SB4004 102ND GENERAL ASSEMBLY

LRB102 24448 CPF 33682 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB4004

Introduced 1/21/2022, by Sen. Ann Gillespie

SYNOPSIS AS INTRODUCED:

20 ILCS 2310/2310-434 new
210 ILCS 9/77 new
210 ILCS 45/3-202.05
210 ILCS 45/3-613 new
210 ILCS 46/3-613 new
210 ILCS 47/3-613 new
305 ILCS 5/5-5.01b new

Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish and implement a Certified Nursing Assistant Intern Program to address the increasing need for trained health care workers and makes conforming changes in the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that upon successful completion of the Program, an individual may provide specified patient and resident care services. Contains requirements for the Program. Amends the Assisted Living and Shared Housing Act, the Nursing Home Care Act, the MC/DD Act, and the ID/DD Community Care Act. Requires a certified nursing assistant intern to report to the charge nurse or nursing supervisor and provides that a certified nursing assistant intern may only be assigned duties authorized under the Certified Nursing Assistant Intern Program by a supervising nurse. Provides that a facility or establishment shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under the Program. Specifies actions to be taken if a facility or establishment learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training. In provisions amending the Nursing Home Care Act, provides that, for the purpose of computing staff to resident ratios, direct care staff shall include certified nursing assistant interns. Amends the Public Aid Code. Requires the Department of Healthcare and Family Services to establish and implement a similar Certified Nursing Assistant Intern Program for facilities certified under the Code. Effective immediately.

A BILL FOR

AN ACT concerning regulation.

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

Section 5. The Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois is amended by adding Section 2310-434 as follows:

(20 ILCS 2310/2310-434 new)

Sec. 2310-434. Certified Nursing Assistant Intern Program.

(a) As used in this Section, "facility" means a facility licensed by the Department under the Nursing Home Care Act, the MC/DD Act, or the ID/DD Community Care Act or an establishment under the Assisted Living and Shared Housing Act.

(b) The Department shall establish and implement a Certified Nursing Assistant Intern Program to address the increasing need for trained health care workers. Upon successful completion of the classroom education and on-the-job training requirements of the Program required under this Section, an individual may provide, at a facility, the patient and resident care services and perform the procedures permitted under subsection (e).

(c) In order to qualify as a certified nursing assistant intern, an individual shall successfully complete at least 8 hours of classroom education on the services and procedures permitted under subsection (e). The classroom education shall be:

(1) taken within a facility or at an alternate location provided by the individual's employer;

(2) proctored by an advanced practice registered nurse; and

(3) satisfied by the successful completion of an approved 8-hour online training course.

(d) In order to qualify as a certified nursing assistant intern, an individual shall successfully complete at least 24 hours of on-the-job training in the services and procedures permitted under subsection (e), as follows:

(1) The training program instructor shall be an advanced practice registered nurse.

(2) The training program instructor shall ensure that the student meets the competencies set forth under subsection (e). The instructor shall document the competencies.

(3) All on-the-job training shall be under the direct observation of an advanced practice registered nurse.

(4) All on-the-job training shall be conducted at a facility.

(e) A certified nursing assistant intern shall receive classroom and on-the-job training on how to provide the patient or resident care services and procedures required of a certified nursing assistant's performance skills, including the Heimlich maneuver and ensuring the safety and well-being of a resident during feeding. A certified nursing assistant intern may perform the following optional skills if the supervising advanced practice registered nurse deems the certified nursing assistant intern able to do so:

(1) Measuring and recording temperature, pulse, and respiration.

(2) Measuring and recording blood pressure.

(3) Measuring and recording weight.

(4) Measuring and recording height.

(f) A certified nursing assistant intern may not perform the following:

(1) Shaving a resident with a nonelectric razor.

(2) Nail care.

(3) Perineal care.

(4) Transfer using mechanical lift.

(5) Passive range of motion.

(6) Donning and doffing of personal protective equipment other than gloves.

(g) A certified nursing assistant intern may only provide the patient or resident care services and perform the procedures that he or she is deemed qualified to perform that are permitted under subsection (e). A certified nursing assistant intern may not provide the procedures excluded under subsection (f).

(i) The Program is subject to the Health Care Worker Background Check Act and the Health Care Worker Background Check Code codified under 77 Ill. Adm. Code 955. Program participants and personnel shall be included on the Health Care Worker Registry.

(j) A Program participant who has completed the training required under paragraph (5) of subsection (a) of Section 3-206 of the Nursing Home Care Act, has completed the Program from April 21, 2020 through September 18, 2020, and has showed competency in all of the performance skills permitted under subsection (e) shall be considered a certified nursing assistant intern.

