Illinois General Assembly - Full Text of HB2465
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Full Text of HB2465  100th General Assembly


Rep. Sara Feigenholtz

Filed: 4/25/2017





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2    AMENDMENT NO. ______. Amend House Bill 2465 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Specialized Mental Health Rehabilitation
5Act of 2013 is amended by changing Sections 1-101.5, 1-102,
62-103, 4-105, and 4-108.5 and by adding Section 4-104.5 as
8    (210 ILCS 49/1-101.5)
9    Sec. 1-101.5. Prior law.
10    (a) This Act provides for licensure of long term care
11facilities that are federally designated as institutions for
12the mentally diseased on the effective date of this Act and
13specialize in providing services to individuals with a serious
14mental illness. On and after the effective date of this Act,
15these facilities shall be governed by this Act instead of the
16Nursing Home Care Act. The existence of a current or pending



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1administrative hearing, notice of violation, or other
2enforcement action, except for a pending notice of revocation,
3authorized under the Nursing Home Care Act shall not be a
4barrier to the provisional licensure of a facility under this
5Act. Provisional licensure under this Act shall not relieve a
6facility from the responsibility for the payment of any past,
7current, or future fines or penalties, or for any other
8enforcement remedy, imposed upon the facility under the Nursing
9Home Care Act.
10    (b) All consent decrees that apply to facilities federally
11designated as institutions for the mentally diseased shall
12continue to apply to facilities licensed under this Act.
13    (c) A facility licensed under this Act may voluntarily
14close, and the facility may reopen in an underserved region of
15the State, if the facility receives a certificate of need from
16the Health Facilities and Services Review Board. At no time
17shall the total number of licensed beds under this Act exceed
18the total number of licensed beds existing on July 22, 2013
19(the effective date of Public Act 98-104).
20(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
21    (210 ILCS 49/1-102)
22    Sec. 1-102. Definitions. For the purposes of this Act,
23unless the context otherwise requires:
24    "Abuse" means any physical or mental injury or sexual
25assault inflicted on a consumer other than by accidental means



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1in a facility.
2    "Accreditation" means any of the following:
3        (1) the Joint Commission;
4        (2) the Commission on Accreditation of Rehabilitation
5    Facilities;
6        (3) the Healthcare Facilities Accreditation Program;
7    or
8        (4) any other national standards of care as approved by
9    the Department.
10    "Applicant" means any person making application for a
11license or a provisional license under this Act.
12    "Consumer" means a person, 18 years of age or older,
13admitted to a mental health rehabilitation facility for
14evaluation, observation, diagnosis, treatment, stabilization,
15recovery, and rehabilitation.
16    "Consumer" does not mean any of the following:
17        (i) an individual requiring a locked setting;
18        (ii) an individual requiring psychiatric
19    hospitalization because of an acute psychiatric crisis;
20        (iii) an individual under 18 years of age;
21        (iv) an individual who is actively suicidal or violent
22    toward others;
23        (v) an individual who has been found unfit to stand
24    trial;
25        (vi) an individual who has been found not guilty by
26    reason of insanity based on committing a violent act, such



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1    as sexual assault, assault with a deadly weapon, arson, or
2    murder;
3        (vii) an individual subject to temporary detention and
4    examination under Section 3-607 of the Mental Health and
5    Developmental Disabilities Code;
6        (viii) an individual deemed clinically appropriate for
7    inpatient admission in a State psychiatric hospital; and
8        (ix) an individual transferred by the Department of
9    Corrections pursuant to Section 3-8-5 of the Unified Code
10    of Corrections.
11    "Consumer record" means a record that organizes all
12information on the care, treatment, and rehabilitation
13services rendered to a consumer in a specialized mental health
14rehabilitation facility.
15    "Controlled drugs" means those drugs covered under the
16federal Comprehensive Drug Abuse Prevention Control Act of
171970, as amended, or the Illinois Controlled Substances Act.
18    "Department" means the Department of Public Health.
19    "Discharge" means the full release of any consumer from a
21    "Drug administration" means the act in which a single dose
22of a prescribed drug or biological is given to a consumer. The
23complete act of administration entails removing an individual
24dose from a container, verifying the dose with the prescriber's
25orders, giving the individual dose to the consumer, and
26promptly recording the time and dose given.



