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1 | | be provided to Illinois participants for the first time and |
2 | | will produce a cost savings for the State of Illinois by |
3 | | supporting the rebalancing efforts of the Patient Protection |
4 | | and Affordable Care Act.
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5 | | (a) Long Term Care Ombudsman Program. The Department shall
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6 | | establish a Long Term Care Ombudsman Program, through the |
7 | | Office of State
Long Term Care Ombudsman ("the Office"), in |
8 | | accordance with the provisions of
the Older Americans Act of |
9 | | 1965, as now or hereafter amended. The Long Term Care Ombudsman |
10 | | Program is authorized, subject to sufficient appropriations, |
11 | | to advocate on behalf of older persons and persons with |
12 | | disabilities residing in their own homes or community-based |
13 | | settings, relating to matters which may adversely affect the |
14 | | health, safety, welfare, or rights of such individuals.
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15 | | (b) Definitions. As used in this Section, unless the |
16 | | context requires
otherwise:
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17 | | (1) "Access" means the right to:
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18 | | (i) Enter any long term care facility or assisted |
19 | | living or shared
housing establishment or supportive |
20 | | living facility;
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21 | | (ii) Communicate privately and without restriction |
22 | | with any resident, regardless of age,
who consents to |
23 | | the communication;
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24 | | (iii) Seek consent to communicate privately and |
25 | | without restriction
with any participant or resident, |
26 | | regardless of age;
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1 | | (iv) Inspect the clinical and other records of a |
2 | | participant or resident, regardless of age, with the
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3 | | express written consent of the participant or |
4 | | resident;
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5 | | (v) Observe all areas of the long term care |
6 | | facility or supportive
living facilities, assisted |
7 | | living or shared housing establishment except the
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8 | | living area of any resident who protests the |
9 | | observation; and
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10 | | (vi) Subject to permission of the participant or |
11 | | resident requesting services or his or her |
12 | | representative, enter a home or community-based |
13 | | setting. |
14 | | (2) "Long Term Care Facility" means (i) any facility as |
15 | | defined by Section
1-113 of the Nursing Home Care Act, as |
16 | | now or hereafter amended; and (ii) any
skilled nursing |
17 | | facility or a nursing facility which meets the
requirements |
18 | | of Section 1819(a), (b), (c), and (d) or Section 1919(a), |
19 | | (b),
(c), and (d) of the Social Security Act, as now or |
20 | | hereafter amended (42
U.S.C. 1395i-3(a), (b), (c), and (d) |
21 | | and 42 U.S.C. 1396r(a), (b), (c), and
(d)); and any |
22 | | facility as defined by Section 1-113 of the MR/DD Community |
23 | | Care Act, as now or hereafter amended.
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24 | | (2.5) "Assisted living establishment" and "shared |
25 | | housing establishment"
have the meanings given those terms |
26 | | in Section 10 of the Assisted Living and
Shared Housing |
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1 | | Act.
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2 | | (2.7) "Supportive living facility" means a facility |
3 | | established under
Section 5-5.01a of the Illinois Public |
4 | | Aid Code.
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5 | | (2.8) "Community-based setting" means any place of |
6 | | abode other than an individual's private home. |
7 | | (3) "State Long Term Care Ombudsman" means any person |
8 | | employed by the
Department to fulfill
the requirements of |
9 | | the Office of State Long Term Care Ombudsman as
required |
10 | | under the Older Americans Act of 1965, as now or hereafter |
11 | | amended,
and Departmental policy.
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12 | | (3.1) "Ombudsman" means any designated representative |
13 | | of the State Long Term Care Ombudsman Program; provided |
14 | | that the representative, whether he is
paid for or |
15 | | volunteers his ombudsman services, shall be qualified and
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16 | | designated by the Office to perform the duties of an |
17 | | ombudsman as specified by
the Department in rules and in |
18 | | accordance with the provisions of
the Older Americans Act |
19 | | of 1965, as now or hereafter amended.
