Public Act 098-0997
 
HB5488 EnrolledLRB098 19022 RPS 55261 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Long Term Acute Care Hospital Quality
Improvement Transfer Program Act is amended by changing
Sections 10, 15, 20, and 50 as follows:
 
    (210 ILCS 155/10)
    Sec. 10. Definitions. As used in this Act:
    (a) "CARE tool" means the Continuity and Record Evaluation
(CARE) tool. It is a patient assessment instrument that has
been developed to document the medical, cognitive, functional,
and discharge status of persons receiving health care services
in acute and post-acute care settings. The data collected is
able to document provider-level quality of care (patient
outcomes) and characterize the clinical complexity of
patients. For the purposes of this Act, the CARE tool must be
identical to the most current version required by the federal
Centers for Medicare and Medicaid Services.
    (b) "Department" means the Illinois Department of
Healthcare and Family Services.
    (c) "Discharge" means the release of a patient from
hospital care for any discharge disposition other than a leave
of absence, even if for Medicare payment purposes the discharge
fits the definition of an interrupted stay.
    (d) "FTE" means "full-time equivalent" or a person or
persons employed in one full-time position.
    (e) "Hospital" means an institution, place, building, or
agency located in this State that is licensed as a general
acute hospital by the Illinois Department of Public Health
under the Hospital Licensing Act, whether public or private and
whether organized for profit or not-for-profit.
    (f) "ICU" means intensive care unit.
    (g) "LTAC hospital" means an Illinois hospital that is
designated by Medicare as a long term acute care hospital as
described in Section 1886(d)(1)(B)(iv)(I) of the Social
Security Act and has an average length of Medicaid inpatient
stay greater than 25 days as reported on the hospital's 2008
Medicaid cost report on file as of February 15, 2010, or a
hospital that begins operations after January 1, 2009 and is
designated by Medicare as a long term acute care hospital.
    (h) "LTAC hospital criteria" means nationally recognized
evidence-based evaluation criteria that have been publicly
tested and includes criteria specific to an LTAC hospital for
admission, continuing stay, and discharge. The criteria cannot
include criteria derived or developed by or for a specific
hospital or group of hospitals. Criteria and tools developed by
hospitals or hospital associations or hospital-owned
organizations are not acceptable and do not meet the
requirements of this subsection.
    (i) "Patient" means an individual who is admitted to a
hospital for an inpatient stay.
    (j) "Program" means the Long Term Acute Care Hospital
Quality Improvement Transfer Program established by this Act.
    (k) "STAC hospital" means a hospital that is not an LTAC
hospital as defined in this Act or a psychiatric hospital or a
rehabilitation hospital.
(Source: P.A. 96-1130, eff. 7-20-10; 97-662, eff. 1-13-12;
97-667, eff. 1-13-12.)
 
    (210 ILCS 155/15)
    Sec. 15. Qualifying Hospitals.
    (a) Beginning October 1, 2010, the Department shall
establish the Long Term Acute Care Hospital Quality Improvement
Transfer Program. Any hospital may participate in the program
if it meets the requirements of this Section as determined by
the Department.
    (b) To participate in the program a hospital must do the
following:
        (1) Operate as an LTAC hospital.
        (2) Employ one-half of an FTE (designated for case
    management) for every 15 patients admitted to the hospital.
        (3) Maintain on-site physician coverage 24 hours a day,
    7 days a week.
        (4) Maintain on-site respiratory therapy coverage 24
    hours a day, 7 days a week.
    (c) A hospital must also execute a program participation
agreement with the Department. The agreement must include:
        (1) An attestation that the hospital complies with the
    criteria in subsection (b) of this Section.
        (2) A process for the hospital to report its continuing
    compliance with subsection (b) of this Section. The
    hospital must submit a compliance report at least annually.
        (3) A requirement that the hospital complete and
    electronically submit to the Department the CARE tool (the
    most currently available version or an equivalent tool
    designated and approved for use by the Department) for each
    patient no later than 13 7 calendar days after discharge: .
            (A) the CARE tool in the format required by the
        federal Centers for Medicare and Medicaid Services;
        and
            (B) in an electronic format developed by the
        Department, (i) whether the patient was successfully
        weaned off invasive mechanical ventilation, (ii)
        whether the patient, if the patient was a ventilator
        patient, acquired pneumonia, and (iii) whether the
        patient fell and required an ancillary or surgical
        procedure (e.g., x-ray, MRI, sutures, or surgery).
        (4) A requirement that the hospital use a patient
    satisfaction survey specifically designed for LTAC
    hospital settings. The hospital must submit survey results
    data to the Department at least annually.
        (5) A requirement that the hospital accept all
    clinically approved patients for admission or transfer
    from a STAC hospital with the exception of STAC hospitals
    identified in paragraphs (1) and (2) under subsection (a)
    of Section 25 of this Act. The patient must be evaluated
    using LTAC hospital criteria approved by the Department for
    use in this program and meet the appropriate criteria.
        (6) A requirement that the hospital report quality and
    outcome measurement data, as described in Section 20 of
    this Act, to the Department at least annually.
        (7) A requirement that the hospital provide the
    Department full access to patient data and other data
    maintained by the hospital. Access must be in compliance
    with State and federal law.
        (8) A requirement that the hospital use LTAC hospital
    criteria to evaluate patients that are admitted to the
    hospital to determine that the patient is in the most
    appropriate setting.
(Source: P.A. 96-1130, eff. 7-20-10.)
 
