ADMINISTRATIVE CODE

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER c: HOSPITALS AND OUTPATIENT SERVICES CARE FACILITIES
PART 245 HOME HEALTH, HOME SERVICES, AND HOME NURSING AGENCY CODE

SUBPART A: GENERAL PROVISIONS

Section 245.10 Purpose

Section 245.20 Definitions

Section 245.25 Incorporated and Referenced Materials

SUBPART B: OPERATIONAL REQUIREMENTS

Section 245.30 Organization and Administration

Section 245.40 Staffing and Staff Responsibilities

Section 245.50 Services (Repealed)

Section 245.55 Vaccinations

Section 245.60 Annual Financial Statement – Home Health Agencies

Section 245.70 Home Health Aide Training

Section 245.71 Qualifications and Requirements for Home Services Workers

Section 245.72 Health Care Worker Background Check

Section 245.75 Infection Control

SUBPART C: LICENSURE PROCEDURES

Section 245.80 Licensure Required

Section 245.90 License Application

Section 245.95 License Application Fee, Single or Multiple Licenses

Section 245.100 Provisional License

Section 245.110 Inspections and Investigations

Section 245.115 Complaints

Section 245.120 Violations

Section 245.130 Adverse Licensure Actions

Section 245.140 Penalties and Fines

Section 245.150 Hearings

SUBPART D: CLIENT/PATIENT SERVICES

Section 245.200 Services – Home Health

Section 245.205 Services – Home Nursing Agencies

Section 245.210 Services – Home Services Agencies

Section 245.211 Services - Alzheimer's Disease and Related Dementias

Section 245.212 Services – Home Nursing Placement Agency

Section 245.214 Services – Home Services Placement Agency

Section 245.220 Client Service Contracts – Home Nursing and Home Services Agencies

Section 245.225 Client Service Contracts – Home Nursing Placement Agency and Home Services Placement Agency

Section 245.240 Quality Improvement Program

Section 245.250 Abuse, Neglect and Financial Exploitation Prevention and Reporting

SUBPART A: GENERAL PROVISIONS

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER b: HOSPITALS AND AMBULATORY CARE FACILITIES
PART 245 HOME HEALTH, HOME SERVICES, AND HOME NURSING AGENCY CODE
SECTION 245.10 PURPOSE

Section 245.10 Purpose

a) This Part has been adopted in accordance with Sections 6, 6.3 and 6.7 of the Home Health, Home Services and Home Nursing Agency Licensing Act (the Act) [210 ILCS 55/6, 6.3 and 6.7].

b) Home health agencies licensed under the Act and this Part may be eligible for participation in the federal Medicare program under the rules of the federal Centers for Medicare and Medicaid Services (42 CFR 484.1 through 484.40).

c) Health care and support services are provided in the consumer's home by three basic types of agencies: home health care, home nursing care, and home support services. Each type of agency delivers a different type and scope of care or service. (Section 1.01 of the Act)

(Source: Amended at 32 Ill. Reg. 8949, effective June 5, 2008)

Section 245.20 Definitions

Act – the Home Health, Home Services and Home Nursing Agency Licensing Act.

Activities of Daily Living or ADL − include, but are not limited to, eating, dressing, bathing, toileting, transferring, or personal hygiene.

Advanced Practice Registered Nurse or APRN – a person who is licensed as an advanced practice registered nurse under the Nurse Practice Act.

Advocate – a person who represents the rights and interests of an individual as though they were the person's own, to realize the rights to which the individual is entitled, obtain needed services, and remove barriers to meeting the individual's needs.

Agency – a home health agency, home nursing agency, or home services agency, unless specifically stated otherwise. (Section 2.03a of the Act)

Agency Manager – the individual designated by the governing body or the entity legally responsible for the agency, who has overall responsibility for the organization and day-to-day operation of the home services or home nursing agency.

Applicant − a firm, partnership, or association, or any of their members, or, if the applicant is a corporation, any of its officers or directors, or the person designated to manage or supervise the agency.

Audiologist – a person who has received a license to practice audiology pursuant to the Illinois Speech-Language Pathology and Audiology Practice Act.

Branch Office – an office location or site other than the parent agency from which an agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the agency and is located sufficiently close to share administration, supervision and services on a daily and emergency basis in a manner that renders it unnecessary for the branch to be independently licensed.

Bylaws or Equivalent – a set of rules adopted by an agency for governing the agency's operation.

Client – an individual receiving services from a home nursing agency, a home services agency or a placement agency. This term includes the client's advocate or designee.

Client Record − a written or electronic record that includes, but is not limited to, personal information, emergency notification information, plans of service agreed to between the client and the home services agency, a copy of the home services contract or agreement, and documentation of the services provided at each visit.

Clinical Note – a dated, written notation or electronic entry by a member of the health team of a contact with a patient, containing a description of signs and symptoms, treatment and any drug given, the patient's reaction, and any changes in physical or emotional condition.

Clinical Record – an accurate account of services and care provided for each patient that is maintained by a home health or home nursing agency in accordance with accepted professional standards.

Companionship – services that provide fellowship, care and protection for a client who, because of advanced age or physical or mental infirmity, cannot care for his or her own needs. Services requested may include, but are not limited to: household work related to the care of the client, such as meal preparation, bed making, or laundry; shopping or errands; or other similar services.

"Data Driven" – an agency uses quality indicator data, including patient care, and other relevant data, in the design of its program. The data collected is used to monitor the effectiveness and safety of services and quality of care and to identify opportunities and priorities for improvement. The frequency and detail of the data collection is approved by the governing body of the agency.

Department or IDPH – the Department of Public Health of the State of Illinois. (Section 2.01 of the Act)

Director – the Director of Public Health of the State of Illinois, or his or her designee. (Section 2.02 of the Act)

Discharge Summary – the written report of services rendered, goals achieved, and final disposition at the time of discharge from service of a home health or home nursing agency.

Documentary Evidence – evidence that an agency covered under this Part maintains as documentation of its quality assessment and performance improvement program. Documentary evidence used to demonstrate the agency's operation to the Centers for Medicare and Medicaid Services includes program scope, program data, program activities, performance improvement projects, and executive responsibilities.

Drop-site – an office or site of the parent agency that does not render services but is used by the parent agency only as a location for administrative tasks, which may include hiring or training staff and a location for staff to obtain supplies.

Employee − a person who works in the service of another person, or company, under an express or implied contract for hire, under which the employer has the right to control the details of work performance for wages, salary, fee or payment.

Geographic Service Area – an area of contiguous counties (recognizable boundaries) in which the agency has been approved by the Department to provides services.

Health Care Professional – a physician licensed to practice medicine in all of its branches, a podiatrist, an advanced practice registered nurse (APRN) licensed under the Nurse Practice Act, or a physician assistant, licensed under the Physician Assistant Practice Act of 1987.

Home Health Agency – a public agency or private organization that provides skilled nursing services and at least one other home health service as defined in this Part. (Section 2.04 of the Act)

Home Health Agency Administrator – an employee of the home health agency who is any one of the following:

A physician who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs;

A registered professional nurse (RN) who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs;

An individual with an undergraduate degree with experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs; or

An individual who meets the requirements for Public Health Administrator as contained in Section 600.310 of the Certified Local Health Department Code who has experience in health service administration, with at least one year of supervisory or administrative experience in home health care or in related health provider programs.

Home Health Aide – a person who provides nursing, medical, or personal care and emotional comfort to assist the patient toward independent living in a safe environment. A person may not be employed as a home health aide unless the person meets the requirements of Section 245.70.

Home Health Services – services provided to a person at his or her residence according to a plan of treatment for illness or infirmity prescribed by a physician licensed to practice medicine in all its branches, a licensed physician assistant, or a licensed advanced practice registered nurse. Such services include part-time and intermittent nursing services and other therapeutic services such as physical therapy, occupational therapy, speech therapy, medical social services or services provided by a home health aide. (Section 2.05 of the Act)

Home Nursing Agency – an agency that provides services directly, or acts as a placement agency, in order to deliver skilled nursing and home health aide services to persons in their personal residences. A home nursing agency provides services that would be required to be performed by an individual licensed under the Nurse Practice Act. Home health aide services are provided under the direction of a registered professional nurse or advanced practice registered nurse. A home nursing agency does not require licensure as a home health agency under the Act. "Home nursing agency" does not include an individually licensed nurse acting as a private contractor or a person that provides or procures temporary employment in health care facilities, as defined in the Nurse Agency Licensing Act. (Section 2.11 of the Act)

Home Nursing Services – services that would be required to be performed by an individual licensed under the Nurse Practice Act on a shift schedule, one-time, full-time or part-time, and/or intermittent basis.

Home Services Agency – an agency that provides services directly, or acts as a placement agency, for the purpose of placing individuals as workers providing home services for consumers in their personal residences. Home services agency does not include agencies licensed under the Nurse Agency Licensing Act, the Hospital Licensing Act, the Nursing Home Care Act, the ID/DD Community Care Act, the MC/DD Act, the Specialized Mental Health Rehabilitation Act of 2013, or the Assisted Living and Shared Housing Act and does not include an agency that limits its business exclusively to providing housecleaning services. Programs providing services exclusively through the Community Care Program of the Illinois Department on Aging, the Department of Human Services Office of Rehabilitation Services, or the United States Department of Veterans Affairs are not considered to be a home services agency under the Act. (Section 2.08 of the Act)

Home Services or In-Home Services or In-Home Support Services – assistance with activities of daily living, housekeeping, personal laundry, and companionship provided to an individual in his or her personal residence, which are intended to enable that individual to remain safely and comfortably in his or her own personal residence. "Home services" or "in-home services" does not include services that would be required to be performed by an individual licensed under the Nurse Practice Act. (Section 2.09 of the Act) Home services are focused on providing assistance that is not medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence, such as companionship, cleaning, laundry, shopping, meal preparation, dressing, and bathing.

Home Services Worker or In-Home Services Worker – an individual who provides home services to a consumer in the consumer's personal residence. (Section 2.10 of the Act) The terms homemaker and companion are commonly used to refer to this type of worker.

Licensed Practical Nurse – a person who is licensed as a licensed practical nurse under the Nurse Practice Act.

Occupational Therapist – a person who is licensed as an occupational therapist under the Illinois Occupational Therapy Practice Act.

Occupational Therapy Assistant – a person who is licensed as an occupational therapy assistant under the Illinois Occupational Therapy Practice Act.

Parent Agency − the agency location responsible for developing and maintaining administrative control of all DPH-approved locations. The parent agency address/location appears on the Department-issued license.

Part-Time or Intermittent Care – home health services given to a patient at least once every 60 days or as frequently as a few hours a day, several times per week.

Patient – a person who is under treatment or care for illness, disease, injury or conditions appropriately responsive to home health or home nursing services to maintain health or prevent illness.

Patient Care Plan – a coordinated and combined care plan prepared by and in collaboration with each discipline providing service to the patient, to the patient's family, or, for home health agencies, to both.

Person – any individual, firm, partnership, corporation, company, association or any other legal entity. (Section 2.03 of the Act)

Personal Care Services – services that are furnished to a client in the client's personal residence to meet the client's physical, maintenance, and supportive needs, when those services are not considered skilled personal care, as described in Section 245.40(c), and do not require a health care provider's orders or the supervision of a nurse.

Physical Therapist – a person who is licensed as a physical therapist under the Illinois Physical Therapy Act.

Physical Therapist Assistant – a person who is licensed as a physical therapist assistant under the Illinois Physical Therapy Act.

Physician – any person licensed to practice medicine in all of its branches under the Medical Practice Act of 1987. For a patient who has received medical care in another state, or has moved from another state, and who has not secured the services of a physician licensed in Illinois, an individual who holds an active license to practice medicine in another state will be considered the physician for the patient during this emergency (as determined by the physician) as provided in Section 3 of the Medical Practice Act of 1987. An emergency may not extend more than six months in any case.

Physician Assistant - any person who meets the licensing requirements of the Physician Assistant Practice Act of 1987.

Placement Agency – any person engaged for gain or profit, regardless of the agency tax status, in the business of securing or attempting to secure work for hire for persons seeking work or workers for employers. The term includes a private employment agency and any other entity that places a worker for private hire by a consumer in that consumer's residence for purposes of providing home services. The term does not include a person that provides or procures temporary employment in health care facilities, as defined in the Nurse Agency Licensing Act. (Section 2.12 of the Act) For the purposes of this Part, there are two types of placement agencies: Home Nursing Placement Agencies (see Section 245.212) and Home Services Placement Agencies (see Section 245.214). A placement agency does not provide ongoing, continuous client support and management of services.

Plan of Treatment – a plan based on the patient's diagnosis and the assessment of the patient's immediate and long-range needs and resources. The plan of treatment is established in consultation with, in the case of a home health agency, the home health services team, which includes the attending physician or podiatrist, pertinent members of the agency staff, the patient, and members of the family.

Podiatrist – a person who is licensed to practice under the Podiatric Medical Practice Act of 1987.

Progress Notes – a dated, written notation by a member of the health team, summarizing facts about care and the patient's response during a given period of time.

Purchase of Services or Contractual – the provision of services through a written agreement with other providers of services.

Quality Assessment and Performance Improvement or QAPI – the coordinated application of two mutually-reinforcing aspects of a quality management system. QAPI takes a systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality in home health agencies while involving all home health caregivers in practical and creative problem solving. Quality assessment is the specification of standards for quality of service and outcomes, and is a process used throughout the organization to ensure care is maintained at acceptable levels in relation to those standards. Performance improvement is the continuous study and improvement of processes with the intent to better services or outcomes, and to decrease the likelihood of problems, by identifying areas of opportunity.

Registered Professional Nurse or RN – a person who is licensed as a registered professional nurse under the Nurse Practice Act.

Service Plan – a plan based on the client's needs and identification of the client's immediate and long-range goals and resources needed to meet these goals.

Service Contract – a written contract between the client and the agency, printed in no less than 12-point font, which includes, at a minimum, all elements listed in Sections 245.220 and 245.225, as applicable.

Skilled Nursing Services – those services that, due to their nature and scope, would require the performing individual to be licensed under the Nurse Practice Act. These services are acts requiring the basic nursing knowledge, judgment and skills acquired by means of completion of an approved nursing education program and include, but are not limited to: assessment of healthcare needs; nursing diagnosis; planning, implementation and nursing evaluation; counseling; patient education; health education; the administration of medications and treatments; and the coordination or management of a nursing or medical plan of care.

Skilled Personal Care –care that may be provided by a home health aide, a registered professional nurse, a licensed practical nurse, a social worker, an occupational therapist, a physical therapist, or a speech-language pathologist as ordered by a health care professional.

Social Work Assistant – a person who has a baccalaureate degree in social work, psychology, sociology, or other field related to social work and has at least one year of social work experience in a health care setting.

Social Worker – a person who is a licensed social worker or a licensed clinical social worker under the Clinical Social Work and Social Work Practice Act.

Speech-Language Pathologist – a person who is licensed as a speech-language pathologist under the Illinois Speech-Language Pathology and Audiology Practice Act.

Student – an individual who is enrolled in an educational institution and who is receiving training in a health-related profession.

Substantially Meets – meeting requirements except for variance from the strict and literal performance, which results in unimportant omissions or defects given the particular circumstances involved.

Supervision – authoritative procedural guidance by a qualified person of the appropriate discipline.

