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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Long Term Acute Care Hospital Quality | ||||||||||||||||||||||||||||||
5 | Improvement Transfer Program Act is amended by changing | ||||||||||||||||||||||||||||||
6 | Sections 10, 15, 20, and 50 as follows: | ||||||||||||||||||||||||||||||
7 | (210 ILCS 155/10)
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8 | Sec. 10. Definitions. As used in this Act: | ||||||||||||||||||||||||||||||
9 | (a) "CARE tool" means the Continuity and Record Evaluation | ||||||||||||||||||||||||||||||
10 | (CARE) tool. It is a patient assessment instrument that has | ||||||||||||||||||||||||||||||
11 | been developed to document the medical, cognitive, functional, | ||||||||||||||||||||||||||||||
12 | and discharge status of persons receiving health care services | ||||||||||||||||||||||||||||||
13 | in acute and post-acute care settings. The data collected is | ||||||||||||||||||||||||||||||
14 | able to document provider-level quality of care (patient | ||||||||||||||||||||||||||||||
15 | outcomes) and characterize the clinical complexity of | ||||||||||||||||||||||||||||||
16 | patients. For the purposes of this Act, the CARE tool must be | ||||||||||||||||||||||||||||||
17 | identical to the most current version required by Medicare. | ||||||||||||||||||||||||||||||
18 | (b) "Department" means the Illinois Department of | ||||||||||||||||||||||||||||||
19 | Healthcare and Family Services. | ||||||||||||||||||||||||||||||
20 | (c) "Discharge" means the release of a patient from | ||||||||||||||||||||||||||||||
21 | hospital care for any discharge disposition other than a leave | ||||||||||||||||||||||||||||||
22 | of absence, even if for Medicare payment purposes the discharge | ||||||||||||||||||||||||||||||
23 | fits the definition of an interrupted stay.
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1 | (d) "FTE" means "full-time equivalent" or a person or | ||||||
2 | persons employed in one full-time position. | ||||||
3 | (e) "Hospital" means an institution, place, building, or | ||||||
4 | agency located in this State that is licensed as a general | ||||||
5 | acute hospital by the Illinois Department of Public Health | ||||||
6 | under the Hospital Licensing Act, whether public or private and | ||||||
7 | whether organized for profit or not-for-profit. | ||||||
8 | (f) "ICU" means intensive care unit. | ||||||
9 | (g) "LTAC hospital" means an Illinois hospital that is | ||||||
10 | designated by Medicare as a long term acute care hospital as | ||||||
11 | described in Section 1886(d)(1)(B)(iv)(I) of the Social | ||||||
12 | Security Act and has an average length of Medicaid inpatient | ||||||
13 | stay greater than 25 days as reported on the hospital's 2008 | ||||||
14 | Medicaid cost report on file as of February 15, 2010, or a | ||||||
15 | hospital that begins operations after January 1, 2009 and is | ||||||
16 | designated by Medicare as a long term acute care hospital. | ||||||
17 | (h) "LTAC hospital criteria" means nationally recognized | ||||||
18 | evidence-based evaluation criteria that have been publicly | ||||||
19 | tested and includes criteria specific to an LTAC hospital for | ||||||
20 | admission, continuing stay, and discharge. The criteria cannot | ||||||
21 | include criteria derived or developed by or for a specific | ||||||
22 | hospital or group of hospitals. Criteria and tools developed by | ||||||
23 | hospitals or hospital associations or hospital-owned | ||||||
24 | organizations are not acceptable and do not meet the | ||||||
25 | requirements of this subsection. | ||||||
26 | (i) "Patient" means an individual who is admitted to a |
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1 | hospital for an inpatient stay. | ||||||
2 | (j) "Program" means the Long Term Acute Care Hospital | ||||||
3 | Quality Improvement Transfer Program established by this Act. | ||||||
4 | (k) "STAC hospital" means a hospital that is not an LTAC | ||||||
5 | hospital as defined in this Act or a psychiatric hospital or a | ||||||
6 | rehabilitation hospital.
