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1 | | Sec. 8.9a. Extension of project completion date. Any party |
2 | | that has previously received approval by the State Board to |
3 | | re-establish a previously discontinued general acute care |
4 | | hospital in accordance with Section 8.9 of this Act shall have |
5 | | the automatic right to extend the project completion date |
6 | | listed by the party in the party's certificate of exemption |
7 | | application by providing notice to the State Board of the new |
8 | | project completion date. |
9 | | Section 10. The Nursing Home Care Act is amended by |
10 | | changing Section 3-202.05 as follows: |
11 | | (210 ILCS 45/3-202.05) |
12 | | Sec. 3-202.05. Staffing ratios effective July 1, 2010 and |
13 | | thereafter. |
14 | | (a) For the purpose of computing staff to resident ratios, |
15 | | direct care staff shall include: |
16 | | (1) registered nurses; |
17 | | (2) licensed practical nurses; |
18 | | (3) certified nurse assistants; |
19 | | (4) psychiatric services rehabilitation aides; |
20 | | (5) rehabilitation and therapy aides; |
21 | | (6) psychiatric services rehabilitation coordinators; |
22 | | (7) assistant directors of nursing; |
23 | | (8) 50% of the Director of Nurses' time; and |
24 | | (9) 30% of the Social Services Directors' time. |
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1 | | The Department shall, by rule, allow certain facilities |
2 | | subject to 77 Ill. Adm. Admin. Code 300.4000 and following |
3 | | (Subpart S) to utilize specialized clinical staff, as defined |
4 | | in rules, to count towards the staffing ratios. |
5 | | Within 120 days of June 14, 2012 ( the effective date of |
6 | | Public Act 97-689) this amendatory Act of the 97th General |
7 | | Assembly , the Department shall promulgate rules specific to |
8 | | the staffing requirements for facilities federally defined as |
9 | | Institutions for Mental Disease. These rules shall recognize |
10 | | the unique nature of individuals with chronic mental health |
11 | | conditions, shall include minimum requirements for specialized |
12 | | clinical staff, including clinical social workers, |
13 | | psychiatrists, psychologists, and direct care staff set forth |
14 | | in paragraphs (4) through (6) and any other specialized staff |
15 | | which may be utilized and deemed necessary to count toward |
16 | | staffing ratios. |
17 | | Within 120 days of June 14, 2012 ( the effective date of |
18 | | Public Act 97-689) this amendatory Act of the 97th General |
19 | | Assembly , the Department shall promulgate rules specific to |
20 | | the staffing requirements for facilities licensed under the |
21 | | Specialized Mental Health Rehabilitation Act of 2013. These |
22 | | rules shall recognize the unique nature of individuals with |
23 | | chronic mental health conditions, shall include minimum |
24 | | requirements for specialized clinical staff, including |
25 | | clinical social workers, psychiatrists, psychologists, and |
26 | | direct care staff set forth in paragraphs (4) through (6) and |
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1 | | any other specialized staff which may be utilized and deemed |
2 | | necessary to count toward staffing ratios. |
3 | | (b) (Blank). |
4 | | (b-5) For purposes of the minimum staffing ratios in this |
5 | | Section, all residents shall be classified as requiring either |
6 | | skilled care or intermediate care. |
7 | | As used in this subsection: |
8 | | "Intermediate care" means basic nursing care and other |
9 | | restorative services under periodic medical direction. |
10 | | "Skilled care" means skilled nursing care, continuous |
11 | | skilled nursing observations, restorative nursing, and other |
12 | | services under professional direction with frequent medical |
13 | | supervision. |
14 | | (c) Facilities shall notify the Department within 60 days |
15 | | after July 29, 2010 ( the effective date of Public Act 96-1372) |
16 | | this amendatory Act of the 96th General Assembly , in a form and |
17 | | manner prescribed by the Department, of the staffing ratios in |
18 | | effect on July 29, 2010 ( the effective date of Public Act |
19 | | 96-1372) this amendatory Act of the 96th General Assembly for |
20 | | both intermediate and skilled care and the number of residents |
21 | | receiving each level of care. |
22 | | (d)(1) (Blank). |
23 | | (2) (Blank). |
24 | | (3) (Blank). |
25 | | (4) (Blank). |
26 | | (5) Effective January 1, 2014, the minimum staffing ratios |
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1 | | shall be increased to 3.8 hours of nursing and personal care |
2 | | each day for a resident needing skilled care and 2.5 hours of |
3 | | nursing and personal care each day for a resident needing |
4 | | intermediate care.
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5 | | (e) Ninety days after June 14, 2012 ( the effective date of |
6 | | Public Act 97-689) this amendatory Act of the 97th General |
7 | | Assembly , a minimum of 25% of nursing and personal care time |
8 | | shall be provided by licensed nurses, with at least 10% of |
9 | | nursing and personal care time provided by registered nurses. |
10 | | These minimum requirements shall remain in effect until an |
11 | | acuity based registered nurse requirement is promulgated by |
12 | | rule concurrent with the adoption of the Resource Utilization |
13 | | Group classification-based payment methodology, as provided in |
14 | | Section 5-5.2 of the Illinois Public Aid Code. Registered |
15 | | nurses and licensed practical nurses employed by a facility in |
16 | | excess of these requirements may be used to satisfy the |
17 | | remaining 75% of the nursing and personal care time |
18 | | requirements. Notwithstanding this subsection, no staffing |
19 | | requirement in statute in effect on June 14, 2012 ( the |
20 | | effective date of Public Act 97-689) this amendatory Act of |
21 | | the 97th General Assembly shall be reduced on account of this |
22 | | subsection. |
23 | | (f) The Department shall submit proposed rules for |
24 | | adoption by January 1, 2020 establishing a system for |
25 | | determining compliance with minimum staffing set forth in this |
26 | | Section and the requirements of 77 Ill. Adm. Code 300.1230 |
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1 | | adjusted for any waivers granted under Section 3-303.1. |
2 | | Compliance shall be determined quarterly by comparing the |
3 | | number of hours provided per resident per day using the |
4 | | Centers for Medicare and Medicaid Services' payroll-based |
5 | | journal and the facility's daily census, broken down by |
6 | | intermediate and skilled care as self-reported by the facility |
7 | | to the Department on a quarterly basis. The Department shall |
8 | | use the quarterly payroll-based journal and the self-reported |
9 | | census to calculate the number of hours provided per resident |
10 | | per day and compare this ratio to the minimum staffing |
11 | | standards required under this Section, as impacted by any |
12 | | waivers granted under Section 3-303.1. Discrepancies between |
13 | | job titles contained in this Section and the payroll-based |
14 | | journal shall be addressed by rule. The manner in which the |
15 | | Department requests payroll-based journal information to be |
16 | | submitted shall align with the federal Centers for Medicare |
17 | | and Medicaid Services' requirements that allow providers to |
18 | | submit the quarterly data in an aggregate manner. |
19 | | (g) Monetary penalties for non-compliance. The Department |
20 | | shall submit proposed rules for adoption by January 1, 2020 |
21 | | establishing monetary penalties for facilities not in |
22 | | compliance with minimum staffing standards under this Section. |
23 | | Facilities shall be required to comply with the provisions of |
24 | | this subsection beginning January 1, 2025. No monetary penalty |
25 | | may be issued for noncompliance prior to during the revised |
26 | | implementation date period , which shall be January 1, 2025 |
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1 | | July 1, 2020 through December 31, 2021 . If a facility is found |
2 | | to be noncompliant prior to during the revised implementation |
3 | | date period , the Department shall provide a written notice |
4 | | identifying the staffing deficiencies and require the facility |
5 | | to provide a sufficiently detailed correction plan that |
6 | | describes proposed and completed actions the facility will |
7 | | take or has taken, including hiring actions, to address the |
8 | | facility's failure to meet the statutory minimum staffing |
9 | | levels. Monetary penalties shall be imposed beginning no later |
10 | | than July 1, 2025, based on data for the quarter beginning |
11 | | January 1, 2025 through March 31, 2025 January 1, 2022 and |
12 | | quarterly thereafter and shall be based on the latest quarter |
13 | | for which the Department has data . Monetary penalties shall be |
14 | | established based on a formula that calculates on a daily |
15 | | basis the cost of wages and benefits for the missing staffing |
16 | | hours. All notices of noncompliance shall include the |
17 | | computations used to determine noncompliance and establishing |
18 | | the variance between minimum staffing ratios and the |
19 | | Department's computations. The penalty for the first offense |
20 | | shall be 125% of the cost of wages and benefits for the missing |
21 | | staffing hours. The penalty shall increase to 150% of the cost |
22 | | of wages and benefits for the missing staffing hours for the |
23 | | second offense and 200% the cost of wages and benefits for the |
24 | | missing staffing hours for the third and all subsequent |
25 | | offenses. The penalty shall be imposed regardless of whether |
26 | | the facility has committed other violations of this Act during |
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1 | | the same period that the staffing offense occurred. The |
2 | | penalty may not be waived, but the Department shall have the |
3 | | discretion to determine the gravity of the violation in |
4 | | situations where there is no more than a 10% deviation from the |
5 | | staffing requirements and make appropriate adjustments to the |
6 | | penalty. The Department is granted discretion to waive the |
7 | | penalty when unforeseen circumstances have occurred that |
8 | | resulted in call-offs of scheduled staff. This provision shall |
9 | | be applied no more than 6 times per quarter. Nothing in this |
10 | | Section diminishes a facility's right to appeal the imposition |
11 | | of a monetary penalty. No facility may appeal a notice of |
12 | | noncompliance issued during the revised implementation period . |
13 | | (Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21; |
14 | | revised 2-28-22.) |
15 | | Section 15. The Specialized Mental Health Rehabilitation |
16 | | Act of 2013 is amended by changing Section 1-102 as follows: |
17 | | (210 ILCS 49/1-102)
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18 | | Sec. 1-102. Definitions. For the purposes of this Act, |
19 | | unless the context otherwise requires: |
20 | | "Abuse" means any physical or mental injury or sexual |
21 | | assault inflicted on a consumer other than by accidental means |
22 | | in a facility. |
23 | | "Accreditation" means any of the following: |
24 | | (1) the Joint Commission; |
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1 | | (2) the Commission on Accreditation of Rehabilitation |
2 | | Facilities; |
3 | | (3) the Healthcare Facilities Accreditation Program; |
4 | | or |
5 | | (4) any other national standards of care as approved |
6 | | by the Department. |
7 | | "APRN" means an Advanced Practice Registered Nurse, |
8 | | nationally certified as a mental health or psychiatric nurse |
9 | | practitioner and licensed under the Nurse Practice Act. |
10 | | "Applicant" means any person making application for a |
11 | | license or a provisional license under this Act. |
12 | | "Consumer" means a person, 18 years of age or older, |
13 | | admitted to a mental health rehabilitation facility for |
14 | | evaluation, observation, diagnosis, treatment, stabilization, |
15 | | recovery, and rehabilitation. |
16 | | "Consumer" does not mean any of the following: |
17 | | (i) an individual requiring a locked setting; |
18 | | (ii) an individual requiring psychiatric |
19 | | hospitalization because of an acute psychiatric crisis; |
20 | | (iii) an individual under 18 years of age; |
21 | | (iv) an individual who is actively suicidal or violent |
22 | | toward others; |
23 | | (v) an individual who has been found unfit to stand |
24 | | trial and is currently subject to a court order requiring |
25 | | placement in secure inpatient care in the custody of the |
26 | | Department of Human Services pursuant to Section 104-17 of |
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1 | | the Code of Criminal Procedure of 1963 ; |
2 | | (vi) an individual who has been found not guilty by |
3 | | reason of insanity and is currently subject to a court |
4 | | order requiring placement in secure inpatient care in the |
5 | | custody of the Department of Human Services pursuant to |
6 | | Section 5-2-4 of the Unified Code of Corrections based on |
7 | | committing a violent act, such as sexual assault, assault |
8 | | with a deadly weapon, arson, or murder ; |
9 | | (vii) an individual subject to temporary detention and |
