[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
90_HB3410
210 ILCS 3/20
210 ILCS 3/30
210 ILCS 3/35
210 ILCS 3/35.1
210 ILCS 3/36
Amends the Alternative Health Care Delivery Act. Provides
that the alternative health care delivery model demonstration
program shall include recovery care center, rather than
postsurgical recovery care center, alternative health care
models. Requires one of the recovery care centers to be a
hospital located in a rural area. Defines terms. Effective
immediately.
LRB9008970JSgcA
LRB9008970JSgcA
1 AN ACT to amend the Alternative Health Care Delivery Act
2 by changing Sections 20, 30, 35, 35.1, and 36.
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 20, 30, 35, 35.1, and 36 as
7 follows:
8 (210 ILCS 3/20)
9 Sec. 20. Board responsibilities. The State Board of
10 Health shall have the responsibilities set forth in this
11 Section.
12 (a) The Board shall investigate new health care delivery
13 models and recommend to the Governor and the General
14 Assembly, through the Department, those models that should be
15 authorized as alternative health care models for which
16 demonstration programs should be initiated. In its
17 deliberations, the Board shall use the following criteria:
18 (1) The feasibility of operating the model in
19 Illinois, based on a review of the experience in other
20 states including the impact on health professionals of
21 other health care programs or facilities.
22 (2) The potential of the model to meet an unmet
23 need.
24 (3) The potential of the model to reduce health
25 care costs to consumers, costs to third party payors, and
26 aggregate costs to the public.
27 (4) The potential of the model to maintain or
28 improve the standards of health care delivery in some
29 measurable fashion.
30 (5) The potential of the model to provide increased
31 choices or access for patients.
-2- LRB9008970JSgcA
1 (b) The Board shall evaluate and make recommendations to
2 the Governor and the General Assembly, through the
3 Department, regarding alternative health care model
4 demonstration programs established under this Act, at the
5 midpoint and end of the period of operation of the
6 demonstration programs. The report shall include, at a
7 minimum, the following:
8 (1) Whether the alternative health care models
9 improved access to health care for their service
10 populations in the State.
11 (2) The quality of care provided by the alternative
12 health care models as may be evidenced by health
13 outcomes, surveillance reports, and administrative
14 actions taken by the Department.
15 (3) The cost and cost effectiveness to the public,
16 third-party payors, and government of the alternative
17 health care models, including the impact of pilot
18 programs on aggregate health care costs in the area. In
19 addition to any other information collected by the Board
20 under this Section, the Board shall collect from
21 postsurgical recovery care centers uniform billing data
22 substantially the same as specified in Section 4-2(e) of
23 the Illinois Health Finance Reform Act. To facilitate
24 its evaluation of that data, the Board shall forward a
25 copy of the data to the Illinois Health Care Cost
26 Containment Council. All patient identifiers shall be
27 removed from the data before it is submitted to the Board
28 or Council.
29 (4) The impact of the alternative health care
30 models on the health care system in that area, including
31 changing patterns of patient demand and utilization,
32 financial viability, and feasibility of operation of
33 service in inpatient and alternative models in the area.
34 (5) The implementation by alternative health care
-3- LRB9008970JSgcA
1 models of any special commitments made during application
2 review to the Illinois Health Facilities Planning Board.
3 (6) The continuation, expansion, or modification of
4 the alternative health care models.
5 (c) The Board shall advise the Department on the
6 definition and scope of alternative health care models
7 demonstration programs.
8 (d) In carrying out its responsibilities under this
9 Section, the Board shall seek the advice of other Department
10 advisory boards or committees that may be impacted by the
11 alternative health care model or the proposed model of health
12 care delivery. The Board shall also seek input from other
13 interested parties, which may include holding public
14 hearings.
15 (e) The Board shall otherwise advise the Department on
16 the administration of the Act as the Board deems appropriate.
17 (Source: P.A. 87-1188; 88-441.)
18 (210 ILCS 3/30)
19 Sec. 30. Demonstration program requirements. The
20 requirements set forth in this Section shall apply to
21 demonstration programs.