(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)

Section 245.25 Incorporated and Referenced Materials

a) The following federal statutes are referenced in this Part:

Civil Rights Act of 1964 (42 USC 1981 et seq.)

b) The following federal regulations are incorporated by reference in this Part and apply only to Medicare certified agencies:

Department of Health and Human Services, Centers for Medicare and Medicaid Services, Home Health Services (42 CFR 484, October 1, 2020).

c) The following guidelines of a federal agency are incorporated by reference in this Part:

Department of Health and Human Services, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333:

1) General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (May 4, 2021) available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

2) Guidelines for Hand Hygiene in Health-Care Settings (October 2002) available at https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf

3) Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (October 25, 2019) available in two parts at https://www.cdc.gov/infectioncontrol/pdf/guidelines/infection-control-HCP-H.pdf and https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/index.html

d) All incorporations by reference of federal regulations and guidelines in this Part refer to the regulations and guidelines on the date specified and do not include any amendments or editions subsequent to the date specified.

e) The following State statutes are referenced in this Part:

1) Administrative Review Law [735 ILCS 5/Art. III]

2) Business Corporation Act of 1983 [805 ILCS 5]

3) Illinois Administrative Procedure Act [5 ILCS 100]

4) Nurse Practice Act [225 ILCS 65]

5) Illinois Occupational Therapy Practice Act [225 ILCS 75]

6) Illinois Physical Therapy Act [225 ILCS 90]

7) Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110]

8) Local Records Act [50 ILCS 205]

9) Medical Practice Act of 1987 [225 ILCS 60]

10) Health Care Worker Background Check Act [225 ILCS 46]

11) Nurse Agency Licensing Act [225 ILCS 510]

12) Clinical Social Worker and Social Work Practice Act [225 ILCS 20]

13) Podiatric Medical Practice Act of 1987 [225 ILCS 100]

14) Assisted Living and Shared Housing Act [210 ILCS 9]

15) Code of Civil Procedure, Article VIII, Part 21 (Medical Studies) [735 ILCS 5/Art. VIII, Part 21]

16) Private Employment Agency Act [225 ILCS 515]

17) Unemployment Insurance Act [820 ILCS 405]

18) Workers' Compensation Act [820 ILCS 305]

19) Hospital Licensing Act [210 ILCS 85]

20) Nursing Home Care Act [210 ILCS 45]

21) Alzheimer's Disease and Related Dementias Services Act [410 ILCS 406]

22) ID/DD Community Care Act [210 ILCS 47]

23) MC/DD Act [210 ILCS 46]

24) Specialized Mental Health Rehabilitation Act of 2013 [210 ILCS 49]

25) Physician Assistant Practice Act of 1987 [225 ILCS 95]

f) The following State rules are referenced in this Part:

1) Department of Public Health, Certified Local Health Department Code (77 Ill. Adm. Code 600)

2) Department of Public Health, Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100)

3) Department of Public Health, Long-Term Care Assistants and Aides Training Programs Code (77 Ill. Adm. Code 395).

4) Department of Public Health, Health Care Worker Background Check Code (77 Ill. Adm. Code 955)

5) Department of Public Health, Central Complaint Registry (77 Ill. Adm. Code 400)

(Source: Amended at 46 Ill. Reg. 10410, effective May 31, 2022)

SUBPART B: OPERATIONAL REQUIREMENTS

Section 245.30 Organization and Administration

a) Governing Body – All Agencies

The agency shall have a governing body or a clearly defined body with legal authority and responsibility for the conduct of the agency. For the purposes of this Section, the governing body shall:

1) Have bylaws or the equivalent, which shall be reviewed annually and be revised as needed. They shall be made available to all members of the governing body. The bylaws or the equivalent shall specify the objectives of the agency;

2) Employ a qualified administrator for home health agencies;

3) Adopt and revise, as needed, policies and procedures for the operation and administration of the agency;

4) Meet to review the operation of the agency; and

5) Keep minutes of all meetings.

b) Administration − All Agencies

1) The agency shall have written administrative policies and procedures to ensure that the patient or client is provided safe and adequate care.

2) The agency shall show evidence of liability insurance in accordance with Section 245.90(a).

3) The agency shall develop and implement written policies for complaint resolution between the agency and its patients or clients and patient or client advocates in regard to services being provided to the patient or client.

c) Personnel Policies – All Agencies (Placement agencies shall meet the requirements of subsections (c)(1)(B), (2), (3) and (4).)

1) Personnel policies applicable and available to all full- and part-time employees shall include, but not be limited to, the following:

A) Wage scales, benefits, hours of work and leave time;

B) Requirements for an initial health evaluation of each new employee or the placed home services worker or placed nurse who has contact with clients or patients, as specified by the governing body;

C) Orientation to the agency and appropriate continuing education;

D) Job descriptions for all positions used by the agency;

E) Annual performance evaluation for all employees;

F) Compliance with all applicable requirements of the Civil Rights Act of 1964;

G) Confidentiality of personnel records;

H) Employee health policies that require employees to report health symptoms and exposure to any communicable or infectious disease, and that specify conditions under which employees are to be removed from patient or client contact and conditions under which employees may resume patient or client contact; and

I) Agency procedures for identifying potential dangers to the health and safety of agency personnel providing services in the home and procedures for protecting agency personnel from identified dangers.

2) Prior to employing or placing any individual in a position that requires a State professional license, the agency shall contact the Illinois Department of Financial and Professional Regulation to verify that the individual's license is active. A copy of the verification of the individual's license shall be placed in the individual's personnel file.

3) Personnel records for all employees or placement agency registry files for placement workers shall include the name and address of the employee or placement worker, Social Security number, date of birth, name and address of next of kin, evidence of qualifications (including any current licensure, registration, or certification that is required by State or federal law for the functions performed), and dates of employment or placement and separation from the agency and the reason for separation.

4) Home health agencies that provide other home health services under arrangement through a contractual purchase of services shall ensure that these services are provided by qualified personnel, who hold any current licensure, registration, or certification that is required by State or federal law for the functions performed, under the supervision of the agency.

5) Home services and home nursing agencies that use some contractual services shall ensure that these services are provided by qualified personnel who hold any current licensure, registration or certification that is required by State or federal law for the functions performed under the supervision of the agency.

d) Agency Supervision – Home Health Agencies

1) The governing body shall appoint a home health administrator with the duties prescribed in Section 245.40.

2) The home health agency shall designate an agency supervisor with one of the following sets of qualifications to supervise the provision of home health services:

A) An RN who:

i) Has completed a baccalaureate degree program approved by the National League for Nursing; and

ii) Has at least one year of nursing experience;

B) An RN who does not have a baccalaureate degree, but who has at least three years of nursing experience that meets the following requirements:

i) At least two years of nursing experience in: a home health agency; a community health program that included care of the sick; or a generalized family-centered nursing program in a community health agency; and

ii) At least two years of the three years of nursing experience obtained within five years prior to current employment with the home health agency.

3) The agency supervisor shall be a full-time RN who is available at all times during operating hours of the agency and who participates in all activities related to providing home health services. The agency supervisor shall designate a qualified staff member to act in the agency supervisor's absence.

4) Any person employed as an agency supervisor prior to July 1, 1983, who does not meet the qualifications for agency supervisor that were in effect prior to October 1, 1983, may continue to serve in that capacity only at that agency.

5) No one person may hold the positions of both home health agency administrator and agency supervisor.

6) If the licensed home health agency is also licensed as a home nursing agency, the agency supervisor may supervise the provision of skilled nursing services in the home nursing agency only if there are equally qualified individuals available in each licensed component of the organization to act in the agency supervisor's absence.

e) Agency Supervisor Responsibilities − Home Health Agencies

1) The entire clinical program shall be under the direction of the agency supervisor. The agency shall organize the personnel and clinical activities of the home health agency so that safe and adequate care will be provided to the patient.

2) The skilled nursing service of a home health agency shall be under the direction of the agency supervisor.

3) The agency supervisor shall be responsible for:

A) Supervising all RNs, licensed practical nurses, home health aides, therapists, social workers and other clinical personnel employed by the agency or with whom the agency contracts for services;

B) Assuring that all staff providing patient care maintain the professional standards of community nursing practice;

C) Maintaining and adhering to agency procedure and patient care policy manuals;

D) Participating in establishing service policies and procedures;

E) Participating in selecting and evaluating nursing personnel and other staff providing patient care;

F) Coordinating patient care services;

G) Keeping and maintaining records of case assignments and case management;

H) Preparing and maintaining the schedule of cases to be brought to the clinical record review committee; and

I) Conducting selective program evaluations to improve deficient services and developing and implementing plans of correction.

f) Agency Manager – Home Services and Home Nursing Agencies

1) A home services agency shall designate a person to supervise the provision of services or to oversee the placement of workers through the licensed home services agency.

2) If the home nursing agency has appointed an agency manager who is not an RN or an APRN, the home nursing agency shall identify an RN or APRN to supervise the provision of skilled nursing services as required by Section 2.11 of the Act. The supervisor shall be an RN or APRN who is available at all times during the operating hours of the agency and who participates in all activities related to the provision of home nursing services. If the agency has both a home health and a home nursing agency license, one person may fulfill this requirement, but the person shall be full-time.

(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)

Section 245.40 Staffing and Staff Responsibilities

a) Home Health Administrator or Agency Manager. The administrator or agency manager shall have the following responsibilities:

1) Ensure that the agency is in compliance with all applicable federal, State and local laws;

2) Be familiar with the applicable rules of the Department and maintain them within the agency;

3) Familiarize all employees as well as providers through contractual purchase of services with the Act and the rules of the Department and make copies available for their use;

4) Ensure that reports and records as required by the Department are completed, maintained and submitted;

5) Maintain ongoing liaison with the governing body, staff members and the community;

6) Maintain a current organizational chart to show lines of authority down to the patient or client level;

7) Manage business affairs and the overall operation of the agency;

8) Maintain personnel records, administrative records and all policies and procedures of the agency;

9) Employ qualified personnel in accordance with job descriptions;

10) Provide orientation of new staff, regularly scheduled in-service education programs and opportunities for continuing education for the staff;

11) Designate in writing the qualified staff member to act in the absence of the administrator;

12) Provide and maintain an office with a working telephone that is staffed during the agency's business hours.

A) The office shall be adequately equipped for an efficient work environment.

B) The office shall be maintained to protect the confidentiality of patient and client records (physical or electronic).

C) The office shall provide a safe working environment that complies with local ordinances and regulations related to fire safety.

13) Adopt and enforce a written policy identifying the agency's operating hours and including, at a minimum, provisions that ensure clients and patients are provided information regarding the procedures for accessing care from the agency or another health care provider outside of the agency's operating hours.

b) Home Health Aide

1) When home health aide services are offered, the services shall be under the supervision of an RN in accordance with the plan of treatment. The RN shall assign the home health aide to a particular patient. The RN or the appropriate therapist (e.g., physical, occupational or speech therapist) shall prepare written instructions for patient care.

2) Duties of the home health aide may include:

A) Performing simple procedures as an extension of therapeutic services;

B) Skilled personal care and personal care, as defined in this Part;

C) Patient ambulation and exercise;

D) Household services essential to health care at home;

E) Assisting with medications that are ordinarily self-administered;

F) Reporting changes in the patient's or client's condition and needs to the RN or the appropriate therapist; and

G) Completing appropriate records.

3) For home health agencies, the supervising RN or appropriate therapist shall make a supervisory visit to the patient's residence at least every two weeks either when the home health aide is present to observe and assist, or when the home health aide is absent.

A) If an area of concern in aide services is noted by the supervising RN or other appropriately skilled professional, then the supervising individual shall make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while the aide is performing care no later than the next supervisory visit.

B) A supervising RN or other appropriately skilled professional shall make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while the aide is performing care.

C) The purpose of the supervisory visits is to assess relationships and determine that the aide furnishes care in a safe and effective manner by following the patient's plan, demonstrating competency with assigned tasks, complying with infection prevention and control policies and procedures, reporting changes in the patient's condition, honoring the patient's rights, and maintaining open communication.

4) For home nursing agencies, the supervising RN shall make a supervisory visit to the patient's/client's residence at least every 60 days when the home health aide is present to observe and assist, or when the home health aide is absent.

A) If an area of concern is noted by the supervising RN in the care provided by the home health aide, then the supervising individual shall make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while the aide is performing care no later than the next supervisory visit.

B) A supervising RN shall make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while the aide is performing care.

C) The purpose of the supervisory visits is to assess relationships and determine that the aide furnishes care in a safe and effective manner by following the patient's plan, demonstrating competency with assigned tasks, complying with infection prevention and control policies and procedures, reporting changes in the patient's condition, honoring patient's rights, and maintaining open communication.

c) Home Services or In-Home Services Worker

1) As defined in this Part and under the Act, home services or in-home services means assistance with activities of daily living, housekeeping, personal laundry, and companionship provided to an individual in his or her personal residence, which are intended to enable that individual to remain safely and comfortably in his or her own personal residence. Home services or in-home services does not include services that would be required to be performed by an individual licensed under the Nurse Practice Act. (Section 2.09 of the Act) Home services are focused on providing assistance that is not medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence, such as companionship, cleaning, laundry, shopping, meal preparation, dressing, and bathing.

2) Home services or in-home services workers shall provide services only in accordance with this Part.

3) Duties of home services or in-home services workers may include the following:

A) Observation of client functioning and reporting changes to their supervisor or employer or to a person designated by the client;

B) Assistance with household chores, including cooking and meal preparation, cleaning and laundry;

C) Assistance in completing activities such as shopping and appointments outside of the home;

D) Companionship;

E) Completion of appropriate records documenting service provision; and

F) Assistance with activities of daily living and personal care.

4) To delineate the types of services that can be provided by a home services worker, the following are examples of acceptable tasks and also limitations when a more medical model of assistance would be needed to meet the higher needs of the client.

A) Skin Care. A home services worker may perform general skin care assistance. Except for the application of simple bandages as first aid, skin care may be performed by a home services worker only when skin is unbroken, and when any chronic skin problems are not active. The skin care provided by a home services worker shall be preventative rather than therapeutic in nature, and may include the application of non-medicated lotions and solutions, or of lotions and solutions not requiring a prescription from a health care professional. Skilled skin care shall be provided only by an agency licensed as a home health or home nursing services agency. Skilled skin care includes wound care, dressing changes, application of prescription medications, skilled observation and reporting.

i) The client or client's representative shall be able to provide ongoing feedback and advocate for their needs, including indications of potential harm and discomfort, to the home services worker;

ii) The home services worker shall have completed training in first aid for a lay person; and

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to implement first aid effectively and safely.

B) Ambulation. A home services worker may assist clients with ambulation. Clients in the process of being trained to use adaptive equipment for ambulation, such as walkers, canes or wheelchairs, require supervision by an agency licensed to provide home health or home nursing services during the period of training. Once the prescribing health care professional or the health care provider responsible for training the client and/or home services worker is comfortable with releasing the client to work on the client's own with the adaptive equipment, a home services worker may assist with ambulation.

i) The client or client's representative shall be able to provide ongoing feedback to the home services worker including indications of potential harm and discomfort, and advocate for their needs;

ii) The home services worker shall have completed training in the methods required to assist clients with adaptive equipment for ambulation; and

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to assist those clients who require the use of adaptive equipment for ambulation effectively and safely.

C) Bathing. A home services worker may assist clients with bathing. When a client has skilled skin care needs or skilled dressings that will need attention before, during, or after bathing, the client shall be in the care of an agency licensed as a home health agency or a home nursing agency to meet those specific needs. Home services workers may assist individuals in all types of bathing (e.g. tub, shower, sponge, bed) only when the following requirements are met:

i) The client or client's representative shall be able to provide ongoing feedback to the home services worker including indications of potential harm and discomfort, and advocate for their needs;

ii) The home services worker shall have completed training in the particular methods required to perform the client-specific bath, including the observations of indications of potential harm or discomfort;

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform the bath; and.

iv) The agency shall conduct annual training and competency evaluation for skills to perform all types of bathing effectively and safely.

D) Dressing. A home services worker may assist a client with dressing. This may include assistance with ordinary clothing and application of support stockings of the type that can be purchased without a prescription from a health care professional. A home services worker may not assist with applying an elastic bandage that can be purchased only with a prescription from a health care professional (the application of which involves wrapping a part of the client's body) or with applying a sequential compression device that can be purchased only with a prescription from a health care professional unless the following requirements are met:

i) The client's prescribing health care professional has issued an order allowing the home service worker to apply the compression device as a part of daily activities of living;

ii) The client or client's representative shall be able to provide ongoing feedback to the home services worker including indications of potential harm and discomfort, and advocate for their needs;

iii) The home services worker shall have completed training in the application of the compression device, including observations of indications of potential harm or discomfort; and

iv) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to apply the compressional device effectively and safely.

