LRB093 09788 AMC 10033 b

 1        AN ACT concerning hospitals.

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

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

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

10        (210 ILCS 85/8.5)
11        Sec.  8.5.  Waiver  of compliance with rules or standards
12    for construction or physical plant.  Upon  application  by  a
13    hospital, the Department may grant or renew the waiver of the
14    hospital's  compliance  with a construction or physical plant
15    rule or standard,  including  without  limitation  rules  and
16    standards  for  (i) design and construction, (ii) engineering
17    and maintenance of the physical plant, site,  equipment,  and
18    systems (heating, cooling, electrical, ventilation, plumbing,
19    water,  sewer,  and solid waste disposal), and (iii) fire and
20    safety, and (iv) other rules or standards that may present  a
21    barrier to the development, adoption, or implementation of an
22    innovation designed to improve patient care, for a period not
23    to exceed the duration of the current license or, in the case
24    of  an  application  for license renewal, the duration of the
25    renewal period.  The  waiver  may  be  conditioned  upon  the
26    hospital  taking  action  prescribed  by  the Department as a
27    measure equivalent to compliance. In determining  whether  to
28    grant  or  renew  a waiver, the Department shall consider the
29    duration and basis for any current waiver with respect to the
30    same rule or  standard  and  the  validity  and  effect  upon
31    patient  health and safety of extending it on the same basis,
32    the effect upon  the  health  and  safety  of  patients,  the
33    quality of patient care, the hospital's history of compliance
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 1    with  the rules and standards of this Act, and the hospital's
 2    attempts to comply with the particular rule  or  standard  in
 3    question.  The  Department  may  provide,  by  rule,  for the
 4    automatic  renewal  of  waivers  concerning  construction  or
 5    physical plant requirements upon the renewal  of  a  license.
 6    The  Department  shall renew waivers relating to construction
 7    or physical plant standards issued pursuant to  this  Section
 8    at  the time of the indicated reviews, unless it can show why
 9    such  waivers  should  not  be  extended  for  the  following
10    reasons:
11             (1)  the  condition  of  the  physical   plant   has
12        deteriorated or its use substantially changed so that the
13        basis  upon  which  the  waiver  was issued is materially
14        different; or
15             (2)  the  hospital  is  renovated  or  substantially
16        remodeled in such a way as to permit compliance with  the
17        applicable   rules   and  standards  without  substantial
18        increase in cost.
19        A copy of each waiver application and each waiver granted
20    or renewed shall be on file with the Department and available
21    for public inspection.
22        The Department shall advise hospitals of  any  applicable
23    federal  waivers  about  which  it is aware and for which the
24    hospital may apply.
25        In the event that the Department does not grant or  renew
26    a  waiver  of  a rule or standard, the Department must notify
27    the hospital in writing detailing the  specific  reasons  for
28    not granting or renewing the waiver and must discuss possible
29    options,  if  any, the hospital could take to have the waiver
30    approved.
31        This  Section  shall  apply  to  both  new  and  existing
32    construction.
33    (Source: P.A. 92-803, eff. 8-16-02.)
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 1        (210 ILCS 85/9) (from Ch. 111 1/2, par. 150)
 2        Sec. 9. Inspections and  investigations.  The  Department
 3    shall   make  or  cause  to  be  made  such  inspections  and
 4    investigations as it deems necessary.  Upon  arrival  at  the
 5    hospital,  the  Department's  inspector  or investigator must
 6    inform the hospital of the scope of  the  investigation  with
 7    references   to   the   particular  statutory  or  regulatory
 8    provisions triggering the inspection or  investigation.   Any
 9    expansion  of  the  scope  of the investigation or inspection
10    beyond what was disclosed upon arrival at the  hospital  must
11    be  disclosed to the hospital along with the reasons for such
12    expansion and the statutory  or  regulatory  provisions  that
13    govern  the  expanded  review.  The inspector or investigator
14    shall document the reasons for  the  expanded  inspection  or
15    investigation.   No inspection or investigation shall proceed
16    beyond the  scope  of  what  the  inspector  or  investigator
17    disclosed   to   the   hospital.    If   the   inspection  or
18    investigation is being conducted in response to a  complaint,
19    the  Department must inform the hospital of the nature of the
20    complaint  before  proceeding  with  the   investigation   or
21    inspection.  Information  received  by the Department through
22    filed reports, inspection, or as otherwise  authorized  under
23    this Act shall not be disclosed publicly in such manner as to
24    identify individuals or hospitals, except (i) in a proceeding
25    involving  the  denial, suspension, or revocation of a permit
26    to establish a hospital or a proceeding involving the denial,
27    suspension, or revocation of  a  license  to  open,  conduct,
28    operate,  and  maintain a hospital, (ii) to the Department of
29    Children and Family Services in the course of a  child  abuse
30    or  neglect  investigation conducted by that Department or by
31    the Department of Public Health,  (iii)  in  accordance  with
32    Section  6.14a of this Act, or (iv) in other circumstances as
33    may be approved by the Hospital Licensing Board.
34    (Source: P.A. 90-608, eff. 6-30-98; 91-242, eff. 1-1-00.)
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 1        (210 ILCS 85/9.2)
 2        Sec. 9.2.  Disclosure. Prior to conducting a survey of  a
 3    hospital  operating under an approved waiver, equivalency, or
 4    other approval, a surveyor must be made aware of the  waiver,
 5    equivalency,   or   other  approval  prior  to  entering  the
 6    hospital. Prior to commencing an inspection,  the  Department
 7    must  provide the hospital with documentation that the survey
 8    is  being  conducted,  with  consideration  of  the  relevant
 9    waiver,  equivalency,  or  approval.  After  conducting   the
10    survey,  the  Department  must  conduct  a comprehensive exit
11    interview with designated hospital representatives  at  which
12    the  hospital  may  present  additional information regarding
13    findings.
14    (Source: P.A. 92-803, eff. 8-16-02.)