22 (a) There shall be no more than:
23 (i) 3 subacute care hospital alternative health
24 care models in the City of Chicago (one of which shall be
25 located on a designated site and shall have been licensed
26 as a hospital under the Illinois Hospital Licensing Act
27 within the 10 years immediately before the application
28 for a license);
29 (ii) 2 subacute care hospital alternative health
30 care models in the demonstration program for each of the
31 following areas:
32 (1) Cook County outside the City of Chicago.
33 (2) DuPage, Kane, Lake, McHenry, and Will
-4- LRB9008970JSgcA
1 Counties.
2 (3) Municipalities with a population greater
3 than 50,000 not located in the areas described in
4 item (i) of subsection (a) and paragraphs (1) and
5 (2) of item (ii) of subsection (a); and
6 (iii) 4 subacute care hospital alternative health
7 care models in the demonstration program for rural areas.
8 In selecting among applicants for these licenses in rural
9 areas, the Health Facilities Planning Board and the
10 Department shall give preference to hospitals that may be
11 unable for economic reasons to provide continued service to
12 the community in which they are located unless the hospital
13 were to receive an alternative health care model license.
14 (a-5) There shall be no more than a total of 12
15 postsurgical recovery care center alternative health care
16 models in the demonstration program, located as follows:
17 (1) Two in the City of Chicago.
18 (2) Two in Cook County outside the City of Chicago.
19 At least one of these shall be owned or operated by a
20 hospital devoted exclusively to caring for children.
21 (3) Two in Kane, Lake, and McHenry Counties.
22 (4) Four in municipalities with a population of
23 50,000 or more not located in the areas described in
24 paragraphs (1), (2), and (3), 3 of which shall be owned
25 or operated by hospitals, at least 2 of which shall be
26 located in counties with a population of less than
27 175,000, according to the most recent decennial census
28 for which data are available, and one of which shall be
29 owned or operated by an ambulatory surgical treatment
30 center.
31 (5) Two in rural areas, both of which shall be
32 owned or operated by hospitals.
33 There shall be no postsurgical recovery care center
34 alternative health care models located in counties with
-5- LRB9008970JSgcA
1 populations greater than 600,000 but less than 1,000,000. A
2 proposed postsurgical recovery care center must be owned or
3 operated by a hospital if it is to be located within, or will
4 primarily serve the residents of, a health service area in
5 which more than 60% of the gross patient revenue of the
6 hospitals within that health service area are derived from
7 Medicaid and Medicare, according to the most recently
8 available calendar year data from the Illinois Health Care
9 Cost Containment Council. Nothing in this paragraph shall
10 preclude a hospital and an ambulatory surgical treatment
11 center from forming a joint venture or developing a
12 collaborative agreement to own or operate a postsurgical
13 recovery care center.
14 (a-10) There shall be no more than a total of 8
15 children's respite care center alternative health care models
16 in the demonstration program, which shall be located as
17 follows:
18 (1) One in the City of Chicago.
19 (2) One in Cook County outside the City of Chicago.
20 (3) A total of 2 in the area comprised of DuPage,
21 Kane, Lake, McHenry, and Will counties.
22 (4) A total of 2 in municipalities with a
23 population of 50,000 or more and not located in the
24 areas described in paragraphs (1), (2), or (3).
25 (5) A total of 2 in rural areas, as defined by the
26 Health Facilities Planning Board.
27 No more than one children's respite care model owned and
28 operated by a licensed skilled pediatric facility shall be
29 located in each of the areas designated in this subsection
30 (a-10).
31 (b) Alternative health care models shall obtain a
32 certificate of need from the Illinois Health Facilities
33 Planning Board under the Illinois Health Facilities Planning
34 Act before receiving a license by the Department.
-6- LRB9008970JSgcA
1 Alternative health care models in medically underserved areas
2 shall receive priority in obtaining a certificate of need.
3 (c) An alternative health care model license shall be
4 issued for a period of one year and shall be annually renewed
5 if the facility or program is in substantial compliance with
6 the Department's rules adopted under this Act. A licensed
7 alternative health care model that continues to be in
8 substantial compliance after the conclusion of the
9 demonstration program shall be eligible for annual renewals
10 unless and until a different licensure program for that type
11 of health care model is established by legislation. The
12 Department may issue a provisional license to any alternative
13 health care model that does not substantially comply with the
14 provisions of this Act and the rules adopted under this Act
15 if (i) the Department finds that the alternative health care
16 model has undertaken changes and corrections which upon
17 completion will render the alternative health care model in
18 substantial compliance with this Act and rules and (ii) the
19 health and safety of the patients of the alternative health
20 care model will be protected during the period for which the
21 provisional license is issued. The Department shall advise
22 the licensee of the conditions under which the provisional
23 license is issued, including the manner in which the
24 alternative health care model fails to comply with the
25 provisions of this Act and rules, and the time within which
26 the changes and corrections necessary for the alternative
27 health care model to substantially comply with this Act and
28 rules shall be completed.
