Sen. William Delgado

Filed: 5/17/2013





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2    AMENDMENT NO. ______. Amend House Bill 1191 as follows:
3on page 1, line 5, by replacing "Section 4.01" with "Sections
44.01 and 4.04"; and
5on page 8, immediately after line 1, by inserting the
7    "(20 ILCS 105/4.04)  (from Ch. 23, par. 6104.04)
8    Sec. 4.04. Long Term Care Ombudsman Program. The purpose of
9the Long Term Care Ombudsman Program is to ensure that older
10persons and persons with disabilities receive quality
11services. This is accomplished by providing advocacy services
12for residents of long term care facilities and participants
13receiving home care and community-based care. Managed care is
14increasingly becoming the vehicle for delivering health and
15long-term services and supports to seniors and persons with



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1disabilities, including dual eligible participants. The
2additional ombudsman authority will allow advocacy services to
3be provided to Illinois participants for the first time and
4will produce a cost savings for the State of Illinois by
5supporting the rebalancing efforts of the Patient Protection
6and Affordable Care Act.
7    (a) Long Term Care Ombudsman Program. The Department shall
8establish a Long Term Care Ombudsman Program, through the
9Office of State Long Term Care Ombudsman ("the Office"), in
10accordance with the provisions of the Older Americans Act of
111965, as now or hereafter amended. The Long Term Care Ombudsman
12Program is authorized, subject to sufficient appropriations,
13to advocate on behalf of older persons and persons with
14disabilities residing in their own homes or community-based
15settings, relating to matters which may adversely affect the
16health, safety, welfare, or rights of such individuals.
17    (b) Definitions. As used in this Section, unless the
18context requires otherwise:
19        (1) "Access" has the same meaning as in Section 1-104
20    of the Nursing Home Care Act, as now or hereafter amended;
21    that is, it means the right to:
22            (i) Enter any long term care facility or assisted
23        living or shared housing establishment or supportive
24        living facility;
25            (ii) Communicate privately and without restriction
26        with any resident, regardless of age, who consents to



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1        the communication;
2            (iii) Seek consent to communicate privately and
3        without restriction with any participant or resident,
4        regardless of age;
5            (iv) Inspect the clinical and other records of a
6        participant or resident, regardless of age, with the
7        express written consent of the participant or
8        resident;
9            (v) Observe all areas of the long term care
10        facility or supportive living facilities, assisted
11        living or shared housing establishment except the
12        living area of any resident who protests the
13        observation; and .
14            (vi) Subject to permission of the participant or
15        resident requesting services or his or her
16        representative, enter a home or community-based
17        setting.
18        (2) "Long Term Care Facility" means (i) any facility as
19    defined by Section 1-113 of the Nursing Home Care Act, as
20    now or hereafter amended; and (ii) any skilled nursing
21    facility or a nursing facility which meets the requirements
22    of Section 1819(a), (b), (c), and (d) or Section 1919(a),
23    (b), (c), and (d) of the Social Security Act, as now or
24    hereafter amended (42 U.S.C. 1395i-3(a), (b), (c), and (d)
25    and 42 U.S.C. 1396r(a), (b), (c), and (d)); and any
26    facility as defined by Section 1-113 of the MR/DD Community



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1    Care Act, as now or hereafter amended.
2        (2.5) "Assisted living establishment" and "shared
3    housing establishment" have the meanings given those terms
4    in Section 10 of the Assisted Living and Shared Housing
5    Act.
6        (2.7) "Supportive living facility" means a facility
7    established under Section 5-5.01a of the Illinois Public
8    Aid Code.
9        (2.8) "Community-based setting" means any place of
10    abode other than an individual's private home.
11        (3) "State Long Term Care Ombudsman" means any person
12    employed by the Department to fulfill the requirements of
13    the Office of State Long Term Care Ombudsman as required
14    under the Older Americans Act of 1965, as now or hereafter
15    amended, and Departmental policy.
16        (3.1) "Ombudsman" means any designated representative
17    of the State Long Term Care Ombudsman Program a regional
18    long term care ombudsman program; provided that the
19    representative, whether he is paid for or volunteers his
20    ombudsman services, shall be qualified and designated by
21    the Office to perform the duties of an ombudsman as
22    specified by the Department in rules and in accordance with
23    the provisions of the Older Americans Act of 1965, as now
24    or hereafter amended.
25        (4) "Participant" means an older person or persons with
26    disabilities who are eligible for services under any of the



