093_SB1332sam001











                                     LRB093 09788 LRD 14059 a

 1                    AMENDMENT TO SENATE BILL 1332

 2        AMENDMENT NO.     .  Amend Senate Bill 1332 by  replacing
 3    everything after the enacting clause with the following:

 4        "Section  5.   The  Hospital  Licensing Act is amended by
 5    changing Sections 8, 8.5, 9, 9.2, and 9.3 and adding Sections
 6    9.4, 9.5, and 9.6 as follows:

 7        (210 ILCS 85/8) (from Ch. 111 1/2, par. 149)
 8        Sec. 8. Facility plan review; fees.
 9        (a)  Before commencing construction of new facilities  or
10    specified  types  of  alteration  or additions to an existing
11    hospital involving major construction, as defined by rule  by
12    the Department, with an estimated cost greater than $100,000,
13    architectural  plans  and  specifications  therefor  shall be
14    submitted by the licensee to the Department  for  review  and
15    approval.  A  hospital  may submit architectural drawings and
16    specifications for other construction projects for Department
17    review according to subsection (b) that shall not be  subject
18    to  fees  under  subsection  (d).  The Department must give a
19    hospital that is planning to submit  a  construction  project
20    for   review   the  opportunity  to  discuss  its  plans  and
21    specifications  with  the  Department  before  the   hospital
22    formally  submits the plans and specifications for Department
 
                            -2-      LRB093 09788 LRD 14059 a
 1    review.  Review  of  drawings  and  specifications  shall  be
 2    conducted by  an  employee  of  the  Department  meeting  the
 3    qualifications  established  by  the  Department  of  Central
 4    Management   Services   class   specifications  for  such  an
 5    individual's position or by a  person  contracting  with  the
 6    Department   who  meets  those  class  specifications.  Final
 7    approval of the plans and specifications for compliance  with
 8    design  and construction standards shall be obtained from the
 9    Department  before   the   alteration,   addition,   or   new
10    construction is begun.
11        (b)  The  Department shall inform an applicant in writing
12    within  10  working  days  after   receiving   drawings   and
13    specifications  and  the  required  fee,  if  any,  from  the
14    applicant  whether  the applicant's submission is complete or
15    incomplete.  Failure  to  provide  the  applicant  with  this
16    notice  within 10 working days shall result in the submission
17    being deemed complete for purposes of initiating  the  60-day
18    review  period  under  this  Section.   If  the submission is
19    incomplete, the Department shall inform the applicant of  the
20    deficiencies   with   the  submission  in  writing.   If  the
21    submission is complete and the required fee, if any, has been
22    paid, the Department shall approve or disapprove drawings and
23    specifications submitted to the Department no later  than  60
24    days  following  receipt by the Department.  The drawings and
25    specifications shall be of sufficient detail, as provided  by
26    Department  rule,  to  enable  the  Department  to  render  a
27    determination  of  compliance  with  design  and construction
28    standards under this Act.  If the Department finds  that  the
29    drawings  are  not  of  sufficient  detail for it to render a
30    determination of compliance, the plans shall be determined to
31    be incomplete and shall not be  considered  for  purposes  of
32    initiating  the  60  day  review  period.  If a submission of
33    drawings and specifications is incomplete, the applicant  may
34    submit  additional  information.   The  60-day  review period
 