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20 | | (4) "Participant" means an older person aged 60 or over |
21 | | or an adult with a disability aged 18 through 59 who is |
22 | | eligible for services under any of the following: |
23 | | (i) A medical assistance waiver administered by |
24 | | the State. |
25 | | (ii) A managed care organization providing care |
26 | | coordination and other services to seniors and persons |
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1 | | with disabilities. |
2 | | (5) "Resident" means an older person aged 60 or over or |
3 | | an adult with a disability aged 18 through 59 who resides |
4 | | in a long-term care facility. |
5 | | (c) Ombudsman; appointment. The Governor shall appoint, |
6 | | and the Senate shall confirm, a State Long Term Care Ombudsman. |
7 | | The State Long Term Care Ombudsman shall be appointed for a |
8 | | term of 4 years and shall function within the Department and |
9 | | shall report to the Director and the Governor. The Office of |
10 | | State Long Term Care Ombudsman rules. The Office of State Long |
11 | | Term Care Ombudsman shall
be composed of at least one full-time |
12 | | ombudsman and shall include a system of
designated regional |
13 | | long term care ombudsman programs. Each regional program
shall |
14 | | be designated by the State Long Term Care Ombudsman as a |
15 | | subdivision of
the Office and any representative of a regional |
16 | | program shall be treated as a
representative of the Office.
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17 | | The State Long Term Care Ombudsman shall function |
18 | | independently within the Department with respect to the |
19 | | operations of the Office, including the performance of |
20 | | investigations and issuance of findings and recommendations. |
21 | | The appropriation for the Office of State Long Term Care |
22 | | Ombudsman shall be separate from the overall appropriation for |
23 | | the Department. |
24 | | The Department, in consultation with the Office, shall |
25 | | promulgate
administrative rules in accordance with the |
26 | | provisions of the Older Americans
Act of 1965, as now or |
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1 | | hereafter amended, to establish the responsibilities of
the |
2 | | Department and the Office of State Long Term Care Ombudsman and |
3 | | the
designated regional Ombudsman programs. The administrative |
4 | | rules shall include
the responsibility of the Office and |
5 | | designated regional programs to
investigate and resolve |
6 | | complaints made by or on behalf of residents of long
term care |
7 | | facilities, supportive living facilities, and assisted living |
8 | | and
shared housing establishments, and participants residing |
9 | | in their own homes or community-based settings, including the |
10 | | option to serve residents and participants under the age of 60, |
11 | | relating to actions, inaction, or
decisions of providers, or |
12 | | their representatives, of such
facilities and establishments, |
13 | | of public agencies, or of social services agencies,
which may |
14 | | adversely affect the health, safety, welfare, or rights of such
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15 | | residents and participants. The Office and designated regional |
16 | | programs may represent all residents and participants, but are |
17 | | not required by this Act to represent persons under 60 years of |
18 | | age, except to the extent required by federal law.
When |
19 | | necessary and appropriate, representatives of the Office shall |
20 | | refer
complaints to the appropriate regulatory State agency.
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21 | | The Department, in consultation with the Office, shall |
22 | | cooperate with the
Department of Human Services and other State |
23 | | agencies in providing information and training to
designated |
24 | | regional long term care ombudsman programs about the |
25 | | appropriate
assessment and treatment (including information |
26 | | about appropriate supportive
services, treatment options, and |
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1 | | assessment of rehabilitation potential) of the participants |
2 | | they serve. |
3 | | The State Long Term Care Ombudsman and all other ombudsmen, |
4 | | as defined in paragraph (3.1) of subsection (b) must submit to |
5 | | background checks under the Health Care Worker Background Check |
6 | | Act and receive training, as prescribed by the Illinois |
7 | | Department on Aging, before visiting facilities, private |
8 | | homes, or community-based settings. The training must include |
9 | | information specific to assisted living establishments, |
10 | | supportive living facilities, shared housing establishments, |
11 | | private homes, and community-based settings and to the rights |
12 | | of residents and participants guaranteed under the |
13 | | corresponding Acts and administrative rules.
