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| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022 SB3897 Introduced 1/21/2022, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: |
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Amends the Nursing Home Care Act. Provides that, for the purpose of computing staff to resident ratios, direct care staff shall include resident attendants.
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| | A BILL FOR |
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| | SB3897 | | LRB102 23986 CPF 33192 b |
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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 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; |
17 | | (7) assistant directors of nursing; |
18 | | (8) 50% of the Director of Nurses' time; and |
19 | | (9) 30% of the Social Services Directors' time ; and . |
20 | | (10) resident attendants. |
21 | | The Department shall, by rule, allow certain facilities |
22 | | subject to 77 Ill. Admin. Code 300.4000 and following (Subpart |
23 | | S) to utilize specialized clinical staff, as defined in rules, |
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1 | | to count towards the staffing ratios. |
2 | | Within 120 days of the effective date of this amendatory |
3 | | Act of the 97th General Assembly, the Department shall |
4 | | promulgate rules specific to the staffing requirements for |
5 | | facilities federally defined as Institutions for Mental |
6 | | Disease. These rules shall recognize the unique nature of |
7 | | individuals with chronic mental health conditions, shall |
8 | | include minimum requirements for specialized clinical staff, |
9 | | including clinical social workers, psychiatrists, |
10 | | psychologists, and direct care staff set forth in paragraphs |
11 | | (4) through (6) and any other specialized staff which may be |
12 | | utilized and deemed necessary to count toward staffing ratios. |
13 | | Within 120 days of the effective date of this amendatory |
14 | | Act of the 97th General Assembly, the Department shall |
15 | | promulgate rules specific to the staffing requirements for |
16 | | facilities licensed under the Specialized Mental Health |
17 | | Rehabilitation Act of 2013. These rules shall recognize the |
18 | | unique nature of individuals with chronic mental health |
19 | | conditions, shall include minimum requirements for specialized |
20 | | clinical staff, including clinical social workers, |
21 | | psychiatrists, psychologists, and direct care staff set forth |
22 | | in paragraphs (4) through (6) and any other specialized staff |
23 | | which may be utilized and deemed necessary to count toward |
24 | | staffing ratios. |
25 | | (b) (Blank). |
26 | | (b-5) For purposes of the minimum staffing ratios in this |
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1 | | Section, all residents shall be classified as requiring either |
2 | | skilled care or intermediate care. |
3 | | As used in this subsection: |
4 | | "Intermediate care" means basic nursing care and other |
5 | | restorative services under periodic medical direction. |
6 | | "Skilled care" means skilled nursing care, continuous |
7 | | skilled nursing observations, restorative nursing, and other |
8 | | services under professional direction with frequent medical |
9 | | supervision. |
10 | | (c) Facilities shall notify the Department within 60 days |
11 | | after the effective date of this amendatory Act of the 96th |
12 | | General Assembly, in a form and manner prescribed by the |
13 | | Department, of the staffing ratios in effect on the effective |
14 | | date of this amendatory Act of the 96th General Assembly for |
15 | | both intermediate and skilled care and the number of residents |
16 | | receiving each level of care. |
17 | | (d)(1) (Blank). |
18 | | (2) (Blank). |
19 | | (3) (Blank). |
20 | | (4) (Blank). |
21 | | (5) Effective January 1, 2014, the minimum staffing ratios |
22 | | shall be increased to 3.8 hours of nursing and personal care |
23 | | each day for a resident needing skilled care and 2.5 hours of |
24 | | nursing and personal care each day for a resident needing |
25 | | intermediate care.
