Full Text of SB0987 100th General Assembly
SB0987sam001 100TH GENERAL ASSEMBLY | Sen. Wm. Sam McCann Filed: 3/28/2017
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| 1 | | AMENDMENT TO SENATE BILL 987
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 987 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Nursing Home Care Act is amended by | 5 | | changing Section 3-202.05 as follows: | 6 | | (210 ILCS 45/3-202.05) | 7 | | Sec. 3-202.05. Staffing ratios effective July 1, 2010 and | 8 | | thereafter. | 9 | | (a) For the purpose of computing staff to resident ratios, | 10 | | direct care staff shall include: | 11 | | (1) registered nurses; | 12 | | (2) licensed practical nurses; | 13 | | (3) certified nurse assistants; | 14 | | (4) psychiatric services rehabilitation aides; | 15 | | (5) rehabilitation and therapy aides; | 16 | | (6) psychiatric services rehabilitation coordinators; |
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| 1 | | (7) assistant directors of nursing; | 2 | | (8) 50% of the Director of Nurses' time; and | 3 | | (9) 30% of the Social Services Directors' time. | 4 | | The Department shall, by rule, allow certain facilities | 5 | | subject to 77 Ill. Admin. Code 300.4000 and following (Subpart | 6 | | S) to utilize specialized clinical staff, as defined in rules, | 7 | | to count towards the staffing ratios. | 8 | | Within 120 days of the effective date of this amendatory | 9 | | Act of the 97th General Assembly, the Department shall | 10 | | promulgate rules specific to the staffing requirements for | 11 | | facilities federally defined as Institutions for Mental | 12 | | Disease. These rules shall recognize the unique nature of | 13 | | individuals with chronic mental health conditions, shall | 14 | | include minimum requirements for specialized clinical staff, | 15 | | including clinical social workers, psychiatrists, | 16 | | psychologists, and direct care staff set forth in paragraphs | 17 | | (4) through (6) and any other specialized staff which may be | 18 | | utilized and deemed necessary to count toward staffing ratios. | 19 | | Within 120 days of the effective date of this amendatory | 20 | | Act of the 97th General Assembly, the Department shall | 21 | | promulgate rules specific to the staffing requirements for | 22 | | facilities licensed under the Specialized Mental Health | 23 | | Rehabilitation Act of 2013. These rules shall recognize the | 24 | | unique nature of individuals with chronic mental health | 25 | | conditions, shall include minimum requirements for specialized | 26 | | clinical staff, including clinical social workers, |
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| 1 | | psychiatrists, psychologists, and direct care staff set forth | 2 | | in paragraphs (4) through (6) and any other specialized staff | 3 | | which may be utilized and deemed necessary to count toward | 4 | | staffing ratios. | 5 | | (b) Beginning January 1, 2011, and thereafter, light | 6 | | intermediate care shall be staffed at the same staffing ratio | 7 | | as intermediate care. | 8 | | (c) Facilities shall notify the Department within 60 days | 9 | | after the effective date of this amendatory Act of the 96th | 10 | | General Assembly, in a form and manner prescribed by the | 11 | | Department, of the staffing ratios in effect on the effective | 12 | | date of this amendatory Act of the 96th General Assembly for | 13 | | both intermediate and skilled care and the number of residents | 14 | | receiving each level of care. | 15 | | (d)(1) Effective July 1, 2010, for each resident needing | 16 | | skilled care, a minimum staffing ratio of 2.5 hours of nursing | 17 | | and personal care each day must be provided; for each resident | 18 | | needing intermediate care, 1.7 hours of nursing and personal | 19 | | care each day must be provided. | 20 | | (2) Effective January 1, 2011, the minimum staffing ratios | 21 | | shall be increased to 2.7 hours of nursing and personal care | 22 | | each day for a resident needing skilled care and 1.9 hours of | 23 | | nursing and personal care each day for a resident needing | 24 | | intermediate care. | 25 | | (3) Effective January 1, 2012, the minimum staffing ratios | 26 | | shall be increased to 3.0 hours of nursing and personal care |
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| 1 | | each day for a resident needing skilled care and 2.1 hours of | 2 | | nursing and personal care each day for a resident needing | 3 | | intermediate care. | 4 | | (4) Effective January 1, 2013, the minimum staffing ratios | 5 | | shall be increased to 3.4 hours of nursing and personal care | 6 | | each day for a resident needing skilled care and 2.3 hours of | 7 | | nursing and personal care each day for a resident needing | 8 | | intermediate care. | 9 | | (5) Effective January 1, 2014, the minimum staffing ratios | 10 | | shall be increased to 3.8 hours of nursing and personal care | 11 | | each day for a resident needing skilled care and 2.5 hours of | 12 | | nursing and personal care each day for a resident needing | 13 | | intermediate care.
