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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Specialized Mental Health Rehabilitation | ||||||
5 | Act of 2013 is amended by changing Sections 1-101.5, 1-102, | ||||||
6 | 2-103, 4-105, and 4-108.5 and by adding Section 4-104.5 as | ||||||
7 | follows: | ||||||
8 | (210 ILCS 49/1-101.5)
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9 | Sec. 1-101.5. Prior law. | ||||||
10 | (a) This Act provides for licensure of long term care | ||||||
11 | facilities that are federally designated as institutions for | ||||||
12 | the mentally diseased on the effective date of this Act and | ||||||
13 | specialize in providing services to individuals with a serious | ||||||
14 | mental illness. On and after the effective date of this Act, | ||||||
15 | these facilities shall be governed by this Act instead of the | ||||||
16 | Nursing Home Care Act. The existence of a current or pending | ||||||
17 | administrative hearing, notice of violation, or other | ||||||
18 | enforcement action, except for a pending notice of revocation, | ||||||
19 | authorized under the Nursing Home Care Act shall not be a | ||||||
20 | barrier to the provisional licensure of a facility under this | ||||||
21 | Act. Provisional licensure under this Act shall not relieve a | ||||||
22 | facility from the responsibility for the payment of any past, | ||||||
23 | current, or future fines or penalties, or for any other |
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1 | enforcement remedy, imposed upon the facility under the Nursing | ||||||
2 | Home Care Act. | ||||||
3 | (b) All consent decrees that apply to facilities federally | ||||||
4 | designated as institutions for the mentally diseased shall | ||||||
5 | continue to apply to facilities licensed under this Act.
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6 | (c) A facility licensed under this Act may voluntarily | ||||||
7 | close, and the facility may reopen in an underserved region of | ||||||
8 | the State, if the facility receives a certificate of need from | ||||||
9 | the Health Facilities and Services Review Board. At no time | ||||||
10 | shall the total number of licensed beds under this Act exceed | ||||||
11 | the total number of licensed beds existing on July 22, 2013 | ||||||
12 | (the effective date of Public Act 98-104). | ||||||
13 | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.) | ||||||
14 | (210 ILCS 49/1-102)
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15 | Sec. 1-102. Definitions. For the purposes of this Act, | ||||||
16 | unless the context otherwise requires: | ||||||
17 | "Abuse" means any physical or mental injury or sexual | ||||||
18 | assault inflicted on a consumer other than by accidental means | ||||||
19 | in a facility. | ||||||
20 | "Accreditation" means any of the following: | ||||||
21 | (1) the Joint Commission; | ||||||
22 | (2) the Commission on Accreditation of Rehabilitation | ||||||
23 | Facilities; | ||||||
24 | (3) the Healthcare Facilities Accreditation Program; | ||||||
25 | or |
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1 | (4) any other national standards of care as approved by | ||||||
2 | the Department. | ||||||
3 | "Applicant" means any person making application for a | ||||||
4 | license or a provisional license under this Act. | ||||||
5 | "Consumer" means a person, 18 years of age or older, | ||||||
6 | admitted to a mental health rehabilitation facility for | ||||||
7 | evaluation, observation, diagnosis, treatment, stabilization, | ||||||
8 | recovery, and rehabilitation. | ||||||
9 | "Consumer" does not mean any of the following: | ||||||
10 | (i) an individual requiring a locked setting; | ||||||
11 | (ii) an individual requiring psychiatric | ||||||
12 | hospitalization because of an acute psychiatric crisis; | ||||||
13 | (iii) an individual under 18 years of age; | ||||||
14 | (iv) an individual who is actively suicidal or violent | ||||||
15 | toward others; | ||||||
16 | (v) an individual who has been found unfit to stand | ||||||
17 | trial; | ||||||
18 | (vi) an individual who has been found not guilty by | ||||||