10 | | examination under Section 3-607 of the Mental Health and |
11 | | Developmental Disabilities Code; |
12 | | (viii) an individual deemed clinically appropriate for |
13 | | inpatient admission in a State psychiatric hospital; and |
14 | | (ix) an individual transferred by the Department of |
15 | | Corrections pursuant to Section 3-8-5 of the Unified Code |
16 | | of Corrections. |
17 | | "Consumer record" means a record that organizes all |
18 | | information on the care, treatment, and rehabilitation |
19 | | services rendered to a consumer in a specialized mental health |
20 | | rehabilitation facility. |
21 | | "Controlled drugs" means those drugs covered under the |
22 | | federal Comprehensive Drug Abuse Prevention Control Act of |
23 | | 1970, as amended, or the Illinois Controlled Substances Act. |
24 | | "Department" means the Department of Public Health. |
25 | | "Discharge" means the full release of any consumer from a |
26 | | facility. |
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1 | | "Drug administration" means the act in which a single dose |
2 | | of a prescribed drug or biological is given to a consumer. The |
3 | | complete act of administration entails removing an individual |
4 | | dose from a container, verifying the dose with the |
5 | | prescriber's orders, giving the individual dose to the |
6 | | consumer, and promptly recording the time and dose given. |
7 | | "Drug dispensing" means the act entailing the following of |
8 | | a prescription order for a drug or biological and proper |
9 | | selection, measuring, packaging, labeling, and issuance of the |
10 | | drug or biological to a consumer. |
11 | | "Emergency" means a situation, physical condition, or one |
12 | | or more practices, methods, or operations which present |
13 | | imminent danger of death or serious physical or mental harm to |
14 | | consumers of a facility. |
15 | | "Facility" means a specialized mental health |
16 | | rehabilitation facility that provides at least one of the |
17 | | following services: (1) triage center; (2) crisis |
18 | | stabilization; (3) recovery and rehabilitation supports; or |
19 | | (4) transitional living units for 3 or more persons. The |
20 | | facility shall provide a 24-hour program that provides |
21 | | intensive support and recovery services designed to assist |
22 | | persons, 18 years or older, with mental disorders to develop |
23 | | the skills to become self-sufficient and capable of increasing |
24 | | levels of independent functioning. It includes facilities that |
25 | | meet the following criteria: |
26 | | (1) 100% of the consumer population of the facility |
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1 | | has a diagnosis of serious mental illness; |
2 | | (2) no more than 15% of the consumer population of the |
3 | | facility is 65 years of age or older; |
4 | | (3) none of the consumers are non-ambulatory; |
5 | | (4) none of the consumers have a primary diagnosis of |
6 | | moderate, severe, or profound intellectual disability; and |
7 | | (5) the facility must have been licensed under the |
8 | | Specialized Mental Health Rehabilitation Act or the |
9 | | Nursing Home Care Act immediately preceding July 22, 2013 |
10 | | (the effective date of this Act) and qualifies as an |
11 | | institute for mental disease under the federal definition |
12 | | of the term. |
13 | | "Facility" does not include the following: |
14 | | (1) a home, institution, or place operated by the |
15 | | federal government or agency thereof, or by the State of |
16 | | Illinois; |
17 | | (2) a hospital, sanitarium, or other institution whose |
18 | | principal activity or business is the diagnosis, care, and |
19 | | treatment of human illness through the maintenance and |
20 | | operation as organized facilities therefor which is |
21 | | required to be licensed under the Hospital Licensing Act; |
22 | | (3) a facility for child care as defined in the Child |
23 | | Care Act of 1969; |
24 | | (4) a community living facility as defined in the |
25 | | Community Living Facilities Licensing Act; |
26 | | (5) a nursing home or sanitarium sanatorium operated |
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1 | | solely by and for persons who rely exclusively upon |
2 | | treatment by spiritual means through prayer, in accordance |
3 | | with the creed or tenets of any well-recognized church or |
4 | | religious denomination; however, such nursing home or |
5 | | sanitarium sanatorium shall comply with all local laws and |
6 | | rules relating to sanitation and safety; |
7 | | (6) a facility licensed by the Department of Human |
8 | | Services as a community-integrated living arrangement as |
9 | | defined in the Community-Integrated Living Arrangements |
10 | | Licensure and Certification Act; |
11 | | (7) a supportive residence licensed under the |
12 | | Supportive Residences Licensing Act; |
13 | | (8) a supportive living facility in good standing with |
14 | | the program established under Section 5-5.01a of the |
15 | | Illinois Public Aid Code, except only for purposes of the |
16 | | employment of persons in accordance with Section 3-206.01 |
17 | | of the Nursing Home Care Act; |
18 | | (9) an assisted living or shared housing establishment |
19 | | licensed under the Assisted Living and Shared Housing Act, |
20 | | except only for purposes of the employment of persons in |
21 | | accordance with Section 3-206.01 of the Nursing Home Care |
22 | | Act; |
23 | | (10) an Alzheimer's disease management center |
24 | | alternative health care model licensed under the |
25 | | Alternative Health Care Delivery Act; |
26 | | (11) a home, institution, or other place operated by |
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1 | | or under the authority of the Illinois Department of |
2 | | Veterans' Affairs; |
3 | | (12) a facility licensed under the ID/DD Community |
4 | | Care Act; |
5 | | (13) a facility licensed under the Nursing Home Care |
6 | | Act after July 22, 2013 (the effective date of this Act); |
7 | | or |
8 | | (14) a facility licensed under the MC/DD Act. |
9 | | "Executive director" means a person who is charged with |
10 | | the general administration and supervision of a facility |
11 | | licensed under this Act and who is a licensed nursing home |
12 | | administrator, licensed practitioner of the healing arts, or |
13 | | qualified mental health professional. |
14 | | "Guardian" means a person appointed as a guardian of the |
15 | | person or guardian of the estate, or both, of a consumer under |
16 | | the Probate Act of 1975. |
17 | | "Identified offender" means a person who meets any of the |
18 | | following criteria: |
19 | | (1) Has been convicted of, found guilty of, |
20 | | adjudicated delinquent for, found not guilty by reason of |
21 | | insanity for, or found unfit to stand trial for, any |
22 | | felony offense listed in Section 25 of the Health Care |
23 | | Worker Background Check Act, except for the following: |
24 | | (i) a felony offense described in Section 10-5 of |
25 | | the Nurse Practice Act; |
26 | | (ii) a felony offense described in Section 4, 5, |
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1 | | 6, 8, or 17.02 of the Illinois Credit Card and Debit |
2 | | Card Act; |
3 | | (iii) a felony offense described in Section 5, |
4 | | 5.1, 5.2, 7, or 9 of the Cannabis Control Act; |
5 | | (iv) a felony offense described in Section 401, |
6 | | 401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois |
7 | | Controlled Substances Act; and |
8 | | (v) a felony offense described in the |
9 | | Methamphetamine Control and Community Protection Act. |
10 | | (2) Has been convicted of, adjudicated delinquent
for, |
11 | | found not guilty by reason of insanity for, or found unfit |
12 | | to stand trial for , any sex offense as defined in |
13 | | subsection (c) of Section 10 of the Sex Offender |
14 | | Management Board Act. |
15 | | "Transitional living units" are residential units within a |
16 | | facility that have the purpose of assisting the consumer in |
17 | | developing and reinforcing the necessary skills to live |
18 | | independently outside of the facility. The duration of stay in |
19 | | such a setting shall not exceed 120 days for each consumer. |
20 | | Nothing in this definition shall be construed to be a |
21 | | prerequisite for transitioning out of a facility. |
22 | | "Licensee" means the person, persons, firm, partnership, |
23 | | association, organization, company, corporation, or business |
24 | | trust to which a license has been issued. |
25 | | "Misappropriation of a consumer's property" means the |
26 | | deliberate misplacement, exploitation, or wrongful temporary |
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1 | | or permanent use of a consumer's belongings or money without |
2 | | the consent of a consumer or his or her guardian. |
3 | | "Neglect" means a facility's failure to provide, or |
4 | | willful withholding of, adequate medical care, mental health |
5 | | treatment, psychiatric rehabilitation, personal care, or |
6 | | assistance that is necessary to avoid physical harm and mental |
7 | | anguish of a consumer. |
8 | | "Personal care" means assistance with meals, dressing, |
9 | | movement, bathing, or other personal needs, maintenance, or |
10 | | general supervision and oversight of the physical and mental |
11 | | well-being of an individual who is incapable of maintaining a |
12 | | private, independent residence or who is incapable of managing |
13 | | his or her person, whether or not a guardian has been appointed |
14 | | for such individual. "Personal care" shall not be construed to |
15 | | confine or otherwise constrain a facility's pursuit to develop |
16 | | the skills and abilities of a consumer to become |
17 | | self-sufficient and capable of increasing levels of |
18 | | independent functioning. |
19 | | "Recovery and rehabilitation supports" means a program |
20 | | that facilitates a consumer's longer-term symptom management |
21 | | and stabilization while preparing the consumer for |
22 | | transitional living units by improving living skills and |
23 | | community socialization. The duration of stay in such a |
24 | | setting shall be established by the Department by rule. |
25 | | "Restraint" means: |
26 | | (i) a physical restraint that is any manual method or
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1 | | physical or mechanical device, material, or equipment |
2 | | attached or adjacent to a consumer's body that the |
3 | | consumer cannot remove easily and restricts freedom of |
4 | | movement or normal access to one's body; devices used for |
5 | | positioning, including, but not limited to, bed rails, |
6 | | gait belts, and cushions, shall not be considered to be |
7 | | restraints for purposes of this Section; or |
8 | | (ii) a chemical restraint that is any drug used for
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9 | | discipline or convenience and not required to treat |
10 | | medical symptoms; the Department shall, by rule, designate |
11 | | certain devices as restraints, including at least all |
12 | | those devices that have been determined to be restraints |
13 | | by the United States Department of Health and Human |
14 | | Services in interpretive guidelines issued for the |
15 | | purposes of administering Titles XVIII and XIX of the |
16 | | federal Social Security Act. For the purposes of this Act, |
17 | | restraint shall be administered only after utilizing a |
18 | | coercive free environment and culture. |
19 | | "Self-administration of medication" means consumers shall |
20 | | be responsible for the control, management, and use of their |
21 | | own medication. |
22 | | "Crisis stabilization" means a secure and separate unit |
23 | | that provides short-term behavioral, emotional, or psychiatric |
24 | | crisis stabilization as an alternative to hospitalization or |
25 | | re-hospitalization for consumers from residential or community |
26 | | placement. The duration of stay in such a setting shall not |
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1 | | exceed 21 days for each consumer. |
2 | | "Therapeutic separation" means the removal of a consumer |
3 | | from the milieu to a room or area which is designed to aid in |
4 | | the emotional or psychiatric stabilization of that consumer. |
5 | | "Triage center" means a non-residential 23-hour center |
6 | | that serves as an alternative to emergency room care, |
7 | | hospitalization, or re-hospitalization for consumers in need |
8 | | of short-term crisis stabilization. Consumers may access a |
9 | | triage center from a number of referral sources, including |
10 | | family, emergency rooms, hospitals, community behavioral |
11 | | health providers, federally qualified health providers, or |
12 | | schools, including colleges or universities. A triage center |
13 | | may be located in a building separate from the licensed |
14 | | location of a facility, but shall not be more than 1,000 feet |
15 | | from the licensed location of the facility and must meet all of |
16 | | the facility standards applicable to the licensed location. If |
17 | | the triage center does operate in a separate building, safety |
18 | | personnel shall be provided, on site, 24 hours per day and the |
19 | | triage center shall meet all other staffing requirements |
20 | | without counting any staff employed in the main facility |
21 | | building.