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1    following:
2            (i) A medical assistance waiver administered by
3        the State.
4            (ii) A managed care organization providing care
5        coordination and other services to seniors and persons
6        with disabilities.
7        (5) "Resident" means an older individual who resides in
8    a long-term care facility.
9    (c) Ombudsman; rules. The Office of State Long Term Care
10Ombudsman shall be composed of at least one full-time ombudsman
11and shall include a system of designated regional long term
12care ombudsman programs. Each regional program shall be
13designated by the State Long Term Care Ombudsman as a
14subdivision of the Office and any representative of a regional
15program shall be treated as a representative of the Office.
16    The Department, in consultation with the Office, shall
17promulgate administrative rules in accordance with the
18provisions of the Older Americans Act of 1965, as now or
19hereafter amended, to establish the responsibilities of the
20Department and the Office of State Long Term Care Ombudsman and
21the designated regional Ombudsman programs. The administrative
22rules shall include the responsibility of the Office and
23designated regional programs to investigate and resolve
24complaints made by or on behalf of residents of long term care
25facilities, supportive living facilities, and assisted living
26and shared housing establishments, and participants residing



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1in their own homes or community-based settings, including the
2option to serve residents and participants under the age of 60,
3relating to actions, inaction, or decisions of providers, or
4their representatives, of such long term care facilities, of
5supported living facilities, of assisted living and shared
6housing establishments, of public agencies, or of social
7services agencies, which may adversely affect the health,
8safety, welfare, or rights of such residents and participants.
9The Office and designated regional programs may represent all
10residents and participants, but are not required by this Act to
11represent persons under 60 years of age, except to the extent
12required by federal law. When necessary and appropriate,
13representatives of the Office shall refer complaints to the
14appropriate regulatory State agency. The Department, in
15consultation with the Office, shall cooperate with the
16Department of Human Services and other State agencies in
17providing information and training to designated regional long
18term care ombudsman programs about the appropriate assessment
19and treatment (including information about appropriate
20supportive services, treatment options, and assessment of
21rehabilitation potential) of the participants residents they
22serve, including children, persons with mental illness (other
23than Alzheimer's disease and related disorders), and persons
24with developmental disabilities.
25    The State Long Term Care Ombudsman and all other ombudsmen,
26as defined in paragraph (3.1) of subsection (b) must submit to



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1background checks under the Health Care Worker Background Check
2Act and receive training, as prescribed by the Illinois
3Department on Aging, before visiting facilities, private
4homes, or community-based settings. The training must include
5information specific to assisted living establishments,
6supportive living facilities, and shared housing
7establishments, private homes, and community-based settings
8and to the rights of residents and participants guaranteed
9under the corresponding Acts and administrative rules.
10    (c-5) Consumer Choice Information Reports. The Office
12        (1) In collaboration with the Attorney General, create
13    a Consumer Choice Information Report form to be completed
14    by all licensed long term care facilities to aid
15    Illinoisans and their families in making informed choices
16    about long term care. The Office shall create a Consumer
17    Choice Information Report for each type of licensed long
18    term care facility. The Office shall collaborate with the
19    Attorney General and the Department of Human Services to
20    create a Consumer Choice Information Report form for
21    facilities licensed under the MR/DD Community Care Act.
22        (2) Develop a database of Consumer Choice Information
23    Reports completed by licensed long term care facilities
24    that includes information in the following consumer
25    categories:
26            (A) Medical Care, Services, and Treatment.



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1            (B) Special Services and Amenities.
2            (C) Staffing.
3            (D) Facility Statistics and Resident Demographics.
4            (E) Ownership and Administration.
5            (F) Safety and Security.
6            (G) Meals and Nutrition.
7            (H) Rooms, Furnishings, and Equipment.
8            (I) Family, Volunteer, and Visitation Provisions.
9        (3) Make this information accessible to the public,
10    including on the Internet by means of a hyperlink labeled
11    "Resident's Right to Know" on the Office's World Wide Web
12    home page. Information about facilities licensed under the
13    MR/DD Community Care Act shall be made accessible to the
14    public by the Department of Human Services, including on
15    the Internet by means of a hyperlink labeled "Resident's
16    and Families' Right to Know" on the Department of Human
17    Services' "For Customers" website.
18        (4) Have the authority, with the Attorney General, to
19    verify that information provided by a facility is accurate.
20        (5) Request a new report from any licensed facility
21    whenever it deems necessary.
22        (6) Include in the Office's Consumer Choice
23    Information Report for each type of licensed long term care
24    facility additional information on each licensed long term
25    care facility in the State of Illinois, including
26    information regarding each facility's compliance with the