19 | reason of insanity based on committing a violent act, such | ||||||
20 | as sexual assault, assault with a deadly weapon, arson, or | ||||||
21 | murder; | ||||||
22 | (vii) an individual subject to temporary detention and | ||||||
23 | examination under Section 3-607 of the Mental Health and | ||||||
24 | Developmental Disabilities Code; | ||||||
25 | (viii) an individual deemed clinically appropriate for | ||||||
26 | inpatient admission in a State psychiatric hospital; and |
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1 | (ix) an individual transferred by the Department of | ||||||
2 | Corrections pursuant to Section 3-8-5 of the Unified Code | ||||||
3 | of Corrections. | ||||||
4 | "Consumer record" means a record that organizes all | ||||||
5 | information on the care, treatment, and rehabilitation | ||||||
6 | services rendered to a consumer in a specialized mental health | ||||||
7 | rehabilitation facility. | ||||||
8 | "Controlled drugs" means those drugs covered under the | ||||||
9 | federal Comprehensive Drug Abuse Prevention Control Act of | ||||||
10 | 1970, as amended, or the Illinois Controlled Substances Act. | ||||||
11 | "Department" means the Department of Public Health. | ||||||
12 | "Discharge" means the full release of any consumer from a | ||||||
13 | facility. | ||||||
14 | "Drug administration" means the act in which a single dose | ||||||
15 | of a prescribed drug or biological is given to a consumer. The | ||||||
16 | complete act of administration entails removing an individual | ||||||
17 | dose from a container, verifying the dose with the prescriber's | ||||||
18 | orders, giving the individual dose to the consumer, and | ||||||
19 | promptly recording the time and dose given. | ||||||
20 | "Drug dispensing" means the act entailing the following of | ||||||
21 | a prescription order for a drug or biological and proper | ||||||
22 | selection, measuring, packaging, labeling, and issuance of the | ||||||
23 | drug or biological to a consumer. | ||||||
24 | "Emergency" means a situation, physical condition, or one | ||||||
25 | or more practices, methods, or operations which present | ||||||
26 | imminent danger of death or serious physical or mental harm to |
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1 | consumers of a facility. | ||||||
2 | "Facility" means a specialized mental health | ||||||
3 | rehabilitation facility that provides at least one of the | ||||||
4 | following services: (1) triage center; (2) crisis | ||||||
5 | stabilization; (3) recovery and rehabilitation supports; or | ||||||
6 | (4) transitional living units for 3 or more persons. The | ||||||
7 | facility shall provide a 24-hour program that provides | ||||||
8 | intensive support and recovery services designed to assist | ||||||
9 | persons, 18 years or older, with mental disorders to develop | ||||||
10 | the skills to become self-sufficient and capable of increasing | ||||||
11 | levels of independent functioning. It includes facilities that | ||||||
12 | meet the following criteria: | ||||||
13 | (1) 100% of the consumer population of the facility has | ||||||
14 | a diagnosis of serious mental illness; | ||||||
15 | (2) no more than 15% of the consumer population of the | ||||||
16 | facility is 65 years of age or older; | ||||||
17 | (3) none of the consumers are non-ambulatory; | ||||||
18 | (4) none of the consumers have a primary diagnosis of | ||||||
19 | moderate, severe, or profound intellectual disability; and | ||||||
20 | (5) the facility must have been licensed under the | ||||||
21 | Specialized Mental Health Rehabilitation Act or the | ||||||
22 | Nursing Home Care Act immediately preceding July 22, 2013 | ||||||
23 | ( the effective date of this Act ) and qualifies as an a | ||||||
24 | institute for mental disease under the federal definition | ||||||
25 | of the term. | ||||||
26 | "Facility" does not include the following: |
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1 | (1) a home, institution, or place operated by the | ||||||
2 | federal government or agency thereof, or by the State of | ||||||
