HB0614 Engrossed LRB095 09381 DRJ 29577 b

1     AN ACT concerning regulation.
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4     Section 5. The Alternative Health Care Delivery Act is
5 amended by changing Section 35 as follows:
6     (210 ILCS 3/35)
7     Sec. 35. Alternative health care models authorized.
8 Notwithstanding any other law to the contrary, alternative
9 health care models described in this Section may be established
10 on a demonstration basis.
11         (1) Alternative health care model; subacute care
12     hospital. A subacute care hospital is a designated site
13     which provides medical specialty care for patients who need
14     a greater intensity or complexity of care than generally
15     provided in a skilled nursing facility but who no longer
16     require acute hospital care. The average length of stay for
17     patients treated in subacute care hospitals shall not be
18     less than 20 days, and for individual patients, the
19     expected length of stay at the time of admission shall not
20     be less than 10 days. Variations from minimum lengths of
21     stay shall be reported to the Department. There shall be no
22     more than 13 subacute care hospitals authorized to operate
23     by the Department. Subacute care includes physician



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1     supervision, registered nursing, and physiological
2     monitoring on a continual basis. A subacute care hospital
3     is either a freestanding building or a distinct physical
4     and operational entity within a hospital or nursing home
5     building. A subacute care hospital shall only consist of
6     beds currently existing in licensed hospitals or skilled
7     nursing facilities, except, in the City of Chicago, on a
8     designated site that was licensed as a hospital under the
9     Illinois Hospital Licensing Act within the 10 years
10     immediately before the application for an alternative
11     health care model license. During the period of operation
12     of the demonstration project, the existing licensed beds
13     shall remain licensed as hospital or skilled nursing
14     facility beds as well as being licensed under this Act. In
15     order to handle cases of complications, emergencies, or
16     exigent circumstances, a subacute care hospital shall
17     maintain a contractual relationship, including a transfer
18     agreement, with a general acute care hospital. If a
19     subacute care model is located in a general acute care
20     hospital, it shall utilize all or a portion of the bed
21     capacity of that existing hospital. In no event shall a
22     subacute care hospital use the word "hospital" in its
23     advertising or marketing activities or represent or hold
24     itself out to the public as a general acute care hospital.
25         (2) Alternative health care delivery model;
26     postsurgical recovery care center. A postsurgical recovery



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1     care center is a designated site which provides
2     postsurgical recovery care for generally healthy patients
3     undergoing surgical procedures that require overnight
4     nursing care, pain control, or observation that would
5     otherwise be provided in an inpatient setting. A
6     postsurgical recovery care center is either freestanding
7     or a defined unit of an ambulatory surgical treatment
8     center or hospital. No facility, or portion of a facility,
9     may participate in a demonstration program as a
10     postsurgical recovery care center unless the facility has
11     been licensed as an ambulatory surgical treatment center or
12     hospital for at least 2 years before August 20, 1993 (the
13     effective date of Public Act 88-441). The maximum length of
14     stay for patients in a postsurgical recovery care center is
15     not to exceed 48 hours unless the treating physician
16     requests an extension of time from the recovery center's
17     medical director on the basis of medical or clinical
18     documentation that an additional care period is required
19     for the recovery of a patient and the medical director
20     approves the extension of time. In no case, however, shall
21     a patient's length of stay in a postsurgical recovery care
22     center be longer than 72 hours. If a patient requires an
23     additional care period after the expiration of the 72-hour
24     limit, the patient shall be transferred to an appropriate
25     facility. Reports on variances from the 48-hour limit shall
26     be sent to the Department for its evaluation. The reports



