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90_HB1828
210 ILCS 3/30
210 ILCS 3/35
Amends the Alternative Health Care Delivery Act.
Provides that there shall be no more than 10 birth center
alternative health care models in the demonstration program
authorized under the Act. Sets forth requirements for the
location of the centers and for services and standards of the
centers. Requires the Department of Public Health to adopt
rules for the operation and research of birth centers. Makes
other changes.
LRB9003663DPmgA
LRB9003663DPmgA
1 AN ACT to amend the Alternative Health Care Delivery Act
2 by changing Sections 30 and 35.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Alternative Health Care Delivery Act is
6 amended by changing Sections 30 and 35 as follows:
7 (210 ILCS 3/30)
8 Sec. 30. Demonstration program requirements. The
9 requirements set forth in this Section shall apply to
10 demonstration programs.
11 (a) There shall be no more than:
12 (i) 3 subacute care hospital alternative health
13 care models in the City of Chicago (one of which shall be
14 located on a designated site and shall have been licensed
15 as a hospital under the Illinois Hospital Licensing Act
16 within the 10 years immediately before the application
17 for a license);
18 (ii) 2 subacute care hospital alternative health
19 care models in the demonstration program for each of the
20 following areas:
21 (1) Cook County outside the City of Chicago.
22 (2) DuPage, Kane, Lake, McHenry, and Will
23 Counties.
24 (3) Municipalities with a population greater
25 than 50,000 not located in the areas described in
26 item (i) of subsection (a) and paragraphs (1) and
27 (2) of item (ii) of subsection (a); and
28 (iii) 4 subacute care hospital alternative health
29 care models in the demonstration program for rural areas.
30 In selecting among applicants for these licenses in rural
31 areas, the Health Facilities Planning Board and the
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1 Department shall give preference to hospitals that may be
2 unable for economic reasons to provide continued service to
3 the community in which they are located unless the hospital
4 were to receive an alternative health care model license.
5 (a-5) There shall be no more than a total of 12
6 postsurgical recovery care center alternative health care
7 models in the demonstration program, located as follows:
8 (1) Two in the City of Chicago.
9 (2) Two in Cook County outside the City of Chicago.
10 At least one of these shall be owned or operated by a
11 hospital devoted exclusively to caring for children.
12 (3) Two in Kane, Lake, and McHenry Counties.
13 (4) Four in municipalities with a population of
14 50,000 or more not located in the areas described in
15 paragraphs (1), (2), and (3), 3 of which shall be owned
16 or operated by hospitals, at least 2 of which shall be
17 located in counties with a population of less than
18 175,000, according to the most recent decennial census
19 for which data are available, and one of which shall be
20 owned or operated by an ambulatory surgical treatment
21 center.
22 (5) Two in rural areas, both of which shall be
23 owned or operated by hospitals.
24 There shall be no postsurgical recovery care center
25 alternative health care models located in counties with
26 populations greater than 600,000 but less than 1,000,000. A
27 proposed postsurgical recovery care center must be owned or
28 operated by a hospital if it is to be located within, or will
29 primarily serve the residents of, a health service area in
30 which more than 60% of the gross patient revenue of the
31 hospitals within that health service area are derived from
32 Medicaid and Medicare, according to the most recently
33 available calendar year data from the Illinois Health Care
34 Cost Containment Council. Nothing in this paragraph shall
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1 preclude a hospital and an ambulatory surgical treatment
2 center from forming a joint venture or developing a
3 collaborative agreement to own or operate a postsurgical
4 recovery care center.
5 (a-10) There shall be no more than a total of 8
6 children's respite care center alternative health care models
7 in the demonstration program, which shall be located as
8 follows:
9 (1) One in the City of Chicago.
10 (2) One in Cook County outside the City of Chicago.
11 (3) A total of 2 in the area comprised of DuPage,
12 Kane, Lake, McHenry, and Will counties.
13 (4) A total of 2 in municipalities with a
14 population of 50,000 or more and not located in the
15 areas described in paragraphs (1), (2), or (3).
16 (5) A total of 2 in rural areas, as defined by the
17 Health Facilities Planning Board.
18 No more than one children's respite care model owned and
19 operated by a licensed skilled pediatric facility shall be
20 located in each of the areas designated in this subsection
21 (a-10).
22 (a-15) There shall be no more than 10 birth center
23 alternative health care models in the demonstration program,
24 located as follows:
25 (1) Four in the area comprising Cook, DuPage, Kane,
26 Lake, McHenry, and Will counties, one of which shall be
27 owned or operated by a hospital and one of which shall be
28 owned or operated by a federally qualified health center.