(k) The requirement under subsection (b) of Section 395.400 of Title 77 of the Illinois Administrative Code that a student must pass a BNATP written competency examination within 12 months after the completion of the BNATP does not apply to a certified nursing assistant intern under this Section.

(l) A certified nursing assistant intern shall enroll in a certified nursing assistant program within 6 months after completing his or her certified nursing assistant intern training under the Program. The individual may continue to work as a certified nursing assistant intern during his or her certified nursing assistant training. If the scope of work for a nurse assistant in training pursuant to 77 Ill. Adm. Code 300.660 is broader in scope than the work permitted to be performed by a certified nursing assistant intern, then the certified nursing assistant intern enrolled in certified nursing assistant training may perform the work allowed under 77. Ill. Adm. Code 300.660. The individual shall receive one hour of credit for every hour employed as a certified nursing assistant intern or as a temporary nurse assistant, not to exceed 40 hours of credit.

(m) A certified nursing assistant intern shall be considered a Nurse Aide in Training as provided under Appendix B of 77 Ill. Adm. Code 300.7080.

Section 10. The Assisted Living and Shared Housing Act is amended by adding Section 77 as follows:

(210 ILCS 9/77 new)

Sec. 77. Certified nursing assistant interns.

(a) A certified nursing assistant intern shall report to an establishment's charge nurse or nursing supervisor and may only be assigned duties authorized in Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois by a supervising nurse.

(b) An establishment shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. The notification shall detail which duties may be delegated to a certified nursing assistant intern.

(c) If an establishment learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training, the establishment shall:

(1) stop the certified nursing assistant intern from performing the work;

(2) inspect the work and correct mistakes, if done improperly; and

(3) assign the work to the appropriate personnel.

Section 15. The Nursing Home Care Act is amended by changing Section 3-202.05 and by adding Section 3-613 as follows:

(210 ILCS 45/3-202.05)

Sec. 3-202.05. Staffing ratios effective July 1, 2010 and thereafter.

(a) For the purpose of computing staff to resident ratios, direct care staff shall include:

(1) registered nurses;

(2) licensed practical nurses;

(3) certified nurse assistants;

(4) psychiatric services rehabilitation aides;

(5) rehabilitation and therapy aides;

(6) psychiatric services rehabilitation coordinators;

(7) assistant directors of nursing;

(8) 50% of the Director of Nurses' time; and

(9) 30% of the Social Services Directors' time; and .

(10) certified nursing assistant interns.

The Department shall, by rule, allow certain facilities subject to 77 Ill. Admin. Code 300.4000 and following (Subpart S) to utilize specialized clinical staff, as defined in rules, to count towards the staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities federally defined as Institutions for Mental Disease. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

(b) (Blank).

(b-5) For purposes of the minimum staffing ratios in this Section, all residents shall be classified as requiring either skilled care or intermediate care.

As used in this subsection:

"Intermediate care" means basic nursing care and other restorative services under periodic medical direction.

"Skilled care" means skilled nursing care, continuous skilled nursing observations, restorative nursing, and other services under professional direction with frequent medical supervision.

(c) Facilities shall notify the Department within 60 days after the effective date of this amendatory Act of the 96th General Assembly, in a form and manner prescribed by the Department, of the staffing ratios in effect on the effective date of this amendatory Act of the 96th General Assembly for both intermediate and skilled care and the number of residents receiving each level of care.

(d)(1) (Blank).

(2) (Blank).

(3) (Blank).

(4) (Blank).

(5) Effective January 1, 2014, the minimum staffing ratios shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care.

(e) Ninety days after the effective date of this amendatory Act of the 97th General Assembly, a minimum of 25% of nursing and personal care time shall be provided by licensed nurses, with at least 10% of nursing and personal care time provided by registered nurses. These minimum requirements shall remain in effect until an acuity based registered nurse requirement is promulgated by rule concurrent with the adoption of the Resource Utilization Group classification-based payment methodology, as provided in Section 5-5.2 of the Illinois Public Aid Code. Registered nurses and licensed practical nurses employed by a facility in excess of these requirements may be used to satisfy the remaining 75% of the nursing and personal care time requirements. Notwithstanding this subsection, no staffing requirement in statute in effect on the effective date of this amendatory Act of the 97th General Assembly shall be reduced on account of this subsection.

