Public Act 93-0402

SB359 Enrolled                       LRB093 05213 AMC 05273 b

    AN ACT concerning health facilities.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.   The Alternative Health Care Delivery Act is
amended by changing Section 35 as follows:

    (210 ILCS 3/35)
    Sec. 35.   Alternative  health  care  models  authorized.
Notwithstanding  any  other  law to the contrary, alternative
health  care  models  described  in  this  Section   may   be
established on a demonstration basis.
         (1)  Alternative  health  care  model; subacute care
    hospital.  A subacute care hospital is a designated  site
    which  provides  medical  specialty care for patients who
    need a greater  intensity  or  complexity  of  care  than
    generally  provided in a skilled nursing facility but who
    no longer require acute hospital care. The average length
    of stay for patients treated in subacute  care  hospitals
    shall  not  be  less  than  20  days,  and for individual
    patients, the expected length of  stay  at  the  time  of
    admission  shall  not  be  less than 10 days.  Variations
    from minimum lengths of stay shall  be  reported  to  the
    Department.  There shall be no more than 13 subacute care
    hospitals   authorized  to  operate  by  the  Department.
    Subacute care includes physician supervision,  registered
    nursing,  and  physiological  monitoring  on  a continual
    basis. A subacute care hospital is either a  freestanding
    building  or  a  distinct physical and operational entity
    within a hospital or nursing home building.   A  subacute
    care  hospital  shall  only  consist  of  beds  currently
    existing   in   licensed  hospitals  or  skilled  nursing
    facilities,  except,  in  the  City  of  Chicago,  on   a
    designated site that was licensed as a hospital under the
    Illinois  Hospital  Licensing  Act  within  the  10 years
    immediately before the  application  for  an  alternative
    health care model license. During the period of operation
    of  the demonstration project, the existing licensed beds
    shall remain licensed  as  hospital  or  skilled  nursing
    facility  beds  as well as being licensed under this Act.
    In order to handle cases of  complications,  emergencies,
    or  exigent circumstances, a subacute care hospital shall
    maintain a contractual relationship, including a transfer
    agreement, with a general  acute  care  hospital.   If  a
    subacute  care  model  is located in a general acute care
    hospital, it shall utilize all or a portion  of  the  bed
    capacity  of that existing hospital.  In no event shall a
    subacute care hospital use the  word  "hospital"  in  its
    advertising  or marketing activities or represent or hold
    itself  out  to  the  public  as  a  general  acute  care
    hospital.
         (2)  Alternative   health   care   delivery   model;
    postsurgical  recovery  care  center.    A   postsurgical
    recovery  care center is a designated site which provides
    postsurgical recovery care for generally healthy patients
    undergoing surgical  procedures  that  require  overnight
    nursing  care,  pain  control,  or observation that would
    otherwise  be  provided  in  an  inpatient  setting.    A
    postsurgical  recovery care center is either freestanding
    or a defined unit of  an  ambulatory  surgical  treatment
    center   or  hospital.  No  facility,  or  portion  of  a
    facility, may participate in a demonstration program as a
    postsurgical recovery care center unless the facility has
    been licensed as an ambulatory surgical treatment  center
    or  hospital  for at least 2 years before August 20, 1993
    (the effective date of Public Act 88-441).   The  maximum
    length  of  stay  for patients in a postsurgical recovery
    care center is not to exceed 48 hours unless the treating
    physician requests an extension of time from the recovery
    center's medical director on  the  basis  of  medical  or
    clinical  documentation that an additional care period is
    required for the recovery of a patient  and  the  medical
    director  approves  the  extension  of time.  In no case,
    however,  shall  a  patient's  length  of   stay   in   a
    postsurgical  recovery  care  center  be  longer  than 72
    hours. If a patient requires an  additional  care  period
    after  the  expiration  of the 72-hour limit, the patient
    shall be transferred to an appropriate facility.  Reports
    on variances from the 48-hour limit shall be sent to  the
    Department for its evaluation.  The reports shall, before
    submission  to the Department, have removed from them all
    patient and physician identifiers.  In  order  to  handle
    cases   of   complications,   emergencies,   or   exigent
    circumstances, every postsurgical recovery care center as
    defined  in  this  paragraph shall maintain a contractual
    relationship, including  a  transfer  agreement,  with  a
    general  acute  care  hospital.   A postsurgical recovery
    care  center  shall  be  no  larger  than  20   beds.   A
    postsurgical recovery care center shall be located within
    15  minutes  travel  time  from  the  general  acute care
    hospital with which the center  maintains  a  contractual
    relationship, including a transfer agreement, as required
    under this paragraph.
         No   postsurgical   recovery   care   center   shall
    discriminate  against  any  patient  requiring  treatment
    because  of the source of payment for services, including
    Medicare and Medicaid recipients.
         The Department shall adopt rules  to  implement  the
    provisions  of  Public Act 88-441 concerning postsurgical
    recovery care centers within 9 months  after  August  20,
    1993.
         (3)  Alternative   health   care   delivery   model;
    children's   community-based   health   care  center.   A
    children's community-based health care center model is  a
    designated  site  that  provides  nursing  care, clinical
    support services, and therapies for a period of one to 14
    days for short-term stays  and  120  days  to  facilitate
    transitions  to  home  or  other appropriate settings for
    medically   fragile   children,   technology    dependent
    children, and children with special health care needs who
    are  deemed  clinically  stable  by  a  physician and are
    younger than 22  years  of  age.   This  care  is  to  be
    provided  in  a home-like environment that serves no more
    than 12 children at a time.   Children's  community-based
    health care center services must be available through the
    model to all families, including those whose care is paid
    for  through the Department of Public Aid, the Department
    of Children and Family Services, the Department of  Human
    Services,  and  insurance companies who cover home health
