Public Act 095-0445
 
SB0264 Enrolled LRB095 03976 DRJ 30779 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Alternative Health Care Delivery Act is
amended by changing Sections 30 and 35 as follows:
 
    (210 ILCS 3/30)
    Sec. 30. Demonstration program requirements. The
requirements set forth in this Section shall apply to
demonstration programs.
    (a) There shall be no more than:
        (i) 3 subacute care hospital alternative health care
    models in the City of Chicago (one of which shall be
    located on a designated site and shall have been licensed
    as a hospital under the Illinois Hospital Licensing Act
    within the 10 years immediately before the application for
    a license);
        (ii) 2 subacute care hospital alternative health care
    models in the demonstration program for each of the
    following areas:
            (1) Cook County outside the City of Chicago.
            (2) DuPage, Kane, Lake, McHenry, and Will
        Counties.
            (3) Municipalities with a population greater than
        50,000 not located in the areas described in item (i)
        of subsection (a) and paragraphs (1) and (2) of item
        (ii) of subsection (a); and
        (iii) 4 subacute care hospital alternative health care
    models in the demonstration program for rural areas.
    In selecting among applicants for these licenses in rural
areas, the Health Facilities Planning Board and the Department
shall give preference to hospitals that may be unable for
economic reasons to provide continued service to the community
in which they are located unless the hospital were to receive
an alternative health care model license.
    (a-5) There shall be no more than a total of 12
postsurgical recovery care center alternative health care
models in the demonstration program, located as follows:
        (1) Two in the City of Chicago.
        (2) Two in Cook County outside the City of Chicago. At
    least one of these shall be owned or operated by a hospital
    devoted exclusively to caring for children.
        (3) Two in Kane, Lake, and McHenry Counties.
        (4) Four in municipalities with a population of 50,000
    or more not located in the areas described in paragraphs
    (1), (2), and (3), 3 of which shall be owned or operated by
    hospitals, at least 2 of which shall be located in counties
    with a population of less than 175,000, according to the
    most recent decennial census for which data are available,
    and one of which shall be owned or operated by an
    ambulatory surgical treatment center.
        (5) Two in rural areas, both of which shall be owned or
    operated by hospitals.
    There shall be no postsurgical recovery care center
alternative health care models located in counties with
populations greater than 600,000 but less than 1,000,000. A
proposed postsurgical recovery care center must be owned or
operated by a hospital if it is to be located within, or will
primarily serve the residents of, a health service area in
which more than 60% of the gross patient revenue of the
hospitals within that health service area are derived from
Medicaid and Medicare, according to the most recently available
calendar year data from the Illinois Health Care Cost
Containment Council. Nothing in this paragraph shall preclude a
hospital and an ambulatory surgical treatment center from
forming a joint venture or developing a collaborative agreement
to own or operate a postsurgical recovery care center.
    (a-10) There shall be no more than a total of 8 children's
respite care center alternative health care models in the
demonstration program, which shall be located as follows:
        (1) One in the City of Chicago.
        (2) One in Cook County outside the City of Chicago.
        (3) A total of 2 in the area comprised of DuPage, Kane,
    Lake, McHenry, and Will counties.
        (4) A total of 2 in municipalities with a population of
    50,000 or more and not located in the areas described in
    paragraphs (1), (2), or (3).
        (5) A total of 2 in rural areas, as defined by the
    Health Facilities Planning Board.
    No more than one children's respite care model owned and
operated by a licensed skilled pediatric facility shall be
located in each of the areas designated in this subsection
(a-10).
    (a-15) There shall be an authorized community-based
residential rehabilitation center alternative health care
model in the demonstration program. The community-based
residential rehabilitation center shall be located in the area
of Illinois south of Interstate Highway 70.
    (a-20) There shall be an authorized Alzheimer's disease
management center alternative health care model in the
demonstration program. The Alzheimer's disease management
center shall be located in Will County, owned by a
not-for-profit entity, and endorsed by a resolution approved by
the county board before the effective date of this amendatory
Act of the 91st General Assembly.
    (a-25) There shall be no more than 10 birth center
alternative health care models in the demonstration program,
located as follows:
        (1) Four in the area comprising Cook, DuPage, Kane,
    Lake, McHenry, and Will counties, one of which shall be
    owned or operated by a hospital and one of which shall be
    owned or operated by a federally qualified health center.
        (2) Three in municipalities with a population of 50,000
    or more not located in the area described in paragraph (1)
    of this subsection, one of which shall be owned or operated
    by a hospital and one of which shall be owned or operated
    by a federally qualified health center.
