HB4815 104TH GENERAL ASSEMBLY

LRB104 18031 BAB 31470 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4815

Introduced , by Rep. Norine K. Hammond

SYNOPSIS AS INTRODUCED:

210 ILCS 9/15
210 ILCS 9/35
210 ILCS 9/70
210 ILCS 9/75
210 ILCS 9/91 new
210 ILCS 9/92
210 ILCS 9/135

Amends the Assisted Living and Shared Housing Act. Provides that the comprehensive assessment of a patient prior to the patient's admission to an establishment shall be completed by a physician or a nurse practitioner or physician assistant. In provisions concerning licensure of an establishment, changes education requirements for the full-time director of an establishment. Makes changes to the definition of "medication administration" in provisions concerning service requirements. Provides that a licensed health care professional may be employed (instead of may not be employed) by the owner or operator of the establishment, its parent entity, or any other entity with ownership common to either the owner or operator of the establishment or parent entity, including, but not limited to, an affiliate of the owner or operator of the establishment, if the resident chooses to utilize the services of the licensed health care professional working within the scope of the professional's practice. Sets forth provisions concerning an emergency plan and disaster preparedness. Provides that incidents must be reported to the Department of Public Health within 24 hours after the incident or by the end of the next business day. Provides that staff in an establishment may be trained to assist in a nonemergency lift of a resident. Provides that repeated technical infractions by an establishment within a calendar year may result in a Type 3 violation.

A BILL FOR

AN ACT concerning regulation.

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

Section 5. The Assisted Living and Shared Housing Act is amended by changing Sections 15, 35, 70, 75, 92, and 135 and by adding Section 91 as follows:

(210 ILCS 9/15)

Sec. 15. Assessment and service plan requirements. Prior to admission to any establishment covered by this Act, a comprehensive assessment that includes an evaluation of the prospective resident's physical, cognitive, and psychosocial condition shall be completed by a physician or a nurse practitioner or physician assistant. At least annually, a comprehensive assessment shall be completed, and upon identification of a significant change in the resident's condition, including, but not limited to, a diagnosis of Alzheimer's disease or a related dementia, the resident shall be reassessed. The Department may by rule specify circumstances under which more frequent assessments of skin integrity and nutritional status shall be required. The comprehensive assessment shall be completed by a physician or a nurse practitioner or physician assistant. Based on the assessment, the resident's interests and preferences, dislikes, and any known triggers for behavior that endangers the resident or others, a written service plan shall be developed and mutually agreed upon by the provider, the resident, and the resident's representative, if any. The service plan, which shall be reviewed annually, or more often as the resident's condition, preferences, or service needs change, shall serve as a basis for the service delivery contract between the provider and the resident. The resident and the resident's representative, if any, shall, upon request, be given a copy of the most recent assessment; a supplemental assessment, if any, completed by the establishment; and a service plan. Based on the assessment, the service plan may provide for the disconnection or removal of any appliance.

(Source: P.A. 104-191, eff. 1-1-26.)

(210 ILCS 9/35)

Sec. 35. Issuance of license.

(a) Upon receipt and review of an application for a license and review of the applicant establishment, the Director may issue a license if he or she finds:

(1) that the individual applicant, or the corporation, partnership, or other entity if the applicant is not an individual, is a person responsible and suitable to operate or to direct or participate in the operation of an establishment by virtue of financial capacity, appropriate business or professional experience, a record of lawful compliance with lawful orders of the Department and lack of revocation of a license issued under this Act, the Nursing Home Care Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, or the MC/DD Act during the previous 5 years;

(2) that the establishment is under the supervision of a full-time director who is at least 21 years of age and has a high school diploma or equivalent plus either:

(A) 2 years of management experience or 2 years of experience in positions of progressive responsibility in health care, housing with services, or adult day care or providing similar services to the elderly; or

(B) 2 years of management experience or 2 years of experience in positions of progressive responsibility in hospitality and training in health care and housing with services management as defined by rule; or

(C) a college degree in health administration or the completion of an approved program within 6 months after hiring;

