SB3709 103RD GENERAL ASSEMBLY

LRB103 39484 CES 69680 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3709

Introduced 2/9/2024, by Sen. Lakesia Collins

SYNOPSIS AS INTRODUCED:

New Act

Creates the Hospital Staffing Plans Act. Provides that for each hospital there shall be established a hospital professional and technical staffing committee. Sets forth requirements and makeup of committee members and cochairs. Directs the professional and technical staffing committee to develop a written hospital-wide professional and technical staffing plan. Sets forth committee rules of operation. Requires the plan to be consistent with the approved nurse staffing plan for the hospital and takes into account the hospital service staffing plan for the hospital. Provides that if the committee does not adopt a staffing plan, or adopts only part of a plan, then either cochair may invoke an additional 60 day period to continue to develop the plan. Sets forth opportunities to extend the discussion, amendment, or adoption timeframe of the staffing plan. Provides that the committee must meet 3 times per year and additionally at the call of either cochair. Sets forth open meeting and record-keeping requirements. Requires the hospital to submit the staffing plan to the Department of Public Health. Provides for a hospital service staffing plan in the same manner and methods as the professional and technical staffing committee. Provides that hospitals may combine 2 or more staffing committees into one committee in particular circumstances. Provides for a nurse staffing committee as the same manner and methods of the professional and technical staffing committee. Provides that hospitals may combine 2 or more staffing committees into one committee in particular circumstances. Sets forth the roles and responsibilities of a nurse in a hospital setting. Sets forth arbitration and complaint resolution. Sets forth required periodic reviews. Provides for penalties for violations of the Act. Provides that the Department of Labor may grant a variance to a written hospital-wide staffing plan. Provides for emergency staffing variances. Establishes the Nurse Staffing Advisory Board within the Department of Public Health. 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 1. Short title. This Act may be cited as the Hospital Staffing Plans Act.

Section 5. Definitions. As used in this Act:

"Charge nurse" means a direct-care registered nurse who coordinates patient care responsibilities among nurses in a hospital unit.

"Clinical care staff" means individuals who are licensed or certified by the state and who provide direct care.

"Direct care" means any care provided by a licensed or certified member of the hospital staff that is within the scope of the license or certification of the member.

"Direct-care staff" means any of the following who are routinely assigned to patient care and are replaced when they are absent:

(1) registered nurses, including registered nurses that do not assume primary responsibility for a patient's care but have responsibility for consulting on patient care;

(2) licensed practical nurses; or

(3) certified nursing assistants.

"Exclusive bargaining representative" means a labor organization that is:

(1) certified as an exclusive representative by the National Labor Relations Board; or

(2) certified as an exclusive representative by the Employment Relations Board.

"Hospital" means a hospital as defined in the Hospital Licensing Act and an acute inpatient care facility.

"Intensive care unit" means a unit of a hospital that provides care to critically ill patients who require advanced treatments, such as mechanical ventilation, vasoactive infusions, or continuous renal replacement treatment or who require frequent assessment and monitoring.

"Intermediate care unit" means a unit of a hospital that provides progressive care, intensive specialty care, or step-down care.

"Medical-surgical unit" means an inpatient unit in which general medical or post- surgical level of care is provided, excluding critical care units and any units referred to in Sections of this Act.

"Professional staff" means professional workers as defined in a collective bargaining agreement or, if no collective bargaining agreement exists, by the chief executive officer of the hospital or the chief executive officer's designee, consistent with National Labor Relations Board regulations.

"Progressive care" means care provided to hospital patients who need more monitoring and assessment than patients on the medical-surgical units but whose conditions are not so unstable that they require care in an intensive care unit.

"Service staff" means service workers as defined by a collective bargaining agreement or, if no collective bargaining agreement exists, by the chief executive officer of the hospital or the chief executive officer's designee, consistent with National Labor Relations Board regulations.

"Step-down care" means care for patients transitioning out of the intensive care unit who require more care and attention than patients in a hospital's medical-surgical units.

"Technical staff" means technical workers as defined in a collective bargaining agreement or, if no collective bargaining agreement exists, by the chief executive officer of the hospital or the chief executive officer's designee, consistent with National Labor Relations Board regulations.