29 (2) Three in municipalities with a population of
30 50,000 or more not located in the area described in
31 subparagraph (1) of this paragraph, one of which shall be
32 owned or operated by a hospital and one of which shall be
33 owned or operated by a federally qualified health center.
34 (3) Three in rural areas, one of which shall be
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1 owned or operated by a hospital and one of which shall be
2 owned or operated by a federally qualified health center.
3 The first 3 birth centers authorized to operate by the
4 Department shall be located in or predominantly serve the
5 residents of a health professional shortage area as
6 determined by the United States Department of Health and
7 Human Services. There shall be no more than 2 birth centers
8 authorized to operate in any single health planning area for
9 obstetric services as determined under the Illinois Health
10 Facilities Planning Act. If a birth center is located
11 outside of a health professional shortage area, (i) the birth
12 center shall be located in a health planning area with a
13 demonstrated need for obstetrical service beds, as determined
14 by the Illinois Health Facilities Planning Board or (ii)
15 there must be a reduction in the existing number of
16 obstetrical service beds in the planning area so that the
17 establishment of the birth center does not result in an
18 increase in the total number of obstetrical service beds in
19 the health planning area.
20 (b) Alternative health care models shall obtain a
21 certificate of need from the Illinois Health Facilities
22 Planning Board under the Illinois Health Facilities Planning
23 Act before receiving a license by the Department.
24 Alternative health care models in medically underserved areas
25 shall receive priority in obtaining a certificate of need.
26 (c) An alternative health care model license shall be
27 issued for a period of one year and shall be annually renewed
28 if the facility or program is in substantial compliance with
29 the Department's rules adopted under this Act. A licensed
30 alternative health care model that continues to be in
31 substantial compliance after the conclusion of the
32 demonstration program shall be eligible for annual renewals
33 unless and until a different licensure program for that type
34 of health care model is established by legislation. The
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1 Department may issue a provisional license to any alternative
2 health care model that does not substantially comply with the
3 provisions of this Act and the rules adopted under this Act
4 if (i) the Department finds that the alternative health care
5 model has undertaken changes and corrections which upon
6 completion will render the alternative health care model in
7 substantial compliance with this Act and rules and (ii) the
8 health and safety of the patients of the alternative health
9 care model will be protected during the period for which the
10 provisional license is issued. The Department shall advise
11 the licensee of the conditions under which the provisional
12 license is issued, including the manner in which the
13 alternative health care model fails to comply with the
14 provisions of this Act and rules, and the time within which
15 the changes and corrections necessary for the alternative
16 health care model to substantially comply with this Act and
17 rules shall be completed.
18 (d) Alternative health care models shall seek
19 certification under Titles XVIII and XIX of the federal
20 Social Security Act. In addition, alternative health care
21 models shall provide charitable care consistent with that
22 provided by comparable health care providers in the
23 geographic area.
24 (d-5) The Illinois Department of Public Aid, in
25 cooperation with the Illinois Department of Public Health,
26 shall develop and implement a reimbursement methodology for
27 all facilities participating in the demonstration program.
28 The Illinois Department of Public Aid shall keep a record of
29 services provided under the demonstration program to
30 recipients of medical assistance under the Illinois Public
31 Aid Code and shall submit an annual report of that
32 information to the Illinois Department of Public Health.
33 (e) Alternative health care models shall, to the extent
34 possible, link and integrate their services with nearby
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1 health care facilities.
2 (f) Each alternative health care model shall implement a
3 quality assurance program with measurable benefits and at
4 reasonable cost.
5 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
6 eff. 8-20-95.)
7 (210 ILCS 3/35)
8 Sec. 35. Alternative health care models authorized.
9 Notwithstanding any other law to the contrary, alternative
10 health care models described in this Section may be
11 established on a demonstration basis.
12 (1) Alternative health care model; subacute care
13 hospital. A subacute care hospital is a designated site
14 which provides medical specialty care for patients who
15 need a greater intensity or complexity of care than
16 generally provided in a skilled nursing facility but who
17 no longer require acute hospital care. The average length
18 of stay for patients treated in subacute care hospitals
19 shall not be less than 20 days, and for individual
20 patients, the expected length of stay at the time of
21 admission shall not be less than 10 days. Variations
22 from minimum lengths of stay shall be reported to the
23 Department. There shall be no more than 13 subacute care
24 hospitals authorized to operate by the Department.