29 (d) Alternative health care models shall seek
30 certification under Titles XVIII and XIX of the federal
31 Social Security Act. In addition, alternative health care
32 models shall provide charitable care consistent with that
33 provided by comparable health care providers in the
34 geographic area.
-7- LRB9008970JSgcA
1 (d-5) The Illinois Department of Public Aid, in
2 cooperation with the Illinois Department of Public Health,
3 shall develop and implement a reimbursement methodology for
4 all facilities participating in the demonstration program.
5 The Illinois Department of Public Aid shall keep a record of
6 services provided under the demonstration program to
7 recipients of medical assistance under the Illinois Public
8 Aid Code and shall submit an annual report of that
9 information to the Illinois Department of Public Health.
10 (e) Alternative health care models shall, to the extent
11 possible, link and integrate their services with nearby
12 health care facilities.
13 (f) Each alternative health care model shall implement a
14 quality assurance program with measurable benefits and at
15 reasonable cost.
16 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
17 eff. 8-20-95.)
18 (210 ILCS 3/35)
19 Sec. 35. Alternative health care models authorized.
20 Notwithstanding any other law to the contrary, alternative
21 health care models described in this Section may be
22 established on a demonstration basis.
23 (1) Alternative health care model; subacute care
24 hospital. A subacute care hospital is a designated site
25 which provides medical specialty care for patients who
26 need a greater intensity or complexity of care than
27 generally provided in a skilled nursing facility but who
28 no longer require acute hospital care. The average length
29 of stay for patients treated in subacute care hospitals
30 shall not be less than 20 days, and for individual
31 patients, the expected length of stay at the time of
32 admission shall not be less than 10 days. Variations
33 from minimum lengths of stay shall be reported to the
-8- LRB9008970JSgcA
1 Department. There shall be no more than 13 subacute care
2 hospitals authorized to operate by the Department.
3 Subacute care includes physician supervision, registered
4 nursing, and physiological monitoring on a continual
5 basis. A subacute care hospital is either a freestanding
6 building or a distinct physical and operational entity
7 within a hospital or nursing home building. A subacute
8 care hospital shall only consist of beds currently
9 existing in licensed hospitals or skilled nursing
10 facilities, except, in the City of Chicago, on a
11 designated site that was licensed as a hospital under the
12 Illinois Hospital Licensing Act within the 10 years
13 immediately before the application for an alternative
14 health care model license. During the period of operation
15 of the demonstration project, the existing licensed beds
16 shall remain licensed as hospital or skilled nursing
17 facility beds as well as being licensed under this Act.
18 In order to handle cases of complications, emergencies,
19 or exigent circumstances, a subacute care hospital shall
20 maintain a contractual relationship, including a transfer
21 agreement, with a general acute care hospital. If a
22 subacute care model is located in a general acute care
23 hospital, it shall utilize all or a portion of the bed
24 capacity of that existing hospital. In no event shall a
25 subacute care hospital use the word "hospital" in its
26 advertising or marketing activities or represent or hold
27 itself out to the public as a general acute care
28 hospital.
29 (2) Alternative health care delivery model;
30 postsurgical recovery care center. A postsurgical
31 recovery care center is a designated site that which
32 provides postsurgical recovery care for generally healthy
33 patients undergoing surgical procedures or medical
34 procedures that may require periodic overnight nursing
-9- LRB9008970JSgcA
1 care, pain control, or observation, or treatment that
2 would otherwise be provided in an inpatient setting.