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26 | | (e) Ninety days after the effective date of this |
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1 | | amendatory Act of the 97th General Assembly, a minimum of 25% |
2 | | of nursing and personal care time shall be provided by |
3 | | licensed nurses, with at least 10% of nursing and personal |
4 | | care time provided by registered nurses. These minimum |
5 | | requirements shall remain in effect until an acuity based |
6 | | registered nurse requirement is promulgated by rule concurrent |
7 | | with the adoption of the Resource Utilization Group |
8 | | classification-based payment methodology, as provided in |
9 | | Section 5-5.2 of the Illinois Public Aid Code. Registered |
10 | | nurses and licensed practical nurses employed by a facility in |
11 | | excess of these requirements may be used to satisfy the |
12 | | remaining 75% of the nursing and personal care time |
13 | | requirements. Notwithstanding this subsection, no staffing |
14 | | requirement in statute in effect on the effective date of this |
15 | | amendatory Act of the 97th General Assembly shall be reduced |
16 | | on account of this subsection. |
17 | | (f) The Department shall submit proposed rules for |
18 | | adoption by January 1, 2020 establishing a system for |
19 | | determining compliance with minimum staffing set forth in this |
20 | | Section and the requirements of 77 Ill. Adm. Code 300.1230 |
21 | | adjusted for any waivers granted under Section 3-303.1. |
22 | | Compliance shall be determined quarterly by comparing the |
23 | | number of hours provided per resident per day using the |
24 | | Centers for Medicare and Medicaid Services' payroll-based |
25 | | journal and the facility's daily census, broken down by |
26 | | intermediate and skilled care as self-reported by the facility |
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1 | | to the Department on a quarterly basis. The Department shall |
2 | | use the quarterly payroll-based journal and the self-reported |
3 | | census to calculate the number of hours provided per resident |
4 | | per day and compare this ratio to the minimum staffing |
5 | | standards required under this Section, as impacted by any |
6 | | waivers granted under Section 3-303.1. Discrepancies between |
7 | | job titles contained in this Section and the payroll-based |
8 | | journal shall be addressed by rule. The manner in which the |
9 | | Department requests payroll-based journal information to be |
10 | | submitted shall align with the federal Centers for Medicare |
11 | | and Medicaid Services' requirements that allow providers to |
12 | | submit the quarterly data in an aggregate manner. |
13 | | (g) The Department shall submit proposed rules for |
14 | | adoption by January 1, 2020 establishing monetary penalties |
15 | | for facilities not in compliance with minimum staffing |
16 | | standards under this Section. No monetary penalty may be |
17 | | issued for noncompliance during the implementation period, |
18 | | which shall be July 1, 2020 through December 31, 2021. If a |
19 | | facility is found to be noncompliant during the implementation |
20 | | period, the Department shall provide a written notice |
21 | | identifying the staffing deficiencies and require the facility |
22 | | to provide a sufficiently detailed correction plan to meet the |
23 | | statutory minimum staffing levels. Monetary penalties shall be |
24 | | imposed beginning no later than January 1, 2022 and quarterly |
25 | | thereafter and shall be based on the latest quarter for which |
26 | | the Department has data. Monetary penalties shall be |
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1 | | established based on a formula that calculates on a daily |
2 | | basis the cost of wages and benefits for the missing staffing |
3 | | hours. All notices of noncompliance shall include the |
4 | | computations used to determine noncompliance and establishing |
5 | | the variance between minimum staffing ratios and the |
6 | | Department's computations. The penalty for the first offense |
7 | | shall be 125% of the cost of wages and benefits for the missing |
8 | | staffing hours. The penalty shall increase to 150% of the cost |
9 | | of wages and benefits for the missing staffing hours for the |
10 | | second offense and 200% the cost of wages and benefits for the |
11 | | missing staffing hours for the third and all subsequent |
12 | | offenses. The penalty shall be imposed regardless of whether |
13 | | the facility has committed other violations of this Act during |
14 | | the same period that the staffing offense occurred. The |
15 | | penalty may not be waived, but the Department shall have the |
16 | | discretion to determine the gravity of the violation in |
17 | | situations where there is no more than a 10% deviation from the |
18 | | staffing requirements and make appropriate adjustments to the |
19 | | penalty. The Department is granted discretion to waive the |
20 | | penalty when unforeseen circumstances have occurred that |
21 | | resulted in call-offs of scheduled staff. This provision shall |
22 | | be applied no more than 6 times per quarter. Nothing in this |
23 | | Section diminishes a facility's right to appeal. |
24 | | (Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21.)
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