(3) that the establishment has staff sufficient in number with qualifications, adequate skills, education, and experience to meet the 24 hour scheduled and unscheduled needs of residents and who participate in ongoing training to serve the resident population;

(4) that all employees who are subject to the Health Care Worker Background Check Act meet the requirements of that Act;

(5) that the applicant is in substantial compliance with this Act and such other requirements for a license as the Department by rule may establish under this Act;

(6) that the applicant pays all required fees;

(7) that the applicant has provided to the Department an accurate disclosure document in accordance with the Alzheimer's Disease and Related Dementias Special Care Disclosure Act and in substantial compliance with Section 150 of this Act.

In addition to any other requirements set forth in this Act, as a condition of licensure under this Act, the director of an establishment must participate in at least 20 hours of training every 2 years to assist him or her in better meeting the needs of the residents of the establishment and managing the operation of the establishment.

Any license issued by the Director shall state the physical location of the establishment, the date the license was issued, and the expiration date. All licenses shall be valid for one year, except as provided in Sections 40 and 45. Each license shall be issued only for the premises and persons named in the application, and shall not be transferable or assignable.

(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)

(210 ILCS 9/70)

Sec. 70. Service requirements. An establishment must provide all mandatory services and may provide optional services, including medication reminders, supervision of self-administered medication and medication administration as defined by this Section and nonmedical services defined by rule, whether provided directly by the establishment or by another entity arranged for by the establishment with the consent of the resident or the resident's representative.

For the purposes of this Section, "medication reminders" means reminding residents to take pre-dispensed, self-administered medication, observing the resident, and documenting whether or not the resident took the medication.

For the purposes of this Section, "supervision of self-administered medication" means assisting the resident with self-administered medication using any combination of the following: reminding residents to take medication, reading the medication label to residents, checking the self-administered medication dosage against the label of the medication, confirming that residents have obtained and are taking the dosage as prescribed, and documenting in writing that the resident has taken (or refused to take) the medication. If residents are physically unable to open the container, the container may be opened for them. Supervision of self-administered medication shall be under the direction of a licensed health care professional or, in the case of a certified medication aide, under the supervision and delegation of a registered nurse as authorized by Section 50-75 of the Nurse Practice Act.

For the purposes of this Section, "medication administration" refers to a licensed health care professional employed by an establishment engaging in administering insulin and vitamin B-12 injections, oral medications, topical treatments, eye and ear drops, or nitroglycerin patches, and intramuscular injections. A certified medication aide may administer medications under the supervision and delegation of a registered nurse as authorized by Section 50-75 of the Nurse Practice Act, except (i) Schedule II controlled substances as set forth in the Illinois Controlled Substances Act and (ii) any subcutaneous, intramuscular, intradermal, or intravenous medication.

The Department shall specify by rule procedures for medication reminders, supervision of self-administered medication, and medication administration.

Nothing in this Act shall preclude a physician licensed under the Medical Practice Act of 1987 from providing services within the scope of his or her license to any resident.

(Source: P.A. 103-886, eff. 8-9-24.)

(210 ILCS 9/75)

Sec. 75. Residency requirements.

(a) No individual shall be accepted for residency or remain in residence if the establishment cannot provide or secure appropriate services, if the individual requires a level of service or type of service for which the establishment is not licensed or which the establishment does not provide, or if the establishment does not have the staff appropriate in numbers and with appropriate skill to provide such services.

(b) Only adults may be accepted for residency.