3 | Illinois; | ||||||
4 | (2) a hospital, sanitarium, or other institution whose | ||||||
5 | principal activity or business is the diagnosis, care, and | ||||||
6 | treatment of human illness through the maintenance and | ||||||
7 | operation as organized facilities therefor which is | ||||||
8 | required to be licensed under the Hospital Licensing Act; | ||||||
9 | (3) a facility for child care as defined in the Child | ||||||
10 | Care Act of 1969; | ||||||
11 | (4) a community living facility as defined in the | ||||||
12 | Community Living Facilities Licensing Act; | ||||||
13 | (5) a nursing home or sanatorium operated solely by and | ||||||
14 | for persons who rely exclusively upon treatment by | ||||||
15 | spiritual means through prayer, in accordance with the | ||||||
16 | creed or tenets of any well-recognized church or religious | ||||||
17 | denomination; however, such nursing home or sanatorium | ||||||
18 | shall comply with all local laws and rules relating to | ||||||
19 | sanitation and safety; | ||||||
20 | (6) a facility licensed by the Department of Human | ||||||
21 | Services as a community-integrated living arrangement as | ||||||
22 | defined in the Community-Integrated Living Arrangements | ||||||
23 | Licensure and Certification Act; | ||||||
24 | (7) a supportive residence licensed under the | ||||||
25 | Supportive Residences Licensing Act; | ||||||
26 | (8) a supportive living facility in good standing with |
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1 | the program established under Section 5-5.01a of the | ||||||
2 | Illinois Public Aid Code, except only for purposes of the | ||||||
3 | employment of persons in accordance with Section 3-206.01 | ||||||
4 | of the Nursing Home Care Act; | ||||||
5 | (9) an assisted living or shared housing establishment | ||||||
6 | licensed under the Assisted Living and Shared Housing Act, | ||||||
7 | except only for purposes of the employment of persons in | ||||||
8 | accordance with Section 3-206.01 of the Nursing Home Care | ||||||
9 | Act; | ||||||
10 | (10) an Alzheimer's disease management center | ||||||
11 | alternative health care model licensed under the | ||||||
12 | Alternative Health Care Delivery Act; | ||||||
13 | (11) a home, institution, or other place operated by or | ||||||
14 | under the authority of the Illinois Department of Veterans' | ||||||
15 | Affairs; | ||||||
16 | (12) a facility licensed under the ID/DD Community Care | ||||||
17 | Act; | ||||||
18 | (13) a facility licensed under the Nursing Home Care | ||||||
19 | Act after July 22, 2013 ( the effective date of this Act ) ; | ||||||
20 | or | ||||||
21 | (14) a facility licensed under the MC/DD Act. | ||||||
22 | "Executive director" means a person who is charged with the | ||||||
23 | general administration and supervision of a facility licensed | ||||||
24 | under this Act and who is a licensed nursing home | ||||||
25 | administrator, licensed practitioner of the healing arts, or | ||||||
26 | qualified mental health professional . |
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1 | "Guardian" means a person appointed as a guardian of the | ||||||
2 | person or guardian of the estate, or both, of a consumer under | ||||||
3 | the Probate Act of 1975. | ||||||
4 | "Identified offender" means a person who meets any of the | ||||||
5 | following criteria: | ||||||
6 | (1) Has been convicted of, found guilty of, adjudicated | ||||||
7 | delinquent for, found not guilty by reason of insanity for, | ||||||
8 | or found unfit to stand trial for, any felony offense | ||||||
9 | listed in Section 25 of the Health Care Worker Background | ||||||
10 | Check Act, except for the following: | ||||||
11 | (i) a felony offense described in Section 10-5 of | ||||||
12 | the Nurse Practice Act; | ||||||
13 | (ii) a felony offense described in Section 4, 5, 6, | ||||||
14 | 8, or 17.02 of the Illinois Credit Card and Debit Card | ||||||
15 | Act; | ||||||
16 | (iii) a felony offense described in Section 5, 5.1, | ||||||
17 | 5.2, 7, or 9 of the Cannabis Control Act; | ||||||
18 | (iv) a felony offense described in Section 401, | ||||||