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7 | (Source: P.A. 96-1130, eff. 7-20-10; 97-662, eff. 1-13-12; | ||||||
8 | 97-667, eff. 1-13-12.) | ||||||
9 | (210 ILCS 155/15)
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10 | Sec. 15. Qualifying Hospitals. | ||||||
11 | (a) Beginning October 1, 2010, the Department shall | ||||||
12 | establish the Long Term Acute Care Hospital Quality Improvement | ||||||
13 | Transfer Program. Any hospital may participate in the program | ||||||
14 | if it meets the requirements of this Section as determined by | ||||||
15 | the Department. | ||||||
16 | (b) To participate in the program a hospital must do the | ||||||
17 | following: | ||||||
18 | (1) Operate as an LTAC hospital. | ||||||
19 | (2) Employ one-half of an FTE (designated for case | ||||||
20 | management) for every 15 patients admitted to the hospital. | ||||||
21 | (3) Maintain on-site physician coverage 24 hours a day, | ||||||
22 | 7 days a week. | ||||||
23 | (4) Maintain on-site respiratory therapy coverage 24 | ||||||
24 | hours a day, 7 days a week. | ||||||
25 | (c) A hospital must also execute a program participation |
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1 | agreement with the Department. The agreement must include: | ||||||
2 | (1) An attestation that the hospital complies with the | ||||||
3 | criteria in subsection (b) of this Section. | ||||||
4 | (2) A process for the hospital to report its continuing | ||||||
5 | compliance with subsection (b) of this Section. The | ||||||
6 | hospital must submit a compliance report at least annually. | ||||||
7 | (3) A requirement that the hospital complete and submit | ||||||
8 | to the Department the CARE tool (the most currently | ||||||
9 | available version required by Medicare or an equivalent | ||||||
10 | tool designated and approved for use by the Department ) for | ||||||
11 | each patient no later than 13 7 calendar days after | ||||||
12 | discharge. | ||||||
13 | (4) A requirement that the hospital use a patient | ||||||
14 | satisfaction survey specifically designed for LTAC | ||||||
15 | hospital settings. The hospital must submit survey results | ||||||
16 | data to the Department at least annually.
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17 | (5) A requirement that the hospital accept all | ||||||
18 | clinically approved patients for admission or transfer | ||||||
19 | from a STAC hospital with the exception of STAC hospitals | ||||||
20 | identified in paragraphs (1) and (2) under subsection (a) | ||||||
21 | of Section 25 of this Act. The patient must be evaluated | ||||||
22 | using LTAC hospital criteria approved by the Department for | ||||||
23 | use in this program and meet the appropriate criteria. | ||||||
24 | (6) A requirement that the hospital report quality and | ||||||
25 | outcome measurement data, as described in Section 20 of | ||||||
26 | this Act, to the Department at least annually. |
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1 | (7) A requirement that the hospital provide the | ||||||
2 | Department full access to patient data and other data | ||||||
3 | maintained by the hospital. Access must be in compliance | ||||||
4 | with State and federal law. | ||||||
5 | (8) A requirement that the hospital use LTAC hospital | ||||||
6 | criteria to evaluate patients that are admitted to the | ||||||
7 | hospital to determine that the patient is in the most | ||||||
8 | appropriate setting.
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9 | (Source: P.A. 96-1130, eff. 7-20-10.) | ||||||
10 | (210 ILCS 155/20)
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11 | Sec. 20. Quality and outcome measurement data.
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12 | (a) For proper evaluation and monitoring of the program, | ||||||
13 | each LTAC hospital must provide quality and outcome measurement | ||||||
14 | data ("measures") that are identical to the measures as | ||||||
15 | specified in Medicare's LTCH Quality Reporting Program Manual | ||||||
16 | (version 2.0) and any subsequent revisions subsections (c) | ||||||
17 | through (h) of this Section to the Department for patients | ||||||
18 | treated under this program. The Department may develop measures | ||||||
19 | in addition to the minimum measures required under this | ||||||
20 | Section . | ||||||
21 | (b) Two sets of measures must be calculated. The first set | ||||||
22 | should only use data for medical assistance patients, and the | ||||||
23 | second set should include all patients of the LTAC hospital | ||||||
24 | regardless of payer. | ||||||
25 | (c) (Blank). Average LTAC hospital length of stay for |
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1 | patients discharged during the reporting period. | ||||||
2 | (d) (Blank). Adverse outcomes rates: Percent of patients | ||||||
3 | who expired or whose condition worsens and requires treatment | ||||||
4 | in a STAC hospital. | ||||||
5 | (e) (Blank). Ventilator weaning rate: Percent of patients | ||||||
6 | discharged during the reporting period who have been | ||||||
7 | successfully weaned off invasive mechanical ventilation. | ||||||
8 | (f) (Blank). Central Line Infection Rate per 1000 central | ||||||
9 | line days: Number of patients discharged from an LTAC hospital | ||||||
10 | during the reporting period that had a central line in place | ||||||
11 | and developed a bloodstream infection 48 hours or more after | ||||||
12 | admission to the LTAC hospital. | ||||||
13 | (g) (Blank). Acquired pressure ulcers per 1000 patient | ||||||
14 | days. | ||||||
15 | (h) (Blank). Falls with injury per 1000 patient days: | ||||||
16 | Number of falls among discharged LTAC hospital patients | ||||||
17 | discharged during the reporting period, who fell during the | ||||||
18 | LTAC hospital stay, regardless of distance fallen, that | ||||||
19 | required an ancillary or surgical procedure (i.e. x-ray, MRI, | ||||||
20 | sutures, surgery, etc.)