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1    "Drug dispensing" means the act entailing the following of
2a prescription order for a drug or biological and proper
3selection, measuring, packaging, labeling, and issuance of the
4drug or biological to a consumer.
5    "Emergency" means a situation, physical condition, or one
6or more practices, methods, or operations which present
7imminent danger of death or serious physical or mental harm to
8consumers of a facility.
9    "Facility" means a specialized mental health
10rehabilitation facility that provides at least one of the
11following services: (1) triage center; (2) crisis
12stabilization; (3) recovery and rehabilitation supports; or
13(4) transitional living units for 3 or more persons. The
14facility shall provide a 24-hour program that provides
15intensive support and recovery services designed to assist
16persons, 18 years or older, with mental disorders to develop
17the skills to become self-sufficient and capable of increasing
18levels of independent functioning. It includes facilities that
19meet the following criteria:
20        (1) 100% of the consumer population of the facility has
21    a diagnosis of serious mental illness;
22        (2) no more than 15% of the consumer population of the
23    facility is 65 years of age or older;
24        (3) none of the consumers are non-ambulatory;
25        (4) none of the consumers have a primary diagnosis of
26    moderate, severe, or profound intellectual disability; and



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1        (5) the facility must have been licensed under the
2    Specialized Mental Health Rehabilitation Act or the
3    Nursing Home Care Act immediately preceding July 22, 2013
4    (the effective date of this Act) and qualifies as an a
5    institute for mental disease under the federal definition
6    of the term.
7    "Facility" does not include the following:
8        (1) a home, institution, or place operated by the
9    federal government or agency thereof, or by the State of
10    Illinois;
11        (2) a hospital, sanitarium, or other institution whose
12    principal activity or business is the diagnosis, care, and
13    treatment of human illness through the maintenance and
14    operation as organized facilities therefor which is
15    required to be licensed under the Hospital Licensing Act;
16        (3) a facility for child care as defined in the Child
17    Care Act of 1969;
18        (4) a community living facility as defined in the
19    Community Living Facilities Licensing Act;
20        (5) a nursing home or sanatorium operated solely by and
21    for persons who rely exclusively upon treatment by
22    spiritual means through prayer, in accordance with the
23    creed or tenets of any well-recognized church or religious
24    denomination; however, such nursing home or sanatorium
25    shall comply with all local laws and rules relating to
26    sanitation and safety;



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1        (6) a facility licensed by the Department of Human
2    Services as a community-integrated living arrangement as
3    defined in the Community-Integrated Living Arrangements
4    Licensure and Certification Act;
5        (7) a supportive residence licensed under the
6    Supportive Residences Licensing Act;
7        (8) a supportive living facility in good standing with
8    the program established under Section 5-5.01a of the
9    Illinois Public Aid Code, except only for purposes of the
10    employment of persons in accordance with Section 3-206.01
11    of the Nursing Home Care Act;
12        (9) an assisted living or shared housing establishment
13    licensed under the Assisted Living and Shared Housing Act,
14    except only for purposes of the employment of persons in
15    accordance with Section 3-206.01 of the Nursing Home Care
16    Act;
17        (10) an Alzheimer's disease management center
18    alternative health care model licensed under the
19    Alternative Health Care Delivery Act;
20        (11) a home, institution, or other place operated by or
21    under the authority of the Illinois Department of Veterans'
22    Affairs;
23        (12) a facility licensed under the ID/DD Community Care
24    Act;
25        (13) a facility licensed under the Nursing Home Care
26    Act after July 22, 2013 (the effective date of this Act);