19 | 401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois | ||||||
20 | Controlled Substances Act; and | ||||||
21 | (v) a felony offense described in the | ||||||
22 | Methamphetamine Control and Community Protection Act. | ||||||
23 | (2) Has been convicted of, adjudicated delinquent
for, | ||||||
24 | found not guilty by reason of insanity for, or found unfit | ||||||
25 | to stand trial for, any sex offense as defined in | ||||||
26 | subsection (c) of Section 10 of the Sex Offender Management |
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1 | Board Act. | ||||||
2 | "Transitional living units" are residential units within a | ||||||
3 | facility that have the purpose of assisting the consumer in | ||||||
4 | developing and reinforcing the necessary skills to live | ||||||
5 | independently outside of the facility. The duration of stay in | ||||||
6 | such a setting shall not exceed 120 days for each consumer. | ||||||
7 | Nothing in this definition shall be construed to be a | ||||||
8 | prerequisite for transitioning out of a facility. | ||||||
9 | "Licensee" means the person, persons, firm, partnership, | ||||||
10 | association, organization, company, corporation, or business | ||||||
11 | trust to which a license has been issued. | ||||||
12 | "Misappropriation of a consumer's property" means the | ||||||
13 | deliberate misplacement, exploitation, or wrongful temporary | ||||||
14 | or permanent use of a consumer's belongings or money without | ||||||
15 | the consent of a consumer or his or her guardian. | ||||||
16 | "Neglect" means a facility's failure to provide, or willful | ||||||
17 | withholding of, adequate medical care, mental health | ||||||
18 | treatment, psychiatric rehabilitation, personal care, or | ||||||
19 | assistance that is necessary to avoid physical harm and mental | ||||||
20 | anguish of a consumer. | ||||||
21 | "Personal care" means assistance with meals, dressing, | ||||||
22 | movement, bathing, or other personal needs, maintenance, or | ||||||
23 | general supervision and oversight of the physical and mental | ||||||
24 | well-being of an individual who is incapable of maintaining a | ||||||
25 | private, independent residence or who is incapable of managing | ||||||
26 | his or her person, whether or not a guardian has been appointed |
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1 | for such individual. "Personal care" shall not be construed to | ||||||
2 | confine or otherwise constrain a facility's pursuit to develop | ||||||
3 | the skills and abilities of a consumer to become | ||||||
4 | self-sufficient and capable of increasing levels of | ||||||
5 | independent functioning. | ||||||
6 | "Recovery and rehabilitation supports" means a program | ||||||
7 | that facilitates a consumer's longer-term symptom management | ||||||
8 | and stabilization while preparing the consumer for | ||||||
9 | transitional living units by improving living skills and | ||||||
10 | community socialization. The duration of stay in such a setting | ||||||
11 | shall be established by the Department by rule. | ||||||
12 | "Restraint" means: | ||||||
13 | (i) a physical restraint that is any manual method or
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14 | physical or mechanical device, material, or equipment | ||||||
15 | attached or adjacent to a consumer's body that the consumer | ||||||
16 | cannot remove easily and restricts freedom of movement or | ||||||
17 | normal access to one's body; devices used for positioning, | ||||||
18 | including, but not limited to, bed rails, gait belts, and | ||||||
19 | cushions, shall not be considered to be restraints for | ||||||
20 | purposes of this Section; or | ||||||
21 | (ii) a chemical restraint that is any drug used for
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22 | discipline or convenience and not required to treat medical | ||||||
23 | symptoms; the Department shall, by rule, designate certain | ||||||
24 | devices as restraints, including at least all those devices | ||||||
25 | that have been determined to be restraints by the United | ||||||