15        (210 ILCS 85/9.3)
16        Sec. 9.3.  Informal dispute resolution.   The  Department
17    must  offer  an  opportunity  for informal dispute resolution
18    concerning the application of  building  codes  for  new  and
19    existing  construction and other related Department rules and
20    standards before the advisory committee under subsection  (b)
21    of Section 2310-560 of the Department of Public Health Powers
22    and  Duties Law of the Civil Administrative Code of Illinois.
23    Participants in this  process  must  include  representatives
24    from  the  Department,  representatives  of the hospital, and
25    additional representatives deemed appropriate by both parties
26    with expertise regarding the contested deficiencies  and  the
27    management of health care facilities.  If the Department does
28    not  resolve disputed deficiencies after the informal dispute
29    resolution process, the Department  must  provide  a  written
30    explanation  to the hospital of why the deficiencies have not
31    been removed from the statement of deficiencies.
32    (Source: P.A. 92-803, eff. 8-16-02.)
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 1        (210 ILCS 85/9.4 new)
 2        Sec. 9.4.  Status and exit  briefings.  While  conducting
 3    inspections,  investigations,  or surveys the Department must
 4    have a daily status briefing with the  hospital  to  disclose
 5    preliminary  findings  before the inspector, investigator, or
 6    surveyor leaves for the day. At the end of  each  inspection,
 7    investigation,  or survey the Department must have a detailed
 8    and comprehensive exit briefing with the hospital to disclose
 9    its preliminary findings and conclusions. As  part  of  these
10    briefings,   the   Department   inspector,  investigator,  or
11    surveyor must disclose any reasonable corrective actions that
12    would bring the hospital into compliance with this Act.

13        (210 ILCS 85/9.5 new)
14        Sec.  9.5.  Findings,  conclusions,  and  citations.  The
15    Department must consider any factual information  offered  by
16    the  hospital  at  any time during the survey, inspection, or
17    investigation, at daily status  briefings  and  in  the  exit
18    briefing  required  under  Section  9.4  before  making final
19    findings and conclusions or issuing citations. The Department
20    must document receipt of such  information  and  provide  the
21    hospital  with  its  findings  and conclusions regarding this
22    information in addition to any other findings and conclusions
23    of its survey, investigation, or inspection.  The  Department
24    must provide the hospital with written notice of its findings
25    and  conclusions within 10 days of the exit briefing required
26    under Section 9.4. This notice  must  provide  the  following
27    information: (i) identification of all deficiencies and areas
28    of  noncompliance with applicable law; (ii) identification of
29    the applicable statutes, rules, codes, or standards that were
30    violated; (iii) the factual  basis  for  each  deficiency  or
31    violation;  and (iv) recommended corrective action or actions
32    as well as any alternative corrective action that would bring
33    the  hospital  into  compliance  with  applicable  law.   The
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 1    Department's  recommended  corrective  action or actions must
 2    take into account the size, resources,  and  ability  of  the
 3    hospital to implement the recommendation.

 4        (210 ILCS 85/9.6 new)
 5        Sec.  9.6.  Reviewer  quality improvement. The Department
 6    must implement a reviewer performance improvement program for
 7    hospital  survey,  inspection,   and   investigation   staff.
 8    Components of the program must address at least the following
 9    minimum  individual  qualifications as defined by rule before
10    the  Department  may  use  that  individual  as  a  surveyor,
11    investigator, or inspector:  (i)  outside  formal  education;
12    (ii)  training  within  the Department; and (iii) a number of
13    supervised  inspections,  surveys,  and  investigations.  The
14    Department  must  also  review  the  work  of  each  of   its
15    surveyors, inspectors, and investigators on a quarterly basis
16    to    assess   whether   its   surveyors,   inspectors,   and
17    investigators: (i) apply  the  same  protocols  and  criteria
18    consistently  to substantially similar situations; (ii) reach
19    similar findings and conclusions when reviewing substantially
20    similar situations; (iii) conduct  surveys,  inspections,  or
21    investigations in a professional manner; and (iv) comply with
22    the   provisions  of  this  Act.  The  Department  must  also
23    implement continuing education programs  for  its  surveyors,
24    inspectors, and investigators to correct review inconsistency
25    and   to  reduce  review  time  and  expense.  At  least  one
26    continuing education program during the  calendar  year  must
27    involve  an  opportunity  for  interaction  among  Department
28    surveyors,  inspectors, investigators, and hospital personnel
29    and representatives.