Section 10. Professional and technical committee staffing.

(a) For each hospital, there shall be established a hospital professional and technical staffing committee as follows:

(1) A hospital professional and technical staffing committee shall consist of an equal number of hospital professional and technical managers and professional and technical staff who work at the hospital.

(2) If the professional and technical staff who work at the hospital have an exclusive bargaining representative, the exclusive bargaining representative shall select the staff members of the hospital professional and technical staffing committee.

(3) If none of the professional and technical staff who work at the hospital have an exclusive bargaining representative, the professional and technical managers shall select the professional and technical staff members of the hospital professional and technical staffing committee.

(b) A hospital professional and technical staffing committee shall develop a written hospital-wide professional and technical staffing plan in accordance with subsection (e). In developing the staffing plan, the primary goal of the committee shall be to ensure that the hospital is staffed sufficiently to meet the health care needs of the patients in the hospital. The committee shall review and modify the staffing plan, as needed, in accordance with this Section.

(c) A majority of the members of the hospital professional and technical staffing committee constitutes a quorum for the transaction of business.

(d) A hospital professional and technical staffing committee must have 2 cochairs. One cochair shall be a professional or technical manager elected by the members of the committee who are professional or technical managers. The other cochair shall be a professional or technical staff person elected by the members of the committee who are professional and technical staff.

(e) A hospital professional and technical staffing committee shall develop a professional and technical staffing plan that is consistent with the approved nurse staffing plan for the hospital and that takes into account the hospital service staffing plan for the hospital developed under Section 15. The hospital professional and technical staffing committee shall consider the following criteria when developing the professional and technical staffing plan:

(1) the hospital's census;

(2) location of the patients;

(3) patient types and patient acuity;

(4) national standards, if any;

(5) the size of the hospital and square footage of the hospital; and

(6) feedback received during committee meetings from staff.

(f) The hospital professional and technical staffing committee must adopt a professional and technical staffing plan by a majority vote of the members of the committee. If a quorum of members present at a meeting comprises an unequal number of professional and technical staff and professional and technical managers, only an equal number of staff and managers may vote. A staffing plan adopted by the committee must include a summary of the committee's consideration of the criteria in subsection (e) and how the plan is consistent with the approved nurse staffing plan and approved hospital service staffing plan for the hospital.

If the hospital professional and technical staffing committee does not adopt a professional and technical staffing plan or adopts only a part of the staffing plan, either cochair may invoke the commencement of a 60-day period during which the committee shall continue to develop the staffing plan. If, by the end of the 60-day period, the committee does not adopt a staffing plan or adopts only part of a staffing plan, the committee shall submit the disputed plan or parts of the plan, as applicable, including a summary of the committee's consideration of the criteria in subsection (e), to the chief executive officer of the hospital. No later than 60 days after receiving the submission from the committee, the chief executive officer or the chief executive officer's designee shall decide the disputed plan or parts of the plan, as applicable, considering the summary of the committee's consideration of the criteria in subsection (e), and adopt the staffing plan or parts of the staffing plan that were not adopted by the committee. The chief executive officer or the chief executive officer's designee shall provide to the committee:

(1) a written explanation of the staffing plan or the parts of the staffing plan that were in dispute;

(2) the final written proposals of the members of the committee and the members' rationales for their proposals and the committee's summary of the committee's consideration of the criteria in subsection (e); and

(3) a summary of the consideration by the chief executive officer or the chief executive officer's designee of the criteria in subsection (e).

If the hospital professional and technical staffing committee is unable to reach an agreement on the professional and technical staffing plan during the 60-day period invoked under subsection (g), the members of the committee may extend deliberations for one additional 60-day period before the disputed plan or parts of the plan must be submitted to the chief executive officer or the chief executive officer's designee in accordance with subsection (f). The deliberations may be extended under this subsection only by a majority vote of the members of the committee. If a quorum of members present at a meeting comprises an unequal number of professional and technical staff and professional and technical managers, only an equal number of staff and managers may vote.