26 | States Department of Health and Human Services in |
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1 | interpretive guidelines issued for the purposes of | ||||||
2 | administering Titles XVIII and XIX of the federal Social | ||||||
3 | Security Act. For the purposes of this Act, restraint shall | ||||||
4 | be administered only after utilizing a coercive free | ||||||
5 | environment and culture. | ||||||
6 | "Self-administration of medication" means consumers shall | ||||||
7 | be responsible for the control, management, and use of their | ||||||
8 | own medication. | ||||||
9 | "Crisis stabilization" means a secure and separate unit | ||||||
10 | that provides short-term behavioral, emotional, or psychiatric | ||||||
11 | crisis stabilization as an alternative to hospitalization or | ||||||
12 | re-hospitalization for consumers from residential or community | ||||||
13 | placement. The duration of stay in such a setting shall not | ||||||
14 | exceed 21 days for each consumer. | ||||||
15 | "Therapeutic separation" means the removal of a consumer | ||||||
16 | from the milieu to a room or area which is designed to aid in | ||||||
17 | the emotional or psychiatric stabilization of that consumer. | ||||||
18 | "Triage center" means a non-residential 23-hour center | ||||||
19 | that serves as an alternative to emergency room care, | ||||||
20 | hospitalization, or re-hospitalization for consumers in need | ||||||
21 | of short-term crisis stabilization. Consumers may access a | ||||||
22 | triage center from a number of referral sources, including | ||||||
23 | family, emergency rooms, hospitals, community behavioral | ||||||
24 | health providers, federally qualified health providers, or | ||||||
25 | schools, including colleges or universities. A triage center | ||||||
26 | may be located in a building separate from the licensed |
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1 | location of a facility, but shall not be more than 1,000 feet | ||||||
2 | from the licensed location of the facility and must meet all of | ||||||
3 | the facility standards applicable to the licensed location. If | ||||||
4 | the triage center does operate in a separate building, safety | ||||||
5 | personnel shall be provided, on site, 24 hours per day and the | ||||||
6 | triage center shall meet all other staffing requirements | ||||||
7 | without counting any staff employed in the main facility | ||||||
8 | building.
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9 | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; | ||||||
10 | 99-180, eff. 7-29-15; revised 9-8-16.) | ||||||
11 | (210 ILCS 49/2-103)
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12 | Sec. 2-103. Staff training. Training for all new employees | ||||||
13 | specific to the various levels of care offered by a facility | ||||||
14 | shall be provided to employees during their orientation period | ||||||
15 | and annually thereafter. Training shall be independent of the | ||||||
16 | Department and overseen by the Division of Mental Health to | ||||||
17 | determine the content of all facility employee training and to | ||||||
18 | provide training for all trainers of facility employees. | ||||||
19 | Training of employees shall be consistent with nationally | ||||||
20 | recognized national accreditation standards as defined later | ||||||
21 | in this Act. Training of existing staff of a recovery and | ||||||
22 | rehabilitation support center shall be conducted in accordance | ||||||
23 | with, and on the schedule provided in, the staff training plan | ||||||
24 | approved by the Division of Mental Health. Training of existing | ||||||
25 | staff for any other level of care licensed under this Act, |
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1 | including triage, crisis stabilization, and transitional | ||||||
2 | living shall be completed at a facility prior to the | ||||||
3 | implementation of that level of care. Training shall be | ||||||
4 | required for all existing staff at a facility prior to the | ||||||
5 | implementation of any new services authorized under this Act.