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1     shall, before submission to the Department, have removed
2     from them all patient and physician identifiers. In order
3     to handle cases of complications, emergencies, or exigent
4     circumstances, every postsurgical recovery care center as
5     defined in this paragraph shall maintain a contractual
6     relationship, including a transfer agreement, with a
7     general acute care hospital. A postsurgical recovery care
8     center shall be no larger than 20 beds. A postsurgical
9     recovery care center shall be located within 15 minutes
10     travel time from the general acute care hospital with which
11     the center maintains a contractual relationship, including
12     a transfer agreement, as required under this paragraph.
13         No postsurgical recovery care center shall
14     discriminate against any patient requiring treatment
15     because of the source of payment for services, including
16     Medicare and Medicaid recipients.
17         The Department shall adopt rules to implement the
18     provisions of Public Act 88-441 concerning postsurgical
19     recovery care centers within 9 months after August 20,
20     1993.
21         (3) Alternative health care delivery model; children's
22     community-based health care center. A children's
23     community-based health care center model is a designated
24     site that provides nursing care, clinical support
25     services, and therapies for a period of one to 14 days for
26     short-term stays and 120 days to facilitate transitions to



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1     home or other appropriate settings for medically fragile
2     children, technology dependent children, and children with
3     special health care needs who are deemed clinically stable
4     by a physician and are younger than 22 years of age. This
5     care is to be provided in a home-like environment that
6     serves no more than 12 children at a time. Children's
7     community-based health care center services must be
8     available through the model to all families, including
9     those whose care is paid for through the Department of
10     Healthcare and Family Services Public Aid, the Department
11     of Children and Family Services, the Department of Human
12     Services, and insurance companies who cover home health
13     care services or private duty nursing care in the home.
14         Each children's community-based health care center
15     model location shall be physically separate and apart from
16     any other facility licensed by the Department of Public
17     Health under this or any other Act and shall provide the
18     following services: respite care, registered nursing or
19     licensed practical nursing care, transitional care to
20     facilitate home placement or other appropriate settings
21     and reunite families, medical day care, weekend camps, and
22     diagnostic studies typically done in the home setting.
23         Coverage for the services provided by the Illinois
24     Department of Healthcare and Family Services Public Aid
25     under this paragraph (3) is contingent upon federal waiver
26     approval and is provided only to Medicaid eligible clients



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1     participating in the home and community based services
2     waiver designated in Section 1915(c) of the Social Security
3     Act for medically frail and technologically dependent
4     children or children in Department of Children and Family
5     Services foster care who receive home health benefits.
6         (4) Alternative health care delivery model; community
7     based residential rehabilitation center. A community-based
8     residential rehabilitation center model is a designated
9     site that provides rehabilitation or support, or both, for
10     persons who have experienced severe brain injury, who are
11     medically stable, and who no longer require acute
12     rehabilitative care or intense medical or nursing
13     services. The average length of stay in a community-based
14     residential rehabilitation center shall not exceed 4
15     months. As an integral part of the services provided,
16     individuals are housed in a supervised living setting while
17     having immediate access to the community. The residential
18     rehabilitation center authorized by the Department may
19     have more than one residence included under the license. A
20     residence may be no larger than 12 beds and shall be
21     located as an integral part of the community. Day treatment
22     or individualized outpatient services shall be provided
23     for persons who reside in their own home. Functional
24     outcome goals shall be established for each individual.
25     Services shall include, but are not limited to, case
26     management, training and assistance with activities of



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1     daily living, nursing consultation, traditional therapies
2     (physical, occupational, speech), functional interventions
3     in the residence and community (job placement, shopping,
4     banking, recreation), counseling, self-management
5     strategies, productive activities, and multiple
6     opportunities for skill acquisition and practice
7     throughout the day. The design of individualized program
8     plans shall be consistent with the outcome goals that are
9     established for each resident. The programs provided in
10     this setting shall be accredited by the Commission on
11     Accreditation of Rehabilitation Facilities (CARF). The
12     program shall have been accredited by CARF as a Brain
13     Injury Community-Integrative Program for at least 3 years.
14         (5) Alternative health care delivery model;
15     Alzheimer's disease management center. An Alzheimer's
16     disease management center model is a designated site that
17     provides a safe and secure setting for care of persons
18     diagnosed with Alzheimer's disease. An Alzheimer's disease
19     management center model shall be a facility separate from
20     any other facility licensed by the Department of Public
21     Health under this or any other Act. An Alzheimer's disease
22     management center shall conduct and document an assessment
23     of each resident every 6 months. The assessment shall
24     include an evaluation of daily functioning, cognitive
25     status, other medical conditions, and behavioral problems.
26     An Alzheimer's disease management center shall develop and



