of October 1, 2010.
7(Source: P.A. 96-1130, eff. 7-20-10.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.".