(f) The Department shall submit proposed rules for adoption by January 1, 2020 establishing a system for determining compliance with minimum staffing set forth in this Section and the requirements of 77 Ill. Adm. Code 300.1230 adjusted for any waivers granted under Section 3-303.1. Compliance shall be determined quarterly by comparing the number of hours provided per resident per day using the Centers for Medicare and Medicaid Services' payroll-based journal and the facility's daily census, broken down by intermediate and skilled care as self-reported by the facility to the Department on a quarterly basis. The Department shall use the quarterly payroll-based journal and the self-reported census to calculate the number of hours provided per resident per day and compare this ratio to the minimum staffing standards required under this Section, as impacted by any waivers granted under Section 3-303.1. Discrepancies between job titles contained in this Section and the payroll-based journal shall be addressed by rule. The manner in which the Department requests payroll-based journal information to be submitted shall align with the federal Centers for Medicare and Medicaid Services' requirements that allow providers to submit the quarterly data in an aggregate manner.

(g) The Department shall submit proposed rules for adoption by January 1, 2020 establishing monetary penalties for facilities not in compliance with minimum staffing standards under this Section. No monetary penalty may be issued for noncompliance during the implementation period, which shall be July 1, 2020 through December 31, 2021. If a facility is found to be noncompliant during the implementation period, the Department shall provide a written notice identifying the staffing deficiencies and require the facility to provide a sufficiently detailed correction plan to meet the statutory minimum staffing levels. Monetary penalties shall be imposed beginning no later than January 1, 2022 and quarterly thereafter and shall be based on the latest quarter for which the Department has data. Monetary penalties shall be established based on a formula that calculates on a daily basis the cost of wages and benefits for the missing staffing hours. All notices of noncompliance shall include the computations used to determine noncompliance and establishing the variance between minimum staffing ratios and the Department's computations. The penalty for the first offense shall be 125% of the cost of wages and benefits for the missing staffing hours. The penalty shall increase to 150% of the cost of wages and benefits for the missing staffing hours for the second offense and 200% the cost of wages and benefits for the missing staffing hours for the third and all subsequent offenses. The penalty shall be imposed regardless of whether the facility has committed other violations of this Act during the same period that the staffing offense occurred. The penalty may not be waived, but the Department shall have the discretion to determine the gravity of the violation in situations where there is no more than a 10% deviation from the staffing requirements and make appropriate adjustments to the penalty. The Department is granted discretion to waive the penalty when unforeseen circumstances have occurred that resulted in call-offs of scheduled staff. This provision shall be applied no more than 6 times per quarter. Nothing in this Section diminishes a facility's right to appeal.

(Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21.)

(210 ILCS 45/3-613 new)

Sec. 3-613. Certified nursing assistant interns.

(a) A certified nursing assistant intern shall report to a facility's charge nurse or nursing supervisor and may only be assigned duties authorized in Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois by a supervising nurse.

(b) A facility shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. The notification shall detail which duties may be delegated to a certified nursing assistant intern.

(c) If a facility learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training, the facility shall:

(1) stop the certified nursing assistant intern from performing the work;

(2) inspect the work and correct mistakes, if done improperly; and

(3) assign the work to the appropriate personnel.

Section 20. The MC/DD Act is amended by adding Section 3-613 as follows:

(210 ILCS 46/3-613 new)

Sec. 3-613. Certified nursing assistant interns.

(a) A certified nursing assistant intern shall report to a facility's charge nurse or nursing supervisor and may only be assigned duties authorized in Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois by a supervising nurse.

(b) A facility shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. The notification shall detail which duties may be delegated to a certified nursing assistant intern.

(c) If a facility learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training, the facility shall:

(1) stop the certified nursing assistant intern from performing the work;

(2) inspect the work and correct mistakes, if done improperly; and

(3) assign the work to the appropriate personnel.

Section 25. The ID/DD Community Care Act is amended by adding Section 3-613 as follows:

(210 ILCS 47/3-613 new)

Sec. 3-613. Certified nursing assistant interns.

(a) A certified nursing assistant intern shall report to a facility's charge nurse or nursing supervisor and may only be assigned duties authorized in Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois by a supervising nurse.

(b) A facility shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under Section 2310-434 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. The notification shall detail which duties may be delegated to a certified nursing assistant intern.

(c) If a facility learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training, the facility shall:

(1) stop the certified nursing assistant intern from performing the work;

(2) inspect the work and correct mistakes, if done improperly; and

(3) assign the work to the appropriate personnel.