        (3) Three in rural areas, one of which shall be owned
    or operated by a hospital and one of which shall be owned
    or operated by a federally qualified health center.
    The first 3 birth centers authorized to operate by the
Department shall be located in or predominantly serve the
residents of a health professional shortage area as determined
by the United States Department of Health and Human Services.
There shall be no more than 2 birth centers authorized to
operate in any single health planning area for obstetric
services as determined under the Illinois Health Facilities
Planning Act. If a birth center is located outside of a health
professional shortage area, (i) the birth center shall be
located in a health planning area with a demonstrated need for
obstetrical service beds, as determined by the Illinois Health
Facilities Planning Board or (ii) there must be a reduction in
the existing number of obstetrical service beds in the planning
area so that the establishment of the birth center does not
result in an increase in the total number of obstetrical
service beds in the health planning area.
    (b) Alternative health care models, other than a model
authorized under subsection (a-20), shall obtain a certificate
of need from the Illinois Health Facilities Planning Board
under the Illinois Health Facilities Planning Act before
receiving a license by the Department. If, after obtaining its
initial certificate of need, an alternative health care
delivery model that is a community based residential
rehabilitation center seeks to increase the bed capacity of
that center, it must obtain a certificate of need from the
Illinois Health Facilities Planning Board before increasing
the bed capacity. Alternative health care models in medically
underserved areas shall receive priority in obtaining a
certificate of need.
    (c) An alternative health care model license shall be
issued for a period of one year and shall be annually renewed
if the facility or program is in substantial compliance with
the Department's rules adopted under this Act. A licensed
alternative health care model that continues to be in
substantial compliance after the conclusion of the
demonstration program shall be eligible for annual renewals
unless and until a different licensure program for that type of
health care model is established by legislation. The Department
may issue a provisional license to any alternative health care
model that does not substantially comply with the provisions of
this Act and the rules adopted under this Act if (i) the
Department finds that the alternative health care model has
undertaken changes and corrections which upon completion will
render the alternative health care model in substantial
compliance with this Act and rules and (ii) the health and
safety of the patients of the alternative health care model
will be protected during the period for which the provisional
license is issued. The Department shall advise the licensee of
the conditions under which the provisional license is issued,
including the manner in which the alternative health care model
fails to comply with the provisions of this Act and rules, and
the time within which the changes and corrections necessary for
the alternative health care model to substantially comply with
this Act and rules shall be completed.
    (d) Alternative health care models shall seek
certification under Titles XVIII and XIX of the federal Social
Security Act. In addition, alternative health care models shall
provide charitable care consistent with that provided by
comparable health care providers in the geographic area.
    (d-5) The Department of Healthcare and Family Services
(formerly Illinois Department of Public Aid), in cooperation
with the Illinois Department of Public Health, shall develop
and implement a reimbursement methodology for all facilities
participating in the demonstration program. The Department of
Healthcare and Family Services Illinois Department of Public
Aid shall keep a record of services provided under the
demonstration program to recipients of medical assistance
under the Illinois Public Aid Code and shall submit an annual
report of that information to the Illinois Department of Public
Health.
    (e) Alternative health care models shall, to the extent
possible, link and integrate their services with nearby health
care facilities.
    (f) Each alternative health care model shall implement a
quality assurance program with measurable benefits and at
reasonable cost.
(Source: P.A. 91-65, eff. 7-9-99; 91-838, eff. 6-16-00; revised
12-15-05.)
 
    (210 ILCS 3/35)
    Sec. 35. Alternative health care models authorized.
Notwithstanding any other law to the contrary, alternative
health care models described in this Section may be established
on a demonstration basis.
        (1) Alternative health care model; subacute care
    hospital. A subacute care hospital is a designated site
    which provides medical specialty care for patients who need
    a greater intensity or complexity of care than generally
    provided in a skilled nursing facility but who no longer
    require acute hospital care. The average length of stay for
    patients treated in subacute care hospitals shall not be
    less than 20 days, and for individual patients, the
    expected length of stay at the time of admission shall not
    be less than 10 days. Variations from minimum lengths of
    stay shall be reported to the Department. There shall be no
    more than 13 subacute care hospitals authorized to operate
    by the Department. Subacute care includes physician
    supervision, registered nursing, and physiological
    monitoring on a continual basis. A subacute care hospital
    is either a freestanding building or a distinct physical
    and operational entity within a hospital or nursing home
    building. A subacute care hospital shall only consist of
    beds currently existing in licensed hospitals or skilled
    nursing facilities, except, in the City of Chicago, on a
    designated site that was licensed as a hospital under the
    Illinois Hospital Licensing Act within the 10 years
    immediately before the application for an alternative
    health care model license. During the period of operation
    of the demonstration project, the existing licensed beds
    shall remain licensed as hospital or skilled nursing
    facility beds as well as being licensed under this Act. In
    order to handle cases of complications, emergencies, or
    exigent circumstances, a subacute care hospital shall
    maintain a contractual relationship, including a transfer
    agreement, with a general acute care hospital. If a
    subacute care model is located in a general acute care
    hospital, it shall utilize all or a portion of the bed
    capacity of that existing hospital. In no event shall a
    subacute care hospital use the word "hospital" in its
    advertising or marketing activities or represent or hold
    itself out to the public as a general acute care hospital.