| 14 | | (e) Ninety days after the effective date of this amendatory | 15 | | Act of the 97th General Assembly, a minimum of 25% of nursing | 16 | | and personal care time shall be provided by licensed nurses, | 17 | | with at least 10% of nursing and personal care time provided by | 18 | | registered nurses. These minimum requirements shall remain in | 19 | | effect until an acuity based registered nurse requirement is | 20 | | promulgated by rule concurrent with the adoption of the | 21 | | Resource Utilization Group classification-based payment | 22 | | methodology, as provided in Section 5-5.2 of the Illinois | 23 | | Public Aid Code. Registered nurses and licensed practical | 24 | | nurses employed by a facility in excess of these requirements | 25 | | may be used to satisfy the remaining 75% of the nursing and | 26 | | personal care time requirements. Notwithstanding this |
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| 1 | | subsection, no staffing requirement in statute in effect on the | 2 | | effective date of this amendatory Act of the 97th General | 3 | | Assembly shall be reduced on account of this subsection. | 4 | | (f) On and after the effective date of this amendatory Act | 5 | | of the 100th General Assembly, in addition to any other | 6 | | staffing requirements under this Section, a facility licensed | 7 | | under this Act shall comply with the following: | 8 | | (1) The facility must have and implement a written plan | 9 | | that: | 10 | | (A) ensures staffing sufficient to meet the | 11 | | minimum staffing requirements described in paragraphs | 12 | | (3) through (8) of this subsection; | 13 | | (B) ensures staffing sufficient to meet the needs | 14 | | of each resident; and | 15 | | (C) identifies procedures to obtain required staff | 16 | | when absences occur. | 17 | | The facility must maintain a written, weekly staffing | 18 | | schedule showing the number and category of staff assigned | 19 | | to each shift and the person to be called in the event of | 20 | | an absence. | 21 | | (2) The facility must have the number of on-duty | 22 | | nursing staff publicly posted 24 hours each day. The posted | 23 | | staffing forms must (A) be prominently displayed in a | 24 | | public area and readily accessible to residents and | 25 | | visitors; (B) be at least 8.5 x 14 inches and printed in a | 26 | | minimum font size of 16; and (C) include the facility's |
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| 1 | | name, current date, current resident census per shift, the | 2 | | total number and actual hours worked by registered nurses, | 3 | | licensed practical nurses, and nursing assistants directly | 4 | | responsible for resident services per shift, and the | 5 | | minimum staffing standard, nursing assistant to resident | 6 | | ratio, under paragraph (6) of this subsection. | 7 | | The posted staffing information must be an accurate | 8 | | reflection of the actual staff working each shift. | 9 | | Upon oral or written request, the facility must make | 10 | | direct care staffing data available to the public for | 11 | | review at a cost not to exceed the community standard. The | 12 | | facility must maintain the posted nurse staffing data for a | 13 | | minimum of 18 months. | 14 | | (3) Resident service needs must be the primary | 15 | | consideration in determining the number and categories of | 16 | | nursing personnel needed. Nursing staff must be sufficient | 17 | | in quantity and quality to provide nursing services for | 18 | | each resident as needed, including restorative services | 19 | | that enable each resident to achieve and maintain the | 20 | | highest practicable degree of function, self-care, and | 21 | | independence, as determined by the resident's care plan. | 22 | | Sufficient staffing under this paragraph must be provided | 23 | | even though it exceeds other requirements specified by this | 24 | | subsection or specified in a waiver. | 25 | | (4) Licensed nurse hours must include no less than one | 26 | | registered nurse hour per resident per week. When a |
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| 1 | | registered nurse serves as the administrator in the | 2 | | temporary absence of an administrator, the registered | 3 | | nurse's hours must not be used to meet minimum nursing | 4 | | hours. In facilities with 41 or more beds, the hours of a | 5 | | licensed nurse who serves as facility administrator must | 6 | | not be included in any licensed nurse coverage required by | 7 | | this subsection. The licensed nurse serving as a charge | 8 | | nurse must not be counted toward the minimum staffing | 9 | | requirements under paragraph (6) of this subsection. | 10 | | (5) The facility must have a licensed charge nurse on | 11 | | each shift 24 hours per day. | 12 | | A registered nurse must serve as the licensed charge | 13 | | nurse for no less than 8 consecutive hours between the | 14 | | start of day shift and the end of evening shift, 7 days a | 15 | | week. | 16 | | The director of nursing services may serve as the | 17 | | charge nurse only when the facility has 60 or fewer | 18 | | residents. | 19 | | The requirements of this paragraph (5) may be waived by | 20 | | the Department. The request for waiver must comply with the | 21 | | provisions of this Act and must be reviewed annually. The | 22 | | waiver shall be considered by the Department if the | 23 | | facility certifies that (i) the facility has been unable to | 24 | | recruit appropriate personnel despite diligent efforts, | 25 | | including offering wages at the community prevailing rate | 26 | | for nursing facilities; (ii) the waiver does not endanger |