3 Procedures to be treated shall be authorized by the
4 consulting committee of the recovery care center. A
5 postsurgical recovery care center is either freestanding
6 or a defined unit of an ambulatory surgical treatment
7 center or hospital. No facility, or portion of a
8 facility, may participate in a demonstration program as a
9 postsurgical recovery care center unless the facility has
10 been licensed as an ambulatory surgical treatment center
11 or hospital for at least 2 years before August 20, 1993
12 (the effective date of Public Act 88-441). The maximum
13 length of stay for patients in a postsurgical recovery
14 care center is not to exceed 48 hours unless the treating
15 physician requests an extension of time from the recovery
16 center's medical director on the basis of medical or
17 clinical documentation that an additional care period is
18 required for the recovery of a patient and the medical
19 director approves the extension of time. In no case,
20 however, shall a patient's length of stay in a
21 postsurgical recovery care center be longer than 72
22 hours. If a patient requires an additional care period
23 after the expiration of the 72-hour limit, the patient
24 shall be transferred to an appropriate facility. Reports
25 on variances from the 48-hour limit shall be sent to the
26 Department for its evaluation. The reports shall, before
27 submission to the Department, have removed from them all
28 patient and physician identifiers. In order to handle
29 cases of complications, emergencies, or exigent
30 circumstances, every postsurgical recovery care center as
31 defined in this paragraph shall maintain a contractual
32 relationship, including a transfer agreement, with a
33 general acute care hospital. A postsurgical recovery
34 care center shall be no larger than 20 beds. A
-10- LRB9008970JSgcA
1 postsurgical recovery care center shall be located within
2 15 minutes travel time from the general acute care
3 hospital with which the center maintains a contractual
4 relationship, including a transfer agreement, as required
5 under this paragraph.
6 No postsurgical recovery care center shall
7 discriminate against any patient requiring treatment
8 because of the source of payment for services, including
9 Medicare and Medicaid recipients.
10 The Department shall adopt rules to implement the
11 provisions of Public Act 88-441 concerning postsurgical
12 recovery care centers within 9 months after August 20,
13 1993.
14 (3) Alternative health care delivery model;
15 children's respite care center. A childrens' respite
16 care center model is a designated site that provides
17 respite for medically frail, technologically dependent,
18 clinically stable children, up to age 18, for a period of
19 one to 14 days. This care is to be provided in a
20 home-like environment that serves no more than 10
21 children at a time. Children's respite care center
22 services must be available through the model to all
23 families, including those whose care is paid for through
24 the Illinois Department of Public Aid or the Illinois
25 Department of Children and Family Services. Each respite
26 care model location shall be a facility physically
27 separate and apart from any other facility licensed by
28 the Department of Public Health under this or any other
29 Act and shall provide, at a minimum, the following
30 services: out-of-home respite care; hospital to home
31 training for families and caregivers; short term
32 transitional care to facilitate placement and training
33 for foster care parents; parent and family support
34 groups.
-11- LRB9008970JSgcA
1 Coverage for the services provided by the Illinois
2 Department of Public Aid under this paragraph (3) is
3 contingent upon federal waiver approval and is provided only
4 to Medicaid eligible clients participating in the home and
5 community based services waiver designated in Section 1915(c)
6 of the Social Security Act for medically frail and
7 technologically dependent children.
8 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
9 eff. 8-20-95.)
10 (210 ILCS 3/35.1)
11 Sec. 35.1. Scope of Program for Recovery Centers. Once
12 the Department has authorized a total of 12 postsurgical
13 recovery care centers under this Act, no new centers shall be
14 authorized for the duration of the demonstration program.
15 (Source: P.A. 89-393, eff. 8-20-95.)
16 (210 ILCS 3/36)
17 Sec. 36. Use of name; patient transfers; consulting
18 committee. No facility or person shall hold itself out to the
19 public as a "recovery care center" or "postsurgical recovery
20 care center" unless it is licensed as a postsurgical recovery
21 care center under this Act.
22 The Department shall establish by rule criteria for
23 patient transfers to postsurgical recovery care models. Each
24 facility licensed as a postsurgical recovery care center
25 shall establish a qualified consulting committee to review
26 the types of surgical procedures performed in ambulatory
27 surgical treatment centers and hospitals which intend to
28 transfer patients to the recovery care center. The committee
29 shall recommend appropriate procedures for approval by the
30 Department of Public Health. Action on these recommendations
31 by the Department shall not be unreasonably withheld.
32 (Source: P.A. 88-490.)
-12- LRB9008970JSgcA
1 Section 99. Effective date. This Act takes effect upon
2 becoming law.