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14 | | (c-5) Consumer Choice Information Reports. The Office |
15 | | shall: |
16 | | (1) In collaboration with the Attorney General, create |
17 | | a Consumer Choice Information Report form to be completed |
18 | | by all licensed long term care facilities to aid |
19 | | Illinoisans and their families in making informed choices |
20 | | about long term care. The Office shall create a Consumer |
21 | | Choice Information Report for each type of licensed long |
22 | | term care facility. The Office shall collaborate with the |
23 | | Attorney General and the Department of Human Services to |
24 | | create a Consumer Choice Information Report form for |
25 | | facilities licensed under the MR/DD Community Care Act. |
26 | | (2) Develop a database of Consumer Choice Information |
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1 | | Reports completed by licensed long term care facilities |
2 | | that includes information in the following consumer |
3 | | categories: |
4 | | (A) Medical Care, Services, and Treatment. |
5 | | (B) Special Services and Amenities. |
6 | | (C) Staffing. |
7 | | (D) Facility Statistics and Resident Demographics. |
8 | | (E) Ownership and Administration. |
9 | | (F) Safety and Security. |
10 | | (G) Meals and Nutrition. |
11 | | (H) Rooms, Furnishings, and Equipment. |
12 | | (I) Family, Volunteer, and Visitation Provisions. |
13 | | (3) Make this information accessible to the public, |
14 | | including on the Internet by means of a hyperlink labeled |
15 | | "Resident's Right to Know" on the Office's World Wide Web |
16 | | home page. Information about facilities licensed under the |
17 | | MR/DD Community Care Act shall be made accessible to the |
18 | | public by the Department of Human Services, including on |
19 | | the Internet by means of a hyperlink labeled "Resident's |
20 | | and Families' Right to Know" on the Department of Human |
21 | | Services' "For Customers" website. |
22 | | (4) Have the authority, with the Attorney General, to |
23 | | verify that information provided by a facility is accurate. |
24 | | (5) Request a new report from any licensed facility |
25 | | whenever it deems necessary.
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26 | | (6) Include in the Office's Consumer Choice
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1 | | Information Report for each type of licensed long term care
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2 | | facility additional information on each licensed long term
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3 | | care facility in the State of Illinois, including
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4 | | information regarding each facility's compliance with the
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5 | | relevant State and federal statutes, rules, and standards;
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6 | | customer satisfaction surveys; and information generated
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7 | | from quality measures developed by the Centers for Medicare
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8 | | and Medicaid Services. |
9 | | (d) Access and visitation rights.
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10 | | (1) In accordance with subparagraphs (A) and (E) of |
11 | | paragraph (3) of
subsection (c) of Section 1819
and |
12 | | subparagraphs (A) and (E) of paragraph (3) of subsection |
13 | | (c) of Section
1919 of the Social Security Act, as now or |
14 | | hereafter amended (42 U.S.C.
1395i-3 (c)(3)(A) and (E) and |
15 | | 42 U.S.C. 1396r (c)(3)(A) and (E)), and
Section
712 of the |
16 | | Older Americans Act of 1965, as now or hereafter
amended |
17 | | (42 U.S.C. 3058f), a long term care facility, supportive |
18 | | living
facility, assisted living
establishment, and shared |
19 | | housing establishment must:
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20 | | (i) permit immediate access to any resident, |
21 | | regardless of age, by a designated
ombudsman;
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22 | | (ii) permit representatives of the Office, with |
23 | | the permission of the
resident's legal representative |
24 | | or legal guardian, to examine a resident's
clinical and |
25 | | other records, regardless of the age of the resident, |
26 | | and if a resident is unable to consent to such
review, |
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1 | | and has no legal guardian, permit representatives of |
2 | | the Office
appropriate access, as defined by the |
3 | | Department, in consultation with the
Office, in |
4 | | administrative rules, to the resident's records; and
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5 | | (iii) permit a representative of the Program to |
6 | | communicate privately and without restriction with any |
7 | | participant who consents to the communication |
8 | | regardless of the consent of, or withholding of consent |
9 | | by, a legal guardian or an agent named in a power of |
10 | | attorney executed by the participant. |
11 | | (2) Each long term care facility, supportive living |
12 | | facility, assisted
living establishment, and
shared |
13 | | housing establishment shall display, in multiple, |
14 | | conspicuous
public places within the facility accessible |
15 | | to both visitors and residents and
in an easily readable |
16 | | format, the address and phone number of the Office of the
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17 | | Long Term Care Ombudsman, in a manner prescribed by the |
18 | | Office.
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19 | | (e) Immunity. An ombudsman or any representative of the |
20 | | Office participating
in the good faith performance of his or |
21 | | her official duties
shall have immunity from any liability |
22 | | (civil, criminal or otherwise) in
any proceedings (civil, |
23 | | criminal or otherwise) brought as a consequence of
the |
24 | | performance of his official duties.
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25 | | (f) Business offenses.