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1    or
2        (14) a facility licensed under the MC/DD Act.
3    "Executive director" means a person who is charged with the
4general administration and supervision of a facility licensed
5under this Act and who is a licensed nursing home
6administrator, licensed practitioner of the healing arts, or
7qualified mental health professional.
8    "Guardian" means a person appointed as a guardian of the
9person or guardian of the estate, or both, of a consumer under
10the Probate Act of 1975.
11    "Identified offender" means a person who meets any of the
12following criteria:
13        (1) Has been convicted of, found guilty of, adjudicated
14    delinquent for, found not guilty by reason of insanity for,
15    or found unfit to stand trial for, any felony offense
16    listed in Section 25 of the Health Care Worker Background
17    Check Act, except for the following:
18            (i) a felony offense described in Section 10-5 of
19        the Nurse Practice Act;
20            (ii) a felony offense described in Section 4, 5, 6,
21        8, or 17.02 of the Illinois Credit Card and Debit Card
22        Act;
23            (iii) a felony offense described in Section 5, 5.1,
24        5.2, 7, or 9 of the Cannabis Control Act;
25            (iv) a felony offense described in Section 401,
26        401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois



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1        Controlled Substances Act; and
2            (v) a felony offense described in the
3        Methamphetamine Control and Community Protection Act.
4        (2) Has been convicted of, adjudicated delinquent for,
5    found not guilty by reason of insanity for, or found unfit
6    to stand trial for, any sex offense as defined in
7    subsection (c) of Section 10 of the Sex Offender Management
8    Board Act.
9    "Transitional living units" are residential units within a
10facility that have the purpose of assisting the consumer in
11developing and reinforcing the necessary skills to live
12independently outside of the facility. The duration of stay in
13such a setting shall not exceed 120 days for each consumer.
14Nothing in this definition shall be construed to be a
15prerequisite for transitioning out of a facility.
16    "Licensee" means the person, persons, firm, partnership,
17association, organization, company, corporation, or business
18trust to which a license has been issued.
19    "Misappropriation of a consumer's property" means the
20deliberate misplacement, exploitation, or wrongful temporary
21or permanent use of a consumer's belongings or money without
22the consent of a consumer or his or her guardian.
23    "Neglect" means a facility's failure to provide, or willful
24withholding of, adequate medical care, mental health
25treatment, psychiatric rehabilitation, personal care, or
26assistance that is necessary to avoid physical harm and mental



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1anguish of a consumer.
2    "Personal care" means assistance with meals, dressing,
3movement, bathing, or other personal needs, maintenance, or
4general supervision and oversight of the physical and mental
5well-being of an individual who is incapable of maintaining a
6private, independent residence or who is incapable of managing
7his or her person, whether or not a guardian has been appointed
8for such individual. "Personal care" shall not be construed to
9confine or otherwise constrain a facility's pursuit to develop
10the skills and abilities of a consumer to become
11self-sufficient and capable of increasing levels of
12independent functioning.
13    "Recovery and rehabilitation supports" means a program
14that facilitates a consumer's longer-term symptom management
15and stabilization while preparing the consumer for
16transitional living units by improving living skills and
17community socialization. The duration of stay in such a setting
18shall be established by the Department by rule.
19    "Restraint" means:
20        (i) a physical restraint that is any manual method or
21    physical or mechanical device, material, or equipment
22    attached or adjacent to a consumer's body that the consumer
23    cannot remove easily and restricts freedom of movement or
24    normal access to one's body; devices used for positioning,
25    including, but not limited to, bed rails, gait belts, and
26    cushions, shall not be considered to be restraints for



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1    purposes of this Section; or
2        (ii) a chemical restraint that is any drug used for
3    discipline or convenience and not required to treat medical
4    symptoms; the Department shall, by rule, designate certain
5    devices as restraints, including at least all those devices
6    that have been determined to be restraints by the United
7    States Department of Health and Human Services in
8    interpretive guidelines issued for the purposes of
9    administering Titles XVIII and XIX of the federal Social
10    Security Act. For the purposes of this Act, restraint shall
11    be administered only after utilizing a coercive free
12    environment and culture.
13    "Self-administration of medication" means consumers shall
14be responsible for the control, management, and use of their
15own medication.
16    "Crisis stabilization" means a secure and separate unit
17that provides short-term behavioral, emotional, or psychiatric
18crisis stabilization as an alternative to hospitalization or
19re-hospitalization for consumers from residential or community
20placement. The duration of stay in such a setting shall not
21exceed 21 days for each consumer.
22    "Therapeutic separation" means the removal of a consumer
23from the milieu to a room or area which is designed to aid in
24the emotional or psychiatric stabilization of that consumer.
25    "Triage center" means a non-residential 23-hour center
26that serves as an alternative to emergency room care,