(c) A person shall not be accepted for residency if:

(1) the person poses a serious threat to himself or herself or to others;

(2) the person is not able to communicate his or her needs and no resident representative residing in the establishment, and with a prior relationship to the person, has been appointed to direct the provision of services;

(3) the person requires total assistance with 2 or more activities of daily living;

(4) the person requires the assistance of more than one paid caregiver at any given time with an activity of daily living;

(5) the person requires more than minimal assistance in moving to a safe area in an emergency;

(6) the person has a severe mental illness, which for the purposes of this Section means a condition that is characterized by the presence of a major mental disorder as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994), where the individual is a person with a substantial disability due to mental illness in the areas of self-maintenance, social functioning, activities of community living and work skills, and the disability specified is expected to be present for a period of not less than one year, but does not mean Alzheimer's disease and other forms of dementia based on organic or physical disorders;

(7) the person requires intravenous therapy or intravenous feedings unless self-administered or administered by a qualified, licensed health care professional;

(8) the person requires gastrostomy feedings unless self-administered or administered by a licensed health care professional;

(9) the person requires insertion, sterile irrigation, and replacement of catheter, except for routine maintenance of urinary catheters, unless the catheter care is self-administered or administered by a licensed health care professional or a nurse in compliance with education, certification, and training in catheter care or infection control by the Centers for Disease Control and Prevention with oversight from an infection preventionist or infection control committee;

(10) the person requires sterile wound care unless care is self-administered or administered by a licensed health care professional;

(11) (blank);

(12) the person is a diabetic requiring routine insulin injections unless the injections are self-administered or administered by a licensed health care professional;

(13) the person requires treatment of stage 3 or stage 4 decubitus ulcers or exfoliative dermatitis;

(14) the person requires 5 or more skilled nursing visits per week for conditions other than those listed in items (13) and (15) of this subsection for a period of 3 consecutive weeks or more except when the course of treatment is expected to extend beyond a 3-week period for rehabilitative purposes and is certified as temporary by a physician; or

(15) other reasons prescribed by the Department by rule.

(d) A resident with a condition listed in items (1) through (15) of subsection (c) shall have his or her residency terminated.

(e) Residency shall be terminated when services available to the resident in the establishment are no longer adequate to meet the needs of the resident. The establishment shall notify the resident and the resident's representative, if any, when there is a significant change in the resident's condition that affects the establishment's ability to meet the resident's needs. The requirements of subsection (c) of Section 80 shall then apply. This provision shall not be interpreted as limiting the authority of the Department to require the residency termination of individuals.

(f) Subsection (d) of this Section shall not apply to terminally ill residents who receive or would qualify for hospice care and such care is coordinated by a hospice program licensed under the Hospice Program Licensing Act or other licensed health care professional employed by a licensed home health agency and the establishment and all parties agree to the continued residency.

(g) Items (3), (4), (5), and (9) of subsection (c) shall not apply to a quadriplegic, paraplegic, or individual with neuro-muscular diseases, such as muscular dystrophy and multiple sclerosis, or other chronic diseases and conditions as defined by rule if the individual is able to communicate his or her needs and does not require assistance with complex medical problems, and the establishment is able to accommodate the individual's needs. The Department shall prescribe rules pursuant to this Section that address special safety and service needs of these individuals.

(h) For the purposes of items (7) through (10) of subsection (c), a licensed health care professional may not be employed by the owner or operator of the establishment, its parent entity, or any other entity with ownership common to either the owner or operator of the establishment or parent entity, including, but not limited to, an affiliate of the owner or operator of the establishment, if the resident chooses to utilize the services of the licensed health care professional working within the scope of the professional's practice. Nothing in this Section is meant to limit a resident's right to choose his or her health care provider.

(i) Subsection (h) is not applicable to residents admitted to an assisted living establishment under a life care contract as defined in the Life Care Facilities Act if the life care facility has both an assisted living establishment and a skilled nursing facility. A licensed health care professional providing health-related or supportive services at a life care assisted living or shared housing establishment must be employed by an entity licensed by the Department under the Nursing Home Care Act or the Home Health, Home Services, and Home Nursing Agency Licensing Act.

(Source: P.A. 103-444, eff. 1-1-24; 103-844, eff. 7-1-25; 104-191, eff. 1-1-26.)

(210 ILCS 9/91 new)

Sec. 91. Emergency plan; disaster preparedness drills.