A professional and technical staffing plan adopted by a hospital professional and technical staffing committee, a chief executive officer or the chief executive officer's designee must include any staffing-related terms and conditions that were previously adopted through any applicable collective bargaining agreement, including any meal break and rest break requirements, unless a term or condition is in direct conflict with an applicable statute or administrative rule.

A hospital professional and technical staffing committee must meet 3 times each year and at the call of either cochair, at a time and place specified by the cochairs.

(g) Except as provided in this subsection, a hospital professional and technical staffing committee meeting must be open to:

(1) the hospital's professional and technical staff, who shall be offered the opportunity to provide feedback to the committee during the committee's meetings; and

(2) other observers or presenters invited by either cochair.

While the committee is deliberating or voting during a meeting, either cochair may exclude individuals described in this subsection.

(h) Minutes must be taken at every hospital professional and technical staffing committee meeting and the minutes must:

(1) include all motions made and the outcome of all votes taken;

(2) include a summary of all discussions; and

(3) be made available in a timely manner to any of the hospital staff upon request.

(i) A manager shall release from their duties staff and managers who serve on the hospital professional and technical staffing committee and compensate the staff and managers who serve on the committee for time spent attending committee meetings.

(j) The hospital shall submit the professional and technical staffing plan adopted under subsection (f) to the Department of Public Health no later than 30 days after adoption of the staffing plan and shall submit any subsequent changes to the Department no later than 30 days after the changes are adopted.

(k) Each hospital unit, as defined by the chief executive officer or the chief executive officer's designee, may deviate from the professional and technical staffing plan within a period of 12 consecutive hours, no more than 6 times during a rolling 30-day period, without being in violation of the staffing plan. The unit manager must notify the hospital professional and technical staffing committee cochairs no later than 10 days after each deviation. Each subsequent deviation during the 30-day period constitutes a separate violation under Section 90.

Section 15. Hospital service staffing.

(a) For each hospital there shall be established a hospital service staffing committee.

(1) A hospital service staffing committee shall consist of an equal number of service staff managers and service staff who work at the hospital.

(2) If the service staff who work at the hospital have an exclusive bargaining representative, the exclusive bargaining representative shall select the service staff members of the hospital service staffing committee.

(3) If none of the service staff who work at the hospital have an exclusive bargaining representative, the service staff managers shall select the service staff members of the hospital service staffing committee.

(b) A hospital service staffing committee shall develop a written hospital-wide hospital service staffing plan in accordance with subsection (e). The committee shall review and modify the staffing plan as needed in accordance with this Section.

(c) A majority of the members of the hospital service staffing committee constitutes a quorum for the transaction of business.

(d) A hospital service staffing committee must have 2 cochairs. One cochair shall be a service staff manager elected by the members of the committee who are service staff managers. The other cochair shall be a service staff person elected by the members of the committee who are service staff.

(e) A hospital service staffing committee shall develop a hospital service staffing plan that is consistent with the approved nurse staffing plan for the hospital and that takes into account the professional and technical staffing plan for the hospital developed under Section 10. The committee shall consider the following criteria in developing the staffing plan:

(1) the hospital's census;

(2) location of the patients;

(3) patient types and patient acuity;

(4) national standards, if any;

(5) the size of the hospital and square footage of the hospital;

(6) ensuring patient access to care; and

(7) feedback received during committee meetings from staff.

(f) A hospital service staffing committee must adopt a hospital service staffing plan by a majority vote of the members of the committee. If a quorum of members present at a meeting comprises an unequal number of service staff and service staff managers, only an equal number of staff and managers may vote. A staffing plan adopted by the committee must include a summary of the committee's consideration of the criteria in subsection (e) and how the plan is consistent with the approved nurse staffing plan and approved professional and technical staffing plan for the hospital.