                            -3-      LRB093 09788 LRD 14059 a
 1    shall not commence until the  Department  determines  that  a
 2    submission  of drawings and specifications is complete or the
 3    submission is deemed complete.  If  the  Department  has  not
 4    approved  or  disapproved  the  drawings  and  specifications
 5    within  60  days,  the  construction,  major  alteration,  or
 6    addition  shall  be  deemed  approved.   If  the drawings and
 7    specifications are disapproved, the Department shall state in
 8    writing, with specificity, the reasons for  the  disapproval.
 9    The  entity  submitting  the  drawings and specifications may
10    submit additional information  in  response  to  the  written
11    comments  from the Department or request a reconsideration of
12    the disapproval.  A final decision of approval or disapproval
13    shall be made within 45 days of the receipt of the additional
14    information  or  reconsideration  request.   If  denied,  the
15    Department shall state the specific reasons  for  the  denial
16    and  the  applicant  may  elect  to  seek  dispute resolution
17    pursuant to Section 25 of the  Illinois  Building  Commission
18    Act, which the Department must participate in.
19        (c)  The  Department  shall  provide written approval for
20    occupancy pursuant to subsection (g) and shall  not  issue  a
21    violation  to  a  facility  as  a  result  of  a licensure or
22    complaint survey based upon the facility's physical structure
23    if:
24             (1)  the Department reviewed and approved or  deemed
25        approved  the  drawing  and specifications for compliance
26        with design and construction standards;
27             (2)  the construction, major alteration, or addition
28        was built as submitted;
29             (3)  the law or rules have not  been  amended  since
30        the original approval; and
31             (4)  the  conditions  at  the facility indicate that
32        there is a reasonable degree of safety provided  for  the
33        patients; and
34             (5)  the  inspected  aspects  of  the  facility were
 
                            -4-      LRB093 09788 LRD 14059 a
 1        found to be in compliance with applicable standards,  the
 2        relevant  law  or  rules  have not been amended since the
 3        facility was found to be in compliance, conditions at the
 4        facility reasonably protect the safety of  its  patients,
 5        and new hazards have not been identified.
 6        (d)  The  Department  shall  charge the following fees in
 7    connection with its reviews conducted before  June  30,  2004
 8    under this Section:
 9             (1)  (Blank).
10             (2)  (Blank).
11             (3)  If  the  estimated  dollar  value  of the major
12        construction is greater than $500,000, the fee  shall  be
13        established  by  the  Department  pursuant  to rules that
14        reflect the reasonable and direct cost of the  Department
15        in  conducting  the  architectural reviews required under
16        this Section. The estimated dollar  value  of  the  major
17        construction  subject  to review under this Section shall
18        be  annually  readjusted  to  reflect  the  increase   in
19        construction costs due to inflation.
20        The  fees provided in this subsection (d) shall not apply
21    to major construction  projects  involving  facility  changes
22    that  are  required  by  Department  rule  amendments  or  to
23    projects related to homeland security.
24        The  fees  provided in this subsection (d) shall also not
25    apply to major construction projects if 51% or  more  of  the
26    estimated  cost  of  the  project  is  attributed  to capital
27    equipment.  For major construction projects where 51% or more
28    of the estimated cost of the project is attributed to capital
29    equipment, the Department shall by rule establish a fee  that
30    is reasonably related to the cost of reviewing the project.
31        Disproportionate  share  hospitals  and  rural  hospitals
32    shall  only  pay  one-half  of  the  fees  required  in  this
33    subsection  (d). For the purposes of this subsection (d), (i)
34    "disproportionate share hospital" means a hospital  described
 
                            -5-      LRB093 09788 LRD 14059 a
 1    in  items (1) through (5) of subsection (b) of Section 5-5.02
 2    of the Illinois Public Aid Code  and  (ii)  "rural  hospital"
 3    means  a  hospital that is (A) located outside a metropolitan
 4    statistical area or (B) located  15  miles  or  less  from  a
 5    county that is outside a metropolitan statistical area and is
 6    licensed  to perform medical/surgical or obstetrical services
 7    and has a combined total bed capacity of 75 or fewer beds  in
 8    these 2 service categories as of July 14, 1993, as determined
 9    by the Department.
10        The  Department  shall  not  commence  the  facility plan
11    review process under this Section until  the  applicable  fee
12    has been paid.
13        (e)  All  fees  received  by  the  Department  under this
14    Section shall be deposited  into  the  Health  Facility  Plan
15    Review  Fund,  a  special fund created in the State treasury.
16    All fees paid by hospitals under subsection (d) shall be used
17    only to cover the direct and reasonable costs relating to the
18    Department's review of hospital projects under this  Section.
19    Moneys shall be appropriated from that Fund to the Department
20    only  to  pay  the  costs  of  conducting  reviews under this
21    Section. None of the  moneys  in  the  Health  Facility  Plan
22    Review  Fund  shall  be  used to reduce the amount of General
23    Revenue  Fund  moneys  appropriated  to  the  Department  for
24    facility plan reviews conducted pursuant to this Section.
25        (f) (Blank).
26        (g)  The Department shall conduct an  on-site  inspection
27    of  the  completed  project no later than 10 business 30 days
28    after notification from the applicant that  the  project  has
29    been   completed  and  all  certifications  required  by  the
30    Department have been received and accepted by the Department.
31    The Department shall provide written approval  for  occupancy
32    to  the  applicant  within 5 working days of the Department's
33    final inspection, provided  the  applicant  has  demonstrated
34    substantial   compliance   as  defined  by  Department  rule.
 