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22 | | (Source: P.A. 102-1053, eff. 6-10-22; revised 8-24-22.) |
23 | | Section 20. The Hospital Licensing Act is amended by |
24 | | changing Section 3 as follows:
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1 | | (210 ILCS 85/3)
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2 | | Sec. 3. As used in this Act:
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3 | | (A) "Hospital" means any institution, place, building, |
4 | | buildings on a campus, or agency, public
or private, whether |
5 | | organized for profit or not, devoted primarily to the
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6 | | maintenance and operation of facilities for the diagnosis and |
7 | | treatment or
care of 2 or more unrelated persons admitted for |
8 | | overnight stay or longer
in order to obtain medical, including |
9 | | obstetric, psychiatric and nursing,
care of illness, disease, |
10 | | injury, infirmity, or deformity.
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11 | | The term "hospital", without regard to length of stay, |
12 | | shall also
include:
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13 | | (a) any facility which is devoted primarily to |
14 | | providing psychiatric and
related services and programs |
15 | | for the diagnosis and treatment or care of
2 or more |
16 | | unrelated persons suffering from emotional or nervous |
17 | | diseases;
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18 | | (b) all places where pregnant females are received, |
19 | | cared for, or
treated during delivery irrespective of the |
20 | | number of patients received ; and . |
21 | | (c) on and after January 1, 2023, a rural emergency |
22 | | hospital, as that term is defined under subsection |
23 | | (kkk)(2) of Section 1861 of the federal Social Security |
24 | | Act; to provide for the expeditious and timely |
25 | | implementation of this amendatory Act of the 102nd General |
26 | | Assembly, emergency rules to implement the changes made to |
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1 | | the definition of "hospital" by this amendatory Act of the |
2 | | 102nd General Assembly may be adopted by the Department |
3 | | subject to the provisions of Section 5-45 of the Illinois |
4 | | Administrative Procedure
Act.
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5 | | The term "hospital" includes general and specialized |
6 | | hospitals,
tuberculosis sanitaria, mental or psychiatric |
7 | | hospitals and sanitaria, and
includes maternity homes, |
8 | | lying-in homes, and homes for unwed mothers in
which care is |
9 | | given during delivery.
|
10 | | The term "hospital" does not include:
|
11 | | (1) any person or institution
required to be licensed |
12 | | pursuant to the Nursing Home Care Act, the Specialized |
13 | | Mental Health Rehabilitation Act of 2013, the ID/DD |
14 | | Community Care Act, or the MC/DD Act;
|
15 | | (2) hospitalization or care facilities maintained by |
16 | | the State or any
department or agency thereof, where such |
17 | | department or agency has authority
under law to establish |
18 | | and enforce standards for the hospitalization or
care |
19 | | facilities under its management and control;
|
20 | | (3) hospitalization or care facilities maintained by |
21 | | the federal
government or agencies thereof;
|
22 | | (4) hospitalization or care facilities maintained by |
23 | | any university or
college established under the laws of |
24 | | this State and supported principally
by public funds |
25 | | raised by taxation;
|
26 | | (5) any person or facility required to be licensed |
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1 | | pursuant to the
Substance Use Disorder Act;
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2 | | (6) any facility operated solely by and for persons |
3 | | who rely
exclusively upon treatment by spiritual means |
4 | | through prayer, in accordance
with the creed or tenets of |
5 | | any well-recognized church or religious
denomination;
|
6 | | (7) an Alzheimer's disease management center |
7 | | alternative health care
model licensed under the |
8 | | Alternative Health Care Delivery Act; or
|
9 | | (8) any veterinary hospital or clinic operated by a |
10 | | veterinarian or veterinarians licensed under the |
11 | | Veterinary Medicine and Surgery Practice Act of 2004 or |
12 | | maintained by a State-supported or publicly funded |
13 | | university or college. |
14 | | (B) "Person" means the State, and any political |
15 | | subdivision or municipal
corporation, individual, firm, |
16 | | partnership, corporation, company,
association, or joint stock |
17 | | association, or the legal successor thereof.
|
18 | | (C) "Department" means the Department of Public Health of |
19 | | the State of
Illinois.
|
20 | | (D) "Director" means the Director of Public Health of
the |
21 | | State of Illinois.
|
22 | | (E) "Perinatal" means the period of time
between the |
23 | | conception of an
infant and the end of the first month after |
24 | | birth.
|
25 | | (F) "Federally designated organ procurement agency" means |
26 | | the organ
procurement agency designated by the Secretary of |
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1 | | the U.S. Department of Health
and Human Services for the |
2 | | service area in which a hospital is located; except
that in the |
3 | | case of a hospital located in a county adjacent to Wisconsin
|
4 | | which currently contracts with an organ procurement agency |
5 | | located in Wisconsin
that is not the organ procurement agency |
6 | | designated by the U.S. Secretary of
Health and Human Services |
7 | | for the service area in which the hospital is
located, if the |
8 | | hospital applies for a waiver pursuant to 42 U.S.C. USC
|
9 | | 1320b-8(a), it may designate an organ procurement agency
|
10 | | located in Wisconsin to be thereafter deemed its federally |
11 | | designated organ
procurement agency for the purposes of this |
12 | | Act.
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13 | | (G) "Tissue bank" means any facility or program operating |
14 | | in Illinois
that is certified by the American Association of |
15 | | Tissue Banks or the Eye Bank
Association of America and is |
16 | | involved in procuring, furnishing, donating,
or distributing |
17 | | corneas, bones, or other human tissue for the purpose of
|
18 | | injecting, transfusing, or transplanting any of them into the |
19 | | human body.
"Tissue bank" does not include a licensed blood |
20 | | bank. For the purposes of this
Act, "tissue" does not include |
21 | | organs.
|
22 | | (H) "Campus", as this term terms applies to operations, |
23 | | has the same meaning as the term "campus" as set forth in |
24 | | federal Medicare regulations, 42 CFR 413.65. |
25 | | (Source: P.A. 99-180, eff. 7-29-15; 100-759, eff. 1-1-19 .) |
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1 | | Section 25. The Behavior Analyst Licensing Act is amended |
2 | | by changing Sections 30, 35, and 150 as follows: |
3 | | (225 ILCS 6/30) |
4 | | (Section scheduled to be repealed on January 1, 2028)
|
5 | | Sec. 30. Qualifications for behavior analyst license. |
6 | | (a) A person qualifies to be licensed as a behavior |
7 | | analyst if that person: |
8 | | (1) has applied in writing or electronically on forms |
9 | | prescribed by the Department; |
10 | | (2) is a graduate of a graduate level program in the |
11 | | field of behavior analysis or a related field with an |
12 | | equivalent course of study in behavior analysis approved |
13 | | by the Department from a regionally accredited university |
14 | | approved by the Department ; |
15 | | (3) has completed at least 500 hours of supervision of |
16 | | behavior analysis, as defined by rule; |
17 | | (4) has qualified for and passed the examination for |
18 | | the practice of behavior analysis as authorized by the |
19 | | Department; and |
20 | | (5) has paid the required fees. |
21 | | (b) The Department may issue a license to a certified |
22 | | behavior analyst seeking licensure as a licensed behavior |
23 | | analyst
who (i) does not have the supervised experience as |
24 | | described in paragraph (3) of subsection (a), (ii) applies for |
25 | | licensure before July 1, 2028, and (iii) has completed all of |
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1 | | the following: |
2 | | (1) has applied in writing or electronically on forms |
3 | | prescribed by the Department; |
4 | | (2) is a graduate of a graduate level program in the |
5 | | field of behavior analysis from a regionally accredited |
6 | | university approved by the Department; |
7 | | (3) submits evidence of certification by an |
8 | | appropriate national certifying body as determined by rule |
9 | | of the Department; |
10 | | (4) has passed the examination for the practice of |
11 | | behavior analysis as authorized by the Department; and |
12 | | (5) has paid the required fees. |
13 | | (c) An applicant has 3 years after the date of application |
14 | | to complete the application process. If the process has not |
15 | | been completed in 3 years, the application shall be denied, |
16 | | the fee shall be forfeited, and the applicant must reapply and |
17 | | meet the requirements in effect at the time of reapplication. |
18 | | (d) Each applicant for licensure as a an behavior analyst |
19 | | shall have his or her fingerprints submitted to the Illinois |
20 | | State Police in an electronic format that complies with the |
21 | | form and manner for requesting and furnishing criminal history |
22 | | record information as prescribed by the Illinois State Police. |
23 | | These fingerprints shall be transmitted through a live scan |
24 | | fingerprint vendor licensed by the Department. These |
25 | | fingerprints shall be checked against the Illinois State |
26 | | Police and Federal Bureau of Investigation criminal history |
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1 | | record databases now and hereafter filed, including, but not |
2 | | limited to, civil, criminal, and latent fingerprint databases. |
3 | | The Illinois State Police shall charge a fee for conducting |
4 | | the criminal history records check, which shall be deposited |
5 | | in the State Police Services Fund and shall not exceed the |
6 | | actual cost of the records check. The Illinois State Police |
7 | | shall furnish, pursuant to positive identification, records of |
8 | | Illinois convictions as prescribed under the Illinois Uniform |
9 | | Conviction Information Act and shall forward the national |
10 | | criminal history record information to the Department.
|
11 | | (Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.) |
12 | | (225 ILCS 6/35) |
13 | | (Section scheduled to be repealed on January 1, 2028)
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14 | | Sec. 35. Qualifications for assistant behavior analyst |
15 | | license. |
16 | | (a) A person qualifies to be licensed as an assistant |
17 | | behavior analyst if that person: |
18 | | (1) has applied in writing or electronically on forms |
19 | | prescribed by the Department; |
20 | | (2) is a graduate of a bachelor's level program in the |
21 | | field of behavior analysis or a related field with an |
22 | | equivalent course of study in behavior analysis approved |
23 | | by the Department from a regionally accredited university |
24 | | approved by the Department ; |
25 | | (3) has met the supervised work experience; |
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1 | | (4) has qualified for and passed the examination for |
2 | | the practice of behavior analysis as a licensed assistant |
3 | | behavior analyst as authorized by the Department; and |
4 | | (5) has paid the required fees. |
5 | | (b) The Department may issue a license to a certified |
6 | | assistant behavior analyst seeking licensure as a licensed |
7 | | assistant behavior analyst who (i) does not have the |
8 | | supervised experience as described in paragraph (3) of |
9 | | subsection (a), (ii) applies for licensure before July 1, |
10 | | 2028, and (iii) has completed all of the following: |
11 | | (1) has applied in writing or electronically on forms |
12 | | prescribed by the Department; |
13 | | (2) is a graduate of a bachelor's bachelors level |
14 | | program in the field of behavior analysis; |
15 | | (3) submits evidence of certification by an |
16 | | appropriate national certifying body as determined by rule |
17 | | of the Department; |
18 | | (4) has passed the examination for the practice of |
19 | | behavior analysis as authorized by the Department; and |
20 | | (5) has paid the required fees. |
21 | | (c) An applicant has 3 years after the date of application |
22 | | to complete the application process. If the process has not |
23 | | been completed in 3 years, the application shall be denied, |
24 | | the fee shall be forfeited, and the applicant must reapply and |
25 | | meet the requirements in effect at the time of reapplication. |
26 | | (d) Each applicant for licensure as an assistant behavior |
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1 | | analyst shall have his or her fingerprints submitted to the |
2 | | Illinois State Police in an electronic format that complies |
3 | | with the form and manner for requesting and furnishing |
4 | | criminal history record information as prescribed by the |
5 | | Illinois State Police. These fingerprints shall be transmitted |
6 | | through a live scan fingerprint vendor licensed by the |
7 | | Department. These fingerprints shall be checked against the |
8 | | Illinois State Police and Federal Bureau of Investigation |
9 | | criminal history record databases now and hereafter filed, |
10 | | including, but not limited to, civil, criminal, and latent |
11 | | fingerprint databases. The Illinois State Police shall charge |
12 | | a fee for conducting the criminal history records check, which |
13 | | shall be deposited in the State Police Services Fund and shall |
14 | | not exceed the actual cost of the records check. The Illinois |
15 | | State Police shall furnish, pursuant to positive |
16 | | identification, records of Illinois convictions as prescribed |
17 | | under the Illinois Uniform Conviction Information Act and |
18 | | shall forward the national criminal history record information |
19 | | to the Department.