        (2) Alternative health care delivery model;
    postsurgical recovery care center. A postsurgical recovery
    care center is a designated site which provides
    postsurgical recovery care for generally healthy patients
    undergoing surgical procedures that require overnight
    nursing care, pain control, or observation that would
    otherwise be provided in an inpatient setting. A
    postsurgical recovery care center is either freestanding
    or a defined unit of an ambulatory surgical treatment
    center or hospital. No facility, or portion of a facility,
    may participate in a demonstration program as a
    postsurgical recovery care center unless the facility has
    been licensed as an ambulatory surgical treatment center or
    hospital for at least 2 years before August 20, 1993 (the
    effective date of Public Act 88-441). The maximum length of
    stay for patients in a postsurgical recovery care center is
    not to exceed 48 hours unless the treating physician
    requests an extension of time from the recovery center's
    medical director on the basis of medical or clinical
    documentation that an additional care period is required
    for the recovery of a patient and the medical director
    approves the extension of time. In no case, however, shall
    a patient's length of stay in a postsurgical recovery care
    center be longer than 72 hours. If a patient requires an
    additional care period after the expiration of the 72-hour
    limit, the patient shall be transferred to an appropriate
    facility. Reports on variances from the 48-hour limit shall
    be sent to the Department for its evaluation. The reports
    shall, before submission to the Department, have removed
    from them all patient and physician identifiers. In order
    to handle cases of complications, emergencies, or exigent
    circumstances, every postsurgical recovery care center as
    defined in this paragraph shall maintain a contractual
    relationship, including a transfer agreement, with a
    general acute care hospital. A postsurgical recovery care
    center shall be no larger than 20 beds. A postsurgical
    recovery care center shall be located within 15 minutes
    travel time from the general acute care hospital with which
    the center maintains a contractual relationship, including
    a transfer agreement, as required under this paragraph.
        No postsurgical recovery care center shall
    discriminate against any patient requiring treatment
    because of the source of payment for services, including
    Medicare and Medicaid recipients.
        The Department shall adopt rules to implement the
    provisions of Public Act 88-441 concerning postsurgical
    recovery care centers within 9 months after August 20,
    1993.
        (3) Alternative health care delivery model; children's
    community-based health care center. A children's
    community-based health care center model is a designated
    site that provides nursing care, clinical support
    services, and therapies for a period of one to 14 days for
    short-term stays and 120 days to facilitate transitions to
    home or other appropriate settings for medically fragile
    children, technology dependent children, and children with
    special health care needs who are deemed clinically stable
    by a physician and are younger than 22 years of age. This
    care is to be provided in a home-like environment that
    serves no more than 12 children at a time. Children's
    community-based health care center services must be
    available through the model to all families, including
    those whose care is paid for through the Department of
    Healthcare and Family Services Public Aid, the Department
    of Children and Family Services, the Department of Human
    Services, and insurance companies who cover home health
    care services or private duty nursing care in the home.
        Each children's community-based health care center
    model location shall be physically separate and apart from
    any other facility licensed by the Department of Public
    Health under this or any other Act and shall provide the
    following services: respite care, registered nursing or
    licensed practical nursing care, transitional care to
    facilitate home placement or other appropriate settings
    and reunite families, medical day care, weekend camps, and
    diagnostic studies typically done in the home setting.
        Coverage for the services provided by the Illinois
    Department of Healthcare and Family Services Public Aid
    under this paragraph (3) is contingent upon federal waiver
    approval and is provided only to Medicaid eligible clients
    participating in the home and community based services
    waiver designated in Section 1915(c) of the Social Security
    Act for medically frail and technologically dependent
    children or children in Department of Children and Family
    Services foster care who receive home health benefits.