25 Subacute care includes physician supervision, registered
26 nursing, and physiological monitoring on a continual
27 basis. A subacute care hospital is either a freestanding
28 building or a distinct physical and operational entity
29 within a hospital or nursing home building. A subacute
30 care hospital shall only consist of beds currently
31 existing in licensed hospitals or skilled nursing
32 facilities, except, in the City of Chicago, on a
33 designated site that was licensed as a hospital under the
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1 Illinois Hospital Licensing Act within the 10 years
2 immediately before the application for an alternative
3 health care model license. During the period of operation
4 of the demonstration project, the existing licensed beds
5 shall remain licensed as hospital or skilled nursing
6 facility beds as well as being licensed under this Act.
7 In order to handle cases of complications, emergencies,
8 or exigent circumstances, a subacute care hospital shall
9 maintain a contractual relationship, including a transfer
10 agreement, with a general acute care hospital. If a
11 subacute care model is located in a general acute care
12 hospital, it shall utilize all or a portion of the bed
13 capacity of that existing hospital. In no event shall a
14 subacute care hospital use the word "hospital" in its
15 advertising or marketing activities or represent or hold
16 itself out to the public as a general acute care
17 hospital.
18 (2) Alternative health care delivery model;
19 postsurgical recovery care center. A postsurgical
20 recovery care center is a designated site which provides
21 postsurgical recovery care for generally healthy patients
22 undergoing surgical procedures that require overnight
23 nursing care, pain control, or observation that would
24 otherwise be provided in an inpatient setting. A
25 postsurgical recovery care center is either freestanding
26 or a defined unit of an ambulatory surgical treatment
27 center or hospital. No facility, or portion of a
28 facility, may participate in a demonstration program as a
29 postsurgical recovery care center unless the facility has
30 been licensed as an ambulatory surgical treatment center
31 or hospital for at least 2 years before August 20, 1993
32 (the effective date of Public Act 88-441). The maximum
33 length of stay for patients in a postsurgical recovery
34 care center is not to exceed 48 hours unless the treating
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1 physician requests an extension of time from the recovery
2 center's medical director on the basis of medical or
3 clinical documentation that an additional care period is
4 required for the recovery of a patient and the medical
5 director approves the extension of time. In no case,
6 however, shall a patient's length of stay in a
7 postsurgical recovery care center be longer than 72
8 hours. If a patient requires an additional care period
9 after the expiration of the 72-hour limit, the patient
10 shall be transferred to an appropriate facility. Reports
11 on variances from the 48-hour limit shall be sent to the
12 Department for its evaluation. The reports shall, before
13 submission to the Department, have removed from them all
14 patient and physician identifiers. In order to handle
15 cases of complications, emergencies, or exigent
16 circumstances, every postsurgical recovery care center as
17 defined in this paragraph shall maintain a contractual
18 relationship, including a transfer agreement, with a
19 general acute care hospital. A postsurgical recovery
20 care center shall be no larger than 20 beds. A
21 postsurgical recovery care center shall be located within
22 15 minutes travel time from the general acute care
23 hospital with which the center maintains a contractual
24 relationship, including a transfer agreement, as required
25 under this paragraph.
26 No postsurgical recovery care center shall
27 discriminate against any patient requiring treatment
28 because of the source of payment for services, including
29 Medicare and Medicaid recipients.
30 The Department shall adopt rules to implement the
31 provisions of Public Act 88-441 concerning postsurgical
32 recovery care centers within 9 months after August 20,
33 1993.
34 (3) Alternative health care delivery model;
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1 children's respite care center. A childrens' respite
2 care center model is a designated site that provides
3 respite for medically frail, technologically dependent,
4 clinically stable children, up to age 18, for a period of
5 one to 14 days. This care is to be provided in a
6 home-like environment that serves no more than 10
7 children at a time. Children's respite care center
8 services must be available through the model to all
9 families, including those whose care is paid for through
10 the Illinois Department of Public Aid or the Illinois
11 Department of Children and Family Services. Each respite
12 care model location shall be a facility physically
13 separate and apart from any other facility licensed by
14 the Department of Public Health under this or any other
15 Act and shall provide, at a minimum, the following
16 services: out-of-home respite care; hospital to home
17 training for families and caregivers; short term
18 transitional care to facilitate placement and training
19 for foster care parents; parent and family support
20 groups.
21 Coverage for the services provided by the Illinois
22 Department of Public Aid under this paragraph (3) is
23 contingent upon federal waiver approval and is provided only
24 to Medicaid eligible clients participating in the home and
25 community based services waiver designated in Section 1915(c)
26 of the Social Security Act for medically frail and
27 technologically dependent children.
28 (4) Alternative health care delivery model; birth
29 center. A birth center shall have no more than 10 beds.
30 A birth center is a designated site that is away from the
31 mother's usual place of residence and in which births are
32 planned to occur following a normal, uncomplicated, and
33 low-risk pregnancy. A birth center shall offer prenatal
34 care and community education services and shall
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1 coordinate these services with other health care services
2 available in the community. A birth center shall be one
3 or more of the following:
4 (A) A part of a hospital.