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20 | | (Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.) |
21 | | (225 ILCS 6/150) |
22 | | (Section scheduled to be repealed on January 1, 2028)
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23 | | Sec. 150. License restrictions and limitations. |
24 | | Notwithstanding the exclusion in paragraph (2) of subsection |
25 | | (c) of Section 20 that permits an individual to implement a |
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1 | | behavior analytic treatment plan under the extended authority, |
2 | | direction, and supervision of a licensed behavior analyst or |
3 | | licensed assistant behavior analyst, no No business |
4 | | organization shall provide, attempt to provide, or offer to |
5 | | provide behavior analysis services unless every member, |
6 | | partner, shareholder, director, officer, holder of any other |
7 | | ownership interest, agent, and employee who renders applied |
8 | | behavior analysis services holds a currently valid license |
9 | | issued under this Act. No business shall be created that (i) |
10 | | has a stated purpose that includes behavior analysis, or (ii) |
11 | | practices or holds itself out as available to practice |
12 | | behavior analysis therapy, unless it is organized under the |
13 | | Professional Service Corporation Act or Professional Limited |
14 | | Liability Company Act. Nothing in this Act shall preclude |
15 | | individuals licensed under this Act from practicing directly |
16 | | or indirectly for a physician licensed to practice medicine in |
17 | | all its branches under the Medical Practice Act of 1987 or for |
18 | | any legal entity as provided under subsection (c) of Section |
19 | | 22.2 of the Medical Practice Act of 1987.
|
20 | | (Source: P.A. 102-953, eff. 5-27-22.) |
21 | | Section 30. The Podiatric Medical Practice Act of 1987 is |
22 | | amended by adding Section 18.1 as follows: |
23 | | (225 ILCS 100/18.1 new) |
24 | | Sec. 18.1. Fee waivers. Notwithstanding any provision of |
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1 | | law to the contrary, during State Fiscal Year 2023, the |
2 | | Department shall allow individuals a one-time waiver of fees |
3 | | imposed under Section 18 of this Act. No individual may |
4 | | benefit from such a waiver more than once. If an individual has |
5 | | already paid a fee required under Section 18 for Fiscal Year |
6 | | 2023, then the Department shall apply the money paid for that |
7 | | fee as a credit to the next required fee. |
8 | | Section 35. The Illinois Public Aid Code is amended by |
9 | | changing Sections 5-5.2, 5-5.7b, and 5B-2 follows:
|
10 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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11 | | Sec. 5-5.2. Payment.
|
12 | | (a) All nursing facilities that are grouped pursuant to |
13 | | Section
5-5.1 of this Act shall receive the same rate of |
14 | | payment for similar
services.
|
15 | | (b) It shall be a matter of State policy that the Illinois |
16 | | Department
shall utilize a uniform billing cycle throughout |
17 | | the State for the
long-term care providers.
|
18 | | (c) (Blank). |
19 | | (c-1) Notwithstanding any other provisions of this Code, |
20 | | the methodologies for reimbursement of nursing services as |
21 | | provided under this Article shall no longer be applicable for |
22 | | bills payable for nursing services rendered on or after a new |
23 | | reimbursement system based on the Patient Driven Payment Model |
24 | | (PDPM) has been fully operationalized, which shall take effect |
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1 | | for services provided on or after the implementation of the |
2 | | PDPM reimbursement system begins. For the purposes of this |
3 | | amendatory Act of the 102nd General Assembly, the |
4 | | implementation date of the PDPM reimbursement system and all |
5 | | related provisions shall be July 1, 2022 if the following |
6 | | conditions are met: (i) the Centers for Medicare and Medicaid |
7 | | Services has approved corresponding changes in the |
8 | | reimbursement system and bed assessment; and (ii) the |
9 | | Department has filed rules to implement these changes no later |
10 | | than June 1, 2022. Failure of the Department to file rules to |
11 | | implement the changes provided in this amendatory Act of the |
12 | | 102nd General Assembly no later than June 1, 2022 shall result |
13 | | in the implementation date being delayed to October 1, 2022. |
14 | | (d) The new nursing services reimbursement methodology |
15 | | utilizing the Patient Driven Payment Model, which shall be |
16 | | referred to as the PDPM reimbursement system, taking effect |
17 | | July 1, 2022, upon federal approval by the Centers for |
18 | | Medicare and Medicaid Services, shall be based on the |
19 | | following: |
20 | | (1) The methodology shall be resident-centered, |
21 | | facility-specific, cost-based, and based on guidance from |
22 | | the Centers for Medicare and Medicaid Services. |
23 | | (2) Costs shall be annually rebased and case mix index |
24 | | quarterly updated. The nursing services methodology will |
25 | | be assigned to the Medicaid enrolled residents on record |
26 | | as of 30 days prior to the beginning of the rate period in |
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1 | | the Department's Medicaid Management Information System |
2 | | (MMIS) as present on the last day of the second quarter |
3 | | preceding the rate period based upon the Assessment |
4 | | Reference Date of the Minimum Data Set (MDS). |
5 | | (3) Regional wage adjustors based on the Health |
6 | | Service Areas (HSA) groupings and adjusters in effect on |
7 | | April 30, 2012 shall be included, except no adjuster shall |
8 | | be lower than 1.06. |
9 | | (4) PDPM nursing case mix indices in effect on March |
10 | | 1, 2022 shall be assigned to each resident class at no less |
11 | | than 0.7858 of the Centers for Medicare and Medicaid |
12 | | Services PDPM unadjusted case mix values, in effect on |
13 | | March 1, 2022 , utilizing an index maximization approach . |
14 | | (5) The pool of funds available for distribution by |
15 | | case mix and the base facility rate shall be determined |
16 | | using the formula contained in subsection (d-1). |
17 | | (6) The Department shall establish a variable per diem |
18 | | staffing add-on in accordance with the most recent |
19 | | available federal staffing report, currently the Payroll |
20 | | Based Journal, for the same period of time, and if |
21 | | applicable adjusted for acuity using the same quarter's |
22 | | MDS. The Department shall rely on Payroll Based Journals |
23 | | provided to the Department of Public Health to make a |
24 | | determination of non-submission. If the Department is |
25 | | notified by a facility of missing or inaccurate Payroll |
26 | | Based Journal data or an incorrect calculation of |
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1 | | staffing, the Department must make a correction as soon as |
2 | | the error is verified for the applicable quarter. |
3 | | Facilities with at least 70% of the staffing indicated |
4 | | by the STRIVE study shall be paid a per diem add-on of $9, |
5 | | increasing by equivalent steps for each whole percentage |
6 | | point until the facilities reach a per diem of $14.88. |
7 | | Facilities with at least 80% of the staffing indicated by |
8 | | the STRIVE study shall be paid a per diem add-on of $14.88, |
9 | | increasing by equivalent steps for each whole percentage |
10 | | point until the facilities reach a per diem add-on of |
11 | | $23.80. Facilities with at least 92% of the staffing |
12 | | indicated by the STRIVE study shall be paid a per diem |
13 | | add-on of $23.80, increasing by equivalent steps for each |
14 | | whole percentage point until the facilities reach a per |
15 | | diem add-on of $29.75. Facilities with at least 100% of |
16 | | the staffing indicated by the STRIVE study shall be paid a |
17 | | per diem add-on of $29.75, increasing by equivalent steps |
18 | | for each whole percentage point until the facilities reach |
19 | | a per diem add-on of $35.70. Facilities with at least 110% |
20 | | of the staffing indicated by the STRIVE study shall be |
21 | | paid a per diem add-on of $35.70, increasing by equivalent |
22 | | steps for each whole percentage point until the facilities |
23 | | reach a per diem add-on of $38.68. Facilities with at |
24 | | least 125% or higher of the staffing indicated by the |
25 | | STRIVE study shall be paid a per diem add-on of $38.68. |
26 | | Beginning April 1, 2023, no nursing facility's variable |
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1 | | staffing per diem add-on shall be reduced by more than 5% |
2 | | in 2 consecutive quarters. For the quarters beginning July |
3 | | 1, 2022 and October 1, 2022, no facility's variable per |
4 | | diem staffing add-on shall be calculated at a rate lower |
5 | | than 85% of the staffing indicated by the STRIVE study. No |
6 | | facility below 70% of the staffing indicated by the STRIVE |
7 | | study shall receive a variable per diem staffing add-on |
8 | | after December 31, 2022. |
9 | | (7) For dates of services beginning July 1, 2022, the |
10 | | PDPM nursing component per diem for each nursing facility |
11 | | shall be the product of the facility's (i) statewide PDPM |
12 | | nursing base per diem rate, $92.25, adjusted for the |
13 | | facility average PDPM case mix index calculated quarterly |
14 | | and (ii) the regional wage adjuster, and then add the |
15 | | Medicaid access adjustment as defined in (e-3) of this |
16 | | Section. Transition rates for services provided between |
17 | | July 1, 2022 and October 1, 2023 shall be the greater of |
18 | | the PDPM nursing component per diem or: |
19 | | (A) for the quarter beginning July 1, 2022, the |
20 | | RUG-IV nursing component per diem; |
21 | | (B) for the quarter beginning October 1, 2022, the |
22 | | sum of the RUG-IV nursing component per diem |
23 | | multiplied by 0.80 and the PDPM nursing component per |
24 | | diem multiplied by 0.20; |
25 | | (C) for the quarter beginning January 1, 2023, the |
26 | | sum of the RUG-IV nursing component per diem |
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1 | | multiplied by 0.60 and the PDPM nursing component per |
2 | | diem multiplied by 0.40; |
3 | | (D) for the quarter beginning April 1, 2023, the |
4 | | sum of the RUG-IV nursing component per diem |
5 | | multiplied by 0.40 and the PDPM nursing component per |
6 | | diem multiplied by 0.60; |
7 | | (E) for the quarter beginning July 1, 2023, the |
8 | | sum of the RUG-IV nursing component per diem |
9 | | multiplied by 0.20 and the PDPM nursing component per |
10 | | diem multiplied by 0.80; or |
11 | | (F) for the quarter beginning October 1, 2023 and |
12 | | each subsequent quarter, the transition rate shall end |
13 | | and a nursing facility shall be paid 100% of the PDPM |
14 | | nursing component per diem. |
15 | | (d-1) Calculation of base year Statewide RUG-IV nursing |
16 | | base per diem rate. |
17 | | (1) Base rate spending pool shall be: |
18 | | (A) The base year resident days which are |
19 | | calculated by multiplying the number of Medicaid |
20 | | residents in each nursing home as indicated in the MDS |
21 | | data defined in paragraph (4) by 365. |
22 | | (B) Each facility's nursing component per diem in |
23 | | effect on July 1, 2012 shall be multiplied by |
24 | | subsection (A). |
25 | | (C) Thirteen million is added to the product of |
26 | | subparagraph (A) and subparagraph (B) to adjust for |
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1 | | the exclusion of nursing homes defined in paragraph |
2 | | (5). |
3 | | (2) For each nursing home with Medicaid residents as |
4 | | indicated by the MDS data defined in paragraph (4), |
5 | | weighted days adjusted for case mix and regional wage |
6 | | adjustment shall be calculated. For each home this |
7 | | calculation is the product of: |
8 | | (A) Base year resident days as calculated in |
9 | | subparagraph (A) of paragraph (1). |
10 | | (B) The nursing home's regional wage adjustor |
11 | | based on the Health Service Areas (HSA) groupings and |
12 | | adjustors in effect on April 30, 2012. |
13 | | (C) Facility weighted case mix which is the number |
14 | | of Medicaid residents as indicated by the MDS data |
15 | | defined in paragraph (4) multiplied by the associated |
16 | | case weight for the RUG-IV 48 grouper model using |
17 | | standard RUG-IV procedures for index maximization. |
18 | | (D) The sum of the products calculated for each |
19 | | nursing home in subparagraphs (A) through (C) above |
20 | | shall be the base year case mix, rate adjusted |
21 | | weighted days. |
22 | | (3) The Statewide RUG-IV nursing base per diem rate: |
23 | | (A) on January 1, 2014 shall be the quotient of the |
24 | | paragraph (1) divided by the sum calculated under |
25 | | subparagraph (D) of paragraph (2); |
26 | | (B) on and after July 1, 2014 and until July 1, |
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1 | | 2022, shall be the amount calculated under |
2 | | subparagraph (A) of this paragraph (3) plus $1.76; and |
3 | | (C) beginning July 1, 2022 and thereafter, $7 |
4 | | shall be added to the amount calculated under |
5 | | subparagraph (B) of this paragraph (3) of this |
6 | | Section. |
7 | | (4) Minimum Data Set (MDS) comprehensive assessments |
8 | | for Medicaid residents on the last day of the quarter used |
9 | | to establish the base rate. |
10 | | (5) Nursing facilities designated as of July 1, 2012 |
11 | | by the Department as "Institutions for Mental Disease" |
12 | | shall be excluded from all calculations under this |
13 | | subsection. The data from these facilities shall not be |