If the hospital service staffing committee does not adopt a hospital service staffing plan or adopts only a part of the staffing plan, either cochair may invoke the commencement of a 60-day period during which the committee shall continue to develop the staffing plan. If, by the end of the 60-day period, the committee does not adopt a staffing plan or adopts only part of a staffing plan, the committee shall submit the disputed plan or parts of the plan, as applicable, including a summary of the committee's consideration of the criteria in subsection (e), to the chief executive officer of the hospital. No later than 60 days after receiving the submission from the committee, the chief executive officer or the chief executive officer's designee shall decide the disputed plan or parts of the plan, as applicable, considering the summary of the committee's consideration of the criteria in subsection (e), and adopt the staffing plan or parts of the staffing plan that were not adopted by the committee. The chief executive officer or the chief executive officer's designee shall provide to the committee:

(1) a written explanation of the staffing plan or the parts of the staffing plan that were in dispute;

(2) the final written proposals of the members of the committee and the members' rationales for their proposals and the committee's summary of the committee's consideration of the criteria in this Section; and

(3) a summary of the consideration by the chief executive officer or the chief executive officer's designee of the criteria in subsection (e).

If the hospital service staffing committee is unable to reach an agreement on the hospital service staffing plan during the 60-day period invoked under this subsection, the members of the committee may extend deliberations for one additional 60-day period before the disputed plan or parts of the plan must be submitted to the chief executive officer or the chief executive officer's designee in accordance with Section. The deliberations may be extended under this paragraph only by a majority vote of the members of the committee. If a quorum of members present at a meeting comprises an unequal number of hospital service staff and hospital service managers, only an equal number of staff and managers may vote.

A hospital service staffing plan adopted by a hospital service staffing committee, a chief executive officer or the chief executive officer's designee must include any staffing-related terms and conditions that were previously adopted through any applicable collective bargaining agreement, including any meal break and rest break requirements, unless a term or condition is in direct conflict with an applicable statute or administrative rule.

A hospital service staffing committee must meet 3 times each year and at the call of either cochair, at a time and place specified by the cochairs.

(g) Except as provided in this subsection, a hospital service staffing committee meeting must be open to:

(1) the hospital's service staff, who shall be offered the opportunity to provide feedback to the committee during the committee's meetings; and

(2) other observers or presenters invited by either cochair.

While the committee is deliberating or voting during a meeting, either cochair may exclude individuals described in paragraph (1) or (2) of this subsection.

(h) Minutes shall be taken at every hospital service staffing committee meeting and the minutes must:

(1) include all motions made and the outcome of all votes taken;

(2) include a summary of all discussions; and

(3) be made available in a timely manner to any of the hospital staff upon request.

(i) A manager shall release from their duties staff and managers who serve on the hospital service staffing committee and compensate the staff and managers who serve on the committee for time spent attending committee meetings.

(j) The hospital shall submit the hospital service staffing plan adopted under this Section to the Department of Healthcare and Family Services no later than 30 days after adoption of the staffing plan and shall submit any subsequent changes to the Department no later than 30 days after the changes are adopted.

(k) Each hospital unit, as defined by the chief executive officer or the chief executive officer's designee, may deviate from the hospital service staffing plan within a period of 12 consecutive hours, no more than 6 times during a rolling 30-day period, without being in violation of the staffing plan. The unit manager must notify the hospital service staffing committee cochairs no later than 10 days after each deviation. Each subsequent deviation during the 30-day period constitutes a separate violation under Section 90.

Section 20. Combined committees.

(a) A hospital nurse staffing committee, a professional and technical staffing committee, and a hospital service staffing committee may, by mutual agreement, combine 2 or more of the staffing committees into one committee if:

(1) the structures of the committees to be combined meet the requirements of the individual committee requirements under this Act, as applicable; and

(2) the members of the combined committee are selected from each committee by an exclusive bargaining representative, or otherwise as provided in this Act.

(b) A majority of members of each staffing committee constitutes a quorum for the transaction of the business of the combined committee. If there is an unequal number of staff and management from each committee present at a meeting of the combined committee, only an equal number of staff and managers from each committee may vote.

(c) Disputes arising in combined committees shall be resolved using the applicable dispute resolution processes under this Act.

Section 25. Nurse staffing plan.

(a) As used in this Section, "unit" means a hospital unit as defined by the chief executive officer of the hospital or the chief executive officer's designee.