E) Exercise. A home services worker may assist a client with exercise. Passive assistance with exercise that can be performed by a home services worker is limited to encouraging normal bodily movement, as tolerated, on the part of the client, and encouragement with a prescribed exercise program. A home services worker shall not perform passive range of motion.

F) Feeding. A home services worker may provide assistance with feeding. Home services workers can assist clients with feeding when the client can independently swallow and be positioned upright. Assistance by a home services worker does not include syringe, tube feedings, and intravenous nutrition. Whenever there is a high risk that the client may choke as a result of the feeding, the client shall be in the care of an agency licensed as a home health or home nursing agency to fulfill this function. The home services worker can assist the client by opening a pre-measured thickening product to be added to liquids as per client request and under direct client observation when the following requirements are met:

i) The client or client's representative shall be able to provide ongoing feedback to the home services worker including indications of potential harm and discomfort, and advocate for their needs;

ii) The home services worker shall have completed training in the indications, precautions, and methods required to use pre-measured thickening products; and

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to use pre-measured thickening products effectively and safely.

G) Hair Care. As a part of the broader set of services provided to clients who are receiving home services, home services workers may assist clients with the maintenance and appearance of their hair, including shampooing with a non-medicated shampoo, drying, combing, and styling. Home services workers may use a shampoo prescribed by the client's health care professional only if the following requirements are met:

i) The client's prescribing health care professional has issued an order allowing the home service worker to apply the prescription shampoo;

ii) The client or client's representative shall be able to provide ongoing feedback to the home services worker including indications of potential harm and discomfort, and advocate for their needs;

iii) The home services worker shall have completed training in the methods required to apply prescription shampoo, including the importance of observing any open skin lesions, and shall document and report these to the agency and client's emergency contact;

iv) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to apply prescription shampoo effectively and safely; and

v) The agency shall conduct annual training and competency evaluation for skills to apply and observe clients during shampooing.

H) Mouth Care. A home services worker may assist in and perform mouth care. This may include denture care and basic oral hygiene, including oral suctioning for mouth care. Mouth care for clients who are unconscious shall be performed by an agency licensed as a home health agency or home nursing agency.

I) Nail Care. A home services worker may assist with nail care. This assistance may include soaking of nails, pushing back cuticles without utensils, and filing nails. Assistance by a home services worker shall not include nail trimming. If a client has a medical condition that might involve peripheral circulatory problems or loss of sensation, a home services worker may file the client's nails only if the following requirements are met:

i) The client's health care professional has issued an order allowing the home service worker to file the client's nails;

ii) The client or client's representative shall be able to provide ongoing feedback to the home services worker, including indications of potential harm or discomfort, and advocate for their needs;

iii) The home services worker shall have completed training in the methods required to assist with nail care, including the importance of observing for and reporting of any potential signs of injury or harm for a client with peripheral circulatory conditions; and

iv) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform nail care effectively and safely and to observe and report potential signs of injury or harm.

J) Positioning. A home services worker may assist a client with positioning when the client is able to identify to the personal care staff, either verbally, non-verbally or through others, when the position needs to be changed. For clients that are unable to identify when their position needs to be changed, a home services worker may assist with client position per subsection 245.210(d)(2) and as instructed by the service plan, only when skilled skin care, as previously described, is not required in conjunction with the positioning. Positioning may include simple alignment in a bed, wheelchair, or other furniture. A home services worker may assist a client with positioning only if the following requirements are met:

i) The home services worker shall have completed training in the methods required to monitor and observe verbal and non-verbal indications and cues from the client that re-positioning may be needed, the indications of and procedures for positioning and repositioning of clients, and the importance of following the service plan concerning the client's positioning needs, including, when possible, reminders to clients concerning the importance of repositioning.

ii) The client or client's representative shall be able to provide ongoing feedback (including non-verbal indications and cues) and advocate for their needs, including indications of potential harm or discomfort by the home services worker during any repositioning. If the client representative is present when the position needs to be changed, the client's representative shall be able to assist with the repositioning, either directly or by providing ongoing feedback, including indications of potential harm or discomfort, to the home services worker; and

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform repositioning effectively and safely as needed.

K) Shaving. A home services worker may assist a client with shaving only with an electric or a safety razor.

L) Toileting. A home services worker may assist a client to and from the bathroom; provide assistance with bed pans, urinals, and commodes; provide pericare; or change clothing and pads of any kind used for the care of incontinence.

i) A home services worker may empty or change external urine collection devices, such as catheter bags or suprapubic catheter bags. In all cases, the insertion and removal of catheters and care of external catheters is considered skilled personal care and shall not be performed by a home services worker.

ii) A home services worker may empty ostomy bags and provide assistance with other client-directed ostomy care only when there is no need for skilled personal skin care or for observation or reporting to a nurse. A home services worker shall not perform digital stimulation, insert suppositories, or give an enema.

M) Transfers. A home services worker may assist with transfers, transfers using adaptive equipment (e.g., wheelchairs, tub seats, and grab bars), transfers using safety equipment (e.g., gait belts), and transfers using a mechanical or electrical transfer device only when the client has sufficient balance and strength to reliably stand and pivot and assist with the transfer either directly or by providing ongoing feedback, including indications of potential harm or discomfort, to the home services worker through either verbal or non-verbal indications and cues, and the following conditions are met:

i) The client or client's representative can provide ongoing feedback to the home services worker, including indications of potential harm or discomfort through either verbal or non-verbal indications and cues, and advocate for their needs;

ii) The home services worker shall have completed training in transfer techniques and any client-specific adaptive equipment, safety equipment, and mechanical or electrical transfer devices; and

iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform transfers effectively and safely, including any adaptive equipment, safety equipment, and mechanical or electrical transfer devices.

N) Medication Reminding. A home services worker may assist a client with medication reminding only when medications have been pre-selected by the client, a family member, a nurse, or a pharmacist and are stored in containers other than the prescription bottles, such as medication minders. Medication minder containers shall be clearly marked as to day and time of dosage. Medication reminding includes: inquiries as to whether medications were taken; verbal prompting to take medications; handing the appropriately marked medication minder container to the client; and opening the appropriately marked medication minder container for the client if the client is physically unable to open the container. These limitations apply to all prescription and all over-the-counter medications. The home services worker shall immediately report to the supervisor, or, in the case of a placement worker, to the client or the client's advocate or designee, any irregularities noted in the pre-selected medications, such as medications taken too often or not often enough, or not at the correct time as identified in the written instructions.

O) Respiratory Care. A home services worker shall not provide respiratory care except within the limitations as enumerated in this Section. Respiratory care is skilled personal care and includes postural drainage; cupping; adjusting oxygen flow within established parameters; nasal, endotracheal and tracheal suctioning; and turning off or changing tanks. However, a home services worker may temporarily remove and replace a cannula or mask from the client's face for the purposes of shaving or washing a client's face and may provide oral suctioning. A home services worker may assist the client with changing the oxygen delivery system from a stationary system to a portable system as directed by the client and the client's health care professional to enable client transport, or in emergency situations such as loss of electrical power in the client's home (stationary systems are electrically powered devices). For the purposes of this Section, a "stationary system" refers to an oxygen concentrator used for at-home oxygen therapy and is not intended to be fully mobile. For those home services workers that are assigned to clients who require continuous supplemental oxygen therapy, the home services worker may assist the client with changing of the delivery system from stationary to portable only when the following conditions are met:

i) The home services worker shall have completed training in switching client-specific oxygen delivery systems from stationary to portable and the risks associated with improper adjustment of O2 flow rates;

ii) The agency shall have conducted a competency evaluation of the home service's workers ability to employ the methods required to change the oxygen delivery system effectively and safely, including any client-specific equipment; and

iii) A home services agency seeking to have a home services worker assist a client with changing of oxygen delivery systems shall maintain an individual on staff that has been trained and is able to conduct training and administer competency evaluation for any home services worker assisting clients with changing of the delivery system from stationary to portable.

P) A home services worker may remind a client to perform client monitoring, including monitoring of heart rate, blood pressure, oxygen saturation, and temperature and weight. The home service agency shall not provide the client and/or family any service to interpret the data or to take clinical action of the monitoring results. The home services worker may assist the client with the application of the heart rate, blood pressure, and oxygen saturation device and assist the client with recording the device reading.

5) In addition to the exclusions prescribed in subsection (c)(4), home services workers shall not act in the following capacities:

A) Provide skilled personal care services to clients as defined in Section 245.20;

B) Become or act as a power of attorney for clients;

C) Be involved in any financial transactions of the client outside of contracted services. In these cases, the home services worker shall follow agency policies in regard to securing receipts for items purchased and ensuring both client and worker signatures documenting those expenditures;

D) Perform or provide medication setup for a client; and

E) Other actions specifically prohibited by agency policy or other State laws.

6) Supervision of a home services worker shall include the following (these provisions do not apply to placement agencies):

A) An individual who is in a supervisory capacity shall be designated and available to the worker for responses to questions at all times.

B) On-site supervision shall take place at a minimum of every 90 days or more often if the plan of service requires it. The supervisory visits may be made when the home services worker is present so that the supervisor may observe, or when the home services worker is absent so that the supervisor may assess relationships and determine whether the service plan is being met.

i) If an area of concern in the performance of a home service worker is noted by the supervisor, then the supervising individual shall make an on-site visit to the location where the client is receiving services in order to observe and assess the home service worker while he or she is performing care no later than the next supervisory visit.

ii) The supervisor shall make an annual on-site visit to the location where a client is receiving care in order to observe and assess each home service worker while he or she is performing care.

iii) The purpose of the supervisory visits is to assess relationships and determine that the home service worker furnishes care in a safe and effective manner by following the client's service plan, demonstrating competency with assigned tasks, complying with infection prevention and control policies and procedures, reporting changes in the patient's condition, honoring patient's rights, and maintaining open communication.

C) Supervision does not constitute time or an activity that can be billed as a service to the client or consumer.

d) Licensed Practical Nurse

1) The licensed practical nurse may perform selected acts in accordance with the Nurse Practice Act and under the direction of an RN, including administering treatments and medications in the care of the ill, injured or infirm; health maintenance; and illness prevention.

2) The licensed practical nurse shall report changes in the patient's condition to the RN, and these reports shall be documented in the clinical notes.

3) The licensed practical nurse shall prepare clinical notes for the clinical record.

e) Social Worker. When medical social services are provided, the social worker or social work assistant under the supervision of a social worker shall provide the services in accordance with the plan of treatment. These services shall include the following:

1) Assist the physician or podiatrist and other members of the health team in understanding significant social and emotional factors related to the patient's health problems.

2) Assess the social and emotional factors to estimate the patient's capacity and potential to cope with the problems of daily living.

3) Help the patient and family to understand, accept, and follow medical recommendations and provide services planned to restore the patient to the optimum social and health adjustment within the patient's capacity.

4) Assist the patient and family with personal and environmental difficulties that predispose toward illness or interfere with obtaining maximum benefits from medical care.

5) Use all available resources, such as family and community agencies, to assist the patient to resume life in the community or to live within the disability.

6) Observe, record and report social and emotional changes.

7) Prepare clinical and progress notes for the clinical record.

8) Supervise the social work assistant, which shall include the following:

A) A licensed social worker shall be accessible by telephone to the social work assistant at all times while the social work assistant is treating patients.

B) On-site supervision shall take place every four to six visits. The supervisory visits may be made either when the social work assistant is present so that the supervisor may observe and assist, or when the social work assistant is absent so that the supervisor may assess relationships and determine whether goals are being met.

C) Supervision does not constitute treatment.

D) The supervisory visit shall include a complete on-site assessment, an on-site review of activities with appropriate revision of treatment plan, and an assessment of the use of outside resources.

f) Occupational Therapist and Occupational Therapy Assistant. When occupational therapy services are required, an occupational therapist or an occupational therapy assistant under the supervision of an occupational therapist shall provide the services in accordance with the plan of treatment and within the licensee's scope of practice as established by the Illinois Occupational Therapy Practice Act. These services shall include the following:

1) Instruct other health team personnel, including, when appropriate, home health aides and family members in certain phases of occupational therapy in which they may work with the patient.

2) Prepare clinical and progress notes for the clinical record.

3) Supervise the occupational therapy assistant, which shall include the following:

A) A licensed occupational therapist shall be accessible by telephone to the occupational therapy assistant at all times while the occupational therapy assistant is treating patients.

B) On-site supervision shall take place every four to six visits. The supervisory visits may be made either when the occupational therapy assistant is present so that the supervisor may observe and assist, or when the occupational therapy assistant is absent so that the supervisor may assess relationships and determine whether goals are being met.

C) Supervision does not constitute treatment.

D) The supervisory visit shall include a complete on-site functional assessment, an on-site review of activities with appropriate revision of treatment plan, and an assessment of the use of outside resources.

g) Physical Therapist and Physical Therapist Assistant

1) When physical therapy services are provided, a physical therapist or a physical therapist assistant under the supervision of a physical therapist shall provide the services in accordance with the plan of treatment and within the licensee's scope of practice as established by the Illinois Physical Therapy Act. These services shall include the following:

A) Instruct other health team personnel, including, when appropriate, home health aides and family members, in certain phases of physical therapy with which they may work with the patient.

B) Instruct the patient and family in the total physical therapy program.

C) Prepare clinical and progress notes for the clinical record.

2) Supervision of the physical therapist assistant shall include the following:

A) A licensed physical therapist shall be accessible by telephone to the physical therapist assistant at all times while the physical therapist assistant is treating patients.

B) On-site supervision shall take place every four to six visits. The supervisory visits may be made either when the physical therapist assistant is present so that the supervisor may observe and assist, or when the physical therapist assistant is absent so that the supervisor may assess relationships and determine whether goals are being met.

C) Supervision does not constitute treatment.

3) The physical therapist assistant shall:

A) Be directed by and under the supervision of a licensed physical therapist and within the licensee's scope of practice as established by the Illinois Physical Therapy Act;

B) Administer the physical therapy program as established by the physical therapist;

C) Observe patient's progress and response to treatment, and report to the physical therapist; and

D) Confer with members of the health care team for planning, modifying and coordinating treatment programs.

h) Registered Professional Nurse. The RN may perform selected acts in accordance with the Nurse Practice Act. Skilled nursing services shall be provided by an RN in accordance with the plan of treatment. The RN shall:

1) Be responsible for the observation, assessment, nursing diagnosis, counsel, care and health teaching for patients, and health maintenance and illness prevention for others;

2) Maintain a clinical record for each patient receiving care;

3) Provide progress notes to the patient's physician or podiatrist about patients under care when the patient's conditions change or there are deviations from the plan of care, or at least every 60 days for a home health agency and every 90 days for a home nursing agency;

4) In the case of an RN working as a part of a home health or home nursing agency, make home health aide assignments, prepare written instructions for the home health aide, and supervise the home health aide in the home;

5) Direct the activities of the licensed practical nurse;

6) Administer medications and treatments as prescribed by the patient's physician or podiatrist; and

7) Act as the coordinator of the health care team in order to maintain the proper linkages within a continuum of care.

i) Speech-Language Pathologist. The speech-language pathologist may perform selected acts in accordance with the Illinois Speech-Language Pathology and Audiology Practice Act. When required, speech therapy services shall be provided by a speech-language pathologist in accordance with the plan of treatment. The speech-language pathologist shall:

1) Assist the physician in determining and recommending appropriate speech and hearing services;

2) Evaluate the patient's speech and language abilities and establish a plan of care;

3) Provide rehabilitation services for speech and language disorders;

4) Record and report to the patient's physician the patient's progress in treatment and any changes in the patient's condition and plan of care;

5) Instruct other health team personnel and family members in methods of assisting the patient in improving communication skills; and

6) Prepare clinical and progress notes for the clinical record.

j) Audiologist. The audiologist may perform selected acts in accordance with the Illinois Speech-Language Pathology and Audiology Practice Act. When audiology services are required, an audiologist shall provide the services in accordance with the plan of treatment. The audiologist shall:

1) Administer diagnostic hearing tests to evaluate the patient's audiological abilities;

2) Assess the patient's need for amplification;

3) Provide rehabilitative services for hearing disorders;

4) Instruct other health team personnel and family members in methods of assisting the patient in improving communication skills; and

5) Record and report to the patient's physician the patient's response to rehabilitative intervention.

k) Student Training Program. When an agency elects to participate with an educational institution to provide clinical experience for students as part of their health-related professional training, a written agreement between the agency and each educational institution shall specify the responsibilities of the agency and the educational institution. The agreement shall include, at a minimum, the following provisions:

1) The agency retains the responsibility for client care;

2) The educational institution retains the responsibility for student education;

3) Student and faculty performance expectations;

4) Faculty supervision of undergraduate students in the clinic and the field;

5) Ratio of faculty to students;

6) Confidentiality regarding patient information;

7) Required insurance coverage; and

8) Provisions for the agency and faculty to jointly evaluate the students' performance and the training program.