14 | | used in the computations described in paragraphs (1) |
15 | | through (4) above to establish the base rate. |
16 | | (e) Beginning July 1, 2014, the Department shall allocate |
17 | | funding in the amount up to $10,000,000 for per diem add-ons to |
18 | | the RUGS methodology for dates of service on and after July 1, |
19 | | 2014: |
20 | | (1) $0.63 for each resident who scores in I4200 |
21 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. |
22 | | (2) $2.67 for each resident who scores either a "1" or |
23 | | "2" in any items S1200A through S1200I and also scores in |
24 | | RUG groups PA1, PA2, BA1, or BA2. |
25 | | (e-1) (Blank). |
26 | | (e-2) For dates of services beginning January 1, 2014 and |
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1 | | ending September 30, 2023, the RUG-IV nursing component per |
2 | | diem for a nursing home shall be the product of the statewide |
3 | | RUG-IV nursing base per diem rate, the facility average case |
4 | | mix index, and the regional wage adjustor. For dates of |
5 | | service beginning July 1, 2022 and ending September 30, 2023, |
6 | | the Medicaid access adjustment described in subsection (e-3) |
7 | | shall be added to the product. |
8 | | (e-3) A Medicaid Access Adjustment of $4 adjusted for the |
9 | | facility average PDPM case mix index calculated quarterly |
10 | | shall be added to the statewide PDPM nursing per diem for all |
11 | | facilities with annual Medicaid bed days of at least 70% of all |
12 | | occupied bed days adjusted quarterly. For each new calendar |
13 | | year and for the 6-month period beginning July 1, 2022, the |
14 | | percentage of a facility's occupied bed days comprised of |
15 | | Medicaid bed days shall be determined by the Department |
16 | | quarterly. For dates of service beginning January 1, 2023, the |
17 | | Medicaid Access Adjustment shall be increased to $4.75. This |
18 | | subsection shall be inoperative on and after January 1, 2028. |
19 | | (f) (Blank). |
20 | | (g) Notwithstanding any other provision of this Code, on |
21 | | and after July 1, 2012, for facilities not designated by the |
22 | | Department of Healthcare and Family Services as "Institutions |
23 | | for Mental Disease", rates effective May 1, 2011 shall be |
24 | | adjusted as follows: |
25 | | (1) (Blank); |
26 | | (2) (Blank); |
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1 | | (3) Facility rates for the capital and support |
2 | | components shall be reduced by 1.7%. |
3 | | (h) Notwithstanding any other provision of this Code, on |
4 | | and after July 1, 2012, nursing facilities designated by the |
5 | | Department of Healthcare and Family Services as "Institutions |
6 | | for Mental Disease" and "Institutions for Mental Disease" that |
7 | | are facilities licensed under the Specialized Mental Health |
8 | | Rehabilitation Act of 2013 shall have the nursing, |
9 | | socio-developmental, capital, and support components of their |
10 | | reimbursement rate effective May 1, 2011 reduced in total by |
11 | | 2.7%. |
12 | | (i) On and after July 1, 2014, the reimbursement rates for |
13 | | the support component of the nursing facility rate for |
14 | | facilities licensed under the Nursing Home Care Act as skilled |
15 | | or intermediate care facilities shall be the rate in effect on |
16 | | June 30, 2014 increased by 8.17%. |
17 | | (j) Notwithstanding any other provision of law, subject to |
18 | | federal approval, effective July 1, 2019, sufficient funds |
19 | | shall be allocated for changes to rates for facilities |
20 | | licensed under the Nursing Home Care Act as skilled nursing |
21 | | facilities or intermediate care facilities for dates of |
22 | | services on and after July 1, 2019: (i) to establish, through |
23 | | June 30, 2022 a per diem add-on to the direct care per diem |
24 | | rate not to exceed $70,000,000 annually in the aggregate |
25 | | taking into account federal matching funds for the purpose of |
26 | | addressing the facility's unique staffing needs, adjusted |
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1 | | quarterly and distributed by a weighted formula based on |
2 | | Medicaid bed days on the last day of the second quarter |
3 | | preceding the quarter for which the rate is being adjusted. |
4 | | Beginning July 1, 2022, the annual $70,000,000 described in |
5 | | the preceding sentence shall be dedicated to the variable per |
6 | | diem add-on for staffing under paragraph (6) of subsection |
7 | | (d); and (ii) in an amount not to exceed $170,000,000 annually |
8 | | in the aggregate taking into account federal matching funds to |
9 | | permit the support component of the nursing facility rate to |
10 | | be updated as follows: |
11 | | (1) 80%, or $136,000,000, of the funds shall be used |
12 | | to update each facility's rate in effect on June 30, 2019 |
13 | | using the most recent cost reports on file, which have had |
14 | | a limited review conducted by the Department of Healthcare |
15 | | and Family Services and will not hold up enacting the rate |
16 | | increase, with the Department of Healthcare and Family |
17 | | Services. |
18 | | (2) After completing the calculation in paragraph (1), |
19 | | any facility whose rate is less than the rate in effect on |
20 | | June 30, 2019 shall have its rate restored to the rate in |
21 | | effect on June 30, 2019 from the 20% of the funds set |
22 | | aside. |
23 | | (3) The remainder of the 20%, or $34,000,000, shall be |
24 | | used to increase each facility's rate by an equal |
25 | | percentage. |
26 | | (k) During the first quarter of State Fiscal Year 2020, |
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1 | | the Department of Healthcare of Family Services must convene a |
2 | | technical advisory group consisting of members of all trade |
3 | | associations representing Illinois skilled nursing providers |
4 | | to discuss changes necessary with federal implementation of |
5 | | Medicare's Patient-Driven Payment Model. Implementation of |
6 | | Medicare's Patient-Driven Payment Model shall, by September 1, |
7 | | 2020, end the collection of the MDS data that is necessary to |
8 | | maintain the current RUG-IV Medicaid payment methodology. The |
9 | | technical advisory group must consider a revised reimbursement |
10 | | methodology that takes into account transparency, |
11 | | accountability, actual staffing as reported under the |
12 | | federally required Payroll Based Journal system, changes to |
13 | | the minimum wage, adequacy in coverage of the cost of care, and |
14 | | a quality component that rewards quality improvements. |
15 | | (l) The Department shall establish per diem add-on |
16 | | payments to improve the quality of care delivered by |
17 | | facilities, including: |
18 | | (1) Incentive payments determined by facility |
19 | | performance on specified quality measures in an initial |
20 | | amount of $70,000,000. Nothing in this subsection shall be |
21 | | construed to limit the quality of care payments in the |
22 | | aggregate statewide to $70,000,000, and, if quality of |
23 | | care has improved across nursing facilities, the |
24 | | Department shall adjust those add-on payments accordingly. |
25 | | The quality payment methodology described in this |
26 | | subsection must be used for at least State Fiscal Year |
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1 | | 2023. Beginning with the quarter starting July 1, 2023, |
2 | | the Department may add, remove, or change quality metrics |
3 | | and make associated changes to the quality payment |
4 | | methodology as outlined in subparagraph (E). Facilities |
5 | | designated by the Centers for Medicare and Medicaid |
6 | | Services as a special focus facility or a hospital-based |
7 | | nursing home do not qualify for quality payments. |
8 | | (A) Each quality pool must be distributed by |
9 | | assigning a quality weighted score for each nursing |
10 | | home which is calculated by multiplying the nursing |
11 | | home's quality base period Medicaid days by the |
12 | | nursing home's star rating weight in that period. |
13 | | (B) Star rating weights are assigned based on the
|
14 | | nursing home's star rating for the LTS quality star
|
15 | | rating. As used in this subparagraph, "LTS quality
|
16 | | star rating" means the long-term stay quality rating |
17 | | for
each nursing facility, as assigned by the Centers |
18 | | for
Medicare and Medicaid Services under the Five-Star
|
19 | | Quality Rating System. The rating is a number ranging
|
20 | | from 0 (lowest) to 5 (highest). |
21 | | (i) Zero-star or one-star rating has a weight |
22 | | of 0. |
23 | | (ii) Two-star rating has a weight of 0.75. |
24 | | (iii) Three-star rating has a weight of 1.5. |
25 | | (iv) Four-star rating has a weight of 2.5. |
26 | | (v) Five-star rating has a weight of 3.5. |
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1 | | (C) Each nursing home's quality weight score is |
2 | | divided by the sum of all quality weight scores for |
3 | | qualifying nursing homes to determine the proportion |
4 | | of the quality pool to be paid to the nursing home. |
5 | | (D) The quality pool is no less than $70,000,000 |
6 | | annually or $17,500,000 per quarter. The Department |
7 | | shall publish on its website the estimated payments |
8 | | and the associated weights for each facility 45 days |
9 | | prior to when the initial payments for the quarter are |
10 | | to be paid. The Department shall assign each facility |
11 | | the most recent and applicable quarter's STAR value |
12 | | unless the facility notifies the Department within 15 |
13 | | days of an issue and the facility provides reasonable |
14 | | evidence demonstrating its timely compliance with |
15 | | federal data submission requirements for the quarter |
16 | | of record. If such evidence cannot be provided to the |
17 | | Department, the STAR rating assigned to the facility |
18 | | shall be reduced by one from the prior quarter. |
19 | | (E) The Department shall review quality metrics |
20 | | used for payment of the quality pool and make |
21 | | recommendations for any associated changes to the |
22 | | methodology for distributing quality pool payments in |
23 | | consultation with associations representing long-term |
24 | | care providers, consumer advocates, organizations |
25 | | representing workers of long-term care facilities, and |
26 | | payors. The Department may establish, by rule, changes |
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1 | | to the methodology for distributing quality pool |
2 | | payments. |
3 | | (F) The Department shall disburse quality pool |
4 | | payments from the Long-Term Care Provider Fund on a |
5 | | monthly basis in amounts proportional to the total |
6 | | quality pool payment determined for the quarter. |
7 | | (G) The Department shall publish any changes in |
8 | | the methodology for distributing quality pool payments |
9 | | prior to the beginning of the measurement period or |
10 | | quality base period for any metric added to the |
11 | | distribution's methodology. |
12 | | (2) Payments based on CNA tenure, promotion, and CNA |
13 | | training for the purpose of increasing CNA compensation. |
14 | | It is the intent of this subsection that payments made in |
15 | | accordance with this paragraph be directly incorporated |
16 | | into increased compensation for CNAs. As used in this |
17 | | paragraph, "CNA" means a certified nursing assistant as |
18 | | that term is described in Section 3-206 of the Nursing |
19 | | Home Care Act, Section 3-206 of the ID/DD Community Care |
20 | | Act, and Section 3-206 of the MC/DD Act. The Department |
21 | | shall establish, by rule, payments to nursing facilities |
22 | | equal to Medicaid's share of the tenure wage increments |
23 | | specified in this paragraph for all reported CNA employee |
24 | | hours compensated according to a posted schedule |
25 | | consisting of increments at least as large as those |
26 | | specified in this paragraph. The increments are as |
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1 | | follows: an additional $1.50 per hour for CNAs with at |
2 | | least one and less than 2 years' experience plus another |
3 | | $1 per hour for each additional year of experience up to a |
4 | | maximum of $6.50 for CNAs with at least 6 years of |
5 | | experience. For purposes of this paragraph, Medicaid's |
6 | | share shall be the ratio determined by paid Medicaid bed |
7 | | days divided by total bed days for the applicable time |
8 | | period used in the calculation. In addition, and additive |
9 | | to any tenure increments paid as specified in this |
10 | | paragraph, the Department shall establish, by rule, |
11 | | payments supporting Medicaid's share of the |
12 | | promotion-based wage increments for CNA employee hours |
13 | | compensated for that promotion with at least a $1.50 |
14 | | hourly increase. Medicaid's share shall be established as |
15 | | it is for the tenure increments described in this |
16 | | paragraph. Qualifying promotions shall be defined by the |
17 | | Department in rules for an expected 10-15% subset of CNAs |
18 | | assigned intermediate, specialized, or added roles such as |
19 | | CNA trainers, CNA scheduling "captains", and CNA |
20 | | specialists for resident conditions like dementia or |
21 | | memory care or behavioral health. |
22 | | (m) The Department shall work with nursing facility |
23 | | industry representatives to design policies and procedures to |
24 | | permit facilities to address the integrity of data from |
25 | | federal reporting sites used by the Department in setting |
26 | | facility rates. |
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1 | | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; |
2 | | 102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff. |
3 | | 5-31-22 .)