                            -6-      LRB093 09788 LRD 14059 a
 1    Occupancy of  new  major  construction  is  prohibited  until
 2    Department  approval  is  received, unless the Department has
 3    not acted within the time frames provided in this  subsection
 4    (g), in which case the construction shall be deemed approved.
 5    Occupancy  shall  be  authorized  after  any  required health
 6    inspection by the Department has been conducted.
 7        (h)  The Department shall establish, by rule, a procedure
 8    to  conduct  interim  on-site  review  of  large  or  complex
 9    construction projects.
10        (i)  The  Department  shall  establish,   by   rule,   an
11    expedited  process  for  emergency  repairs or replacement of
12    like equipment.
13        (j)  Nothing in this Section shall be construed to  apply
14    to  maintenance,  upkeep,  or renovation that does not affect
15    the structural integrity of the building, does not  add  beds
16    or  services  over  the  number  for  which  the  facility is
17    licensed, and provides a reasonable degree of safety for  the
18    patients.
19    (Source:  P.A.  91-712,  eff.  7-1-00;  92-563, eff. 6-24-02;
20    92-803, eff. 8-16-02; revised 9-19-02.)

21        (210 ILCS 85/8.5)
22        Sec. 8.5. Waiver of compliance with  rules  or  standards
23    for  construction  or  physical plant.  Upon application by a
24    hospital, the Department may grant or renew the waiver of the
25    hospital's compliance with a construction or  physical  plant
26    rule  or  standard,  including  without  limitation rules and
27    standards for (i) design and construction,  (ii)  engineering
28    and  maintenance  of the physical plant, site, equipment, and
29    systems (heating, cooling, electrical, ventilation, plumbing,
30    water, sewer, and solid waste disposal), and (iii)  fire  and
31    safety,  and (iv) other rules or standards that may present a
32    barrier to the development, adoption, or implementation of an
33    innovation designed to improve patient care, for a period not
 
                            -7-      LRB093 09788 LRD 14059 a
 1    to exceed the duration of the current license or, in the case
 2    of an application for license renewal, the  duration  of  the
 3    renewal  period.  The  waiver  may  be  conditioned  upon the
 4    hospital taking action prescribed  by  the  Department  as  a
 5    measure  equivalent  to compliance. In determining whether to
 6    grant or renew a waiver, the Department  shall  consider  the
 7    duration and basis for any current waiver with respect to the
 8    same  rule  or  standard  and  the  validity  and effect upon
 9    patient health and safety of extending it on the same  basis,
10    the  effect  upon  the  health  and  safety  of patients, the
11    quality of patient care, the hospital's history of compliance
12    with the rules and standards of this Act, and the  hospital's
13    attempts  to  comply  with the particular rule or standard in
14    question. The  Department  may  provide,  by  rule,  for  the
15    automatic  renewal  of  waivers  concerning  construction  or
16    physical  plant  requirements  upon the renewal of a license.
17    The Department shall renew waivers relating  to  construction
18    or  physical  plant standards issued pursuant to this Section
19    at the time of the indicated reviews, unless it can show  why
20    such  waivers  should  not  be  extended  for  the  following
21    reasons:
22             (1)  the   condition   of  the  physical  plant  has
23        deteriorated or its use substantially changed so that the
24        basis upon which the  waiver  was  issued  is  materially
25        different; or
26             (2)  the  hospital  is  renovated  or  substantially
27        remodeled  in such a way as to permit compliance with the
28        applicable  rules  and  standards   without   substantial
29        increase in cost.
30        A copy of each waiver application and each waiver granted
31    or renewed shall be on file with the Department and available
32    for public inspection.
33        The  Department  shall advise hospitals of any applicable
34    federal waivers about which it is aware  and  for  which  the
 