(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)

Section 245.50 Services (Repealed)

(Source: Repealed at 32 Ill. Reg. 8949, effective June 5, 2008)

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER c: HOSPITALS AND OUTPATIENT SERVICES CARE FACILITIES
PART 245 HOME HEALTH, HOME SERVICES, AND HOME NURSING AGENCY CODE
SECTION 245.55 VACCINATIONS

Section 245.55 Vaccinations

a) Influenza

1) A home health agency and home nursing agency shall annually administer or arrange for administration of a vaccination against influenza to each client/patient, in accordance with the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that are most recent to the time of vaccination, unless the vaccination is medically contraindicated or the client/patient has refused the vaccine. (Section 6.5 of the Act)

2) The following activities by home health or home nursing agencies shall be considered to be "arranging for" a client/patient to receive an influenza vaccination:

A) Referring a client/patient to the health care professional who is supervising the client's/patient's home care, or to his/her primary health care professional; or

B) Referring a client/patient to the hospital affiliated with the home health agency; or

C) Referring a client/patient to the local health department or other community location (e.g., local pharmacy, influenza vaccine clinic, hospital) where influenza vaccinations are available; or

D) Arranging for the local health department or other private or community health organization to provide the vaccination in the client's/patient's home.

3) When a referral or arrangement is made, home health or home nursing agency staff shall assist the client/patient in developing a plan for implementing the referral or arrangement and shall assess implementation of the plan and document the outcome.

4) Influenza vaccination for all clients/patients age 65 or over shall be completed by November 30 of each year or as soon as practicable if vaccine supplies are not available before November 1. Home health or home nursing clients/patients whose services start after November 30, during the flu season, and until February 1, shall, as medically appropriate, receive an influenza vaccination prior to or upon service initiation or as soon as practicable if vaccine supplies are not available at the time of the service initiation, unless the vaccine is medically contraindicated or the client/patient has refused the vaccine. (Section 6.5(a) of the Act)

5) For all clients/patients who are provided services between November 1 and February 28, the home health or home nursing agency shall document in the client's/patient's medical record that an annual vaccination against influenza was administered, arranged, refused, or medically contraindicated or that the client/patient is not a member of a vaccination priority population. (Section 6.5(a) of the Act)

6) The following shall be considered to be documentation approaches that meet the requirements of Section 6.5 of the Act:

A) Individual client/patient record entries identifying the assessment for the need of vaccination; date of offer or referral; client/patient response; administration, contraindication, or refusal; and any follow-up activities.

B) Standardized check-off form recording client/patient specific information, including the assessment for the need of vaccination; date of offer or referral; client/patient response; administration, contraindication, or refusal; and any follow-up activities.

b) Pneumococcal pneumonia

1) A home health or home nursing agency shall administer or arrange for administration of a pneumococcal vaccination, in accordance with the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that are most recent to the time of vaccination, to each client/patient who is age 65 or over and who has not received this immunization prior to or upon service initiation, unless the client/patient refuses the offer for vaccination or the vaccination is medically contraindicated. (Section 6.5(b) of the Act)

2) The following activities by home health or home nursing agencies shall be considered to be "arranging for" a home health client/patient to receive a pneumonia vaccination:

A) Referring a client/patient to the health care professional who is supervising his/her home care, or to his/her primary health care professional; or

B) Referring a client/patient to the hospital affiliated with the home health agency; or

C) Referring a client/patient to the local health department or other community location (e.g., local pharmacy, clinic, hospital) where pneumonia vaccinations are available; or

D) Arranging for the local health department or other private or community health organization to provide the vaccination in the client's/patient's home.

4) A home health or home nursing agency shall document in each client's/patient's medical record that a vaccination against pneumococcal pneumonia was offered and was administered, arranged, refused, or medically contraindicated or that the client/patient is not a member of a vaccination priority population. (Section 6.5(b) of the Act)

5) The following shall be considered to be documentation approaches that meet the requirements of Section 6.5 of the Act:

(Source: Amended at 46 Ill. Reg. 10410, effective May 31, 2022)

Section 245.60 Annual Financial Statement – Home Health Agencies

a) Each home health agency licensee shall file annually an attested financial statement on a form prescribed, prepared and furnished by the Department in conjunction with the Illinois Department of Healthcare and Family Services. The application shall contain such information as may be required by the Department and the Illinois Department of Healthcare and Family Services for the proper administration of the Act and this Part. An audited financial statement may be required of a particular facility, if the Director determines that additional information is needed. (Section 11(a) of the Act)

b) No public funds shall be expended for the services of a home health agency which has failed to file the financial statement required by this Section. (Section 11(b) of the Act)

c) No other State agency may require submission of financial data except as expressly authorized by law or as necessary to meet requirements of federal law or regulation. (Section 11(d) of the Act)

d) Information obtained under this Section shall be made available, upon request, by the Department only to any other State agency or legislative commission to which such information is necessary for investigations or to execute the intent of State or federal law or regulation. (Section 11(d) of the Act)

(Source: Amended at 32 Ill. Reg. 8949, effective June 5, 2008)

Section 245.70 Home Health Aide Training

a) Each home health agency and home nursing agency shall ensure that all persons employed as home health aides or under any other title, whose duties are to assist with the personal, nursing or medical care and emotional comfort of the patients, and who are not otherwise licensed, certified or registered in accordance with Illinois law to render such care, comply with one of the following conditions:

1) Is approved on the Department's Health Care Worker Registry. (see Section 245.72);

2) Meets training requirements by completion of a training program approved under the Long-Term Care Assistants and Aides Training Programs Code (see 77 Ill. Adm. Code 395); or

3) Meets equivalencies established in subsection (b).

b) Equivalency may be established by any one of the following:

1) Documentation of current registration from another state.

2) Documentation of successful completion of a nursing arts course that includes at least 40 hours of supervised clinical experience, in an accredited nurse training program as evidenced by diploma, certificate or other written verification from the school, and successful completion of the written portion of the Department-established nursing assistant competency test.

3) Documentation of successful completion of a United States military training program that includes the content of the Basic Nursing Assistant Training Program (see 77 Ill. Adm. Code 395), as evidenced by a diploma, certification DD-214, or other written verification, and successful completion of the written portion of the Department-established nursing assistant competency evaluation.

4) Documentation of completion of a nursing program in a foreign country, including the following, and successful completion of the written portion of the Department-established competency test:

A) A copy of the license, diploma, registration or other proof of completion of the program;

B) A copy of the Social Security card; and

C) Visa or proof of citizenship.

c) Requests to establish equivalency shall be submitted to the Department with accompanying documentation.

d) To maintain an active Certified Nursing Assistant (CNA) certification, a CNA must work at least one 8-hour shift within a 24-month period, performing nursing or nursing-related services for pay under the supervision of a licensed nurse.

e) The home health or home nursing agency is responsible for ensuring that the individuals who furnish home health aide services on its behalf are competent to carry out assigned tasks in the patient's place of residence. The competency evaluation conducted by an RN in the home health or home nursing agency shall address each of the following subjects:

1) Communication skills relating to persons who are hard of hearing, have dementia, or have other special needs;

2) Observation, reporting, and documentation of patient status and the care or service furnished;

3) Reading and recording temperature, pulse and respiration;

4) Basic infection prevention and control procedures;

5) Basic elements of body functioning and changes in body function that shall be reported to an aide's supervisor;

6) Maintenance of a clean, safe and healthy environment;

7) Recognizing emergencies and initiating emergency procedures;

8) The physical, emotional and developmental needs of and ways to work with the populations served by the home health agency, including the need for respect for the patient, his or her privacy, and his or her property;

9) Appropriate and safe techniques in personal hygiene and grooming that include:

A) Bed bath;

B) Sponge, tub or shower bath;

C) Hair shampooing in sink, tub and bed;

D) Nail and skin care;

E) Oral hygiene; and

F) Toileting and elimination;

10) Safe transfer techniques and ambulation;

11) Normal range of motion and positioning;

12) Adequate nutrition and fluid intake;

13) Problem solving with individuals with dementia who exhibit challenging behavior;

14) Understanding dementia;

15) Recognizing and reporting changes in skin condition; and

16) Any other task that the agency may choose to have the home health aide perform, as permitted by statute.

f) A home health or home nursing agency shall not employ an individual as a home health aide unless the agency has inquired of the Department as to information in the Health Care Worker Registry concerning findings of abuse, neglect or misappropriation of property.

(Source: Amended at 43 Ill. Reg. 9134, effective August 12, 2019)

Section 245.71 Qualifications and Requirements for Home Services Workers

a) Each agency shall ensure and shall maintain documentation in the home services worker's employee file that all persons employed or providing services as an in-home services worker, and who are not otherwise licensed, certified or registered in accordance with Illinois law to render this care, comply with the following conditions:

1) Does not have a disqualifying background check under the requirements of the Health Care Worker Background Check Act without a waiver;

2) Has a copy of the person's Social Security card; and

3) Has a visa or proof of citizenship in compliance with federal requirements for employment.

b) Each placement agency shall require proof that the home service worker has completed a minimum of eight hours of training prior to the worker's first assignment. The training shall include all of the items noted in subsection (e).

c) Each home services agency shall provide or arrange for a minimum of ten hours of training for each home services worker. Five hours of training shall be provided prior to the home services worker's first assignment, and the remaining five hours shall be provided within the worker's first 30 days after the start of employment. The training shall include the components of subsection (e). The home services agency may accept proof that the worker has successfully completed a training program at or through another licensed home services agency within the prior year (previous 365 days) in lieu of providing or arranging for training, including a CNA who is approved on the Health Care Worker Registry. The agency shall give the home services worker, with proof of prior training within the prior year, and the CNA a competency evaluation prior to the worker's first assignment. The home services agency shall not give a worker an assignment until the worker has first passed a competency evaluation given by the agency of the topics included in the first five hours of training. The competency evaluation shall ensure that the home services worker is competent to provide the services required for the worker's first assignment. The worker shall be similarly tested following the remaining five hours of training.

d) The placement agency may accept proof that the worker has successfully completed a training program at or through another licensed home services agency within the prior year (previous 365 days). The home services placement agency shall not give a worker an assignment until the worker has first passed a competency evaluation given by the agency. The competency evaluation shall ensure that the home services worker is competent to provide the services required in the worker's assignment. The competency evaluation or proof of prior training at a licensed home services agency within the prior year shall address each of the subjects outlined in subsection (e).

e) Training for the home services worker shall address each of the following subjects below, in addition to the training requirements included in Section 245.40(c)(4)(A) through (P):

1) The employee's job responsibilities and limitations;

2) Communication skills relating to persons who are hard of hearing, have dementia, or have other special needs;

3) Observing, reporting and documenting client status and the care or service provided, including changes in functional ability and mental status demonstrated by the client;

4) Performing personal care tasks for clients, including: bathing; skin care; hair care; nail care; mouth care; shaving; dressing; feeding; assistance with ambulation; exercise and transfers; positioning; toileting; and medication reminding;

5) Assisting in the use of specific adaptive equipment, such as a mechanical lifting device, if the worker will be working with clients who use the device;

6) Basic hygiene and basic infection prevention and control practices;

7) Maintaining a clean, safe and healthy environment;

8) Basic personal and environmental safety precautions;

9) Recognizing emergencies and initiating emergency procedures, including basic first aid and implementation of a client's emergency preparedness plan;

10) Confidentiality of client's personal, financial and health information;

11) Understanding dementia;

12) Problem solving skills to care for patients with dementia who exhibit challenging behavior;

13) Behaviors that would constitute abuse or neglect and the legal prohibitions against these behaviors, as well as knowledge and understanding of abuse and neglect prevention and reporting requirements; and

14) Any other task that the agency may choose to have the worker perform.

f) All home services workers shall complete a minimum of ten hours of training during each year of employment to maintain placement availability, based on either a calendar year or an anniversary date basis, whichever is selected by the agency. The initial ten hours of training required in subsection (c) shall satisfy the annual training requirement for the home services worker's first year of employment. The annual training can include self-study courses with demonstration of learned concepts that are applicable to the employee's responsibilities. Training shall include:

1) Promoting client dignity, independence, self-determination, privacy, choice and rights;

2) Disaster procedures;

3) Hygiene and infection control;

4) Abuse and neglect prevention and reporting requirements; and

5) Activities of daily living related to application of simple bandages, ambulation, bathing, application of compression stockings, feeding, application of prescription shampoo, nail care, client positioning, transfer of clients, and oxygen delivery systems (for home service workers assigned to work with clients who require oxygen delivery support) per Section 245.40(c)(4)(A) through (P).

g) The agency shall have home services supervisors or trainers that provide initial training and supervision on an ongoing basis to home service workers to address requirements in Section 245.40(c)(4)(A) through (P). The home services supervisor or trainer shall:

1) Within the last five years, have a minimum of two years’ experience working in a home health, home services, facility-based healthcare setting, or home nursing environment performing those tasks permitted by this Part to be completed by home services workers, including assistance with activities of daily living; or

2) Be in a current supervisory or trainer position with a home services agency and have received training within the past year on those tasks permitted by this Part to be completed by home services workers. The training provided to the home services supervisors or trainers shall, at a minimum, demonstrate the general standards of care for each topic in Section 245.40(c)(4)(A) through (P), and be provided by or developed by someone qualified (e.g., licensed or certified) in their respective field.

h) Agency supervisors and trainers shall be available to home service workers to provide updated and continuing education related to staff responsibilities for client care as outlined in Section 245.40(c)(4)(A) through (P).

i) All training shall be documented with the date of the training; the length of time spent on each training topic; instructors and their qualifications; short description of content; and staff member's signature or electronic certificate with a date and time stamp indicating completion. Upon request, the agency shall provide the home services worker with a copy of their training certificate in a hard copy or electronic format.

(Source: Amended at 49 Ill. Reg. 4661, effective March 25, 2025)

Section 245.72 Health Care Worker Background Check

An agency shall comply with the Health Care Worker Background Check Act [225 ILCS 46] and the Health Care Worker Background Check Code (77 Ill. Adm. Code 955).

(Source: Amended at 29 Ill. Reg. 20003, effective November 28, 2005)

Section 245.75 Infection Control

a) Each agency shall develop and implement policies and procedures for investigating, controlling and preventing infections. Placement agencies shall provide to in-home services workers the Centers for Disease Control and Prevention (CDC) publication "Guidelines for Hand Hygiene in Health-Care Settings".

b) Each agency shall adhere, at a minimum and as appropriate, to the guidelines of the CDC, United States Public Health Service, Department of Health and Human Services, as incorporated in Section 245.25(c).

c) The home health agency shall maintain and document an infection control program to prevent and control infections and communicable diseases. Under that program, the agency shall:

1) Follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases;

2) Maintain a coordinated agency-wide program for the surveillance, identification, prevention, control and investigation of infectious and communicable disease that is an integral part of the agency's QAPI program; and

3) Provide infection control education to staff, patients and caregivers.