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21 | (Source: P.A. 96-1130, eff. 7-20-10.) | ||||||
22 | (210 ILCS 155/50)
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23 | Sec. 50. Duties of the Department. | ||||||
24 | (a) The Department is responsible for implementing, | ||||||
25 | monitoring, and evaluating the program. This includes but is |
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1 | not limited to: | ||||||
2 | (1) Collecting data required under Section 15 and data | ||||||
3 | necessary to calculate the measures under Section 20 of | ||||||
4 | this Act. To minimize the administrative burden for | ||||||
5 | participating LTAC hospitals, the Department must accept | ||||||
6 | data reported to other State or federal authorities. The | ||||||
7 | Department shall not require participating LTAC hospitals | ||||||
8 | to manually enter data into the Department's or its agent's | ||||||
9 | data system if that data has already been submitted to any | ||||||
10 | other State or federal authority. | ||||||
11 | (2) Setting annual benchmarks or targets for the | ||||||
12 | measures in Section 20 of this Act or other measures beyond | ||||||
13 | the minimum required under Section 20 . The Department must | ||||||
14 | consult participating LTAC hospitals when setting these | ||||||
15 | benchmarks and targets. | ||||||
16 | (3) Monitoring compliance with all requirements of | ||||||
17 | this Act. | ||||||
18 | (b) The Department shall include specific information on | ||||||
19 | the Program in its annual medical programs report. | ||||||
20 | (c) The Department must establish monitoring procedures | ||||||
21 | that ensure the LTAC supplemental payment is only paid for | ||||||
22 | patients who upon admission meet the LTAC hospital criteria. | ||||||
23 | The Department must notify qualified LTAC hospitals of the | ||||||
24 | procedures and establish an appeals process as part of those | ||||||
25 | procedures. The Department must recoup any LTAC supplemental | ||||||
26 | payments that are identified as being paid for patients who do |
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1 | not meet the LTAC hospital criteria. | ||||||
2 | (d) The Department must implement the program by October 1, | ||||||
3 | 2010. | ||||||
4 | (e) The Department must create and distribute to LTAC | ||||||
5 | hospitals the agreement required under subsection (c) of | ||||||
6 | Section 15 no later than September 1, 2010. | ||||||
7 | (f) The Department must notify Illinois hospitals which | ||||||
8 | LTAC hospital criteria are approved for use under the program.
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9 | The Department may limit LTAC hospital criteria to the most | ||||||
10 | strict criteria that meet the definitions of this Act. | ||||||
11 | (g) (Blank). The Department must identify discharge tools | ||||||
12 | that are considered equivalent to the CARE tool and approved | ||||||
13 | for use under the program. The Department must notify LTAC | ||||||
14 | hospitals which tools are approved for use under the program. | ||||||
15 | (h) The Department must notify Illinois LTAC hospitals of | ||||||
16 | the program and inform them how to apply for qualification and | ||||||
17 | what the qualification requirements are as described under | ||||||
18 | Section 15 of this Act. | ||||||
19 | (i) The Department must notify Illinois STAC hospitals | ||||||
20 | about the operation and implementation of the program | ||||||
21 | established by this Act. The Department must also notify LTAC | ||||||
22 | hospitals that accepting transfers from the STAC hospitals | ||||||
23 | identified in paragraphs (1) and (2) under subsection (a) of | ||||||
24 | Section 25 of this Act are not required under paragraph (5) of | ||||||
25 | subsection (c) of Section 15 of this Act. The Department must | ||||||
26 | notify LTAC hospitals that accepting transfers from the STAC |
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1 | hospitals identified in paragraphs (1) and (2) under subsection | ||||||
2 | (a) of Section 25 of this Act shall negatively impact the | ||||||
3 | savings calculations under the Program evaluation required by | ||||||
4 | Section 40 of this Act and shall in turn require the Department | ||||||
5 | to initiate the penalty described in subsection (d) of Section | ||||||
6 | 40 of this Act. | ||||||
7 | (j) The Department shall deem LTAC hospitals qualified | ||||||
8 | under Section 15 of this Act as qualifying for expedited | ||||||
9 | payments. | ||||||
10 | (k) The Department may use up to $500,000 of funds | ||||||
11 | contained in the Public Aid Recoveries Trust Fund per State | ||||||
12 | fiscal year to operate the program under this Act. The | ||||||
13 | Department may expand existing contracts, issue new contracts, | ||||||
14 | issue personal service contracts, or purchase other services, | ||||||
15 | supplies, or equipment.
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16 | (l) The Department may promulgate rules as allowed by the | ||||||
17 | Illinois Administrative Procedure Act to implement this Act; | ||||||
18 | however, the requirements under this Act shall be implemented | ||||||
19 | by the Department even if the Department's proposed rules are | ||||||
20 | not yet adopted by the implementation date of October 1, 2010.
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21 | (Source: P.A. 96-1130, eff. 7-20-10.)
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22 | Section 99. Effective date. This Act takes effect upon | ||||||
23 | becoming law.
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