|
4 | | (305 ILCS 5/5-5.7b) |
5 | | Sec. 5-5.7b. Pandemic related stability payments to |
6 | | ambulance service providers in response to COVID-19. |
7 | | (a) Definitions. As used in this Section: |
8 | | "Ambulance Services Industry" means the industry that is |
9 | | comprised of "Qualifying Ground Ambulance Service Providers", |
10 | | as defined in this Section. |
11 | | "Qualifying Ground Ambulance Service Provider" means a |
12 | | "vehicle service provider," as that term is defined in Section |
13 | | 3.85 of the Emergency Medical Services (EMS) Systems Act, |
14 | | which operates licensed ambulances for the purpose of |
15 | | providing emergency, non-emergency ambulance services, or both |
16 | | emergency and non-emergency ambulance services. The term |
17 | | "Qualifying Ground Ambulance Service Provider" is limited to |
18 | | ambulance and EMS agencies that are privately held and |
19 | | nonprofit organizations headquartered within the State and |
20 | | licensed by the Department of Public Health as of March 12, |
21 | | 2020. |
22 | | "Eligible worker" means a staff member of a Qualifying |
23 | | Ground Ambulance Service Provider engaged in "essential work", |
24 | | as defined by Section 9901 of the ARPA and related federal |
25 | | guidance, and (1) whose total pay is below 150% of the average |
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1 | | annual wage for all occupations in the worker's county of |
2 | | residence, as defined by the BLS Occupational Employment and |
3 | | Wage Statistics or (2) is not exempt from the federal Fair |
4 | | Labor Standards Act overtime provisions. |
5 | | (b) Purpose. The Department may receive federal funds |
6 | | under the authority of legislation passed in response to the |
7 | | Coronavirus epidemic, including, but not limited to, the |
8 | | American Rescue Plan Act of 2021, P.L. 117-2 (the "ARPA"). |
9 | | Upon receipt or availability of such State or federal funds, |
10 | | and subject to appropriations for their use, the Department |
11 | | shall establish and administer programs for purposes allowable |
12 | | under Section 9901 of the ARPA to provide financial assistance |
13 | | to Qualifying Ground Ambulance Service Providers for premium |
14 | | pay for eligible workers, to provide reimbursement for |
15 | | eligible expenditures, and to provide support following the |
16 | | negative economic impact of the COVID-19 public health |
17 | | emergency on the Ambulance Services Industry. Financial |
18 | | assistance may include, but is not limited to, grants, expense |
19 | | reimbursements, or subsidies. |
20 | | (b-1) By December 31, 2022, the Department shall obtain |
21 | | appropriate documentation from Qualifying Ground Ambulance |
22 | | Service Providers to ascertain an accurate count of the number |
23 | | of licensed vehicles available to serve enrollees in the |
24 | | State's medical assistance programs, which shall be known as |
25 | | the "total eligible vehicles". By February 28, 2023, |
26 | | Qualifying Ground Ambulance Service Providers shall be |
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1 | | initially notified of their eligible award, which shall be the |
2 | | product of (i) the total amount of funds allocated under this |
3 | | Section and (ii) a quotient, the numerator of which is the |
4 | | number of licensed ground ambulance vehicles of an individual |
5 | | Qualifying Ground Ambulance Service Provider and the |
6 | | denominator of which is the total eligible vehicles. After |
7 | | March 31, 2024, any unobligated funds shall be reallocated pro |
8 | | rata to the remaining Qualifying Ground Ambulance Service |
9 | | Providers that are able to prove up eligible expenses in |
10 | | excess of their initial award amount until all such |
11 | | appropriated funds are exhausted. |
12 | | Providers shall indicate to the Department what portion of |
13 | | their award they wish to allocate under the purposes outlined |
14 | | under paragraphs (d), (e), or (f), if applicable, of this |
15 | | Section. |
16 | | (c) Non-Emergency Service Certification. To be eligible |
17 | | for funding under this Section, a Qualifying Ground Ambulance |
18 | | Service Provider that provides non-emergency services to |
19 | | institutional residents must certify whether or not it is able |
20 | | to that it will provide non-emergency ambulance services to |
21 | | individuals enrolled in the State's Medical Assistance Program |
22 | | and residing in non-institutional settings for at least one |
23 | | year following the receipt of funding pursuant to this |
24 | | amendatory Act of the 102nd General Assembly. Certification |
25 | | indicating that a provider has such an ability does not mean |
26 | | that a provider is required to accept any or all requested |
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1 | | transports. The provider shall maintain the certification in |
2 | | its records. The provider shall also maintain documentation of |
3 | | all non-emergency ambulance services for the period covered by |
4 | | the certification. The provider shall produce the |
5 | | certification and supporting documentation upon demand by the |
6 | | Department or its representative. Failure to comply shall |
7 | | result in recovery of any payments made by the Department. |
8 | | (d) Premium Pay Initiative. Subject to paragraph (c) of |
9 | | this Section, the Department shall establish a Premium Pay |
10 | | Initiative to distribute awards to each Qualifying Ground |
11 | | Ambulance Service Provider for the purpose of providing |
12 | | premium pay to eligible workers. |
13 | | (1) Financial assistance pursuant to this paragraph |
14 | | (d) shall be scaled based on a process determined by the |
15 | | Department. The amount awarded to each Qualifying Ground |
16 | | Ambulance Service Provider shall be up to $13 per hour for |
17 | | each eligible worker employed. |
18 | | (2) The financial assistance awarded shall only be |
19 | | expended for premium pay for eligible workers, which must |
20 | | be in addition to any wages or remuneration the eligible |
21 | | worker has already received and shall be subject to the |
22 | | other requirements and limitations set forth in the ARPA |
23 | | and related federal guidance. |
24 | | (3) Upon receipt of funds, the Qualifying Ground |
25 | | Ambulance Service Provider shall distribute funds such |
26 | | that an eligible worker receives an amount up to $13 per |
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1 | | hour but no more than $25,000 for the duration of the |
2 | | program. The Qualifying Ground Ambulance Service Provider |
3 | | shall provide a written certification to the Department |
4 | | acknowledging compliance with this paragraph (d). |
5 | | (4) No portion of these funds shall be spent on |
6 | | volunteer staff. |
7 | | (5) These funds shall not be used to make retroactive |
8 | | premium payments prior to the effective date of this |
9 | | amendatory Act of the 102nd General Assembly. |
10 | | (6) The Department shall require each Qualifying |
11 | | Ground Ambulance Service Provider that receives funds |
12 | | under this paragraph (d) to submit appropriate |
13 | | documentation acknowledging compliance with State and |
14 | | federal law on an annual basis. |
15 | | (e) COVID-19 Response Support Initiative. Subject to |
16 | | paragraph (c) of this Section and based on an application |
17 | | filed by a Qualifying Ground Ambulance Service Provider, the |
18 | | Department shall establish the Ground Ambulance COVID-19 |
19 | | Response Support Initiative. The purpose of the award shall be |
20 | | to reimburse Qualifying Ground Ambulance Service Providers for |
21 | | eligible expenses under Section 9901 of the ARPA related to |
22 | | the public health impacts of the COVID-19 public health |
23 | | emergency, including , but not limited to : (i) costs incurred |
24 | | due to the COVID-19 public health emergency; (ii) costs |
25 | | related to vaccination programs, including vaccine incentives; |
26 | | (iii) costs related to COVID-19 testing; (iv) costs related to |
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1 | | COVID-19 prevention and treatment equipment; (v) expenses for |
2 | | medical supplies; (vi) expenses for personal protective |
3 | | equipment; (vii) costs related to isolation and quarantine; |
4 | | (viii) costs for ventilation system installation and |
5 | | improvement; (ix) costs related to other emergency response |
6 | | equipment, such as ground ambulances, ventilators, cardiac |
7 | | monitoring equipment, defibrillation equipment, pacing |
8 | | equipment, ambulance stretchers, and radio equipment; and (x) |
9 | | other emergency medical response expenses. costs related to |
10 | | COVID-19 testing for patients, COVID-19 prevention and |
11 | | treatment equipment, medical supplies, personal protective |
12 | | equipment, and other emergency medical response treatments. |
13 | | (1) The award shall be for eligible obligated |
14 | | expenditures incurred no earlier than May 1, 2022 and no |
15 | | later than June 30, 2024 2023 . Expenditures under this |
16 | | paragraph must be incurred by June 30, 2025. |
17 | | (2) Funds awarded under this paragraph (e) shall not |
18 | | be expended for premium pay to eligible workers. |
19 | | (3) The Department shall require each Qualifying |
20 | | Ground Ambulance Service Provider that receives funds |
21 | | under this paragraph (e) to submit appropriate |
22 | | documentation acknowledging compliance with State and |
23 | | federal law on an annual basis. For purchases of medical |
24 | | equipment or other capital expenditures, the Qualifying |
25 | | Ground Ambulance Service Provider shall include |
26 | | documentation that describes the harm or need to be |
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1 | | addressed by the expenditures and how that capital |
2 | | expenditure is appropriate to address that identified harm |
3 | | or need. |
4 | | (f) Ambulance Industry Recovery Program. If the Department |
5 | | designates the Ambulance Services Industry as an "impacted |
6 | | industry", as defined by the ARPA and related federal |
7 | | guidance, the Department shall establish the Ambulance |
8 | | Industry Recovery Grant Program, to provide aid to Qualifying |
9 | | Ground Ambulance Service Providers that experienced staffing |
10 | | losses due to the COVID-19 public health emergency. |
11 | | (1) Funds awarded under this paragraph (f) shall not |
12 | | be expended for premium pay to eligible workers. |
13 | | (2) Each Qualifying Ground Ambulance Service Provider |
14 | | that receives funds under this paragraph (f) shall comply |
15 | | with paragraph (c) of this Section. |
16 | | (3) The Department shall require each Qualifying |
17 | | Ground Ambulance Service Provider that receives funds |
18 | | under this paragraph (f) to submit appropriate |
19 | | documentation acknowledging compliance with State and |
20 | | federal law on an annual basis.