(Source: Amended at 43 Ill. Reg. 9134, effective August 12, 2019)

SUBPART C: LICENSURE PROCEDURES

Section 245.80 Licensure Required

a) No person shall open, manage, conduct or maintain a home health agency without a license issued by the Department. (Section 3 of the Act)

b) On and after September 1, 2008, no person shall open, manage, conduct, or maintain a home services agency, or advertise himself or herself as a home services agency or as offering services that would be included in the definition of home services or a home services agency, without a license issued by the Department. (Section 3.3 of the Act)

c) On and after September 1, 2008, no person shall open, manage, conduct, or maintain a home nursing agency, or advertise himself or herself as a home nursing agency or as offering services that would be included in the definition of a home nursing agency, without a license issued by the Department. (Section 3.7 of the Act)

d) License Nontransferable

1) Each license shall be issued only for the specific agency named in the application and shall not be transferred or assigned to any other person, agency or corporation.

2) Sale, assignment, lease or other transfer, voluntary or involuntary, shall require a new license by the new owner prior to maintaining, operating or conducting an agency.

3) In the case of agencies operating under a franchise arrangement, each unique business entity shall obtain and maintain a distinct license and shall not share licensure based on franchised name status.

4) A licensee shall notify the Department in writing at least 30 days in advance of any intention to:

A) Change ownership; or

B) Sell its agency.

5) A change of ownership happens when one of the following transactions occurs:

A) In an unincorporated sole proprietorship, when the property is transferred to another party;

B) A material change in a partnership that is caused by the removal, addition or substitution of a partner;

C) In a corporation, when the provider corporation merges into another corporation, or the consolidation of two or more corporations, one of which is the licensee, resulting in the creation of a new corporation;

D) The transfer of any corporation stock that results in a change of the person or persons who control the agency; or

E) The transfer of any stock in excess of 75 percent of the outstanding stock.

6) Pursuant to subsection (d)(5)(C), the transfer of corporate stock or the merger of another corporation into the licensee corporation does not constitute a change of ownership if the licensee corporation remains in existence. In these transactions, the name of the corporation, its officers, its independent subsidiaries, and any other relevant information that the Department may require shall be made available to the Department upon request.

7) If a sale of an agency causes a change in the person or persons who control or operate the agency, the agency is considered a new agency, and the licensee shall apply for a new license and shall comply with this Part and any other applicable State and federal rules.

8) Whenever ownership of an agency is sold from the person or organization named on the license to another person or organization, the new owner shall apply for a new license. The new owner shall file an application for license on the renewal/change of ownership application at least 30 days prior to the sale.

9) The Department shall issue a new license to a new owner who meets the requirements for licensure under this Part. The transactions described in this Section shall not be complete until the Department issues a new license to the new person, legal entity or partnership. The former licensee shall return its license to the Department by certified mail.

e) Each license shall be for a term of one year and shall expire one year from the date of issuance. However, initial licenses shall expire one year from the end of the month in which the initial license was issued.

f) Out-of-State Agencies. A license is required for any agency providing care in Illinois, or functioning in a capacity of matching workers with clients or consumers for home nursing or home service care, including internet matching services where the parent agency is domiciled in a state other than Illinois. In these cases, the following conditions shall be met:

1) The licensee shall be registered to do business in Illinois under the Business Corporation Act of 1983 or otherwise authorized to do business in Illinois.

2) The licensee shall have an office in Illinois.

3) All professional care supervisory and staff personnel caring for patients or clients residing in Illinois shall be subject to any licensure, certification or registration that is required to perform the respective service in Illinois, and shall be so licensed, certified or registered.

g) The licensee shall notify the Department in writing not less than 30 days prior to closing the agency or a branch office, if applicable.

1) The licensee shall include in the written notice the reasons for closing, the location of patient or client records, and the name and address for the custodian of the client and patient records.

2) If the licensee closes with an active client or patient roster, the licensee shall transfer a copy of the record with the client or patient to the receiving agency to ensure continuity of care and services. The licensee shall provide the Department with the name of the receiving agency for each client or patient.

3) The licensee shall surrender the initial license or renewal license to the Department via certified mail at the end of the day that services cease (not applicable for a branch closure).

h) A licensee shall notify the Department within 10 days after any change to the following information (this requirement also applies to change at branch locations):

1) Agency name;

2) Agency manager/administrator;

3) Agency supervising nurse (this applies to home health and home nursing agencies only);

4) Agency physical address;

5) Agency mailing address;

6) Agency changes in operating hours;

7) Agency phone number;

8) Agency fax number; or

9) Agency email.

i) A licensee shall request Department approval for any change to the following information (this requirement also applies to change at branch locations):

1) Addition or removal of agency service categories for home health; or

2) Expansion or reduction of agency's geographic service area.

j) Any agency conducted by and for the adherents of any well recognized church or religious denomination for the purpose of providing services for the care or treatment of the sick who depend upon prayer or spiritual means for healing in the practice of the religion of such church or religious denomination is not subject to licensure. (Section 13 of the Act)

k) Branch Offices and Drop-Sites. A licensee may have multiple physical locations within their geographical service area under the supervision of the parent agency as approved by the Department.

1) A branch office shall be part of the agency and shall be located close (but not more than 100 miles from the parent office location) and shall provide the same services as the parent office within a portion of the total geographic area served by the parent office. All branch offices shall meet the following requirements:

A) Lines of authority and administrative control shall be clearly delineated in both organizational structure and in practice and shall be traceable to the parent office. The parent office may appoint an effective full time branch supervisor or manager if this individual is and remains under the supervision of the parent agency office administrator/agency manager;

B) The agency's parent office administrator/agency manager shall be responsible for the ongoing management of the branch office staff and client and patient services provided by the branch office;

C) The administrator/agency manager of the parent agency shall provide supervision during all operating hours of the agency's branch office;

D) The agency's parent office shall maintain current personnel records for all staff;

E) The agency's parent office and branch office shall communicate regarding client and patient services;

F) The agency's parent office shall be responsible for contracted services;

G) The agency's parent office shall monitor all clinical and administrative activities of the branch office and shall include all branch office locations in quality assurance and improvement reviews;

H) The agency's parent office is responsible for ongoing training for all staff; and

I) The agency's parent office administrator, supervising nurse, or agency manager shall conduct an on-site supervisory visit to the branch office at least monthly. All supervisory visits must be documented and include the date of the visit, the content of the consultation, the individuals in attendance, and any recommendations made to the staff at the branch location.

2) A drop-site location is distinct from a branch office and is prohibited from the following:

A) Having designated staff; and

B) Assigning orders, accepting client and patient referrals, conducting payroll or billing activities, or storing files (client or personnel). A drop-site location cannot be advertised under the parent license.

l) Failure to comply with the requirements in subsection (k) may result in fines of up to $100.00 per day pursuant to Section 245.140 or requirement of a separate license for the secondary location.

(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)

Section 245.90 License Application

a) Initial Application – All Agencies

1) Any person who desires to obtain a license to operate a home health, home nursing, home services, home nursing placement, or home service placement agency shall file a licensure application with the Department. Any person of interest, different from the licensee, who desires to conduct, maintain, or operate a home health, home nursing, home services, home nursing placement or home services placement agency shall also file an application for licensure with the Department.

2) The application shall be accompanied by a Certificate of Insurance documenting minimum liability coverage of $1 million per occurrence and $3 million in the aggregate.

3) Each initial application for licensure shall be on forms provided by the Department, and shall contain, at a minimum, the following information:

A) Name, address, and location of the agency;

B) Ownership, organization and governing structure of the agency including the alternate administrative staff required per Section 245.40(a)(11);

C) The names and addresses of all persons who own at least 5% of the agency and the type of ownership of the agency (for example individual, partnership or corporation). In addition, the corporation shall submit:

i) A list of the title, name and address of each of its corporate officers;

ii) A list of the name and address of each of its shareholders holding more than 5% of the shares; and

iii) Information for the applicant and its officers regarding any conviction of, or plea of guilty to, a felony, or two or more misdemeanors involving moral turpitude during the previous year;

D) A description of the services to be provided;

E) A list of the staff of the agency or a list of placement agency registry, including any applicable licensure, registration, or certification and any other qualifications of the staff of the agency, and a copy of the job description for all positions used by the agency as required per Section 245.30(c)(1)(D);

F) Sources of financing of services and any other sources of income of the agency;

G) A description or map of the geographic service area in which services are provided by the agency;

H) Charges for services by types of services provided by the agency;

I) Copies of policies and procedures for the following:

i) Complaint resolution as required per Section 245.30(b)(3);

ii) Employee health and safety as required per Section 245.30(c)(1)(H) and (I);

iii) Infection control as required per Section 245.75;

iv) Health care worker background check compliance as required per Section 245.72 and mandated reporting compliance as required per Section 245.250;

v) Supervisory visits of various disciplines as required per Section 245.40;

vi) Client records management, retention and release requirements as required per Section 245.200(h) for home health agencies, Section 245.205(g) for home nursing agencies, and Section 245.210(j) for home services agencies;

vii) Employee training as required per Sections 245.70, 245.71, and 245.211.

J) Documents demonstrating the agency is registered with the DPH Web Portal and granted access to the Health Care Worker Registry.

4) For home health agencies, copies of any affiliation agreements with other health care providers. (Section 5(a) of the Act)

5) For home services and home nursing agencies, copies of client service contracts as required per Section 245.220.

6) For home services placement and home nursing placement agencies, copies of client service contracts and worker contracts as required per Section 245.225.

7) Criteria for acceptance of patients and clients as required per Section 245.200(d) for home health agencies; 245.205(d) for home nursing agencies; and 245.210(d) home services agencies.

8) Sample forms to be utilized for service plans as required per Section 245.210(e) for home services agencies; and

9) Plans of treatment as required per Section 245.205(e) for home nursing agencies and Section 245.200(e) for home health agencies.

b) Renewal Application – All Agencies

1) Each licensee shall file a renewal application with the Department not less than 60 days, or more than 90 days, prior to the expiration date of the licensee's current license. If a licensee does not submit its renewal application and fee within 60 days prior to the expiration date, the licensee may be fined in accordance with Section 245.140.

2) Each renewal application shall be on forms provided by the Department and shall contain the information specified in subsection (a)(3).

3) Each licensee shall submit information for the licensee and its officers regarding any conviction of, or plea of guilty to, a felony, or two or more misdemeanors involving moral turpitude, during the previous year for the licensee and its officers.

c) Renewal Application – Home Health Agencies

Applications for renewal of home health agency licenses shall additionally contain the following information:

1) Patient load data for the preceding year, including the number of patients discharged, the total number of patients who received services, the number of patients over 65 years of age who received services, and the number of patients being served at the end of the year; and

2) Agency utilization data, including the number of patients receiving specific types of services and the number of visits by types of services provided. (Section 5(a) of the Act)

d) Renewal Application – Home Services, Home Nursing, Home Services Placement and Home Nursing Placement Agencies

Applications for renewal shall additionally contain the following information:

1) Client load data for home services and home nursing for the preceding year, including the number of clients admitted, the number of clients discharged, the number of patients over 65 years of age who received services, and the number of clients being served at the end of the year, with the exception of those clients being served through the Community Care Program of the Illinois Department on Aging, the Department of Human Services Office of Rehabilitation Services, or the United States Department of Veterans Affairs; and

2) Client data for home services placement and home nursing placement for the preceding year, including the number of placements, the number of placements for clients 65 or older, and the number of clients in process on the last day of the most recent fiscal period.

e) A home health agency shall be in operation and be able to demonstrate patient activity prior to the second renewal of the agency's license to verify compliance for a renewal of the agency's license. A home services, home nursing, home services placement and home nursing placement agency shall be in operation and be able to demonstrate client activity prior to the second renewal of the agency's license to verify compliance for a renewal of the agency's license.

f) An entity that meets the requirements for licensure under the Act and this Part may obtain licensure singly or in any combination for the categories authorized under the Act and this Part. (Section 4(d) of the Act)

g) The Department will review each application. The Department will approve the application and issue an initial or renewal license to the applicant for operation of an agency when it finds that the applicant meets all of the requirements of the Act and this Part. The Department may also issue a provisional license, as provided in Section 4 of the Act and Section 245.100, or deny an application, as provided in Sections 8 and 9 of the Act and Section 245.130. (Section 4(c) of the Act)

(Source: Amended at 48 Ill. Reg. 12368, effective August 5, 2024)

ADMINISTRATIVE CODE

Section 245.95 License Application Fee, Single or Multiple Licenses

a) Applicants for multiple licenses under the licensure system set forth in this Part shall pay the applicable license fees for each license. (Section 4(d) of the Act)

b) A home nursing agency or a home services agency shall pay a licensure fee not to exceed $1,500 annually. The fee is not refundable. A certified local health department is exempt from the license fee per Section 6.7(b) of the Act.

c) A home nursing placement agency or home services placement agency shall pay a licensure fee not to exceed $500 annually. The fee is not refundable. A certified local health department is exempt from the license fee per Section 6.3(b) of the Act.

d) For a single home health agency license only, each initial and renewal application shall be accompanied by a license fee of $1,500 for a two-year license. (Section 4(c) of the Act) The fee is not refundable. A certified local health department is exempt from the license fee per Section 4(c) of the Act.

e) An applicant for dual licenses as a home services agency and a home services placement agency, or a home nursing agency and a home nursing placement agency, shall operate each licensed agency as a separate entity to meet the requirements of the Act and this Part as an employer of workers and as a placement agency that places individuals.

(Source: Amended at 49 Ill. Reg. 11469, effective September 2, 2025)

Section 245.100 Provisional License

a) Provisional License for New Agencies

1) The Department will issue a provisional license to a new agency within 90 days after the receipt of the application provided that the application is in compliance with the requirements of Section 245.90. Incomplete applications may be denied per provisions set forth in Section 245.130(b). A new agency is an agency that meets either of the following circumstances:

A) The applicant for licensure has not previously been licensed; or

B) The agency is not in operation at the time the application is made. (Section 4(a) of the Act).

2) A provisional license shall be valid for a period of 240 days unless sooner suspended or revoked pursuant to Section 9 of the Act and Section 245.130 of this Part. (Section 4(b)(1) of the Act)

3) Within 30 days prior to the termination of the provisional license, the Department will inspect the agency and, if the applicant substantially meets the requirements for licensure, the Department will issue a license.

A) For home services, home nursing, home services placement, and home nursing placement agencies, this license shall expire one year from the end of the month in which the provisional license was first issued.

B) For home health agencies, this license shall expire two years from the end of the month in which the provisional license was first issued.

C) For all agencies, the initial license fee shall be applied to the provisional license.

4) If the Department finds that a holder of a provisional license does not substantially meet the requirements for licensure, but has made significant progress toward meeting those requirements, the Department may renew the provisional license once for a period not to exceed 90 days from the expiration date of the initial provisional license. (Section 4(a) of the Act)

b) Provisional License for Operating Agencies

1) If an operating agency does not substantially comply with the provisions of the Act and this Part, the Department will issue a provisional license, provided that:

A) The health, safety, and well-being of the patients and/or clients of the agency will be protected during the period for which the provisional license is issued (Section 4(b)(1) of the Act); and

B) The violations of the requirements of the Act and this Part are not serious enough to support adverse licensure action as provided under Sections 8 and 9 of the Act and Section 245.130 of this Part.

2) The term of a provisional license shall not exceed 120 days. (Section 4(b)(1) of the Act)

3) When a provisional license is issued to an operating agency, the Department will notify the agency of the issuance of the provisional license. The notice to the agency shall include the following information:

A) A description of the manner in which the agency fails to substantially comply with all of the requirements of the Act and this Part.

B) A description of the corrections which must be made by the agency to substantially comply with all of the requirements of the Act and this Part.