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| 1 | | the health or safety of residents; and (iii) a registered | 2 | | nurse or physician is available and obligated to | 3 | | immediately respond to telephone calls from the facility. | 4 | | (6) The facility must determine the specific time frame | 5 | | for beginning and ending each consecutive 8-hour shift | 6 | | using one of the following options: | 7 | | (A) Option one shall include (i) a day shift from | 8 | | 5:30 a.m. to 1:30 p.m., (ii) an evening shift from 1:30 | 9 | | p.m. to 9:30 p.m., and (iii) a night shift from 9:30 | 10 | | p.m. to 5:30 a.m. | 11 | | (B) Option 2 shall include (i) a day shift from 6 | 12 | | a.m. to 2 p.m., (ii) an evening shift from 2 p.m. to 10 | 13 | | p.m., and (iii) a night shift from 10 p.m. to 6 a.m. | 14 | | (C) Option 3 shall include (i) a day shift from | 15 | | 6:30 a.m. to 2:30 p.m., (ii) an evening shift from 2:30 | 16 | | p.m. to 10:30 p.m., and (iii) a night shift from 10:30 | 17 | | p.m. to 6:30 a.m. | 18 | | (D) Option 4 shall include (i) a day shift from 7 | 19 | | a.m. to 3 p.m., (ii) an evening shift from 3 p.m. to 11 | 20 | | p.m., and (iii) a night shift from 11 p.m. to 7 a.m. | 21 | | Each resident must have assigned and be informed of the | 22 | | nursing assistant responsible for his or her care and | 23 | | services on each shift. The numbers listed in this | 24 | | subsection represent the minimum staffing requirement. The | 25 | | numbers do not represent sufficient nursing staff. The | 26 | | number of staff necessary to meet the needs of each |
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| 1 | | resident determines sufficient nursing staff. The number | 2 | | of residents per nursing assistant must not exceed the | 3 | | ratios under this paragraph. | 4 | | On and after January 1, 2018, the number of residents | 5 | | per nursing assistant must not exceed the following ratios: | 6 | | for day shifts, there shall be at least one nursing | 7 | | assistant per 7 residents; for evening shifts, there shall | 8 | | be at least one nursing assistant per 9.5 residents; for | 9 | | night shifts, there shall be at least one nursing assistant | 10 | | per 17 residents. | 11 | | Each facility must submit a quarterly staffing report | 12 | | to the Department using the Department's approved method | 13 | | and format. The report must provide an accurate daily | 14 | | account of resident census and nursing assistant staffing | 15 | | levels for each shift. The facility must submit the report | 16 | | to the Department no later than the end of the month | 17 | | immediately following the end of each calendar quarter. The | 18 | | report must specify the shifts in which the minimum | 19 | | staffing standards as set forth in this paragraph were not | 20 | | met. Upon the Department's request, the facility must | 21 | | provide documents to support the quarterly staffing | 22 | | report, including payroll records. | 23 | | (7) This subsection does not prohibit nursing | 24 | | assistants from providing services to a resident to whom | 25 | | they are not assigned. The facility must ensure that | 26 | | nursing assistants only perform those tasks for which they |
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| 1 | | are competent and qualified to perform and that are | 2 | | permitted by the laws of this State. Nursing assistants | 3 | | with a restricted duty status may be counted toward meeting | 4 | | the minimum staffing ratio as set forth in paragraph (6) of | 5 | | this subsection if the nursing assistant is able to perform | 6 | | 90% of the authorized duties and responsibilities, with or | 7 | | without accommodation, required of a certified nursing | 8 | | assistant. | 9 | | The facility must ensure that a nursing assistant is | 10 | | not assigned more residents than the number for which the | 11 | | nursing assistant is able to meet the individual service | 12 | | needs. The facility must have a minimum of 2 nursing staff | 13 | | on duty within the facility at all times. Nursing staff | 14 | | must be present at all times in each detached building, | 15 | | distinct and segregated area including those separated by | 16 | | closed doors, and on each level or floor where residents | 17 | | are housed. | 18 | | Nursing assistants do not include dining assistants. | 19 | | Nursing assistants serving as restorative aides must not be | 20 | | counted toward the minimum staffing requirement under | 21 | | paragraph (6) of this subsection. | 22 | | (8) A facility must not employ any person as a nursing | 23 | | assistant for longer than 4 months from the date of hire | 24 | | without the person being certified as a certified nursing | 25 | | assistant. The facility must ensure no more than 25% of the | 26 | | nursing assistants assigned to residents per shift |
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| 1 | | pursuant to paragraph (6) of this subsection are | 2 | | uncertified nursing assistants. | 3 | | (9) The facility must ensure that all nursing | 4 | | assistants administering non-injectable medications are | 5 | | certified as nursing assistants and licensed as medication | 6 | | aides. Documentation of this certification and license | 7 | | must be maintained in the facility. The licensed medication | 8 | | aide assigned to administer medications must not be counted | 9 | | toward meeting the minimum staffing requirements for | 10 | | direct service of residents under paragraph (6) of this | 11 | | subsection. | 12 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
| 13 | | Section 99. Effective date. This Act takes effect July 1, | 14 | | 2017.".
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