(b) With respect to direct-care registered nurses, a nurse staffing plan must ensure that at all times:

(1) In an emergency department:

(A) a direct-care registered nurse is assigned to not more than one trauma patient; and

(B) the ratio of direct-care registered nurses to patients averages no more than one to 4 over a 12-hour shift and a single direct-care registered nurse may not be assigned more than 5 patients at one time. direct-care registered nurses assigned to trauma patients may not be taken into account in determining the average ratio.

(2) In an intensive care unit, a direct-care registered nurse is assigned to no more than 2 patients.

(3) In a labor and delivery unit, a direct-care registered nurse is assigned to no more than:

(A) 2 patients if the patients are not in active labor or experiencing complications; or

(B) One patient if the patient is in active labor or if the patient is at any stage of labor and is experiencing complications.

(4) In a postpartum, antepartum, and well-baby nursery, a direct-care registered nurse is assigned to no more than 6 patients, counting mother and baby each as separate patients.

(5) In a mother-baby unit, a direct-care registered nurse is assigned to no more than 8 patients, counting mother and baby each as separate patients.

(6) In an operating room, a direct-care registered nurse is assigned to no more than one patient.

(7) In an oncology unit, a direct-care registered nurse is assigned to no more than 4 patients.

(8) In a post-anesthesia care unit, a direct-care registered nurse is assigned to no more than 2 patients.

(9) In an intermediate care unit, a direct-care registered nurse is assigned to no more than 3 patients.

(10) In a medical-surgical unit, a direct-care registered nurse is assigned to no more than 5 patients.

(11) In a cardiac telemetry unit, a direct-care registered nurse is assigned to no more than 4 patients.

(12) In a pediatric unit, a direct-care registered nurse is assigned to no more than 4 patients.

(c) Notwithstanding subsection (b), the direct-care registered nurse-to-patient ratio for an individual patient shall be based on a licensed independent practitioner's classification of the patient, as indicated in the patient's medical record, regardless of the unit where the patient is being cared for.

(d) With the approval of a majority of the members of the hospital nurse staffing committee, a unit can deviate from the direct-care registered nurse-to-patient ratios in subsection (b), in pursuit of innovative care models that were considered by the committee, by allowing other clinical care staff to constitute up to 50% of the registered nurses needed to comply with the applicable nurse-to-patient ratio. The staffing in an innovative care model must be reapproved by the committee every 2 years.

(e) A hospital shall provide for meal breaks and rest breaks in accordance with all rules and applicable laws.

(f) Each hospital unit may deviate from a nurse staffing plan, except with respect to meal breaks and rest breaks, including the applicable direct-care registered nurse-to-patient ratios under this Section, within a period of 12 consecutive hours, no more than 6 times during a rolling 30-day period, without being in violation of the nurse staffing plan. The unit manager must notify the hospital nurse staffing committee no later than 10 days after each deviation. Each subsequent deviation during the 30-day period constitutes a separate violation under Section 90.

(g) A hospital may not require a direct-care registered nurse to be assigned to more patients than as specified in this Section or in the nurse staffing plan approved by the hospital nurse staffing committee, as applicable.

(h) A charge nurse may:

(1) take patient assignments, including patient assignments taken for the purpose of covering staff who are on meal breaks or rest breaks, in units with 10 or fewer beds;

(2) take patient assignments, including patient assignments taken for the purpose of covering staff who are on meal breaks or rest breaks, in units with 11 or more beds with the approval of the hospital nurse staffing committee; and

(3) be taken into account in determining the direct-care registered nurse-to-patient ratio during periods when the charge nurse is taking patient assignments under this Section.

Section 30. Psychiatric multidisciplinary subcommittee.

(a) As used in this Section, "psychiatric unit" includes:

(1) inpatient psychiatric units;

(2) psychiatric geriatric units;

(3) psychiatric pediatric units; or

(4) emergency departments that provide psychiatric emergency service, as defined by rule.

(b) A psychiatric unit shall create a multidisciplinary subcommittee of the hospital nurse staffing committee consisting of staff from the unit. The subcommittee shall adopt the staffing plan for the psychiatric unit and shall be considered a hospital nurse staffing committee for purposes of:

(1) The adoption of a nurse staffing plan under Section 25; and

(2) Provisions of this Act related to:

(A) Dispute resolution through mandatory arbitration; and

(B) Determining the circumstances when the nurse-to-patient ratios in Section 25 will not apply.