C) A specific time within which the necessary corrections shall be completed by the agency. (Section 4(b)(2) of the Act)

4) The Department may extend the term of the provisional license for an additional 120 days, if the Department finds that the agency has made substantial progress toward correcting the violations and bringing the agency into full compliance with the Act and this Part. (Section 4(b)(3) of the Act)

(Source: Amended at 48 Ill. Reg. 12368, effective August 5, 2024)

Section 245.110 Inspections and Investigations

a) The Department will conduct such investigations and inspections of licensed agencies and of persons suspected of operating an agency without a license as it deems necessary to assess compliance with the Act and this Part. (Section 9.01 of the Act)

b) Agencies shall facilitate any necessary visits by the Department's staff to patients or clients in their homes during the Department's investigations or inspections. The Department will obtain consent from the patient or client prior to conducting direct observation of patient care or the provision of home services in the home during an investigation or inspection. (Section 9.01 of the Act)

c) Agencies shall make available to the Department all books, records, policies and procedures, or any other materials requested during the course of an investigation or inspection. (Section 9.01 of the Act)

(Source: Amended at 32 Ill. Reg. 8949, effective June 5, 2008)

Section 245.115 Complaints

a) Complaints in regard to agencies licensed under the Act and this Part may be submitted either in writing, by telephone or by other electronic means to the IDPH Central Complaint Registry.

b) The Department will conduct an investigation of all complaints received. An appropriate investigation may include but is not limited to record reviews and/or telephone interviews, on-site surveys or a combination of methods.

(Source: Added at 32 Ill. Reg. 8949, effective June 5, 2008)

Section 245.120 Violations

a) Notice of Violation

1) When the Department determines that an agency is in violation of the Act or this Part, a notice of violation shall be served on the licensee. The notice shall be served on the licensee personally or by certified mail. (Section 9.02 of the Act)

2) If the Department finds that the violation does not pose a substantial risk to the health or safety of the agency's clients or patients, the Department may choose to request a plan of correction for the Department's approval prior to issuing the notice of violation. If the agency fails to submit an acceptable plan of correction or fails to implement a Department-approved plan of correction within the time provided by the Department, the Department will then issue the notice of violation. (Section 9.02 of the Act)

3) Each notice of violation shall be in writing and shall include:

A) A description of the nature of the violation.

B) Citation of the statutory provision or rule alleged to have been violated.

C) A statement that the agency must submit a plan of correction as provided under Section 9.03 of the Act and subsection (b) of this Section.

D) A description of additional action the Department may take under the Act, including adverse licensure action under Section 9 of the Act and Section 245.130 of this Part or assessment of a penalty under Section 9.04 of the Act and Section 245.140 of this Part.

E) A statement that the licensee has a right to a hearing to contest the violation, as provided in Section 10 of the Act and Section 245.150 of this Part, and a description of the procedure for requesting a hearing. (Section 9.02 of the Act)

b) Plan of Correction

1) In response to the receipt of a notice of violation, the agency shall file with the Department a written plan of correction. Each plan of correction is subject to the approval of the Department and shall comply with the following requirements:

A) Be filed with the Department within 10 days after the agency's receipt of the notice of violation.

B) State with particularity the method by which the agency intends to correct each violation specified in the notice of violation.

C) Contain a stated date by which each violation will be corrected. (Section 9.03 of the Act)

2) The Department will review each plan of correction. If the Department finds that the plan of correction fails to comply with the requirements in subsection (b)(1) of this Section, the Department will reject the plan of correction and notify the licensee of the rejection and the reason for the rejection. (Section 9.03 of the Act)

3) The agency shall have 10 days after the receipt of a notice of rejection in which to submit a modified plan of correction. The Department will review each modified plan of correction. (Section 9.03 of the Act)

4) The Department will reject a modified plan and impose a plan of correction, which the agency shall follow, in any of the following conditions:

A) The modified plan is not submitted on time.

B) The modified plan fails to resolve the reasons for the rejection of the plan of correction.

C) The modified plan fails to state with particularity the method by which the agency intends to correct each violation specified in the notice of violation.

D) The modified plan fails to contain a stated date by which each violation will be corrected. (Section 9.03 of the Act)

c) Hearing to Contest Violations

1) An agency may contest any Department action under subsection (a) or (b) by sending a written request for a hearing to the Department within 10 days after the receipt of the notice of the action being contested, as provided in Section 10 of the Act and Section 245.150 of this Part. (Section 9.03(c) of the Act)

2) Whenever possible, all action of the Department under subsection (a) or (b) arising out of a violation shall be contested and determined at a single hearing. (Section 9.03(c) of the Act)

(Source: Amended at 48 Ill. Reg. 12368, effective August 5, 2024)

Section 245.130 Adverse Licensure Actions

a) Adverse licensure actions include the denial of an initial license application, denial of an application for license renewal, revocation of a license, suspension of a license, and the imposition of a penalty or fine.

b) Adverse licensure action shall be considered by the Department under the following conditions:

1) Failure of the agency to meet the standards prescribed by the Department in this Part.

2) Satisfactory evidence that the moral character of the applicant or supervisor of the agency is not reputable. In determining moral character, the Department may take into consideration any convictions of the applicant or supervisor for criminal offenses, but such convictions shall not operate as a bar to licensing. (Section 8(b) of the Act)

3) Lack of personnel qualified by training and experience to properly perform the function of an agency. This determination shall be based on the personnel requirements established in this Part. (Section 8(c) of the Act)

4) Insufficient financial or other resources to operate and conduct a home health, home services or home nursing agency in accordance with the requirements of the Act and this Part. (Section 8(d) of the Act)

5) Refusal to make books, records, policies and procedures, or any other materials requested during the course of an investigation or inspection available to the Department. (Section 9.01 of the Act)

6) Violation of any provision of the Act or this Part. (Section 9(a) of the Act)

7) Conduct or practice found by the Department to be detrimental to the health, safety or welfare of a patient or client.

8) A final determination, that includes exhaustion of all available appeal and administrative review rights, of a violation of Section 1400 or 1400.2 of the Unemployment Insurance Act or Section 4(d) of the Workers' Compensation Act. (Section 8(e) of the Act)

c) In determining whether to take adverse licensure action, the Department shall consider the following factors:

1) The gravity of the violation, including the probability that death or serious physical or mental harm to a patient or consumer will result or has resulted and the severity of the actual or potential harm.

2) The extent to which the provisions of the Act or this Part were violated.

3) The reasonable diligence exercised by the licensee and any efforts by the licensee to correct the violations.

4) Any previous violations committed by the licensee.

5) The financial benefit to the agency of committing or continuing the violation. (Section 9.04(c) of the Act)

d) The Department shall deny an application for license renewal when the licensee refuses to make payment at the time of the application for renewal of the license for penalties or fines that have been imposed and added to the license fee. (Section 10.01(c) of the Act)

e) The Director will order an emergency suspension of a license when the Director finds that continued operation of the agency poses an immediate and serious danger to the public health, safety or welfare. The suspension shall take effect upon the issuance of an order of emergency suspension by the Director and shall remain in effect during any administrative proceeding contesting the action. Promptly following any emergency suspension of a license, the Department shall take action to revoke the license.

f) Notice of Adverse Licensure Action

1) The Department shall notify the applicant or licensee in writing before denying an application refusing to renew a license, or revoking a license. (Section 10(a) of the Act)

2) The notice shall be served on the applicant or licensee either by personal service or by certified mail. The notice shall contain the following information:

A) A description of the particular reasons for the proposed action, including citations of the specific provisions of the Act and this Part under which the proposed action is being taken.

B) The date, not less than 15 days from the date of the mailing or service of the notice, on which the action will take effect, unless appealed by the applicant or licensee.

C) A description of the manner in which the applicant or licensee may appeal the proposed action and the right of the applicant or licensee to a hearing under Section 10 of the Act and Section 245.150 of this Part. (Section 10(b) of the Act)

(Source: Amended at 43 Ill. Reg. 9134, effective August 12, 2019)

Section 245.140 Penalties and Fines

a) Notice of Assessment of Penalties and Fines

1) When the Department determines that a penalty or fine is to be assessed under Section 245.130 of this Part, the Department shall issue a notice of fine assessment which shall contain the following information:

A) A specific description of the violations for which the fine is levied. (Section 9.04(b) of the Act)

B) The amount of the penalty or fine, based on consideration of the factors specified in Section 9.04(c) of the Act and Section 245.130(c) of this Part. The Department may impose a fine of up to $100 per day commencing on the date the violation was identified and ending on the date the violation is corrected, or action is taken by the Department to suspend, revoke or deny renewal of the license, whichever comes first. (Section 9.04(b) of the Act)

C) A description of the manner in which the licensee may appeal the assessment and the right of the licensee to a hearing under Section 10 of the Act and Section 245.150 of this Part.

2) The notice shall be served on the applicant or licensee either by personal service or by registered mail. (Section 10(b) of the Act)

b) Payment of Penalties and Fines

1) All penalties and fines shall be paid to the Department by the licensee within the following time periods:

A) If the assessment is not contested by the licensee, no later than 10 days after the notice of assessment.

B) If the fine is contested in accordance with Section 10 of the Act and Section 245.150 of this Part, no later than 10 days after the licensee's receipt of the final decision, unless the decision is appealed and the order is stayed by court order under Section 12 of the Act. (Section 10.01 of the Act)

2) If payment has not been made by the licensee within the time periods specified in subsection (b)(1) of this Section, the Director shall issue a written demand for payment to the licensee. (Section 10.01 of the Act)

3) If the licensee against whom a penalty or fine has been assessed does not comply with a written demand for payment within 30 days of the demand, the director shall issue an order to do any of the following:

A) certify to the Comptroller that the delinquent fines are due and owing from the licensee. The certification shall include any amounts due and owing as a result of a civil action pursuant to Section 10.01(d) of the Act and subsection (b)(3)(D) of this Section. The Department shall send notice of the certification to the licensee and to any other person known to the Department who may be affected by the certification. (Section 10.01(a) of the Act)

B) Certify to the Social Security Administration that the delinquent fines are due and owing from the licensee. The certification shall include any amounts due and owing as a result of a civil action pursuant to Section 10.01(d) of the Act and subsection (b)(3)(D) of this Section. The Department shall send notice of the certification to the licensee and to any other person known to the Department who may be affected by the certification. (Section 10.01(b) of the Act)

C) Add the amount of the penalty or fine to the Agency's licensing fee. (Section 10.01(c) of the Act)

D) Bring an action in circuit court to recover the amount of the penalty or fine. (Section 10.01(d) of the Act)

(Source: Added at 15 Ill. Reg. 5376, effective May 1, 1991)

Section 245.150 Hearings

a) Applicants for an agency license and licensees may appeal certain actions of the Department under the Act and this Part. Following receipt of an appeal or a request for a hearing from an applicant or licensee, the Department shall conduct a hearing to review the contested action.

b) Hearings conducted pursuant to the Act and this Part shall be conducted in accordance with the following:

1) Section 10 of the Act.

2) The Illinois Administrative Procedure Act .

3) The rules of the Department titled Rules of Practice and Procedure in Administrative Hearings.

c) Applicants and licensees have a right to administrative review of actions and decisions of the Department by the courts under the Administrative Review Law .

(Source: Amended at 32 Ill. Reg. 8949, effective June 5, 2008)

SUBPART D: CLIENT/PATIENT SERVICES

Section 245.200 Services – Home Health

a) Each home health agency shall provide skilled nursing service and at least one other home health service on a part-time or intermittent basis. The agency staff shall directly provide basic skilled nursing service. The agency staff may provide other home health services directly or through a contractual purchase of services. Additional skilled specialty nursing services and use of additional nursing staff to meet changes in caseload may be provided by contract. All services shall be provided in accordance with the orders of the patient's health care professional, under a plan of treatment established by the health care professional, and under the supervision of agency staff.

b) The agency shall state in writing what services will be provided directly and what services will be provided under contractual arrangements.

c) Services provided under contractual arrangements shall be through a written agreement that includes, but is not limited to, the following:

1) A detailed description of the services to be provided;

2) Provision for adherence to all applicable agency policies and personnel requirements, including requirements for initial health evaluations and employee health policies;

3) Designation of full responsibility for agency control over contracted services;

4) Procedures for submitting clinical and progress notes;

5) Charges for contracted services;

6) Statement of responsibility of liability and insurance coverage;

7) Period of time in effect;

8) Date and signatures of appropriate authorities; and

9) Provision for termination of services.

d) Acceptance of Patients. Patient acceptance and discharge policies shall include, but not be limited to, the following:

1) Persons shall be accepted for health services on a part-time or intermittent basis in accordance with a plan of treatment established by the patient's health care professional. This plan shall be promulgated in writing within 14 days after acceptance and signed by the health care professional within 30 days after the start of the care date.

2) Prior to acceptance of a patient, the agency shall inform the person of the agency's charges for the various services that it offers.

3) No person shall be refused service because of age, race, color, sex, marital status, national origin or source of payment. An agency is not required to accept a patient whose source of payment is less than the cost of services.

4) Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing and social needs can be met adequately by the agency in the patient's place of residence.

5) When services are to be terminated by the home health agency, the patient is to be notified three working days in advance of the date of termination, stating the reason for termination. This information shall be documented in the clinical record. When any continuing care is indicated, a plan shall be developed or a referral made.

6) Services shall not be terminated until the RN, or the appropriate therapist, or both, in consultation with the patient's health care professional, consider termination appropriate or arrangements are made for continuing care.

e) Plan of Treatment

Skilled nursing and other home health services shall be in accordance with a plan based on the patient's diagnosis and an assessment of the patient's immediate and long-range needs and resources. The plan of treatment is established in consultation with the home health services team, which includes the patient's health care professional, pertinent members of the agency staff, the patient, and members of the patient's family. The plan of treatment shall include:

1) Diagnoses;

2) Functional limitations and rehabilitation potential;

3) Expected outcomes for the patient;

4) The patient's health care professional regimen of:

A) Medications;

B) Treatments;

C) Activity;

D) Diet;

E) Specific procedures considered essential for the health and safety of the patient;

F) Mental status;

G) Frequency of visits;

H) Equipment required;

I) Instructions for timely discharge or referral; and

J) Assessed need for influenza and pneumococcal vaccination;

5) The patient's health care professional signature and date.

f) Consultation with the patient's health care professional on any modifications in the plan of treatment deemed necessary shall be documented, and the patient's health care professional's signature shall be obtained within 30 days after any modification of the medical plan of treatment.

1) The home health services team shall review the plan every 60 days, or more often if the patient's condition warrants.

2) An updated plan of treatment shall be given to the patient's health care professional for review, for any necessary revisions, and for signature every 60 days, or more often as indicated.

g) Patient Care Plan

1) Home health services from members of the agency staff, as well as those under contractual arrangements, shall be provided in accordance with the plan of treatment and the patient care plan. The patient care plan shall be written by appropriate members of the home health services team based upon the plan of treatment and an assessment of the patient's needs, resources, family and environment. An RN shall make the initial assessment. An assessment by other members of the health services team shall be made on orders of the patient's health care professional or by request of an RN. If the patient's health care professional has ordered only therapy services, the appropriate therapist (physical therapist, speech-language pathologist or occupational therapist) may perform the initial assessment.

2) The patient care plan shall be updated as often as the patient's condition indicates. The plan shall be maintained as a permanent part of the patient's record. The patient care plan shall indicate:

A) Patient problems;

B) Patient's goals, family's goals, and service goals;

C) Service approaches to modify or eliminate problems;

D) The staff responsible for each element of service;

E) Anticipated outcome of the service approach with an estimated time frame for completion; and

F) Potential for discharge from service.

h) Clinical Records

1) Each patient shall have a clinical record identifiable for home health services and maintained by the agency in accordance with accepted professional standards. Clinical records shall contain:

A) Appropriate identifying information for the patient, household members and caretakers, medical history, and current findings;

B) A plan of treatment signed by the patient's health care professional;

C) A patient care plan developed by the home health services team in accordance with the patient's health care professional's plan of treatment;

D) A noted medication list with dates reviewed and revised and date sent to the patient's health care professional;

E) Initial and periodic patient assessments by the RN that include documentation of the patient's functional status and eligibility for service;

F) Assessments made by other members of the home health services team;

G) Signed and dated clinical notes for each contact that are written the day of service and incorporated into the patient's clinical record at least weekly;

H) Reports on all patient home health care conferences;

I) Reports of contacts with the patient's health care professional by patient and staff;

J) Indication of supervision of home health services by the supervising nurse, an RN, or other members of the home health services team;

K) Written and signed confirmation of the patient's health care professional's interim verbal orders;

L) A discharge summary giving a brief review of service, patient status, reason for discharge, and plans for post-discharge needs of the patient. A discharge summary may suffice as documentation to close the patient record for one-time visits and short-term or event-focused or diagnoses-focused interventions. A completed discharge summary shall be sent to the primary care physician or other health care professional who will be responsible for providing care and services to the patient after discharge from the home health agency (if any) within five business days after the patient's discharge; and

M) A copy of appropriate patient transfer information. When a patient is transferred to another health facility or health agency for continued health services, the patient transfer records must be sent to the new health facility or health agency within two business days after a planned transfer, if the patient's care will be immediately continued in a health care facility. In the event of an unplanned patient transfer, the transfer information must be sent within two business days from when the home health agency became aware of the unplanned transfer, if the patient is still receiving care in a health care facility.

