Full Text of HB5488 98th General Assembly
HB5488enr 98TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 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)
| 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 the federal | 18 | | Centers for Medicare and Medicaid Services. | 19 | | (b) "Department" means the Illinois Department of | 20 | | Healthcare and Family Services. | 21 | | (c) "Discharge" means the release of a patient from | 22 | | hospital care for any discharge disposition other than a leave | 23 | | of absence, even if for Medicare payment purposes the discharge |
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| 1 | | fits the definition of an interrupted stay.
| 2 | | (d) "FTE" means "full-time equivalent" or a person or | 3 | | persons employed in one full-time position. | 4 | | (e) "Hospital" means an institution, place, building, or | 5 | | agency located in this State that is licensed as a general | 6 | | acute hospital by the Illinois Department of Public Health | 7 | | under the Hospital Licensing Act, whether public or private and | 8 | | whether organized for profit or not-for-profit. | 9 | | (f) "ICU" means intensive care unit. | 10 | | (g) "LTAC hospital" means an Illinois hospital that is | 11 | | designated by Medicare as a long term acute care hospital as | 12 | | described in Section 1886(d)(1)(B)(iv)(I) of the Social | 13 | | Security Act and has an average length of Medicaid inpatient | 14 | | stay greater than 25 days as reported on the hospital's 2008 | 15 | | Medicaid cost report on file as of February 15, 2010, or a | 16 | | hospital that begins operations after January 1, 2009 and is | 17 | | designated by Medicare as a long term acute care hospital. | 18 | | (h) "LTAC hospital criteria" means nationally recognized | 19 | | evidence-based evaluation criteria that have been publicly | 20 | | tested and includes criteria specific to an LTAC hospital for | 21 | | admission, continuing stay, and discharge. The criteria cannot | 22 | | include criteria derived or developed by or for a specific | 23 | | hospital or group of hospitals. Criteria and tools developed by | 24 | | hospitals or hospital associations or hospital-owned | 25 | | organizations are not acceptable and do not meet the | 26 | | requirements of this subsection. |
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| 1 | | (i) "Patient" means an individual who is admitted to a | 2 | | hospital for an inpatient stay. | 3 | | (j) "Program" means the Long Term Acute Care Hospital | 4 | | Quality Improvement Transfer Program established by this Act. | 5 | | (k) "STAC hospital" means a hospital that is not an LTAC | 6 | | hospital as defined in this Act or a psychiatric hospital or a | 7 | | rehabilitation hospital.
| 8 | | (Source: P.A. 96-1130, eff. 7-20-10; 97-662, eff. 1-13-12; | 9 | | 97-667, eff. 1-13-12.) | 10 | | (210 ILCS 155/15)
| 11 | | Sec. 15. Qualifying Hospitals. | 12 | | (a) Beginning October 1, 2010, the Department shall | 13 | | establish the Long Term Acute Care Hospital Quality Improvement | 14 | | Transfer Program. Any hospital may participate in the program | 15 | | if it meets the requirements of this Section as determined by | 16 | | the Department. | 17 | | (b) To participate in the program a hospital must do the | 18 | | following: | 19 | | (1) Operate as an LTAC hospital. | 20 | | (2) Employ one-half of an FTE (designated for case | 21 | | management) for every 15 patients admitted to the hospital. | 22 | | (3) Maintain on-site physician coverage 24 hours a day, | 23 | | 7 days a week. | 24 | | (4) Maintain on-site respiratory therapy coverage 24 | 25 | | hours a day, 7 days a week. |
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| 1 | | (c) A hospital must also execute a program participation | 2 | | agreement with the Department. The agreement must include: | 3 | | (1) An attestation that the hospital complies with the | 4 | | criteria in subsection (b) of this Section. | 5 | | (2) A process for the hospital to report its continuing | 6 | | compliance with subsection (b) of this Section. The | 7 | | hospital must submit a compliance report at least annually. | 8 | | (3) A requirement that the hospital complete and | 9 | | electronically submit to the Department the CARE tool (the | 10 | | most currently available version or an equivalent tool | 11 | | designated and approved for use by the Department) for each | 12 | | patient no later than 13 7 calendar days after discharge : . | 13 | | (A) the CARE tool in the format required by the | 14 | | federal Centers for Medicare and Medicaid Services; | 15 | | and | 16 | | (B) in an electronic format developed by the | 17 | | Department, (i) whether the patient was successfully | 18 | | weaned off invasive mechanical ventilation, (ii) | 19 | | whether the patient, if the patient was a ventilator | 20 | | patient, acquired pneumonia, and (iii) whether the | 21 | | patient fell and required an ancillary or surgical | 22 | | procedure (e.g., x-ray, MRI, sutures, or surgery). | 23 | | (4) A requirement that the hospital use a patient | 24 | | satisfaction survey specifically designed for LTAC | 25 | | hospital settings. The hospital must submit survey results | 26 | | data to the Department at least annually.