                            -8-      LRB093 09788 LRD 14059 a
 1    hospital may apply.
 2        In  the event that the Department does not grant or renew
 3    a waiver of a rule or standard, the  Department  must  notify
 4    the  hospital  in  writing detailing the specific reasons for
 5    not granting or renewing the waiver and must discuss possible
 6    options, if any, the hospital could take to have  the  waiver
 7    approved.
 8        This  Section  shall  apply  to  both  new  and  existing
 9    construction.
10    (Source: P.A. 92-803, eff. 8-16-02.)

11        (210 ILCS 85/9) (from Ch. 111 1/2, par. 150)
12        Sec.  9.  Inspections  and investigations. The Department
13    shall  make  or  cause  to  be  made  such  inspections   and
14    investigations  as  it  deems  necessary. Upon arrival at the
15    hospital, the Department's  inspector  or  investigator  must
16    inform  the  hospital  of the scope of the investigation with
17    references  to  the  particular   statutory   or   regulatory
18    provisions  triggering  the  inspection or investigation.  If
19    the scope of  an  inspection  is  expanded  beyond  what  was
20    originally  disclosed  to  the  hospital,  the  surveyor must
21    inform  the  hospital's  administrator  or  designee.    This
22    information   must   be  provided  before  the  inspector  or
23    investigator  leaves  the  hospital   premises.   Information
24    received by the Department through filed reports, inspection,
25    or  as  otherwise  authorized  under  this  Act  shall not be
26    disclosed publicly in such manner as to identify  individuals
27    or  hospitals,  except  (i)  in  a  proceeding  involving the
28    denial, suspension, or revocation of a permit to establish  a
29    hospital or a proceeding involving the denial, suspension, or
30    revocation  of  a  license  to  open,  conduct,  operate, and
31    maintain a hospital, (ii) to the Department of  Children  and
32    Family  Services  in  the  course of a child abuse or neglect
33    investigation  conducted  by  that  Department  or   by   the
 
                            -9-      LRB093 09788 LRD 14059 a
 1    Department of Public Health, (iii) in accordance with Section
 2    6.14a  of  this Act, or (iv) in other circumstances as may be
 3    approved by the Hospital Licensing Board.
 4    (Source: P.A. 90-608, eff. 6-30-98; 91-242, eff. 1-1-00.)

 5        (210 ILCS 85/9.2)
 6        Sec. 9.2.  Disclosure. Prior to conducting a survey of  a
 7    hospital  operating under an approved waiver, equivalency, or
 8    other approval, a surveyor must be made aware of the  waiver,
 9    equivalency,   or   other  approval  prior  to  entering  the
10    hospital. Prior to commencing an inspection,  the  Department
11    must  provide the hospital with documentation that the survey
12    is  being  conducted,  with  consideration  of  the  relevant
13    waiver,  equivalency,  or  approval.  After  conducting   the
14    survey,  the  Department  must  conduct  a comprehensive exit
15    interview with designated hospital representatives  at  which
16    the  hospital  may  present  additional information regarding
17    findings.
18    (Source: P.A. 92-803, eff. 8-16-02.)