Section 30. The Illinois Public Aid Code is amended by adding Section 5-5.01b as follows:

(305 ILCS 5/5-5.01b new)

Sec. 5-5.01b. Certified Nursing Assistant Intern Program.

(a) The Department shall establish and implement a Certified Nursing Assistant Intern Program to address the increasing need for trained health care workers. Upon successful completion of the classroom education and on-the-job training requirements of the Program under this Section, an individual may provide, at a facility certified under this Act, the patient and resident care services and perform the procedures permitted under subsection (d).

(b) In order to qualify as a certified nursing assistant intern, an individual shall successfully complete at least 8 hours of classroom education on the services and procedures permitted under subsection (d). The classroom education shall be:

(1) taken within a facility or at an alternate location provided by the individual's employer;

(2) proctored by an advanced practice registered nurse; and

(3) satisfied by the successful completion of an approved 8-hour online training course.

(c) In order to qualify as a certified nursing assistant intern, an individual shall successfully complete at least 24 hours of on-the-job training in the services and procedures permitted under subsection (d), as follows:

(1) The training program instructor shall be an advanced practice registered nurse.

(2) The training program instructor shall ensure that the student meets the competencies under subsection (d). The instructor shall document the competencies.

(3) All on-the-job training shall be under the direct observation of an advanced practice registered nurse.

(4) All on-the-job training shall be conducted at a facility.

(d) A certified nursing assistant intern shall receive classroom and on-the-job training on how to provide the patient or resident care services and procedures required of a certified nursing assistant's performance skills, including the Heimlich maneuver and ensuring the safety and well-being of a resident during feeding. A certified nursing assistant intern may perform the following optional skills if the supervising advanced practice registered nurse deems the certified nursing assistant intern able to do so:

(1) Measuring and recording temperature, pulse, and respiration.

(2) Measuring and recording blood pressure.

(3) Measuring and recording weight.

(4) Measuring and recording height.

(e) A certified nursing assistant intern may not perform the following:

(1) Shaving a resident with a nonelectric razor.

(2) Nail care.

(3) Perineal care.

(4) Transfer using mechanical lift.

(5) Passive range of motion.

(6) Donning and doffing of personal protective equipment other than gloves.

(f) A certified nursing assistant intern may only provide the patient or resident care services and perform the procedures that he or she is deemed qualified to perform that are permitted under subsection (d). A certified nursing assistant intern may not provide the procedures excluded under subsection (e).

(g) A certified nursing assistant intern shall report to a facility's charge nurse or nursing supervisor and may only be assigned duties authorized in this Section by a supervising nurse.

(h) A facility shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under subsection (d). The notification shall detail which duties may be delegated to a certified nursing assistant intern.

(i) If a facility learns that a certified nursing assistant intern is performing work outside of the scope of the Program's training, the facility shall:

(1) stop the certified nursing assistant intern from performing the work;

(2) inspect the work and correct mistakes, if done improperly; and

(3) assign the work to the appropriate personnel.

(j) The Program is subject to the Health Care Worker Background Check Act and the Health Care Worker Background Check Code codified under 77 Ill. Adm. Code 955. Program participants and personnel shall be included on the Health Care Worker Registry.

(k) A Program participant who has completed the training required under paragraph (5) of subsection (a) of Section 3-206 of the Nursing Home Care Act, has completed the Program from April 21, 2020 through September 18, 2020, and has shown competency in all of the performance skills permitted under subsection (d) shall be considered a certified nursing assistant intern.

(l) The requirement under subsection (b) of Section 395.400 of Title 77 of the Illinois Administrative Code that a student must pass a BNATP written competency examination within 12 months after the completion of the BNATP does not apply to a certified nursing assistant intern under this Section.

(m) A certified nursing assistant intern shall enroll in a certified nursing assistant program within 6 months after completing his or her certified nursing assistant intern training under the Program. The individual may continue to work as a certified nursing assistant intern during his or her certified nursing assistant training. If the scope of work for a nurse assistant in training pursuant to 77 Ill. Adm. Code 300.660 is broader in scope than the work permitted to be performed by a certified nursing assistant intern, then the certified nursing assistant intern enrolled in certified nursing assistant training may perform the work allowed under 77. Ill. Adm. Code 300.660. The individual shall receive one hour of credit for every hour employed as a certified nursing assistant intern or as a temporary nurse assistant, not to exceed 40 hours of credit.

(n) A certified nursing assistant intern shall be considered a Nurse Aide in Training as provided under Appendix B of 77 Ill. Adm. Code 300.7080.

Section 99. Effective date. This Act takes effect upon becoming law.