|
21 | | (Source: P.A. 102-699, eff. 4-19-22.)
|
22 | | (305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
|
23 | | Sec. 5B-2. Assessment; no local authorization to tax.
|
24 | | (a) For the privilege of engaging in the occupation of |
25 | | long-term care
provider, beginning July 1, 2011 through June |
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1 | | 30, 2022, or upon federal approval by the Centers for Medicare |
2 | | and Medicaid Services of the long-term care provider |
3 | | assessment described in subsection (a-1), whichever is later, |
4 | | an assessment is imposed upon each long-term care provider in |
5 | | an amount equal to $6.07 times the number of occupied bed days |
6 | | due and payable each month. Notwithstanding any provision of |
7 | | any other Act to the
contrary, this assessment shall be |
8 | | construed as a tax, but shall not be billed or passed on to any |
9 | | resident of a nursing home operated by the nursing home |
10 | | provider.
|
11 | | (a-1) For the privilege of engaging in the occupation of |
12 | | long-term care provider for each occupied non-Medicare bed |
13 | | day, beginning July 1, 2022, an assessment is imposed upon |
14 | | each long-term care provider in an amount varying with the |
15 | | number of paid Medicaid resident days per annum in the |
16 | | facility with the following schedule of occupied bed tax |
17 | | amounts. This assessment is due and payable each month. The |
18 | | tax shall follow the schedule below and be rebased by the |
19 | | Department on an annual basis. The Department shall publish |
20 | | each facility's rebased tax rate according to the schedule in |
21 | | this Section 30 days prior to the beginning of the 6-month |
22 | | period beginning July 1, 2022 and thereafter 30 days prior to |
23 | | the beginning of each calendar year which shall incorporate |
24 | | the number of paid Medicaid days used to determine each |
25 | | facility's rebased tax rate. |
26 | | (1) 0-5,000 paid Medicaid resident days per annum, |
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1 | | $10.67. |
2 | | (2) 5,001-15,000 paid Medicaid resident days per |
3 | | annum, $19.20. |
4 | | (3) 15,001-35,000 paid Medicaid resident days per |
5 | | annum, $22.40. |
6 | | (4) 35,001-55,000 paid Medicaid resident days per |
7 | | annum, $19.20. |
8 | | (5) 55,001-65,000 paid Medicaid resident days per |
9 | | annum, $13.86. |
10 | | (6) 65,001+ paid Medicaid resident days per annum, |
11 | | $10.67. |
12 | | (7) Any non-profit nursing facilities without |
13 | | Medicaid-certified beds or any nursing facility owned and |
14 | | operated by a county government , $7 per occupied bed day. |
15 | | The changes made by this amendatory Act of the 102nd |
16 | | General Assembly to this paragraph (7) shall be |
17 | | implemented only upon federal approval. |
18 | | Notwithstanding any provision of any other Act to the |
19 | | contrary, this assessment shall be construed as a tax but |
20 | | shall not be billed or passed on to any resident of a nursing |
21 | | home operated by the nursing home provider. |
22 | | For each new calendar year and for the 6-month period |
23 | | beginning July 1, 2022, a facility's paid Medicaid resident |
24 | | days per annum shall be determined using the Department's |
25 | | Medicaid Management Information System to include Medicaid |
26 | | resident days for the year ending 9 months earlier. |
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1 | | (b) Nothing in this amendatory Act of 1992 shall be |
2 | | construed to
authorize any home rule unit or other unit of |
3 | | local government to license
for revenue or impose a tax or |
4 | | assessment upon long-term care providers or
the occupation of |
5 | | long-term care provider, or a tax or assessment measured
by |
6 | | the income or earnings or occupied bed days of a long-term care |
7 | | provider.
|
8 | | (c) The assessment imposed by this Section shall not be |
9 | | due and payable, however, until after the Department notifies |
10 | | the long-term care providers, in writing, that the payment |
11 | | methodologies to long-term care providers required under |
12 | | Section 5-5.2 of this Code have been approved by the Centers |
13 | | for Medicare and Medicaid Services of the U.S. Department of |
14 | | Health and Human Services and that the waivers under 42 CFR |
15 | | 433.68 for the assessment imposed by this Section, if |
16 | | necessary, have been granted by the Centers for Medicare and |
17 | | Medicaid Services of the U.S. Department of Health and Human |
18 | | Services. |
19 | | (Source: P.A. 102-1035, eff. 5-31-22.)
|
20 | | Section 40. The Rebuild Illinois Mental Health Workforce |
21 | | Act is amended by changing Sections 20-10 and 20-20 as |
22 | | follows: |
23 | | (305 ILCS 66/20-10)
|
24 | | Sec. 20-10. Medicaid funding for community mental health |
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1 | | services. Medicaid funding for the specific community mental |
2 | | health services listed in this Act shall be adjusted and paid |
3 | | as set forth in this Act. Such payments shall be paid in |
4 | | addition to the base Medicaid reimbursement rate and add-on |
5 | | payment rates per service unit. |
6 | | (a) The payment adjustments shall begin on July 1, 2022 |
7 | | for State Fiscal Year 2023 and shall continue for every State |
8 | | fiscal year thereafter. |
9 | | (1) Individual Therapy Medicaid Payment rate for |
10 | | services provided under the H0004 Code: |
11 | | (A) The Medicaid total payment rate for individual |
12 | | therapy provided by a qualified mental health |
13 | | professional shall be increased by no less than $9 per |
14 | | service unit. |
15 | | (B) The Medicaid total payment rate for individual |
16 | | therapy provided by a mental health professional shall |
17 | | be increased by no less then $9 per service unit. |
18 | | (2) Community Support - Individual Medicaid Payment |
19 | | rate for services provided under the H2015 Code: All |
20 | | community support - individual services shall be increased |
21 | | by no less than $15 per service unit. |
22 | | (3) Case Management Medicaid Add-on Payment for |
23 | | services provided under the T1016 code: All case |
24 | | management services rates shall be increased by no less |
25 | | than $15 per service unit. |
26 | | (4) Assertive Community Treatment Medicaid Add-on |
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1 | | Payment for services provided under the H0039 code: The |
2 | | Medicaid total payment rate for assertive community |
3 | | treatment services shall increase by no less than $8 per |
4 | | service unit. |
5 | | (5) Medicaid user-based directed payments. |
6 | | (A) For each State fiscal year, a monthly directed |
7 | | payment shall be paid to a community mental health |
8 | | provider of community support team services based on |
9 | | the number of Medicaid users of community support team |
10 | | services documented by Medicaid fee-for-service and |
11 | | managed care encounter claims delivered by that |
12 | | provider in the base year. The Department of |
13 | | Healthcare and Family Services shall make the monthly |
14 | | directed payment to each provider entitled to directed |
15 | | payments under this Act by no later than the last day |
16 | | of each month throughout each State fiscal year. |
17 | | (i) The monthly directed payment for a |
18 | | community support team provider shall be |
19 | | calculated as follows: The sum total number of |
20 | | individual Medicaid users of community support |
21 | | team services delivered by that provider |
22 | | throughout the base year, multiplied by $4,200 per |
23 | | Medicaid user, divided into 12 equal monthly |
24 | | payments for the State fiscal year. |
25 | | (ii) As used in this subparagraph, "user" |
26 | | means an individual who received at least 200 |
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1 | | units of community support team services (H2016) |
2 | | during the base year. |
3 | | (B) For each State fiscal year, a monthly directed |
4 | | payment shall be paid to each community mental health |
5 | | provider of assertive community treatment services |
6 | | based on the number of Medicaid users of assertive |
7 | | community treatment services documented by Medicaid |
8 | | fee-for-service and managed care encounter claims |
9 | | delivered by the provider in the base year. |
10 | | (i) The monthly direct payment for an |
11 | | assertive community treatment provider shall be |
12 | | calculated as follows: The sum total number of |
13 | | Medicaid users of assertive community treatment |
14 | | services provided by that provider throughout the |
15 | | base year, multiplied by $6,000 per Medicaid user, |
16 | | divided into 12 equal monthly payments for that |
17 | | State fiscal year. |
18 | | (ii) As used in this subparagraph, "user" |
19 | | means an individual that received at least 300 |
20 | | units of assertive community treatment services |
21 | | during the base year. |
22 | | (C) The base year for directed payments under this |
23 | | Section shall be calendar year 2019 for State Fiscal |
24 | | Year 2023 and State Fiscal Year 2024. For the State |
25 | | fiscal year beginning on July 1, 2024, and for every |
26 | | State fiscal year thereafter, the base year shall be |
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1 | | the calendar year that ended 18 months prior to the |
2 | | start of the State fiscal year in which payments are |
3 | | made.
|
4 | | (b) Subject to federal approval, a one-time directed |
5 | | payment must be made in calendar year 2023 for community |
6 | | mental health services provided by community mental health |
7 | | providers. The one-time directed payment shall be for an |
8 | | amount appropriated for these purposes. The one-time directed |
9 | | payment shall be for services for Integrated Assessment and |
10 | | Treatment Planning and other intensive services, including, |
11 | | but not limited to, services for Mobile Crisis Response, |
12 | | crisis intervention, and medication monitoring. The amounts |
13 | | and services used for designing and distributing these |
14 | | one-time directed payments shall not be construed to require |
15 | | any future rate or funding increases for the same or other |
16 | | mental health services. |
17 | | (Source: P.A. 102-699, eff. 4-19-22.) |
18 | | (305 ILCS 66/20-20)
|
19 | | Sec. 20-20. Base Medicaid rates or add-on payments. |
20 | | (a) For services under subsection (a) of Section 20-10. No |
21 | | base Medicaid rate or Medicaid rate add-on payment or any |
22 | | other payment for the provision of Medicaid community mental |
23 | | health services in place on July 1, 2021 shall be diminished or |
24 | | changed to make the reimbursement changes required by this |
25 | | Act. Any payments required under this Act that are delayed due |
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1 | | to implementation challenges or federal approval shall be made |
2 | | retroactive to July 1, 2022 for the full amount required by |
3 | | this Act regardless of the amount a provider bills Illinois' |
4 | | Medical Assistance Program (via a Medicaid managed care |
5 | | organization or the Department of Healthcare and Family |
6 | | Services directly) for such services .