        (4) Alternative health care delivery model; community
    based residential rehabilitation center. A community-based
    residential rehabilitation center model is a designated
    site that provides rehabilitation or support, or both, for
    persons who have experienced severe brain injury, who are
    medically stable, and who no longer require acute
    rehabilitative care or intense medical or nursing
    services. The average length of stay in a community-based
    residential rehabilitation center shall not exceed 4
    months. As an integral part of the services provided,
    individuals are housed in a supervised living setting while
    having immediate access to the community. The residential
    rehabilitation center authorized by the Department may
    have more than one residence included under the license. A
    residence may be no larger than 12 beds and shall be
    located as an integral part of the community. Day treatment
    or individualized outpatient services shall be provided
    for persons who reside in their own home. Functional
    outcome goals shall be established for each individual.
    Services shall include, but are not limited to, case
    management, training and assistance with activities of
    daily living, nursing consultation, traditional therapies
    (physical, occupational, speech), functional interventions
    in the residence and community (job placement, shopping,
    banking, recreation), counseling, self-management
    strategies, productive activities, and multiple
    opportunities for skill acquisition and practice
    throughout the day. The design of individualized program
    plans shall be consistent with the outcome goals that are
    established for each resident. The programs provided in
    this setting shall be accredited by the Commission on
    Accreditation of Rehabilitation Facilities (CARF). The
    program shall have been accredited by CARF as a Brain
    Injury Community-Integrative Program for at least 3 years.
        (5) Alternative health care delivery model;
    Alzheimer's disease management center. An Alzheimer's
    disease management center model is a designated site that
    provides a safe and secure setting for care of persons
    diagnosed with Alzheimer's disease. An Alzheimer's disease
    management center model shall be a facility separate from
    any other facility licensed by the Department of Public
    Health under this or any other Act. An Alzheimer's disease
    management center shall conduct and document an assessment
    of each resident every 6 months. The assessment shall
    include an evaluation of daily functioning, cognitive
    status, other medical conditions, and behavioral problems.
    An Alzheimer's disease management center shall develop and
    implement an ongoing treatment plan for each resident. The
    treatment plan shall have defined goals. The Alzheimer's
    disease management center shall treat behavioral problems
    and mood disorders using nonpharmacologic approaches such
    as environmental modification, task simplification, and
    other appropriate activities. All staff must have
    necessary training to care for all stages of Alzheimer's
    Disease. An Alzheimer's disease management center shall
    provide education and support for residents and
    caregivers. The education and support shall include
    referrals to support organizations for educational
    materials on community resources, support groups, legal
    and financial issues, respite care, and future care needs
    and options. The education and support shall also include a
    discussion of the resident's need to make advance
    directives and to identify surrogates for medical and legal
    decision-making. The provisions of this paragraph
    establish the minimum level of services that must be
    provided by an Alzheimer's disease management center. An
    Alzheimer's disease management center model shall have no
    more than 100 residents. Nothing in this paragraph (5)
    shall be construed as prohibiting a person or facility from
    providing services and care to persons with Alzheimer's
    disease as otherwise authorized under State law.
        (6) Alternative health care delivery model; birth
    center. A birth center shall be exclusively dedicated to
    serving the childbirth-related needs of women and their
    newborns and shall have no more than 10 beds. A birth
    center is a designated site that is away from the mother's
    usual place of residence and in which births are planned to
    occur following a normal, uncomplicated, and low-risk
    pregnancy. A birth center shall offer prenatal care and
    community education services and shall coordinate these
    services with other health care services available in the
    community.
            (A) A birth center shall not be separately licensed
        if it is one of the following:
                (1) A part of a hospital; or
                (2) A freestanding facility that is physically
            distinct from a hospital but is operated under a
            license issued to a hospital under the Hospital
            Licensing Act.
            (B) A separate birth center license shall be
        required if the birth center is operated as:
                (1) A part of the operation of a federally
            qualified health center as designated by the
            United States Department of Health and Human
            Services; or
                (2) A facility other than one described in
            subparagraph (A)(1), (A)(2), or (B)(1) of this
            paragraph (6) whose costs are reimbursable under
            Title XIX of the federal Social Security Act.
        In adopting rules for birth centers, the Department
    shall consider: the American Association of Birth Centers'
    Standards for Freestanding Birth Centers; the American
    Academy of Pediatrics/American College of Obstetricians
    and Gynecologists Guidelines for Perinatal Care; and the
    Regionalized Perinatal Health Care Code. The Department's
    rules shall stipulate the eligibility criteria for birth
    center admission. The Department's rules shall stipulate
    the necessary equipment for emergency care according to the
    American Association of Birth Centers' standards and any
    additional equipment deemed necessary by the Department.
    The Department's rules shall provide for a time period
    within which each birth center not part of a hospital must
    become accredited by either the Commission for the
    Accreditation of Freestanding Birth Centers or The Joint
    Commission.