5 (B) A freestanding facility that is physically
6 distinct from a hospital but is operated under a
7 license issued to a hospital under the Hospital
8 Licensing Act.
9 (C) A part of the operation of a federally
10 qualified health center as designated by the United
11 States Department of Health and Human Services.
12 (D) An entity or facility whose costs are
13 reimbursable under Title XIX of the federal Social
14 Security Act.
15 The Department shall adopt rules that establish standards
16 equivalent to those of the National Association of
17 Childbearing Centers' Standards for Freestanding Birth
18 Centers for all birth centers. The Department's rules shall
19 provide for a time period for each birth center not part of a
20 hospital to become accredited by the Commission for the
21 Accreditation of Freestanding Birth Centers.
22 A birth center shall be certified to participate in the
23 Medicare and Medicaid programs under Titles XVIII and XIX,
24 respectively, of the federal Social Security Act. To the
25 extent necessary, the Illinois Department of Public Aid shall
26 apply for a waiver from the United States Health Care
27 Financing Administration to allow birth centers to be
28 reimbursed under Title XIX of the federal Social Security
29 Act.
30 A birth center shall be located within 15 minutes travel
31 time, except for a birth center located in a rural area that
32 has been designated as a health professional shortage area as
33 determined by the United States Department of Health and
34 Human Services and that has a demonstrated need for
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1 obstetrical service beds as determined by the Illinois Health
2 Facilities Planning Board where the travel time may not
3 exceed 30 minutes, from the general acute care hospital with
4 which the birth center maintains a contractual relationship,
5 including a transfer agreement, as required under this
6 paragraph. The services of a consultant physician who is
7 certified or eligible for certification by the American Board
8 of Obstetrics and Gynecology or the American Board of
9 Osteopathic Obstetricians and Gynecologists or has hospital
10 obstetrical privileges are required in birth centers that do
11 not have a physician on the clinical staff who is certified
12 or eligible for certification by the American Board of
13 Obstetrics and Gynecology or the American Board of
14 Osteopathic Obstetricians and Gynecologists or has hospital
15 obstetrical privileges. A consultant physician may be
16 available either on the premises or by phone. If a birth
17 center employs certified nurse midwives, a certified nurse
18 midwife shall be the Director of Nursing for Midwifery
19 Services who is responsible for the development of policies
20 and procedures for services as provided by Department rules.
21 An obstetrician, family practitioner, or certified nurse
22 midwife shall attend each woman in labor from the time of
23 admission through birth and throughout the immediate post
24 partum period. Attendance may be delegated only to another
25 physician or certified nurse midwife. Additionally, a second
26 staff person shall also be present at each birth who is under
27 the supervision of the physician or certified nurse midwife
28 in attendance, has specialized training in labor and delivery
29 techniques and care of newborns, and receives planned and
30 ongoing training as needed to perform assigned duties
31 effectively. The maximum length of stay for patients in a
32 birth center is not to exceed 24 hours unless the treating
33 provider requests additional days from the birth center's
34 medical director on the basis of medical or clinical
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1 documentation that an additional care period is required for
2 the recovery of a patient. Reports on variances from the 24
3 hour limit shall be sent to the Department for evaluation.
4 Before submission to the Department, all patient and
5 physician identifiers must be removed from the reports. The
6 birth center shall participate in the Illinois Perinatal
7 System under the Developmental Disability Prevention Act. At
8 a minimum, this participation shall require birth centers to
9 establish a letter of agreement with a hospital designated
10 under the Perinatal System. A hospital that operates or has
11 a letter of agreement with a birth center shall include the
12 birth center under its maternity service plan under the
13 Hospital Licensing Act and shall include the birth center in
14 the hospital's letter of agreement with its regional
15 perinatal center.
16 No birth center shall discriminate against any patient
17 requiring treatment because of the source of payment for
18 services, including Medicare and Medicaid recipients.
19 Within 9 months after the effective date of this
20 amendatory Act of 1997, the Department shall adopt rules that
21 are consistent with standards developed by the American
22 College of Obstetrics and Gynecology and operation and
23 research protocols developed in cooperation with obstetric
24 departments and related institutional review boards.
25 Obstetric departments and related institutional review boards
26 shall collect and review birth center information as
27 necessary to assess the safety and birth outcomes at the
28 birth centers.
29 The Department shall adopt other rules to implement the
30 provisions of this amendatory Act of 1997 within 9 months
31 after the effective date of this amendatory Act of 1997.
32 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
33 eff. 8-20-95.)