|
7 | | (b) For directed payments under subsection (b) of Section |
8 | | 20-10. No base Medicaid rate payment or any other payment for |
9 | | the provision of Medicaid community mental health services in |
10 | | place on January 1, 2023 shall be diminished or changed to make |
11 | | the reimbursement changes required by this Act. The Department |
12 | | of Healthcare and Family Services must pay the directed |
13 | | payment in one installment within 60 days of receiving federal |
14 | | approval. |
15 | | (Source: P.A. 102-699, eff. 4-19-22.) |
16 | | Section 45. The Code of Criminal Procedure of 1963 is |
17 | | amended by changing Sections 104-17 and 104-23 as follows:
|
18 | | (725 ILCS 5/104-17) (from Ch. 38, par. 104-17)
|
19 | | Sec. 104-17. Commitment for treatment; treatment plan.
|
20 | | (a) If the defendant
is eligible to be or has been released |
21 | | on pretrial release or on his own recognizance,
the court |
22 | | shall select the least physically restrictive form of |
23 | | treatment
therapeutically appropriate and consistent with the |
24 | | treatment plan. The placement may be ordered either on an |
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1 | | inpatient or an outpatient basis.
|
2 | | (b) If the defendant's disability is mental, the court may |
3 | | order him placed
for secure treatment in the custody of the |
4 | | Department of Human Services, or the court may order him |
5 | | placed in
the custody of any other
appropriate public or |
6 | | private mental health facility or treatment program
which has |
7 | | agreed to provide treatment to the defendant. If the most |
8 | | serious charge faced by the defendant is a misdemeanor, the |
9 | | court shall order outpatient treatment, unless the court finds |
10 | | good cause on the record to order inpatient treatment. If the |
11 | | court orders the defendant to inpatient treatment placed in |
12 | | the custody of the Department of Human Services, the |
13 | | Department shall evaluate the defendant to determine the most |
14 | | appropriate to which secure facility to receive the defendant |
15 | | shall be transported and, within 20 days of the transmittal by |
16 | | the clerk of the circuit court of the court's placement court |
17 | | order, notify the court of sheriff of the designated facility |
18 | | to receive the defendant . The Department shall admit the |
19 | | defendant to a secure facility within 60 days of the |
20 | | transmittal of the court's placement order, unless the |
21 | | Department can demonstrate good faith efforts at placement and |
22 | | a lack of bed and placement availability. If placement cannot |
23 | | be made within 60 days of the transmittal of the court's |
24 | | placement order and the Department has demonstrated good faith |
25 | | efforts at placement and a lack of bed and placement |
26 | | availability, the Department shall provide an update to the |
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1 | | ordering court every 30 days until the defendant is placed. |
2 | | Once bed and placement availability is determined, the |
3 | | Department shall notify Upon receipt of that notice, the |
4 | | sheriff who shall promptly transport the defendant to the |
5 | | designated facility. If the defendant
is placed in the custody |
6 | | of the Department of Human Services, the defendant shall be |
7 | | placed in a
secure setting. During
the period of time required |
8 | | to determine bed and placement availability at the designated |
9 | | facility, the appropriate placement the
defendant shall remain |
10 | | in jail. If during the course of evaluating the defendant for |
11 | | placement, the Department of Human Services determines that |
12 | | the defendant is currently fit to stand trial, it shall |
13 | | immediately notify the court and shall submit a written report |
14 | | within 7 days. In that circumstance the placement shall be |
15 | | held pending a court hearing on the Department's report. |
16 | | Otherwise, upon completion of the placement process, including |
17 | | identifying bed and placement availability, the
sheriff shall |
18 | | be notified and shall transport the defendant to the |
19 | | designated
facility. If, within 60 20 days of the transmittal |
20 | | by the clerk of the circuit court of the court's placement |
21 | | court order, the Department fails to provide notify the |
22 | | sheriff with notice of bed and placement availability at the |
23 | | designated facility, of the identity of the facility to which |
24 | | the defendant shall be transported, the sheriff shall contact |
25 | | a designated person within the Department to inquire about |
26 | | when a placement will become available at the designated |
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1 | | facility as well as bed and placement and bed availability at |
2 | | other secure facilities. If, within
20 days of the transmittal |
3 | | by the clerk of the circuit court of the placement court order, |
4 | | the Department
fails to notify the sheriff of the identity of |
5 | | the facility to
which the defendant shall be transported, the |
6 | | sheriff shall
notify the Department of its intent to transfer |
7 | | the defendant to the nearest secure mental health facility |
8 | | operated by the Department and inquire as to the status of the |
9 | | placement evaluation and availability for admission to such |
10 | | facility operated by the Department by contacting a designated |
11 | | person within the Department. The Department shall respond to |
12 | | the sheriff within 2 business days of the notice and inquiry by |
13 | | the sheriff seeking the transfer and the Department shall |
14 | | provide the sheriff with the status of the evaluation, |
15 | | information on bed and placement availability, and an |
16 | | estimated date of admission for the defendant and any changes |
17 | | to that estimated date of admission. If the Department |
18 | | notifies the sheriff during the 2 business day period of a |
19 | | facility operated by the Department with placement |
20 | | availability, the sheriff shall promptly transport the |
21 | | defendant to that facility. The placement may be ordered |
22 | | either on an inpatient or an outpatient
basis.
|
23 | | (c) If the defendant's disability is physical, the court |
24 | | may order him
placed under the supervision of the Department |
25 | | of Human
Services
which shall place and maintain the defendant |
26 | | in a suitable treatment facility
or program, or the court may |
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1 | | order him placed in an appropriate public or
private facility |
2 | | or treatment program which has agreed to provide treatment
to |
3 | | the defendant. The placement may be ordered either on an |
4 | | inpatient or
an outpatient basis.
|
5 | | (d) The clerk of the circuit court shall within 5 days of |
6 | | the entry of the order transmit to the Department, agency
or |
7 | | institution, if any, to which the defendant is remanded for |
8 | | treatment, the
following:
|
9 | | (1) a certified copy of the order to undergo |
10 | | treatment. Accompanying the certified copy of the order to |
11 | | undergo treatment shall be the complete copy of any report |
12 | | prepared under Section 104-15 of this Code or other report |
13 | | prepared by a forensic examiner for the court;
|
14 | | (2) the county and municipality in which the offense |
15 | | was committed;
|
16 | | (3) the county and municipality in which the arrest |
17 | | took place; |
18 | | (4) a copy of the arrest report, criminal charges, |
19 | | arrest record; and
|
20 | | (5) all additional matters which the Court directs the |
21 | | clerk to transmit.
|
22 | | (e) Within 30 days of admission to the designated facility |
23 | | entry of an order to undergo treatment , the person
supervising |
24 | | the defendant's treatment shall file with the court, the |
25 | | State,
and the defense a report assessing the facility's or |
26 | | program's capacity
to provide appropriate treatment for the |
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1 | | defendant and indicating his opinion
as to the probability of |
2 | | the defendant's attaining fitness within a period
of time from |
3 | | the date of the finding of unfitness. For a defendant charged |
4 | | with a felony, the period of time shall be one year. For a |
5 | | defendant charged with a misdemeanor, the period of time shall |
6 | | be no longer than the sentence if convicted of the most serious |
7 | | offense. If the report indicates
that there is a substantial |
8 | | probability that the defendant will attain fitness
within the |
9 | | time period, the treatment supervisor shall also file a |
10 | | treatment
plan which shall include:
|
11 | | (1) A diagnosis of the defendant's disability;
|
12 | | (2) A description of treatment goals with respect to |
13 | | rendering the
defendant
fit, a specification of the |
14 | | proposed treatment modalities, and an estimated
timetable |
15 | | for attainment of the goals;
|
16 | | (3) An identification of the person in charge of |
17 | | supervising the
defendant's
treatment.
|
18 | | (Source: P.A. 100-27, eff. 1-1-18; 101-652, eff. 1-1-23 .)
|
19 | | (725 ILCS 5/104-23) (from Ch. 38, par. 104-23)
|
20 | | Sec. 104-23. Unfit defendants. Cases involving an unfit |
21 | | defendant who
demands a discharge hearing or a defendant who |
22 | | cannot become fit to stand
trial and for whom no special |
23 | | provisions or assistance can compensate for
his disability and |
24 | | render him fit shall proceed in the following manner:
|
25 | | (a) Upon a determination that there is not a substantial |
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1 | | probability
that the defendant will attain fitness within the |
2 | | time period set in subsection (e) of Section 104-17 of this |
3 | | Code from the original
finding of unfitness, the court shall |
4 | | hold a discharge hearing within 60 days, unless good cause is |
5 | | shown for the delay. a defendant or the attorney for the |
6 | | defendant
may move for a discharge hearing pursuant to the |
7 | | provisions of Section 104-25.
The discharge hearing shall be |
8 | | held within 120 days of the filing of a
motion for a discharge |
9 | | hearing, unless the delay is occasioned by the defendant.
|
10 | | (b) If at any time the court determines that there is not a |
11 | | substantial
probability that the defendant will become fit to |
12 | | stand trial or to plead
within the time period set in |
13 | | subsection (e) of Section 104-17 of this Code from the date of |
14 | | the original finding of unfitness,
or if at the end of the time |
15 | | period set in subsection (e) of Section 104-17 of this Code |
16 | | from that date the court finds the defendant
still unfit and |
17 | | for whom no special provisions or assistance can compensate
|
18 | | for his disabilities and render him fit, the State shall |
19 | | request the court:
|
20 | | (1) To set the matter for hearing pursuant to Section |
21 | | 104-25 unless
a hearing has already been held pursuant to |
22 | | paragraph (a) of this Section; or
|
23 | | (2) To release the defendant from custody and to |
24 | | dismiss with prejudice
the charges against him; or
|
25 | | (3) To remand the defendant to the custody of the |
26 | | Department of
Human Services and order a
hearing to be |
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1 | | conducted
pursuant to the provisions of the Mental Health |
2 | | and Developmental Disabilities
Code, as now or hereafter |
3 | | amended. The Department of Human Services shall have 7 |
4 | | days from the
date it receives the
defendant to prepare |
5 | | and file the necessary petition and certificates that are
|
6 | | required for commitment under the Mental Health and |
7 | | Developmental Disabilities
Code. If the defendant is |
8 | | committed to the
Department of Human Services pursuant to |
9 | | such
hearing, the court
having jurisdiction over the |
10 | | criminal matter shall dismiss the charges against
the |
11 | | defendant, with the leave to reinstate. In such cases the |
12 | | Department of Human Services shall notify the court,
the |
13 | | State's attorney and the defense attorney upon the |
14 | | discharge of the
defendant. A former defendant so |
15 | | committed
shall be treated in the same manner as any other |
16 | | civilly committed patient
for all purposes including |
17 | | admission, selection of the place of treatment
and the |
18 | | treatment modalities, entitlement to rights and |
19 | | privileges, transfer,
and discharge. A defendant who is |
20 | | not committed shall be remanded to the
court having |
21 | | jurisdiction of the criminal matter for disposition |
22 | | pursuant
to subparagraph (1) or (2) of paragraph (b) of |
23 | | this Section.
|
24 | | (c) If the defendant is restored to fitness and the |
25 | | original charges
against him are reinstated, the speedy trial |
26 | | provisions of Section 103-5
shall commence to run.
|