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6 | (Source: P.A. 98-104, eff. 7-22-13.) | ||||||
7 | (210 ILCS 49/4-104.5 new) | ||||||
8 | Sec. 4-104.5. Waiver of compliance. Upon application by a | ||||||
9 | facility, the Director may grant or renew the waiver of the | ||||||
10 | facility's compliance with a rule or standard for a period not | ||||||
11 | to exceed the duration of the current license or, in the case | ||||||
12 | of an application for license renewal, the duration of the | ||||||
13 | renewal period. The waiver may be conditioned upon the facility | ||||||
14 | taking action prescribed by the Director as a measure | ||||||
15 | equivalent to compliance. In determining whether to grant or | ||||||
16 | renew a waiver, the Director shall consider the duration and | ||||||
17 | basis for any current waiver with respect to the same rule or | ||||||
18 | standard and the validity and effect upon patient health and | ||||||
19 | safety of extending it on the same basis, the effect upon the | ||||||
20 | health and safety of consumers, the quality of consumer care, | ||||||
21 | the facility's history of compliance with the rules and | ||||||
22 | standards of this Act and the facility's attempts to comply | ||||||
23 | with the particular rule or standard in question. Upon request | ||||||
24 | by a facility, the Department must evaluate or allow for an | ||||||
25 | evaluation of compliance with the Life Safety Code using the |
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1 | Fire Safety Evaluation System. In determining whether to grant | ||||||
2 | or renew a waiver of a standard pertaining to Chapter 33 of the | ||||||
3 | National Fire Protection Association (NFPA) 101 Life Safety | ||||||
4 | Code, the Director shall use Fire Safety Evaluation Systems in | ||||||
5 | determining whether to grant or renew the waiver. The | ||||||
6 | Department may provide, by rule, for the automatic renewal of | ||||||
7 | waivers concerning physical plant requirements upon the | ||||||
8 | renewal of a license. The Department shall renew waivers | ||||||
9 | relating to physical plant standards issued in accordance with | ||||||
10 | this Section at the time of the indicated reviews, unless it | ||||||
11 | can show why such waivers should not be extended for either of | ||||||
12 | the following reasons: | ||||||
13 | (1) the condition of the physical plant has | ||||||
14 | deteriorated or its use substantially changed so that the | ||||||
15 | basis upon which the waiver was issued is materially | ||||||
16 | different; or | ||||||
17 | (2) the facility is renovated or substantially | ||||||
18 | remodeled in such a way as to permit compliance with the | ||||||
19 | applicable rules and standards without a substantial | ||||||
20 | increase in cost. | ||||||
21 | A copy of each waiver application and each waiver granted | ||||||
22 | or renewed shall be on file with the Department and available | ||||||
23 | for public inspection. | ||||||
24 | No penalty or fine may be assessed for a condition for | ||||||
25 | which the facility has received a variance or waiver of a | ||||||
26 | standard. |
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1 | Waivers granted to a facility by the Department under any | ||||||
2 | other law shall not be considered by the Department in its | ||||||
3 | determination of a facility's compliance with the requirements | ||||||
4 | of this Act, including, but not limited to, compliance with the | ||||||
5 | Life Safety Code. | ||||||
6 | (210 ILCS 49/4-105)
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7 | Sec. 4-105. Provisional licensure duration. A provisional | ||||||
8 | license shall be valid upon fulfilling the requirements | ||||||
9 | established by the Department by emergency rule. The license | ||||||
10 | shall remain valid as long as a facility remains in compliance | ||||||
11 | with the licensure provisions established in rule. Provisional | ||||||
12 | licenses issued upon initial licensure as a specialized mental | ||||||
13 | health rehabilitation facility shall expire at the end of a | ||||||
14 | 3-year period, which commences on the date the provisional | ||||||
15 | license is issued. Issuance of a provisional license for any | ||||||
16 | reason other than initial licensure (including, but not limited | ||||||
17 | to, change of ownership, location, number of beds, or services) | ||||||
18 | shall not extend the maximum 3-year period, at the end of which | ||||||
19 | a facility must be licensed pursuant to Section 4-201. | ||||||
20 | Notwithstanding any other provision of this Act or the | ||||||
21 | Specialized Mental Health Rehabilitation Facilities Code, 77 | ||||||
22 | Ill. Admin. Code 380, to the contrary, if a facility has | ||||||
23 | received notice from the Department that its application for | ||||||
24 | provisional licensure to provide recovery and rehabilitation | ||||||
25 | services has been accepted as complete and the facility has |
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1 | attested in writing to the Department that it will comply with | ||||||
2 | the staff training plan approved by the Division of Mental | ||||||
3 | Health, then a provisional license for recovery and | ||||||
4 | rehabilitation services shall be issued to the facility within | ||||||
5 | 60 days after the Department determines that the facility is in | ||||||
6 | compliance with the requirements of the Life Safety Code in | ||||||
7 | accordance with Section 4-104.5 of this Act.