    care services or private duty nursing care in the home.
         Each children's community-based health  care  center
    model  location  shall  be  physically separate and apart
    from any other facility licensed  by  the  Department  of
    Public  Health  under  this  or  any  other Act and shall
    provide the following services: respite care,  registered
    nursing  or licensed practical nursing care, transitional
    care to facilitate home placement  or  other  appropriate
    settings  and reunite families, medical day care, weekend
    camps, and diagnostic studies typically done in the  home
    setting.   Alternative   health   care   delivery  model;
    children's respite care  center.   A  children's  respite
    care  center  model  is  a  designated site that provides
    respite for medically frail,  technologically  dependent,
    clinically stable children, up to age 18, for a period of
    one  to  14  days.   This  care  is  to  be provided in a
    home-like  environment  that  serves  no  more  than   10
    children  at  a  time.  Children's  respite  care  center
    services  must  be  available  through  the  model to all
    families, including those whose care is paid for  through
    the  Illinois  Department  of  Public Aid or the Illinois
    Department of Children and Family Services.  Each respite
    care  model  location  shall  be  a  facility  physically
    separate and apart from any other  facility  licensed  by
    the  Department  of Public Health under this or any other
    Act and  shall  provide,  at  a  minimum,  the  following
    services:  out-of-home  respite  care;  hospital  to home
    training  for  families  and   caregivers;   short   term
    transitional  care  to  facilitate placement and training
    for  foster  care  parents;  parent  and  family  support
    groups.
         Coverage for the services provided by  the  Illinois
    Department  of  Public  Aid  under  this paragraph (3) is
    contingent upon federal waiver approval and  is  provided
    only  to  Medicaid  eligible clients participating in the
    home and community based services  waiver  designated  in
    Section  1915(c) of the Social Security Act for medically
    frail and technologically dependent children or  children
    in Department of Children and Family Services foster care
    who receive home health benefits.
         (4)  Alternative   health   care   delivery   model;
    community  based  residential  rehabilitation  center.  A
    community-based residential rehabilitation  center  model
    is  a  designated  site  that  provides rehabilitation or
    support, or both, for persons who have experienced severe
    brain injury, who are medically stable, and who no longer
    require acute rehabilitative care or intense  medical  or
    nursing  services.   The  average  length  of  stay  in a
    community-based residential rehabilitation  center  shall
    not exceed 4 months.  As an integral part of the services
    provided,  individuals  are housed in a supervised living
    setting while having immediate access to  the  community.
    The  residential  rehabilitation center authorized by the
    Department may have  more  than  one  residence  included
    under  the license.  A residence may be no larger than 12
    beds and shall be located as  an  integral  part  of  the
    community.   Day  treatment  or individualized outpatient
    services shall be provided  for  persons  who  reside  in
    their  own  home.   Functional  outcome  goals  shall  be
    established for each individual.  Services shall include,
    but  are  not  limited  to, case management, training and
    assistance  with  activities  of  daily  living,  nursing
    consultation,    traditional     therapies     (physical,
    occupational,  speech),  functional  interventions in the
    residence  and  community   (job   placement,   shopping,
    banking,    recreation),    counseling,   self-management
    strategies,   productive   activities,    and    multiple
    opportunities   for   skill   acquisition   and  practice
    throughout the day.  The design of individualized program
    plans shall be consistent with the outcome goals that are
    established for each resident.  The programs provided  in
    this  setting  shall  be  accredited by the Commission on
    Accreditation of Rehabilitation Facilities  (CARF).   The
    program  shall  have  been  accredited by CARF as a Brain
    Injury  Community-Integrative  Program  for  at  least  3
    years.
         (5)  Alternative   health   care   delivery   model;
    Alzheimer's disease management  center.   An  Alzheimer's
    disease management center model is a designated site that
    provides  a  safe  and secure setting for care of persons
    diagnosed  with  Alzheimer's  disease.   An   Alzheimer's
    disease  management  center  model  shall  be  a facility
    separate  from  any  other  facility  licensed   by   the
    Department  of Public Health under this or any other Act.
    An Alzheimer's disease management  center  shall  conduct
    and  document  an  assessment  of  each  resident every 6
    months.  The assessment shall include  an  evaluation  of
    daily   functioning,   cognitive  status,  other  medical
    conditions,  and  behavioral  problems.   An  Alzheimer's
    disease management center shall develop and implement  an
    ongoing  treatment plan for each resident.  The treatment
    plan shall have defined goals.  The  Alzheimer's  disease
    management  center  shall  treat  behavioral problems and
    mood disorders using nonpharmacologic approaches such  as
    environmental   modification,  task  simplification,  and
    other  appropriate  activities.  All  staff   must   have
    necessary  training to care for all stages of Alzheimer's
    Disease.  An Alzheimer's disease management center  shall
    provide   education   and   support   for  residents  and
    caregivers.  The  education  and  support  shall  include
    referrals   to   support  organizations  for  educational
    materials on community resources, support  groups,  legal
    and financial issues, respite care, and future care needs
    and  options.   The  education  and  support  shall  also
    include  a  discussion  of  the  resident's  need to make
    advance directives and to identify surrogates for medical
    and  legal  decision-making.   The  provisions  of   this
    paragraph  establish  the  minimum level of services that
    must be provided by  an  Alzheimer's  disease  management
    center.   An  Alzheimer's disease management center model
    shall have no more than 100 residents.  Nothing  in  this
    paragraph  (5) shall be construed as prohibiting a person
    or facility from providing services and care  to  persons
    with  Alzheimer's  disease  as otherwise authorized under
    State law.
(Source: P.A.  91-65,  eff.  7-9-99;  91-357,  eff.  7-29-99;
91-838, eff. 6-16-00.)