LRB093 09788 AMC 15493 a

 1                    AMENDMENT TO SENATE BILL 1332

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

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

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

24        (210 ILCS 85/8.5)
25        Sec. 8.5. Waiver or alternative compliance of  compliance
26    with  rules  or standards for construction or physical plant.
27    Upon application by a hospital, the Department may  grant  or
28    renew  a  the waiver or alternative compliance methodology of
29    the hospital's compliance with  a  construction  or  physical
30    plant  rule  or  standard, including without limitation rules
31    and  standards  for  (i)  design   and   construction,   (ii)
32    engineering  and  maintenance  of  the  physical plant, site,
33    equipment,  and  systems   (heating,   cooling,   electrical,
                            -7-      LRB093 09788 AMC 15493 a
 1    ventilation,   plumbing,   water,   sewer,  and  solid  waste
 2    disposal), and (iii) fire and safety, and (iv) other rules or
 3    standards that may present  a  barrier  to  the  development,
 4    adoption,  or  implementation  of  an  innovation designed to
 5    improve patient care, for a period not to exceed the duration
 6    of the current license or, in the case of an application  for
 7    license  renewal,  the  duration  of  the renewal period. The
 8    waiver may be conditioned upon  the  hospital  taking  action
 9    prescribed  by  the  Department  as  a  measure equivalent to
10    compliance. In  determining  whether  to  grant  or  renew  a
11    waiver,  the Department shall consider the duration and basis
12    for any current waiver with  respect  to  the  same  rule  or
13    standard  and the validity and effect upon patient health and
14    safety of extending it on the same basis, the effect upon the
15    health and safety of patients, the quality of  patient  care,
16    the  hospital's  history  of  compliance  with  the rules and
17    standards of this Act, and the hospital's attempts to  comply
18    with  the  particular  rule  or  standard  in  question.  The
19    Department may provide, by rule, for the automatic renewal of
20    waivers    concerning    construction   or   physical   plant
21    requirements upon the renewal of a  license.  The  Department
22    shall  renew  waivers  relating  to  construction or physical
23    plant standards issued pursuant to this Section at  the  time
24    of the indicated reviews, unless it can show why such waivers
25    should not be extended for the following reasons:
26             (1)  the   condition   of  the  physical  plant  has
27        deteriorated or its use substantially changed so that the
28        basis upon which the  waiver  was  issued  is  materially
29        different; or
30             (2)  the  hospital  is  renovated  or  substantially
31        remodeled  in such a way as to permit compliance with the
32        applicable  rules  and  standards   without   substantial
33        increase in cost.
34        A copy of each waiver application and each waiver granted
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 1    or renewed shall be on file with the Department and available
 2    for public inspection.
 3        The  Department  shall advise hospitals of any applicable
 4    federal waivers about which it is aware  and  for  which  the
 5    hospital may apply.
 6        In  the event that the Department does not grant or renew
 7    a waiver of a rule or standard, the  Department  must  notify
 8    the  hospital  in  writing detailing the specific reasons for
 9    not granting or renewing the waiver and must discuss possible
10    options, if any, the hospital could take to have  the  waiver
11    approved.
12        This  Section  shall  apply  to  both  new  and  existing
13    construction.
14    (Source: P.A. 92-803, eff. 8-16-02.)

15        (210 ILCS 85/9) (from Ch. 111 1/2, par. 150)
16        Sec.  9.  Inspections  and investigations. The Department
17    shall  make  or  cause  to  be  made  such  inspections   and
18    investigations  as  it  deems  necessary. Upon arrival at the
19    hospital, the Department's  inspector  or  investigator  must
20    inform  the  hospital  of the scope of the investigation with
21    references  to  the  particular   statutory   or   regulatory
22    provisions  triggering  the  inspection or investigation.  If
23    the scope of  an  inspection  is  expanded  beyond  what  was
24    originally  disclosed  to  the  hospital,  the  surveyor must
25    inform  the  hospital's  administrator  or  designee.    This
26    information   must   be  provided  before  the  inspector  or
27    investigator  leaves  the  hospital  premises,  if  possible.
28    Information received by the Department through filed reports,
29    inspection, or as otherwise authorized under this  Act  shall
30    not  be  disclosed  publicly  in  such  manner as to identify
31    individuals  or  hospitals,  except  (i)  in   a   proceeding
32    involving  the  denial, suspension, or revocation of a permit
33    to establish a hospital or a proceeding involving the denial,
                            -9-      LRB093 09788 AMC 15493 a
 1    suspension, or revocation of  a  license  to  open,  conduct,
 2    operate,  and  maintain a hospital, (ii) to the Department of
 3    Children and Family Services in the course of a  child  abuse
 4    or  neglect  investigation conducted by that Department or by
 5    the Department of Public Health,  (iii)  in  accordance  with
 6    Section  6.14a of this Act, or (iv) in other circumstances as
 7    may be approved by the Hospital Licensing Board.
 8    (Source: P.A. 90-608, eff. 6-30-98; 91-242, eff. 1-1-00.)

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

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

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

27        (210 ILCS 85/9.5 new)
28        Sec.  9.5.  Findings,  conclusions,  and  citations.  The
29    Department must consider any factual information  offered  by
30    the hospital during the survey, inspection, or investigation,
31    at  daily status briefings, and in the exit briefing required
32    under  Section  9.4  before   making   final   findings   and
                            -11-     LRB093 09788 AMC 15493 a
 1    conclusions   or   issuing  citations.  The  Department  must
 2    document receipt of such  information.  The  Department  must
 3    provide  the hospital with written notice of its findings and
 4    conclusions within 10 days  of  the  exit  briefing  required
 5    under  Section  9.4.  This  notice must provide the following
 6    information: (i) identification of all deficiencies and areas
 7    of noncompliance with applicable law; (ii) identification  of
 8    the applicable statutes, rules, codes, or standards that were
 9    violated;  and (iii) the factual basis for each deficiency or
10    violation.

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