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1hospitalization, or re-hospitalization for consumers in need
2of short-term crisis stabilization. Consumers may access a
3triage center from a number of referral sources, including
4family, emergency rooms, hospitals, community behavioral
5health providers, federally qualified health providers, or
6schools, including colleges or universities. A triage center
7may be located in a building separate from the licensed
8location of a facility, but shall not be more than 1,000 feet
9from the licensed location of the facility and must meet all of
10the facility standards applicable to the licensed location. If
11the triage center does operate in a separate building, safety
12personnel shall be provided, on site, 24 hours per day and the
13triage center shall meet all other staffing requirements
14without counting any staff employed in the main facility
16(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
1799-180, eff. 7-29-15; revised 9-8-16.)
18    (210 ILCS 49/2-103)
19    Sec. 2-103. Staff training. Training for all new employees
20specific to the various levels of care offered by a facility
21shall be provided to employees during their orientation period
22and annually thereafter. Training shall be independent of the
23Department and overseen by the Division of Mental Health to
24determine the content of all facility employee training and to
25provide training for all trainers of facility employees.



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1Training of employees shall be consistent with nationally
2recognized national accreditation standards as defined later
3in this Act. Training of existing staff of a recovery and
4rehabilitation support center shall be conducted in accordance
5with, and on the schedule provided in, the staff training plan
6approved by the Division of Mental Health. Training of existing
7staff for any other level of care licensed under this Act,
8including triage, crisis stabilization, and transitional
9living shall be completed at a facility prior to the
10implementation of that level of care. Training shall be
11required for all existing staff at a facility prior to the
12implementation of any new services authorized under this Act.
13(Source: P.A. 98-104, eff. 7-22-13.)
14    (210 ILCS 49/4-104.5 new)
15    Sec. 4-104.5. Waiver of compliance. Upon application by a
16facility, the Director may grant or renew the waiver of the
17facility's compliance with a rule or standard for a period not
18to exceed the duration of the current license or, in the case
19of an application for license renewal, the duration of the
20renewal period. The waiver may be conditioned upon the facility
21taking action prescribed by the Director as a measure
22equivalent to compliance. In determining whether to grant or
23renew a waiver, the Director shall consider the duration and
24basis for any current waiver with respect to the same rule or
25standard and the validity and effect upon patient health and



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1safety of extending it on the same basis, the effect upon the
2health and safety of consumers, the quality of consumer care,
3the facility's history of compliance with the rules and
4standards of this Act and the facility's attempts to comply
5with the particular rule or standard in question. Upon request
6by a facility, the Department must evaluate or allow for an
7evaluation of compliance with the Life Safety Code using the
8Fire Safety Evaluation System. In determining whether to grant
9or renew a waiver of a standard pertaining to Chapter 33 of the
10National Fire Protection Association (NFPA) 101 Life Safety
11Code, the Director shall use Fire Safety Evaluation Systems in
12determining whether to grant or renew the waiver. The
13Department may provide, by rule, for the automatic renewal of
14waivers concerning physical plant requirements upon the
15renewal of a license. The Department shall renew waivers
16relating to physical plant standards issued in accordance with
17this Section at the time of the indicated reviews, unless it
18can show why such waivers should not be extended for either of
19the following reasons:
20        (1) the condition of the physical plant has
21    deteriorated or its use substantially changed so that the
22    basis upon which the waiver was issued is materially
23    different; or
24        (2) the facility is renovated or substantially
25    remodeled in such a way as to permit compliance with the
26    applicable rules and standards without a substantial