        A birth center shall be certified to participate in the
    Medicare and Medicaid programs under Titles XVIII and XIX,
    respectively, of the federal Social Security Act. To the
    extent necessary, the Illinois Department of Healthcare
    and Family Services shall apply for a waiver from the
    United States Health Care Financing Administration to
    allow birth centers to be reimbursed under Title XIX of the
    federal Social Security Act.
        A birth center that is not operated under a hospital
    license shall be located within a ground travel time
    distance from the general acute care hospital with which
    the birth center maintains a contractual relationship,
    including a transfer agreement, as required under this
    paragraph, that allows for an emergency caesarian delivery
    to be started within 30 minutes of the decision a caesarian
    delivery is necessary. A birth center operating under a
    hospital license shall be located within a ground travel
    time distance from the licensed hospital that allows for an
    emergency caesarian delivery to be started within 30
    minutes of the decision a caesarian delivery is necessary.
        The services of a medical director physician, licensed
    to practice medicine in all its branches, who is certified
    or eligible for certification by the American College of
    Obstetricians and Gynecologists or the American Board of
    Osteopathic Obstetricians and Gynecologists or has
    hospital obstetrical privileges are required in birth
    centers. The medical director in consultation with the
    Director of Nursing and Midwifery Services shall
    coordinate the clinical staff and overall provision of
    patient care. The medical director or his or her physician
    designee shall be available on the premises or within a
    close proximity as defined by rule. The medical director
    and the Director of Nursing and Midwifery Services shall
    jointly develop and approve policies defining the criteria
    to determine which pregnancies are accepted as normal,
    uncomplicated, and low-risk, and the anesthesia services
    available at the center. No general anesthesia may be
    administered at the center.
        If a birth center employs certified nurse midwives, a
    certified nurse midwife shall be the Director of Nursing
    and Midwifery Services who is responsible for the
    development of policies and procedures for services as
    provided by Department rules.
        An obstetrician, family practitioner, or certified
    nurse midwife shall attend each woman in labor from the
    time of admission through birth and throughout the
    immediate postpartum period. Attendance may be delegated
    only to another physician or certified nurse midwife.
    Additionally, a second staff person shall also be present
    at each birth who is licensed or certified in Illinois in a
    health-related field and under the supervision of the
    physician or certified nurse midwife in attendance, has
    specialized training in labor and delivery techniques and
    care of newborns, and receives planned and ongoing training
    as needed to perform assigned duties effectively.
        The maximum length of stay in a birth center shall be
    consistent with existing State laws allowing a 48-hour stay
    or appropriate post-delivery care, if discharged earlier
    than 48 hours.
        A birth center shall participate in the Illinois
    Perinatal System under the Developmental Disability
    Prevention Act. At a minimum, this participation shall
    require a birth center to establish a letter of agreement
    with a hospital designated under the Perinatal System. A
    hospital that operates or has a letter of agreement with a
    birth center shall include the birth center under its
    maternity service plan under the Hospital Licensing Act and
    shall include the birth center in the hospital's letter of
    agreement with its regional perinatal center.
        A birth center may not discriminate against any patient
    requiring treatment because of the source of payment for
    services, including Medicare and Medicaid recipients.
        No general anesthesia and no surgery may be performed
    at a birth center. The Department may by rule add birth
    center patient eligibility criteria or standards as it
    deems necessary. The Department shall by rule require each
    birth center to report the information which the Department
    shall make publicly available, which shall include, but is
    not limited to, the following:
            (i) Birth center ownership.
            (ii) Sources of payment for services.
            (iii) Utilization data involving patient length of
        stay.
            (iv) Admissions and discharges.
            (v) Complications.
            (vi) Transfers.
            (vii) Unusual incidents.
            (viii) Deaths.
            (ix) Any other publicly reported data required
        under the Illinois Consumer Guide.
            (x) Post-discharge patient status data where
        patients are followed for 14 days after discharge from
        the birth center to determine whether the mother or
        baby developed a complication or infection.
        Within 9 months after the effective date of this
    amendatory Act of the 95th General Assembly, the Department
    shall adopt rules that are developed with consideration of:
    the American Association of Birth Centers' Standards for
    Freestanding Birth Centers; the American Academy of
    Pediatrics/American College of Obstetricians and
    Gynecologists Guidelines for Perinatal Care; and the
    Regionalized Perinatal Health Care Code.
        The Department shall adopt other rules as necessary to
    implement the provisions of this amendatory Act of the 95th
    General Assembly within 9 months after the effective date
    of this amendatory Act of the 95th General Assembly.
(Source: P.A. 93-402, eff. 1-1-04; revised 12-15-05.)