19        (210 ILCS 85/9.3)
20        Sec. 9.3.  Informal dispute resolution.   The  Department
21    must  offer  an  opportunity  for informal dispute resolution
22    concerning the application of  building  codes  for  new  and
23    existing  construction and other related Department rules and
24    standards before the advisory committee under subsection  (b)
25    of Section 2310-560 of the Department of Public Health Powers
26    and  Duties Law of the Civil Administrative Code of Illinois.
27    Participants in this  process  must  include  representatives
28    from  the  Department,  representatives  of the hospital, and
29    additional representatives deemed appropriate by both parties
30    with expertise regarding the contested deficiencies  and  the
31    management of health care facilities.  If the Department does
32    not  resolve disputed deficiencies after the informal dispute
 
                            -10-     LRB093 09788 LRD 14059 a
 1    resolution process, the Department  must  provide  a  written
 2    explanation  to the hospital of why the deficiencies have not
 3    been removed from the statement of deficiencies.
 4    (Source: P.A. 92-803, eff. 8-16-02.)

 5        (210 ILCS 85/9.4 new)
 6        Sec.  9.4.  Status  and  exit  briefings.  If  there  are
 7    significant findings during inspections,  investigations,  or
 8    surveys,  the  Department  must offer a daily status briefing
 9    with the hospital administrator or his  or  her  designee  to
10    disclose  the findings before the inspector, investigator, or
11    surveyor leaves for the day. At the end of  each  inspection,
12    investigation,  or survey the Department must have a detailed
13    and comprehensive exit briefing with the hospital to disclose
14    its preliminary findings and conclusions. As  part  of  these
15    briefings,   the   Department   inspector,  investigator,  or
16    surveyor must explain to the provider  what the deficiency is
17    in terms specific enough to allow a reasonably  knowledgeable
18    person   to  understand  why  the  requirement  is  not  met.
19    Surveyors must explain the requirements and why something  is
20    a  deficiency.   A data tag or reiteration of the regulations
21    must not be used as a substitute for an explanation.

22        (210 ILCS 85/9.5 new)
23        Sec.  9.5.  Findings,  conclusions,  and  citations.  The
24    Department must consider any factual information  offered  by
25    the hospital during the survey, inspection, or investigation,
26    at  daily status briefings, and in the exit briefing required
27    under  Section  9.4  before   making   final   findings   and
28    conclusions   or   issuing  citations.  The  Department  must
29    document receipt of such information and provide the hospital
30    with its findings and conclusions regarding this  information
31    in  addition  to  any  other  findings and conclusions of its
32    survey, investigation, or  inspection.  The  Department  must
 
                            -11-     LRB093 09788 LRD 14059 a
 1    provide  the hospital with written notice of its findings and
 2    conclusions within 10 days  of  the  exit  briefing  required
 3    under  Section  9.4.  This  notice must provide the following
 4    information: (i) identification of all deficiencies and areas
 5    of noncompliance with applicable law; (ii) identification  of
 6    the applicable statutes, rules, codes, or standards that were
 7    violated;  and (iii) the factual basis for each deficiency or
 8    violation.

 9        (210 ILCS 85/9.6 new)
10        Sec. 9.6.  Reviewer quality improvement.  The  Department
11    must implement a reviewer performance improvement program for
12    hospital  survey,  inspection,  and investigation staff.  The
13    Department  must  also  review  the  work  of  each  of   its
14    surveyors, inspectors, and investigators on a quarterly basis
15    to    assess   whether   its   surveyors,   inspectors,   and
16    investigators: (i) apply  the  same  protocols  and  criteria
17    consistently  to substantially similar situations; (ii) reach
18    similar findings and conclusions when reviewing substantially
19    similar situations; (iii) conduct  surveys,  inspections,  or
20    investigations in a professional manner; and (iv) comply with
21    the  provisions  of  this  Act.   The  Department  must  also
22    implement  continuing  education  programs for its surveyors,
23    inspectors, and investigators to correct review inconsistency
24    and to reduce review time and expense.".