    (210 ILCS 155/20)
    Sec. 20. Quality and outcome measurement data.
    (a) For proper evaluation and monitoring of the program,
each LTAC hospital must provide quality and outcome measurement
data ("measures") identical to Medicare as specified in
Medicare's LTCH Quality Reporting Program Manual (version 2.0)
and any subsequent revisions subsections (c) through (h) of
this Section to the Department for patients treated under this
program. The Department may develop measures in addition to the
minimum measures required under this Section.
    (b) Two sets of measures must be calculated. The first set
should only use data for medical assistance patients, and the
second set should include all patients of the LTAC hospital
regardless of payer.
    (c) (Blank). Average LTAC hospital length of stay for
patients discharged during the reporting period.
    (d) (Blank). Adverse outcomes rates: Percent of patients
who expired or whose condition worsens and requires treatment
in a STAC hospital.
    (e) (Blank). Ventilator weaning rate: Percent of patients
discharged during the reporting period who have been
successfully weaned off invasive mechanical ventilation.
    (f) (Blank). Central Line Infection Rate per 1000 central
line days: Number of patients discharged from an LTAC hospital
during the reporting period that had a central line in place
and developed a bloodstream infection 48 hours or more after
admission to the LTAC hospital.
    (g) (Blank). Acquired pressure ulcers per 1000 patient
days.
    (h) (Blank). Falls with injury per 1000 patient days:
Number of falls among discharged LTAC hospital patients
discharged during the reporting period, who fell during the
LTAC hospital stay, regardless of distance fallen, that
required an ancillary or surgical procedure (i.e. x-ray, MRI,
sutures, surgery, etc.)
(Source: P.A. 96-1130, eff. 7-20-10.)
 
    (210 ILCS 155/50)
    Sec. 50. Duties of the Department.
    (a) The Department is responsible for implementing,
monitoring, and evaluating the program. This includes but is
not limited to:
        (1) Collecting data required under Section 15 and data
    necessary to calculate the measures under Section 20 of
    this Act. The Department must make every effort to collect
    this data with the minimal amount of administrative burden
    to participating LTAC hospitals.
        (2) Setting annual benchmarks or targets for the
    measures in Section 20 of this Act or other measures beyond
    the minimum required under Section 20. The Department must
    consult participating LTAC hospitals when setting these
    benchmarks and targets.
        (3) Monitoring compliance with all requirements of
    this Act.
    (b) The Department shall include specific information on
the Program in its annual medical programs report.
    (c) The Department must establish monitoring procedures
that ensure the LTAC supplemental payment is only paid for
patients who upon admission meet the LTAC hospital criteria.
The Department must notify qualified LTAC hospitals of the
procedures and establish an appeals process as part of those
procedures. The Department must recoup any LTAC supplemental
payments that are identified as being paid for patients who do
not meet the LTAC hospital criteria.
    (d) The Department must implement the program by October 1,
2010.
    (e) The Department must create and distribute to LTAC
hospitals the agreement required under subsection (c) of
Section 15 no later than September 1, 2010.
    (f) The Department must notify Illinois hospitals which
LTAC hospital criteria are approved for use under the program.
The Department may limit LTAC hospital criteria to the most
strict criteria that meet the definitions of this Act.
    (g) (Blank). The Department must identify discharge tools
that are considered equivalent to the CARE tool and approved
for use under the program. The Department must notify LTAC
hospitals which tools are approved for use under the program.
    (h) The Department must notify Illinois LTAC hospitals of
the program and inform them how to apply for qualification and
what the qualification requirements are as described under
Section 15 of this Act.
    (i) The Department must notify Illinois STAC hospitals
about the operation and implementation of the program
established by this Act. The Department must also notify LTAC
hospitals that accepting transfers from the STAC hospitals
identified in paragraphs (1) and (2) under subsection (a) of
Section 25 of this Act are not required under paragraph (5) of
subsection (c) of Section 15 of this Act. The Department must
notify LTAC hospitals that accepting transfers from the STAC
hospitals identified in paragraphs (1) and (2) under subsection
(a) of Section 25 of this Act shall negatively impact the
savings calculations under the Program evaluation required by
Section 40 of this Act and shall in turn require the Department
to initiate the penalty described in subsection (d) of Section
40 of this Act.
    (j) The Department shall deem LTAC hospitals qualified
under Section 15 of this Act as qualifying for expedited
payments.
    (k) The Department may use up to $500,000 of funds
contained in the Public Aid Recoveries Trust Fund per State
fiscal year to operate the program under this Act. The
Department may expand existing contracts, issue new contracts,
issue personal service contracts, or purchase other services,
supplies, or equipment.
    (l) The Department may promulgate rules as allowed by the
Illinois Administrative Procedure Act to implement this Act;
however, the requirements under this Act shall be implemented
by the Department even if the Department's proposed rules are
not yet adopted by the implementation date of October 1, 2010.
(Source: P.A. 96-1130, eff. 7-20-10.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.