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1     implement an ongoing treatment plan for each resident. The
2     treatment plan shall have defined goals. The Alzheimer's
3     disease management center shall treat behavioral problems
4     and mood disorders using nonpharmacologic approaches such
5     as environmental modification, task simplification, and
6     other appropriate activities. All staff must have
7     necessary training to care for all stages of Alzheimer's
8     Disease. An Alzheimer's disease management center shall
9     provide education and support for residents and
10     caregivers. The education and support shall include
11     referrals to support organizations for educational
12     materials on community resources, support groups, legal
13     and financial issues, respite care, and future care needs
14     and options. The education and support shall also include a
15     discussion of the resident's need to make advance
16     directives and to identify surrogates for medical and legal
17     decision-making. The provisions of this paragraph
18     establish the minimum level of services that must be
19     provided by an Alzheimer's disease management center. An
20     Alzheimer's disease management center model shall have no
21     more than 100 residents. Nothing in this paragraph (5)
22     shall be construed as prohibiting a person or facility from
23     providing services and care to persons with Alzheimer's
24     disease as otherwise authorized under State law.
25         (6) Alternative health care model; long term acute care
26     hospital conversion. A long term acute care hospital



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1     conversion is a Long Term Acute Care Hospital (LTACH)
2     created by converting a facility or a portion of a facility
3     previously licensed as a long-term care facility under the
4     Nursing Home Care Act. This model shall allow for a maximum
5     of 4 such LTACH conversions, one of which shall be located
6     in the area of Illinois within the St. Louis Metropolitan
7     Statistical Area. The LTACH conversions shall each have no
8     more than 60 beds and provide services to patients whose
9     medical condition requires long-term medical care as
10     described in Section 1886(d)(i)(B)(n) of the Social
11     Security Act as hospitals that have an average Medicare
12     inpatient length of stay greater than 25 days. The LTACH
13     conversion shall provide extended medical and
14     rehabilitative care, such as but not limited to
15     comprehensive rehabilitation, respiratory therapy, cancer
16     treatment, head trauma treatment, and pain management, for
17     patients who are clinically complex and may suffer from
18     multiple acute or chronic conditions. Facilities licensed
19     under this model shall be exempt from the requirements of
20     the Illinois Health Facilities Planning Act. The
21     Department shall adopt rules specifying criteria,
22     standards, and procedures for the establishment,
23     licensure, and operation of LTACH conversions as
24     authorized under this Act. These rules shall create a new
25     category of licensure, which shall be consistent with the
26     LTACH requirements under the applicable provisions of the



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1     Social Security Act to ensure that the LTACH conversions
2     can be certified under Medicare to provide such services.
3     The Department shall also adopt rules that identify the
4     applicable building codes for licensure of LTACH
5     conversions. The rules shall allow existing licensed and
6     certified buildings to be reviewed under "existing
7     construction" standards in the applicable codes. For
8     purposes of this Act, the facility must maintain a 2-hour
9     separation in accordance with the applicable construction
10     codes, for purposes of fire safety. This separation may be
11     vertical, horizontal, or a combination of both. For the
12     purpose of defining a horizontal building separation, a
13     barrier of 2.5 inches or more of concrete, or any other
14     tested assembly that has a rating of 2 hours or more, will
15     be acceptable.
16         The Department shall adopt the rules implementing this
17     model within 6 months after the effective date of this
18     amendatory Act of the 95th General Assembly. If the
19     Department fails to adopt rules by the required date, the
20     Department shall proceed with licensure utilizing the
21     applicable Medicare conditions of participation.
22 (Source: P.A. 93-402, eff. 1-1-04; revised 12-15-05.)
23     Section 99. Effective date. This Act takes effect upon
24 becoming law.