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8 | (Source: P.A. 98-104, eff. 7-22-13; 99-712, eff. 8-5-16.) | ||||||
9 | (210 ILCS 49/4-108.5) | ||||||
10 | Sec. 4-108.5. Provisional licensure period; surveys. | ||||||
11 | During the provisional licensure period, the Department shall | ||||||
12 | conduct surveys to determine compliance with timetables and | ||||||
13 | benchmarks with a facility's provisional licensure application | ||||||
14 | plan of operation. Timetables and benchmarks shall be | ||||||
15 | established in rule and shall include, but not be limited to, | ||||||
16 | the following: (1) training of new and existing staff; (2) | ||||||
17 | establishment of a data collection and reporting program for | ||||||
18 | the facility's Quality Assessment and Performance Improvement | ||||||
19 | Program; and (3) compliance with building environment | ||||||
20 | standards beyond compliance with Chapter 33 of the National | ||||||
21 | Fire Protection Association (NFPA) 101 Life Safety Code. | ||||||
22 | Waivers granted by the Department in accordance with Section | ||||||
23 | 4-104.5 of this Act shall be considered by the Department in | ||||||
24 | its determination of the facility's compliance with the Life | ||||||
25 | Safety Code. |
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1 | During the provisional licensure period, the Department | ||||||
2 | shall conduct State licensure surveys as well as a conformance | ||||||
3 | standard review to determine compliance with timetables and | ||||||
4 | benchmarks associated with the accreditation process. | ||||||
5 | Timetables and benchmarks shall be met in accordance with the | ||||||
6 | preferred accrediting organization conformance standards and | ||||||
7 | recommendations and shall include, but not be limited to, | ||||||
8 | conducting a comprehensive facility self-evaluation in | ||||||
9 | accordance with an established national accreditation program. | ||||||
10 | The facility shall submit all data reporting and outcomes | ||||||
11 | required by accrediting organization to the Department of | ||||||
12 | Public Health for review to determine progress towards | ||||||
13 | accreditation. Accreditation status shall supplement but not | ||||||
14 | replace the State's licensure surveys of facilities licensed | ||||||
15 | under this Act and their certified programs and services to | ||||||
16 | determine the extent to which these facilities provide high | ||||||
17 | quality interventions, especially evidence-based practices, | ||||||
18 | appropriate to the assessed clinical needs of individuals in | ||||||
19 | the 4 certified levels of care. | ||||||
20 | Except for incidents involving the potential for harm, | ||||||
21 | serious harm, death, or substantial facility failure to address | ||||||
22 | a serious systemic issue within 60 days, findings of the | ||||||
23 | facility's root cause analysis of problems and the facility's | ||||||
24 | Quality Assessment and Performance Improvement program in | ||||||
25 | accordance with item (22) of Section 4-104 shall not be used as | ||||||
26 | a basis for non-compliance. |
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1 | The Department shall have the authority to hire licensed | ||||||
2 | practitioners of the healing arts and qualified mental health | ||||||
3 | professionals to consult with and participate in survey and | ||||||
4 | inspection activities.
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5 | (Source: P.A. 98-651, eff. 6-16-14.)
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6 | Section 99. Effective date. This Act takes effect July 1, | ||||||
7 | 2017.
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