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| 1 | | (5) A requirement that the hospital accept all | 2 | | clinically approved patients for admission or transfer | 3 | | from a STAC hospital with the exception of STAC hospitals | 4 | | identified in paragraphs (1) and (2) under subsection (a) | 5 | | of Section 25 of this Act. The patient must be evaluated | 6 | | using LTAC hospital criteria approved by the Department for | 7 | | use in this program and meet the appropriate criteria. | 8 | | (6) A requirement that the hospital report quality and | 9 | | outcome measurement data, as described in Section 20 of | 10 | | this Act, to the Department at least annually. | 11 | | (7) A requirement that the hospital provide the | 12 | | Department full access to patient data and other data | 13 | | maintained by the hospital. Access must be in compliance | 14 | | with State and federal law. | 15 | | (8) A requirement that the hospital use LTAC hospital | 16 | | criteria to evaluate patients that are admitted to the | 17 | | hospital to determine that the patient is in the most | 18 | | appropriate setting.
| 19 | | (Source: P.A. 96-1130, eff. 7-20-10.) | 20 | | (210 ILCS 155/20)
| 21 | | Sec. 20. Quality and outcome measurement data.
| 22 | | (a) For proper evaluation and monitoring of the program, | 23 | | each LTAC hospital must provide quality and outcome measurement | 24 | | data ("measures") identical to Medicare as specified in | 25 | | Medicare's LTCH Quality Reporting Program Manual (version 2.0) |
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| 1 | | and any subsequent revisions subsections (c) through (h) of | 2 | | this Section to the Department for patients treated under this | 3 | | program. The Department may develop measures in addition to the | 4 | | minimum measures required under this Section . | 5 | | (b) Two sets of measures must be calculated. The first set | 6 | | should only use data for medical assistance patients, and the | 7 | | second set should include all patients of the LTAC hospital | 8 | | regardless of payer. | 9 | | (c) (Blank). Average LTAC hospital length of stay for | 10 | | patients discharged during the reporting period. | 11 | | (d) (Blank). Adverse outcomes rates: Percent of patients | 12 | | who expired or whose condition worsens and requires treatment | 13 | | in a STAC hospital. | 14 | | (e) (Blank). Ventilator weaning rate: Percent of patients | 15 | | discharged during the reporting period who have been | 16 | | successfully weaned off invasive mechanical ventilation. | 17 | | (f) (Blank). Central Line Infection Rate per 1000 central | 18 | | line days: Number of patients discharged from an LTAC hospital | 19 | | during the reporting period that had a central line in place | 20 | | and developed a bloodstream infection 48 hours or more after | 21 | | admission to the LTAC hospital. | 22 | | (g) (Blank). Acquired pressure ulcers per 1000 patient | 23 | | days. | 24 | | (h) (Blank). Falls with injury per 1000 patient days: | 25 | | Number of falls among discharged LTAC hospital patients | 26 | | discharged during the reporting period, who fell during the |
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| 1 | | LTAC hospital stay, regardless of distance fallen, that | 2 | | required an ancillary or surgical procedure (i.e. x-ray, MRI, | 3 | | sutures, surgery, etc.)