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1    relevant State and federal statutes, rules, and standards;
2    customer satisfaction surveys; and information generated
3    from quality measures developed by the Centers for Medicare
4    and Medicaid Services.
5    (d) Access and visitation rights.
6        (1) In accordance with subparagraphs (A) and (E) of
7    paragraph (3) of subsection (c) of Section 1819 and
8    subparagraphs (A) and (E) of paragraph (3) of subsection
9    (c) of Section 1919 of the Social Security Act, as now or
10    hereafter amended (42 U.S.C. 1395i-3 (c)(3)(A) and (E) and
11    42 U.S.C. 1396r (c)(3)(A) and (E)), and Section 712 of the
12    Older Americans Act of 1965, as now or hereafter amended
13    (42 U.S.C. 3058f), a long term care facility, supportive
14    living facility, assisted living establishment, and shared
15    housing establishment must:
16            (i) permit immediate access to any resident,
17        regardless of age, by a designated ombudsman; and
18            (ii) permit representatives of the Office, with
19        the permission of the resident's legal representative
20        or legal guardian, to examine a resident's clinical and
21        other records, regardless of the age of the resident,
22        and if a resident is unable to consent to such review,
23        and has no legal guardian, permit representatives of
24        the Office appropriate access, as defined by the
25        Department, in consultation with the Office, in
26        administrative rules, to the resident's records.



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1        (2) Each long term care facility, supportive living
2    facility, assisted living establishment, and shared
3    housing establishment shall display, in multiple,
4    conspicuous public places within the facility accessible
5    to both visitors and residents and in an easily readable
6    format, the address and phone number of the Office of the
7    Long Term Care Ombudsman, in a manner prescribed by the
8    Office.
9    (e) Immunity. An ombudsman or any representative of the
10Office participating in the good faith performance of his or
11her official duties shall have immunity from any liability
12(civil, criminal or otherwise) in any proceedings (civil,
13criminal or otherwise) brought as a consequence of the
14performance of his official duties.
15    (f) Business offenses.
16        (1) No person shall:
17            (i) Intentionally prevent, interfere with, or
18        attempt to impede in any way any representative of the
19        Office in the performance of his official duties under
20        this Act and the Older Americans Act of 1965; or
21            (ii) Intentionally retaliate, discriminate
22        against, or effect reprisals against any long term care
23        facility resident or employee for contacting or
24        providing information to any representative of the
25        Office.
26        (2) A violation of this Section is a business offense,



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1    punishable by a fine not to exceed $501.
2        (3) The Director of Aging, in consultation with the
3    Office, shall notify the State's Attorney of the county in
4    which the long term care facility, supportive living
5    facility, or assisted living or shared housing
6    establishment is located, or the Attorney General, of any
7    violations of this Section.
8    (g) Confidentiality of records and identities. The
9Department shall establish procedures for the disclosure by the
10State Ombudsman or the regional ombudsmen entities of files
11maintained by the program. The procedures shall provide that
12the files and records may be disclosed only at the discretion
13of the State Long Term Care Ombudsman or the person designated
14by the State Ombudsman to disclose the files and records, and
15the procedures shall prohibit the disclosure of the identity of
16any complainant, resident, participant, witness, or employee
17of a long term care provider unless:
18        (1) the complainant, resident, participant, witness,
19    or employee of a long term care provider or his or her
20    legal representative consents to the disclosure and the
21    consent is in writing;
22        (2) the complainant, resident, participant, witness,
23    or employee of a long term care provider gives consent
24    orally; and the consent is documented contemporaneously in
25    writing in accordance with such requirements as the
26    Department shall establish; or



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1        (3) the disclosure is required by court order.
2    (h) Legal representation. The Attorney General shall
3provide legal representation to any representative of the
4Office against whom suit or other legal action is brought in
5connection with the performance of the representative's
6official duties, in accordance with the State Employee
7Indemnification Act.
8    (i) Treatment by prayer and spiritual means. Nothing in
9this Act shall be construed to authorize or require the medical
10supervision, regulation or control of remedial care or
11treatment of any resident in a long term care facility operated
12exclusively by and for members or adherents of any church or
13religious denomination the tenets and practices of which
14include reliance solely upon spiritual means through prayer for
16    (j) The Long Term Care Ombudsman Fund is created as a
17special fund in the State treasury to receive moneys for the
18express purposes of this Section. All interest earned on moneys
19in the fund shall be credited to the fund. Moneys contained in
20the fund shall be used to support the purposes of this Section.
21(Source: P.A. 96-328, eff. 8-11-09; 96-758, eff. 8-25-09;
2296-1372, eff. 7-29-10; 97-38, eff. 6-28-11.)".