2) For record keeping, the agency may utilize hard copies or an electronic format. Each agency shall have written policies and procedures for records maintenance and shall retain records for a minimum of five years beyond the last date of service provided. These procedures may include that the agency will use and maintain faxed or electronic copies of records from licensed professionals, rather than original records, provided that the original records are maintained for a period of five years by the professional who originated the records. If the professional is providing services through a contract with the agency, then the contract shall include that the professional shall maintain the original records for a period of five years.

3) Agencies that are subject to the Local Records Act should note that, except as otherwise provided by law, no public record shall be disposed of by any officer or agency unless the written approval of the appropriate Local Records Commission is first obtained. (Section 7 of the Local Records Act)

4) Each agency shall have a written policy and procedure for protecting the confidentiality of patient records that explains the use of records, removal of records and release of information.

5) Agencies that maintain client records electronically rather than hard copy may use electronic signatures. The agency shall develop policies and procedures governing these entries and the appropriate authentication and dating of electronic records. Authentication may include signatures, written initials, or computer-secure entry by a unique identifier or primary author who has received and approved the entry. The agency shall enact safeguards to prevent unauthorized access to the records and shall draft a process for reconstruction of the records if the system fails or breaks down.

i) Drugs and Biologicals. The agency shall have written policies governing the supervision and administration of drugs and biologicals that shall include, but not be limited to, the following:

1) All orders for medications to be given shall be dated and signed by the patient's health care professional.

2) Drugs and treatments shall be administered by agency staff only as ordered by the health care professional, with the exception of influenza and pneumococcal polysaccharide vaccines, which may be administered per agency policy developed in consultation with a health care professional, and after an assessment of the patient.

3) All orders for medications shall contain the name of the drug, dosage, frequency, method or site of injection, and permission from the patient's health care professional if the patient, the patient's family, or both are to be taught to give medications.

4) The agency's health care professional or RN shall check all medicines that a patient may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medications, and shall promptly report any problem to the patient's health care professional.

5) All verbal orders for medication or change in medication orders shall be taken by the nurse, written, and signed by the patient's health care professional within 30 days after the verbal order.

6) When any compound, sera, allergenic desensitizing agent, or other potentially hazardous compound drug is administered, the RN shall have an emergency plan and any drugs and devices that may be necessary if an adverse reaction occurs.

j) QAPI. The home health agency shall develop, implement, evaluate and maintain an effective ongoing, agency-wide, data-driven QAPI program. The agency's governing body shall ensure that the program reflects the complexity of its organization and services; involves all home health agency services (including those services provided under contract or arrangement); focuses on indicators related to improved outcomes, including the use of emergent care services, hospital admissions and re-admissions; and takes action that addresses the home health agency's performance across the spectrum of care, including the prevention and reduction of medical errors. The home health agency shall maintain documentary evidence of its QAPI program and be able to demonstrate its operations. The program shall:

1) Be capable of showing measurable improvement in indicators when there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care;

2) Measure, analyze and track:

A) quality indicators, including adverse patient events; and

B) other aspects of performance that enable the home health agency to access processes of care, home health agency services, and operations;

3) Use quality indicator data, including measures and data collected to monitor the effectiveness and safety of services and quality of care; and identify opportunities for improvement;

4) Develop improvement activities to focus on high risk, high volume or a problem-prone area; consider incidence, prevalence, and severity of problems in those areas; and lead to an immediate correction of any individual problem that directly or potentially threatens the health and safety of patients;

5) Track adverse patient events, analyze their causes, and implement preventive actions; and

6) Measure actions implemented to improve performance to determine their success and track performance to ensure improvements are sustained.

k) Policy and Administrative Review. As a part of the evaluation process, the policies and administrative practices of the agency shall be reviewed to determine the extent to which they promote patient care that is appropriate, adequate, effective and efficient

l) Clinical Record Review

Clinical records shall be reviewed continually for each 60-day period that a patient received home health services to determine the adequacy of the plan of treatment and the appropriateness of continuing home health care.

(Source: Amended at 45 Ill. Reg. 11077, effective August 27, 2021)

Section 245.205 Services – Home Nursing Agencies

a) Each home nursing agency shall provide skilled nursing services and may provide home health aide services under the supervision of the registered nurse. Home nursing services may be provided directly by agency staff or through a contractual purchase of services. All services shall be provided:

1) In accordance with the client's health care professional, or under a plan of treatment established by the health care professional; and

2) Under the supervision of agency staff, by a health care professional. If the agency manager is the designated nursing supervisor, the agency shall also have another nurse on staff to provide the direct skilled nursing care.

b) The agency shall state in writing to the client what services will be provided directly by agency staff, and what services will be provided under contractual arrangements with a third party.

c) If the agency provides services under contractual arrangements with a third party, it shall have a written agreement that includes, but is not limited to, the following:

1) A detailed description of the services to be provided;

2) Provisions for adherence to all applicable agency policies and personnel requirements, including requirements for initial health evaluations and employee health policies, and criminal background checks if applicable;

3) Designation of full responsibility for agency control over contracted services;

4) Procedures for submitting clinical and progress notes;

5) Charges for contracted services;

6) A statement of responsibility of liability and insurance coverage (employment, workers' compensation) and taxes, including employment and social security taxes;

7) The period of time the written agreement is in effect;

8) The date and signatures of appropriate authorities; and

9) Provisions for termination of services.

d) Acceptance and Discharge of Patients

Patient acceptance and discharge policies shall include, but not be limited to, the following:

1) Persons shall be accepted for services with a plan of treatment established by the patient's health care professional. This plan shall be promulgated in writing within 30 days after acceptance and shall be signed by the prescribing health care professional within 45 days after acceptance.

2) Prior to acceptance, the person shall be informed of the agency's charges for the various services that it offers.

3) No person shall be refused service because of age, race, color, sex, marital status, national origin or sexual orientation. Patients shall be accepted for treatment on the basis of a reasonable expectation that the patient's nursing needs can be met adequately in the patient's place of residence.

4) When services are to be terminated by the agency, the patient shall be notified seven working days in advance of the date of termination. The notice shall state the reason for termination. This information shall be documented in the clinical record. When any continuing care is indicated, a plan shall be developed or a referral made.

5) Services shall not be terminated until the registered nurse has provided a minimum of seven days' notice to the patient's health care professional. The seven-day notice requirement is not applicable in cases in which the worker's safety is at risk. In these cases, the agency shall notify the client of the timing of the termination of services and the reason for the termination. Documentation of the risk to the worker shall be maintained in the client record.

e) Plan of Treatment

Skilled nursing services shall be in accordance with a plan based on the client's diagnosis, an assessment of the client's immediate and long-range needs and resources, and client participation. The plan is to be established in consultation with the nursing personnel; the client's health care professional; other pertinent members of the agency staff; the client; and client's advocate. The plan shall include:

1) Diagnoses;

2) Client limitations and prognosis;

3) Expected outcomes for the client;

4) The prescribing health care professional's regimen of care designed to address identified client needs, including medications; treatments; activity; diet; specific procedures deemed essential for the health and safety of the client; mental status; and potential for discharge;

5) The types and frequency of services to be provided; and

6) Assessment of need for influenza and pneumococcal vaccination.

f) Consultation with the client's health care professional on any modifications in the plan of treatment deemed necessary shall be documented, and the prescribing health care professional's signature shall be obtained within 45 days after any modification of the plan.

1) The home nursing services team shall review the plan every 90 days, or more often should the patient's condition warrant.

2) An updated plan of treatment shall be given to the client's health care professional for review, for any necessary revisions, and for signature every 90 days, or more often as indicated.

g) Clinical Records

1) The agency shall maintain a clinical record for each client in accordance with accepted professional standards. Clinical records shall contain:

A) Appropriate identifying information for the client, household members and caretakers;

B) A plan of treatment developed by the home nursing agency in accordance with the health care professional's order;

C) A list of medications that the client is taking, updated as needed. The list shall specify the dose, method, route of administration, and frequency of administration of each medication. All potential contraindications, drug interactions, and adverse reactions shall be reported to the health care professional within 24 hours, or sooner as warranted, and documented in the clinical record;

D) Initial and periodic client assessments by the registered nurse;

E) Signed and dated clinical notes for each contact that are written the day of service and incorporated into the client's clinical record at least weekly;

F) Reports on all client conferences;

G) Report of contacts with the client's health care professional by client and staff;

H) Documentation of supervision of services by the supervising nurse, a registered nurse, or other members of the home nursing supervisory/management team;

I) Written and signed confirmation of the client's health care professional's interim verbal orders;

J) A discharge summary giving a brief review of service, client status, reason for discharge, and plans for post-discharge needs of the client. A discharge summary may suffice as documentation to close the client record for one-time visits or short-term services. The discharge summary need not be a separate piece of paper and may be incorporated into the routine summary of reports already furnished to the physician or health care professional;

K) A copy of appropriate client transfer information, when requested, if the client is transferred to another health facility or health agency.

2) For record keeping, the agency may utilize hard copies or an electronic format. Each agency shall have written policies and procedures for records maintenance and shall retain records for a minimum of five years beyond the last date of service provided. The procedures may include that the agency will use and maintain faxed copies of records from licensed professionals, rather than original records, provided that the faxed copies will be maintained on non-thermal paper and that the original records will be maintained for a period of five years by the professional who originated the records. If that professional is providing services through a contract with the agency, then the contract shall provide that the professional maintain the original records for a period of five years.

3) Agencies that maintain client records by computer rather than hard copy may use electronic signatures. The agency shall have policies and procedures in place in regard to these entries and the appropriate authentication and dating of those records. Authentication may include signatures, written initials, or computer secure entry by a unique identifier of a primary author who has received and approved the entry. The agency shall have safeguards in place to prevent unauthorized access to the records and a process for reconstruction of the records if the system fails or breaks down.

4) Agencies that are subject to the Local Records Act should note that, except as otherwise provided by law, no public record shall be disposed of by any officer or agency unless the written approval of the appropriate Local Records Commission is first obtained. (Section 7 of the Local Records Act)

5) Each agency shall have a written policy and procedure for protecting the confidentiality of client records that explains the use of records, removal of records and release of information.

h) Drugs and Biologicals

The agency shall have written policies governing the supervision and administration of drugs and biologicals, which shall include, but not be limited to, the following:

1) All orders for medications to be given shall be dated and signed by the client's health care professional.

2) All orders for medications shall contain the name of the drug, dosage, frequency, method, and route of administration, and permission from the prescribing health care professional if the client, the client's family, or both are to be taught to give medications.

3) All verbal orders for medication or change in medication orders shall be taken by the nurse, written, and signed by the patient's health care professional within 45 days.

4) When any experimental drug, sera, allergenic desensitizing agent, penicillin or other potentially hazardous drug is administered, the registered nurse administering the drugs shall have an emergency plan and any drugs and devices that may be necessary if a drug reaction occurs.

(Source: Amended at 45 Ill. Reg. 11077, effective August 27, 2021)

Section 245.210 Services – Home Services Agencies

a) Agencies licensed as home services agencies shall provide non-medical services, which may be provided directly by agency staff or through a contractual purchase of services, that are intended to assist clients with activities of daily living. Services may include, but are not limited to, activity of daily living support, personal care, medication reminding, housekeeping services, personal laundry, cooking, shopping, assistance in getting to and from appointments, maintenance of household records, and companionship. Each agency shall maintain a listing of the types of services offered by the agency, and the scope of the work to be provided under each area, which the agency shall distribute to clients before contracting with the client, with the signed contract, and when changes occur.

b) If the agency provides services under contractual arrangements with a third party, it shall have a written agreement that includes, but is not limited to, the following:

1) A detailed description of the services to be provided;

3) Designation of full responsibility for agency control over contracted services;

4) Procedures for submitting clinical and progress notes;

5) Charges for contracted services;

6) A statement of responsibility of liability and insurance coverage (employment, workers' compensation) and taxes, including employment and Social Security taxes;

7) The period of time the written agreement is in effect;

8) Date and signatures of appropriate authorities; and

9) Provisions for termination of services.

c) When services are provided to clients by a home services agency, there shall be a written contractual agreement between the client and the agency that includes, but is not limited to:

1) Indication and assurance of compliance by the agency with the requirements of the Act, including the Health Care Worker Background Check Act;

2) Identification of parties responsible for payment of employment taxes, Social Security taxes, and workers' compensation;

3) Information on the parties responsible for supervising workers, as well as hiring, firing and discipline of in-home services workers;

4) Identification of the charges to be paid, payment schedule, and to whom the client, or person acting on behalf of the client, is to make payments for services under the contract;

5) Time period for the contractual arrangement and conditions for termination of the contract; and

6) Contact information for the client to use in case of concerns, complaints, or questions on care to be provided.

d) Acceptance of Clients. Home services agencies shall develop and follow policies on acceptance and discharge of clients, which shall include, but not be limited to, the following:

1) Persons shall be accepted for service on the basis of their desire or need for assistance with household or personal support or companionship services. A home services agency shall not provide medical services that would be performed by an agency licensed as a home health agency or home nursing agency.

2) The agency may accept a client who requires complete repositioning and where the client is unable to assist either verbally, non-verbally (including non-verbal indications and cues), or through others (i.e., a bed-ridden client who requires complete assistance to reposition in bed every two hours with no ability to provide any verbal or non-verbal indications and cues that repositioning may be needed) only when the following conditions are met:

A) The home services worker shall have been trained in the indications of and the procedures for positioning and repositioning a client in the above situation;

B) The client's representative shall be able to assist with the positioning or repositioning, either directly or by providing ongoing feedback, including indications of potential harm or discomfort, to the home services workers through either verbal or non-verbal indications and cues if the client representative is present when the position needs to be changed; and

C) The agency shall have conducted a competency evaluation of the worker that confirms competency with the indications of and the procedures for positioning and repositioning a client in the above situation.

3) No person shall be refused services based on actual or perceived race, color, religion, national origin, ancestry, age, sex, marital status, order of protection status, disability, military status, sexual orientation, pregnancy, or unfavorable discharge from military service [775 ILCS 5/1-103(Q)].

4) When services are terminated by the agency, the client is to be notified at least seven working days in advance of the date of termination, with a stated reason for the termination. This information shall be maintained in the client record. The seven-day notice requirement is not applicable in cases in which the worker's safety is at risk. In these cases, the agency may notify the client of termination of services and the reason for termination. Documentation of the risk to the provider shall be maintained in the client record.

5) The acceptance of the client for non-medical services shall be based on the following documented information, in consultation with the client and the client's appropriate family members or representative:

A) Any functional limitations of the client and the relevance of the limitation to the services requested; and

B) Any circumstances that may have an impact on activity or involvement by the client, such as basic information on medications being taken, treatments received, client's physical activity, diet and mental status in relation to the services requested.

e) Service Plan. The agency shall establish a plan for each client, in consultation with agency staff, the client, or the client's representative or Power of Attorney (if applicable), or members of the client's family (at the request of the client, client's representative, or client's Power of Attorney), that outlines the services to be provided to the client. The plan shall address and include, but not be limited to:

1) Client care regimen including:

A) Assistance with ADLs and in-home support services (see Section 245.20), which may include staff responsibilities outlined in Section 245.40(c)(4)(A) through (P);

B) Medication reminders (frequency and time of day);

C) Information on treatments being received;

D) Activity;

E) Diet;

F) Functional limitations and specific procedures considered essential for the health and safety of the client;

G) Mental health status; and

H) Frequency of the home service worker visits.