(a) Each establishment shall have a written plan for protection of all persons in the event of disasters, for keeping persons in place, evacuating persons to areas of refuge, and evacuating persons from the building when necessary. The plan shall address the physical and cognitive needs of residents and include special staff response, including the procedures needed to ensure the safety of any resident. The plan shall be amended or revised whenever any resident with unusual needs is admitted. The plan shall also:

(1) provide for the temporary relocation of residents for any disaster requiring relocation;

(2) provide for the movement of residents to safe locations within the establishment in the event of a tornado warning or severe thunderstorm warning issued by the National Weather Service;

(3) provide for the temporary relocation of residents any time the temperature in residents' bedrooms falls below 55 degrees Fahrenheit for 12 hours or more as a result of a mechanical problem or loss of power in the establishment;

(4) provide for the health, safety, welfare, and comfort of all residents when the heat index or apparent temperature, as established by the National Oceanic and Atmospheric Administration, inside the residents' living, dining, activities, or sleeping areas of the establishment exceeds a heat index or apparent temperature of 80 degrees Fahrenheit;

(5) address power outages; and

(6) include contingencies in the event of flooding, if located on a flood plain.

(b) Each establishment shall conduct at least 6 drills per year on a bimonthly basis. At least 2 of the drills, involving staff only, shall be conducted during the night when residents are sleeping. All drills shall be held under varied conditions to:

(1) ensure that all personnel on all shifts are trained to perform assigned tasks;

(2) ensure that all personnel on all shifts are familiar with the use of the firefighting equipment in the facility; and

(3) evaluate the effectiveness of disaster plans, procedures, and training.

Drills shall include residents, except at night when residents are sleeping, establishment personnel, and other persons in the establishment. Drills shall involve the actual evacuation of residents to an assembly point specified in the emergency plan, unless the community has a shelter-in-place protocol approved by the local fire department and shall provide residents with experience using various means of escape. If an establishment has an evacuation capability classification of impractical, those residents who cannot meaningfully assist in their own evacuation or who have special health problems shall not be required to participate in the drill. If weather or other conditions present risk to residents for actual evacuation of the entire building, the establishment shall conduct drills that involve evacuating to designated sections or portions of the building. These drills must simulate real evacuation conditions and ensure that, with the personnel typically available, the entire building could be evacuated if necessary.

As used in this subsection, "an evacuation capability of impractical" means a situation where an establishment has a high number of occupants with severe mobility limitations so that a full evacuation within a reasonable time frame is deemed nearly impossible.

Memory care units shall be deemed as impractical for conducting drills, and residents shall be exempt. This exemption does not apply to staff working in the memory care unit.

(210 ILCS 9/92)

Sec. 92. Incident and accident reporting.

(a) Within 24 hours after the incident or by the end of the next business day, an An establishment must report to the Department any incident or accident that results in significant physical harm or injury to a resident or any situation where a resident requires outside emergent medical treatment as a direct result of an incident or accident. A change in a resident's condition that is due to health or medical decline is not a reportable incident or accident.

(b) As used in this subsection, "nonemergency lift" means lifting a resident from the resident's current position to a desired position. "Nonemergency lift" does not include an incident or accident that results in significant physical harm or injury to a resident or any situation where a resident requires outside emergent medical treatment as a direct result of an incident or accident. Staff in an establishment may be trained to assist in a nonemergency lift of a resident.

(Source: P.A. 104-209, eff. 1-1-26.)

(210 ILCS 9/135)

Sec. 135. Civil penalties.

(a) The Department may assess a civil penalty not to exceed $5,000 against any establishment subject to this Act for violations of this Act. Each day a violation continues shall be deemed a separate violation.

(b) Beginning 180 days after the adoption of rules under this Act, the Department may assess a civil penalty not to exceed $3,000 against any establishment subject to this Act for caring for a resident who exceeds the care needs defined in this Act. Each day a violation continues shall be deemed a separate violation.

(c) The Department is authorized to hold hearings in contested cases regarding appeals of the penalties assessed pursuant to this Section.

(d) Repeated technical infractions within a calendar year may result in a Type 3 violation.

(Source: P.A. 91-656, eff. 1-1-01.)