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26 | | (1) No person shall:
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1 | | (i) Intentionally prevent, interfere with, or |
2 | | attempt to impede in any
way any representative of the |
3 | | Office in the performance of his
official
duties under |
4 | | this Act and the Older Americans Act of 1965; or
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5 | | (ii) Intentionally retaliate, discriminate |
6 | | against, or effect reprisals
against any long term care |
7 | | facility resident or employee for contacting or
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8 | | providing information to any representative of the |
9 | | Office.
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10 | | (2) A violation of this Section is a business offense, |
11 | | punishable by a
fine not to exceed $501.
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12 | | (3) The State Long Term Care Ombudsman shall
notify the |
13 | | State's Attorney of the
county in which the long term care |
14 | | facility, supportive living facility, or
assisted living |
15 | | or shared housing establishment is located,
or the Attorney |
16 | | General, of any violations of this Section.
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17 | | (g) Confidentiality of records and identities. The |
18 | | Department shall
establish procedures for the disclosure by the |
19 | | State Ombudsman or the regional
ombudsmen
entities of files |
20 | | maintained by the program. The procedures shall provide that
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21 | | the files and records may be disclosed only at the discretion |
22 | | of the State Long
Term Care
Ombudsman or the person designated |
23 | | by the State Ombudsman to disclose the files
and records, and |
24 | | the procedures shall prohibit the disclosure of the identity
of |
25 | | any complainant, resident, participant, witness, or employee |
26 | | of a long term care provider
unless:
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1 | | (1) the complainant, resident, participant, witness, |
2 | | or employee of a long term care
provider or his or her |
3 | | legal representative consents to the disclosure and the
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4 | | consent is in writing;
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5 | | (2) the complainant, resident, participant, witness, |
6 | | or employee of a long term care
provider gives consent |
7 | | orally; and the consent is documented contemporaneously
in |
8 | | writing in
accordance with such requirements as the |
9 | | Department shall establish; or
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10 | | (3) the disclosure is required by court order.
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11 | | (h) Legal representation. The Attorney General shall
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12 | | provide legal representation to any representative of the |
13 | | Office
against
whom suit or other legal action is brought in |
14 | | connection with the
performance of the representative's |
15 | | official duties, in accordance with the
State Employee |
16 | | Indemnification Act.
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17 | | (i) Treatment by prayer and spiritual means. Nothing in |
18 | | this Act shall
be construed to authorize or require the medical |
19 | | supervision, regulation
or control of remedial care or |
20 | | treatment of any resident in a long term
care facility operated |
21 | | exclusively by and for members or adherents of any
church or |
22 | | religious denomination the tenets and practices of which |
23 | | include
reliance solely upon spiritual means through prayer for |
24 | | healing.
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25 | | (j) The Long Term Care Ombudsman Fund is created as a |
26 | | special fund in the State treasury to receive moneys for the |
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1 | | express purposes of this Section. All interest earned on moneys |
2 | | in the fund shall be credited to the fund. Moneys contained in |
3 | | the fund shall be used to support the purposes of this Section. |
4 | | (k) Each Regional Ombudsman may, in accordance with rules |
5 | | promulgated by the Office, establish a multi-disciplinary team |
6 | | to act in an advisory role for the purpose of providing |
7 | | professional knowledge and expertise in handling complex |
8 | | abuse, neglect, and advocacy issues involving participants. |
9 | | Each multi-disciplinary team may consist of one or more |
10 | | volunteer representatives from any combination of at least 7 |
11 | | members from the following professions: banking or finance; |
12 | | disability care; health care; pharmacology; law; law |
13 | | enforcement; emergency responder; mental health care; clergy; |
14 | | coroner or medical examiner; substance abuse; domestic |
15 | | violence; sexual assault; or other related fields. To support |
16 | | multi-disciplinary teams in this role, law enforcement |
17 | | agencies and coroners or medical examiners shall supply records |
18 | | as may be requested in particular cases. The Regional |
19 | | Ombudsman, or his or her designee, of the area in which the |
20 | | multi-disciplinary team is created shall be the facilitator of |
21 | | the multi-disciplinary team. |
22 | | (Source: P.A. 97-38, eff. 6-28-11; 98-380, eff. 8-16-13; |
23 | | 98-989, eff. 1-1-15 .)".
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