2) Equipment required

3) Client limitations

4) The service plan shall not include services outside the scope of work for a home services worker as provided in Section 245.40(c)(4)(A) through (P).

f) Physician signature is not required for the plan of service developed under this Section.

g) The service plan shall be reviewed and revised as necessary, but not less than once annually.

h) Client Records. A client record shall be maintained for each client receiving in-home services. The record shall contain:

1) Appropriate identifying information for the client, including the client's name, address and telephone numbers;

2) The name, telephone numbers and address of the client's representative, if applicable;

3) The name, telephone numbers and address of an individual or relative to be contacted in an emergency;

4) The plan of services agreed to by the client and agency;

5) A copy of the client home care services agreement or contract; and

6) Documentation by the home services worker of each of the services provided at each visit.

i) Each agency shall have a written policy on records procedures and shall retain records for a minimum of two years beyond the last date of service provided. The agency may utilize hard copies or an electronic format. Each agency shall have written policies and procedures for records maintenance and shall retain records for a minimum of two years beyond the last date of service provided. The procedures may include that the agency will use and maintain faxed copies of records, rather than original records, provided that faxed copies shall be maintained on non-thermal paper and that the original records will be maintained for a period of two years by the originating entity.

j) Each agency shall have a written policy for protecting the confidentiality of patient records that explains the use of records, removal of records, and release of information.

(Source: Amended at 47 Ill. Reg. 17468, effective November 8, 2023)

Section 245.211 Services − Alzheimer's Disease and Related Dementias

A home health, home nursing and home services agency that provides any and all Alzheimer's disease or related dementias services shall comply with the Alzheimer's Disease and Related Dementias Services Act and this Part. (Section 25(1) of the Alzheimer's Disease and Related Dementias Services Act)

(Source: Added at 43 Ill. Reg. 9134, effective August 12, 2019)

Section 245.212 Services – Home Nursing Placement Agency

a) "Placement agency" includes a private employment agency and any other entity that places a worker for private hire by a consumer in that consumer's residence for purposes of providing home services. (Section 2.12 of the Act) Agencies licensed as home nursing placement agencies are in the business of securing or attempting to secure work for hire for persons seeking work or workers for employers. A placement agency shall not be the employer of the nurse for whom it procures, offers, refers, provides or attempts to provide work. The nurse shall perform services ordered by the client's physician without any direction, control or supervision by the home nursing placement agency with respect to performing the skilled nursing services. Following the placement of the worker with the client, the placement agency shall not have any control of the worker's assignments or duties, or assist the client in the payment of the worker. A placement agency shall not provide ongoing support and administrative management of the client's needs.

1) The maximum duration of a contract shall be no longer than 12 months.

2) The home nursing placement agency may charge only a one-time fee for placement. The home nursing placement agency may allow the client to pay the fee throughout the duration of the contract. An ongoing, continuous client service fee beyond the duration of the contract is prohibited.

b) Actions taken by the placement agency as part of its quality review process as required by Section 245.240(d) shall not be considered an ongoing relationship.

c) Actions taken by a client that fall under Section 245.250(a)(4) shall not be considered an ongoing relationship.

d) A placement agency shall identify itself as a placement agency in all advertisement and marketing materials, including, but not limited to, a statement that the placed nurse is the client's employee and not the placement agency's employee.

e) The placement agency shall require and document that anyone wishing to remain eligible for placement by the agency shall provide, to the agency, a copy of his or her current Illinois Professional RN or LPN license. The placement agency shall contact the Illinois Department of Financial and Professional Regulation to verify that the individual's license is active.

f) The placement agency shall notify the worker both verbally and in writing of the implications of the worker's relationship to the client as the worker's employer. The document shall be printed in no less than 12-point type and shall include at least the following elements in the body or through supporting documents or attachments, indicating the responsible parties for the following:

1) Employer of the licensed worker;

2) Liability for the licensed worker;

3) Payment of wages to the licensed worker;

4) Payment of employment taxes, unemployment insurance, and workers' compensation for the licensed worker;

5) Payment of Social Security taxes for the licensed worker;

6) Day-to-day supervision of the licensed worker;

7) Assignment of duties to the licensed worker;

8) Responsibility for hiring, firing and disciplining the licensed worker; and

9) Provision of equipment or materials for the licensed worker's use in providing services to the consumer.

g) A placement agency shall provide the placed nurse with contact information for the Department on Aging and the Department of Children and Family Services to report abuse, neglect or financial exploitation, and a list of situations for which the client or placed worker shall contact local law enforcement.

(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)

Section 245.214 Services – Home Services Placement Agency

a) "Placement agency" includes a private employment agency and any other entity that places a worker for private hire by a consumer in that consumer's residence for purposes of providing home services. (Section 2.12 of the Act) Agencies licensed as home services placement agencies are in the business of securing or attempting to secure work for hire for persons seeking work or workers for employers. A placement agency shall not be the employer of a home services worker for whom it procures, offers, refers, provides or attempts to provide work. The home services worker shall perform services pursuant to Section 245.71 without any direction, control or supervision exercised by the home services placement agency with respect to performing the home services work. Following the placement of the worker with the client, the placement agency shall not have any control of the worker's assignments or duties, or assist the client in the payment of the worker. A placement agency shall not provide ongoing support and administrative management of the client's needs.

1) The maximum duration of a contract shall be no longer than 12 months.

2) The home services placement agency may charge only a one-time fee for placement. The home services placement agency may allow the client to pay the fee throughout the duration of the contract. An ongoing, continuous client service fee beyond the duration of the contract is prohibited.

b) Actions taken by the placement agency as part of its quality review process (required by Section 245.240(d)) shall not be considered an ongoing relationship.

c) Actions taken by a client that fall under Section 245.250(a)(4) shall not be considered an ongoing relationship.

d) A placement agency shall identify itself as a placement agency in all advertisement and marketing materials, including, but not limited to, a statement that the placed home services worker is the client's employee and not the placement agency's employee.

e) The placement agency shall require and document that:

1) An individual wishing to remain eligible for placement by the agency has submitted to a health care worker background check and is active on the Department's Health Care Worker Registry;

2) Anyone wishing to remain eligible for placement by the agency shall provide proof of eight hours of training pursuant to Section 245.71(d) of this Part prior to his or her first placement; and

3) Anyone wishing to remain eligible for placement by the agency, even after an initial placement, shall provide proof of a minimum of eight hours of in-service training per year.

f) The placement agency shall notify the worker both verbally and in writing of the implications of his or her relationship to the client as his or her employer. The document shall be printed in no less than 12-point type and shall include at least the following elements in the body or through supporting documents or attachments, indicating the responsible parties for the following:

1) Employer of the in-home services worker;

2) Liability for the in-home services worker;

3) Payment of wages to the in-home services worker;

4) Payment of employment taxes, unemployment insurance, and workers' compensation for the in-home services worker;

5) Payment of Social Security taxes for the in-home services worker;

6) Day-to-day supervision of the in-home services worker;

7) Assignment of duties to the in-home services worker;

8) Responsibility for hiring, firing and disciplining the in-home services worker;

9) Provision of equipment or materials for the in-home services worker's use in providing services to the consumer; and

10) All worker placement fees, which shall be payable to the placement agency, and procedures for refunds of fees and a complaint resolution process for disputes concerning placement fees, which shall comply with the Private Employment Agency Act.

g) A placement agency shall provide the placed worker with contact information for the Department on Aging and the Department of Children and Family Services to report abuse, neglect or financial exploitation, and a list of situations for which the client and/or placed worker shall contact local law enforcement.

(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)

Section 245.220 Client Service Contracts – Home Nursing and Home Services Agencies

A contract shall be in force between a home nursing or home services agency and a client. A copy of the contract shall be provided to the client and a copy shall be maintained in the client file at the agency. If the agency has both a home services license and a home nursing license, the agency shall maintain two separate client contracts, one for skilled medical care and one for non-medical services. The contracts shall be printed in no less than 12-point type, and shall include at least the following elements in the body or through supporting documents or attachments:

a) Client consent to receive services;

b) The name, street address, mailing address and telephone number of the agency;

c) The name, mailing address and telephone number of the persons designated as the agency manager and/or other individual beyond the in-home worker to contact in regard to questions, problems, needs or concerns;

d) A statement describing the agency license status;

e) Indication and assurance of compliance by the agency with the requirements of the Act, including compliance with the Health Care Worker Background Check Act;

f) The duration of the contract;

g) The rate to be paid by the client and a detailed description of services to be provided as a part of the rate;

h) A description of the process through which the contract may be modified, amended or terminated;

i) A description of the agency complaint resolution process;

j) The billing and payment procedures and requirements;

k) A statement regarding the agency's policy on notification of a relative or other individual in case of an emergency;

l) A notice as developed and provided by the agency, indicating the responsible party for the following:

1) Employer of the in-home/licensed worker;

2) Liability for the in-home/licensed worker;

3) Payment of wages to the in-home/licensed worker;

4) Payment of employment taxes, unemployment insurance, and worker's compensation for the in-home/licensed worker;

5) Payment of Social Security taxes for the in-home/licensed worker;

6) Day-to-day supervision of the in-home/licensed worker;

7) Assignment of duties to the in-home/licensed worker;

8) Responsibility for hiring, firing and disciplining the in-home/licensed worker; and

9) Provision of equipment or materials for the in-home/licensed worker's use in providing services to the consumer.

(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)

Section 245.225 Client Service Contracts – Home Nursing Placement Agency and Home Services Placement Agency

A contract between a home nursing placement agency or home services placement agency and a client shall be in force, a copy of which is provided to the client and a copy of which is maintained in the client file at the agency. The document shall be printed in no less than 12-point type, and shall include at least the following elements in the body or through supporting documents or attachments:

a) Client consent to receive referral services of a placed worker;

b) The name, street address, mailing address and telephone number of the agency;

c) The name, mailing address and telephone number of the persons designated as the placement agency manager or other individual representing the placement agency who the consumer may contact if the contract terms are not performed;

d) A statement describing the agency license status;

e) The duration of the contract, not to exceed 12 months;

f) The placement fees to be paid by the client;

g) A description of the process through which the contract may be modified, amended or terminated;

h) The billing and payment procedures and requirements;

i) The entity to whom the client can report abuse, neglect or financial exploitation, and the number of the Department's complaint hotline;

j) A notice, as developed and provided by the agency, indicating that the client is the employer of the home services worker or nurse and that the client is responsible for the following:

1) Liability for the in-home/licensed worker or nurse;

2) Paying wages to the in-home/licensed worker or nurse;

3) Paying employment taxes, unemployment insurance, and workers' compensation for the in-home/licensed worker or nurse;

4) Paying Social Security taxes for the in-home/licensed worker or nurse;

5) Day-to-day supervision of the in-home/licensed worker or nurse;

6) Assigning duties to the in-home/licensed worker or nurse;

7) Hiring, firing and disciplining the in-home/licensed worker or nurse; and

8) Providing equipment or materials for the in-home/licensed worker's or nurse's use in providing services to the consumer.

(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)

Section 245.240 Quality Improvement Program

a) Home nursing, home services and placement agencies shall develop a quality improvement program. The quality improvement program shall include written policies and shall evaluate the agency's total program at least once a year. The evaluation for home services agencies and home nursing agencies shall, at a minimum, include a clinical or client record review, as appropriate. This evaluation shall assess the extent to which the agency's program is appropriate, adequate, effective and efficient. Results of the evaluation shall be reported to and acted upon by those responsible for the operation of the agency and shall be maintained separately as administrative records.

b) Record Review. At least quarterly, the agency shall review a sample of both active and closed clinical or client records to assure that established policies are followed in providing services (direct services, as well as those under contractual arrangement). If applicable, this review shall include, but not be limited to:

1) Whether the care plan was directly related to the stated diagnosis and plan of care;

2) Whether the frequency of visits was consistent with the plan of care; and

3) Whether the service plan was followed by the home services worker or nursing staff.

c) None of the information, interviews, reports, statements, memoranda and recommendations produced during or resulting from the agency's quality improvement program may be admissible as evidence nor discoverable in any action of any kind in any court, as provided in Article VIII, Part 21 of the Code of Civil Procedure (Medical Studies).

d) Placement agencies shall assess the extent to which the agency's program is appropriate, adequate, effective and efficient, including, but not limited to, the placement of workers who have prior training and who are on the Health Care Worker Registry. Results of the evaluation shall be reported to those responsible for the operation of the agency and shall be maintained in a separate file as administrative records.

(Source: Amended at 43 Ill. Reg. 9134, effective August 12, 2019)

Section 245.250 Abuse, Neglect and Financial Exploitation Prevention and Reporting

a) When an agency has reasonable suspicion that a client has been the victim of abuse, neglect or financial exploitation, the agency shall do the following:

1) In the case of an individual who is 60 years of age or older, an individual who has been found to be disabled or one who otherwise qualifies as an "eligible adult" under the Adult Protective Services Act [320 ILCS 20], the agency shall notify the elder abuse provider agency designated by the Department on Aging or an Area Agency on Aging for the area in which the client resides. The agency shall document this report and maintain documentation on the premises for 12 months after the date of the report.

2) In the case of an alleged victim under the age of 18, the agency shall notify the Department of Children and Family Services through the Child Abuse Hotline. The agency shall document this report and maintain documentation on the premises for 12 months after the date of the report.

3) If the abuse or neglect is alleged to be a result of actions by an employee of the agency providing in-home, home health, or home nursing services, the agency shall immediately remove the alleged perpetrator from direct contact with clients and investigate the allegation.

4) If the client contacts the home services placement agency regarding an allegation of abuse or neglect by the placed worker, the agency shall comply with the home services agency reporting requirements in Section 6.3 of the Act. If the client contacts the home nursing placement agency regarding an allegation of abuse or neglect by the placed worker, the agency shall comply with the home nursing agency reporting requirements in Section 6.7 of the Act.

b) In cases of allegations of abuse or neglect by an employee, the agency shall conduct an investigation and develop a written report of the findings of the investigation within 14 days after the initial report. The agency shall send the written report of the investigation to the Department within 24 hours after completion of the investigation and shall maintain a copy of the report on the agency premises for 12 months after the date of the report.

c) A placement agency shall provide the client, at the time of the placement of the worker, and the placed worker with contact information for the Department on Aging and the Department of Children and Family Services to report abuse, neglect or financial exploitation and a list of situations for which the client or placed worker shall contact local law enforcement.

d) The written report of the investigation conducted pursuant to this Section shall contain at least the following:

1) Dates, times and description of alleged abuse, neglect or financial exploitation;

2) Description of injury or abuse to client;

3) Any actions taken by the licensee;

4) A list of individuals and agencies interviewed or notified by the licensee;

5) A description of the action to be taken by the licensee to prevent the abuse, neglect or financial exploitation from occurring in the future; and

6) Statements of any witnesses.

e) Agency employees and volunteers shall report abuse, neglect or financial exploitation of a client to the agency management and to the appropriate elder abuse provider agency or the Department on Aging.

f) The agency shall immediately contact local law enforcement authorities (e.g., telephoning 911 where available) in the following situations:

1) Physical abuse involving physical injury inflicted on a patient or client by a staff member;

2) Sexual abuse of a patient or client by a staff member;

3) When a crime has been committed in the patient's or client's home by a person other than the patient or client;

4) When a patient's or client's death has occurred other than by disease processes; or

5) When an allegation of physical abuse, sexual abuse or crime has been reported, or when death (other than by disease or natural causes) has occurred to a patient or client.

g) The agency shall develop and implement a policy concerning local law enforcement notification, including:

1) Ensuring the safety of patients or clients in situations requiring local law enforcement notification;

2) Contacting local law enforcement in situations involving physical abuse of a patient or client by another person;

3) Contacting police, fire, ambulance and rescue services; and

4) Seeking advice concerning preservation of a potential crime scene.

h) Nothing in this Section relieves a mandated reporter from the responsibility of making a report to an agency designated to receive reports under the Adult Protective Services Act [320 ILCS 20] or to the Department.

(Source: Amended at 39 Ill. Reg. 16406, effective December 10, 2015)