| 4 | | (Source: P.A. 96-1130, eff. 7-20-10.) | 5 | | (210 ILCS 155/50)
| 6 | | Sec. 50. Duties of the Department. | 7 | | (a) The Department is responsible for implementing, | 8 | | monitoring, and evaluating the program. This includes but is | 9 | | not limited to: | 10 | | (1) Collecting data required under Section 15 and data | 11 | | necessary to calculate the measures under Section 20 of | 12 | | this Act. The Department must make every effort to collect | 13 | | this data with the minimal amount of administrative burden | 14 | | to participating LTAC hospitals. | 15 | | (2) Setting annual benchmarks or targets for the | 16 | | measures in Section 20 of this Act or other measures beyond | 17 | | the minimum required under Section 20 . The Department must | 18 | | consult participating LTAC hospitals when setting these | 19 | | benchmarks and targets. | 20 | | (3) Monitoring compliance with all requirements of | 21 | | this Act. | 22 | | (b) The Department shall include specific information on | 23 | | the Program in its annual medical programs report. | 24 | | (c) The Department must establish monitoring procedures | 25 | | that ensure the LTAC supplemental payment is only paid for |
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| 1 | | patients who upon admission meet the LTAC hospital criteria. | 2 | | The Department must notify qualified LTAC hospitals of the | 3 | | procedures and establish an appeals process as part of those | 4 | | procedures. The Department must recoup any LTAC supplemental | 5 | | payments that are identified as being paid for patients who do | 6 | | not meet the LTAC hospital criteria. | 7 | | (d) The Department must implement the program by October 1, | 8 | | 2010. | 9 | | (e) The Department must create and distribute to LTAC | 10 | | hospitals the agreement required under subsection (c) of | 11 | | Section 15 no later than September 1, 2010. | 12 | | (f) The Department must notify Illinois hospitals which | 13 | | LTAC hospital criteria are approved for use under the program.
| 14 | | The Department may limit LTAC hospital criteria to the most | 15 | | strict criteria that meet the definitions of this Act. | 16 | | (g) (Blank). The Department must identify discharge tools | 17 | | that are considered equivalent to the CARE tool and approved | 18 | | for use under the program. The Department must notify LTAC | 19 | | hospitals which tools are approved for use under the program. | 20 | | (h) The Department must notify Illinois LTAC hospitals of | 21 | | the program and inform them how to apply for qualification and | 22 | | what the qualification requirements are as described under | 23 | | Section 15 of this Act. | 24 | | (i) The Department must notify Illinois STAC hospitals | 25 | | about the operation and implementation of the program | 26 | | established by this Act. The Department must also notify LTAC |
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| 1 | | hospitals that accepting transfers from the STAC hospitals | 2 | | identified in paragraphs (1) and (2) under subsection (a) of | 3 | | Section 25 of this Act are not required under paragraph (5) of | 4 | | subsection (c) of Section 15 of this Act. The Department must | 5 | | notify LTAC hospitals that accepting transfers from the STAC | 6 | | hospitals identified in paragraphs (1) and (2) under subsection | 7 | | (a) of Section 25 of this Act shall negatively impact the | 8 | | savings calculations under the Program evaluation required by | 9 | | Section 40 of this Act and shall in turn require the Department | 10 | | to initiate the penalty described in subsection (d) of Section | 11 | | 40 of this Act. | 12 | | (j) The Department shall deem LTAC hospitals qualified | 13 | | under Section 15 of this Act as qualifying for expedited | 14 | | payments. | 15 | | (k) The Department may use up to $500,000 of funds | 16 | | contained in the Public Aid Recoveries Trust Fund per State | 17 | | fiscal year to operate the program under this Act. The | 18 | | Department may expand existing contracts, issue new contracts, | 19 | | issue personal service contracts, or purchase other services, | 20 | | supplies, or equipment.
| 21 | | (l) The Department may promulgate rules as allowed by the | 22 | | Illinois Administrative Procedure Act to implement this Act; | 23 | | however, the requirements under this Act shall be implemented | 24 | | by the Department even if the Department's proposed rules are | 25 | | not yet adopted by the implementation date of October 1, 2010.
| 26 | | (Source: P.A. 96-1130, eff. 7-20-10.)
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.
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