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1    increase in cost.
2    A copy of each waiver application and each waiver granted
3or renewed shall be on file with the Department and available
4for public inspection.
5    No penalty or fine may be assessed for a condition for
6which the facility has received a variance or waiver of a
8    Waivers granted to a facility by the Department under any
9other law shall not be considered by the Department in its
10determination of a facility's compliance with the requirements
11of this Act, including, but not limited to, compliance with the
12Life Safety Code.
13    (210 ILCS 49/4-105)
14    Sec. 4-105. Provisional licensure duration. A provisional
15license shall be valid upon fulfilling the requirements
16established by the Department by emergency rule. The license
17shall remain valid as long as a facility remains in compliance
18with the licensure provisions established in rule. Provisional
19licenses issued upon initial licensure as a specialized mental
20health rehabilitation facility shall expire at the end of a
213-year period, which commences on the date the provisional
22license is issued. Issuance of a provisional license for any
23reason other than initial licensure (including, but not limited
24to, change of ownership, location, number of beds, or services)
25shall not extend the maximum 3-year period, at the end of which



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1a facility must be licensed pursuant to Section 4-201.
2Notwithstanding any other provision of this Act or the
3Specialized Mental Health Rehabilitation Facilities Code, 77
4Ill. Admin. Code 380, to the contrary, if a facility has
5received notice from the Department that its application for
6provisional licensure to provide recovery and rehabilitation
7services has been accepted as complete and the facility has
8attested in writing to the Department that it will comply with
9the staff training plan approved by the Division of Mental
10Health, then a provisional license for recovery and
11rehabilitation services shall be issued to the facility within
1260 days after the Department determines that the facility is in
13compliance with the requirements of the Life Safety Code in
14accordance with Section 4-104.5 of this Act.
15(Source: P.A. 98-104, eff. 7-22-13; 99-712, eff. 8-5-16.)
16    (210 ILCS 49/4-108.5)
17    Sec. 4-108.5. Provisional licensure period; surveys.
18During the provisional licensure period, the Department shall
19conduct surveys to determine compliance with timetables and
20benchmarks with a facility's provisional licensure application
21plan of operation. Timetables and benchmarks shall be
22established in rule and shall include, but not be limited to,
23the following: (1) training of new and existing staff; (2)
24establishment of a data collection and reporting program for
25the facility's Quality Assessment and Performance Improvement



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1Program; and (3) compliance with building environment
2standards beyond compliance with Chapter 33 of the National
3Fire Protection Association (NFPA) 101 Life Safety Code.
4Waivers granted by the Department in accordance with Section
54-104.5 of this Act shall be considered by the Department in
6its determination of the facility's compliance with the Life
7Safety Code.
8    During the provisional licensure period, the Department
9shall conduct State licensure surveys as well as a conformance
10standard review to determine compliance with timetables and
11benchmarks associated with the accreditation process.
12Timetables and benchmarks shall be met in accordance with the
13preferred accrediting organization conformance standards and
14recommendations and shall include, but not be limited to,
15conducting a comprehensive facility self-evaluation in
16accordance with an established national accreditation program.
17The facility shall submit all data reporting and outcomes
18required by accrediting organization to the Department of
19Public Health for review to determine progress towards
20accreditation. Accreditation status shall supplement but not
21replace the State's licensure surveys of facilities licensed
22under this Act and their certified programs and services to
23determine the extent to which these facilities provide high
24quality interventions, especially evidence-based practices,
25appropriate to the assessed clinical needs of individuals in
26the 4 certified levels of care.



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1    Except for incidents involving the potential for harm,
2serious harm, death, or substantial facility failure to address
3a serious systemic issue within 60 days, findings of the
4facility's root cause analysis of problems and the facility's
5Quality Assessment and Performance Improvement program in
6accordance with item (22) of Section 4-104 shall not be used as
7a basis for non-compliance.
8    The Department shall have the authority to hire licensed
9practitioners of the healing arts and qualified mental health
10professionals to consult with and participate in survey and
11inspection activities.
12(Source: P.A. 98-651, eff. 6-16-14.)
13    Section 99. Effective date. This Act takes effect July 1,