Section 35. Certified nursing assistants and patient care technicians. A hospital may not assign a certified nursing assistant or patient care technician to more than 7 patients at a time during a day or evening shift or to more than 11 patients at a time during a night shift.

Section 40. Direct-care registered nurse-to-patient staffing ratios.

(a) Direct-care registered nurse-to-patient staffing ratios under Section 25 do not apply to the care of:

(1) patients in intensive care or critical units in circumstances prescribed by the hospital nurse staffing committee;

(2) emergency department patients who are in critical condition, until they are stable;

(3) patients in swing beds, as defined by the Centers for Medicare and Medicaid Services;

(4) patients in inpatient units who are ready for discharge but are facing a barrier to discharge, as indicated by a licensed independent practitioner in each patient's medical record;

(5) patients, including patients in an emergency department, who are located in adjacent rooms or the same room in the hospital and who are ready for discharge but are facing a barrier to discharge, as indicated by a licensed independent practitioner in each patient's medical record;

(6) patients in outpatient units that operate under a hospital's license; or

(7) patients in psychiatric units.

(b) For patients described in subsection (a), the hospital nurse staffing committee shall adopt a nurse staffing plan that is:

(1) consistent with nationally recognized nurse staffing standards or benchmarks;

(2) consistent with a tool that measures patient acuity and intensity and that has been calibrated to the applicable unit; or

(3) approved after the committee has considered:

(A) the specialized qualifications and competencies of the staff in the unit;

(B) historic acuity and intensity of the patients in the unit;

(C) nationally recognized nurse staffing standards, if any; and

(D) ensuring patient access to care.

(c) If the hospital nurse staffing committee does not adopt a nurse staffing plan under subsection (b), either cochair of the committee may invoke the commencement of a 60-day period during which the committee shall continue to develop the staffing plan as follows:

(1) If by the end of the 60-day period, the hospital nurse staffing committee does not adopt a nurse staffing plan, the members of the committee may extend deliberations for one additional 60-day period only by a majority vote of the members of the committee.

(2) If a quorum of members present at a meeting comprises an unequal number of nursing staff and managers, only an equal number of staff and managers may vote.

(3) If by the end of the initial 60-day period of deliberations, or by the end of the second 60-day period of deliberations, or if deliberations are extended under this subsection, the hospital nurse staffing committee does not adopt a nurse staffing plan, the cochairs of the committee shall submit the disputed plan or parts of the plan, as applicable, to the and the Department shall initiate expedited binding arbitration as follows:

(A) The arbitrator shall be selected using alternating strikes by the cochairs or their designees from a list of 7 drawn from the interest arbitrator panel maintained by the State.

(B) Arbitration must be scheduled by mutual agreement no later than 30 calendar days after the cochairs submit the disputed nurse staffing plan or the disputed parts of the plan to the Department except as, by mutual agreement, the time may be extended.

(C) The arbitrator shall issue a decision on the nurse staffing plan, or the disputed parts of the plan, as applicable, based on the written submissions of evidence and arguments and may not conduct an evidentiary hearing or allow discovery. The arbitrator's decision must be based on and within the parameters of the versions of the plan or the disputed parts of the plan submitted by the cochairs and must be within the staffing parameters.

(D) The arbitrator shall issue a decision no later than 60 days after the submission of evidence and written arguments.

(E) The hospital shall pay for the cost of the arbitrator.

Section 45. Complaint procedure.

(a) As used in this Section:

"Employee" includes the following:

(1) registered nurses who provide direct care;

(2) professional staff;

(3) technical staff; and

(4) service staff.

"Employee" does not include an individual described in this Section if the individual is covered by a collective bargaining agreement that includes a monetary remedy for missed meal periods and missed rest periods.

(b) An employee or an exclusive bargaining representative of an employee may enforce requirements for meal periods and rest periods adopted by rule by the Illinois Department of Labor by electing to file a complaint in one of the following ways:

(1) with the Illinois Department of Labor under this Act; or

(2) with the State Department of Labor under rules adopted under this Act.

(c) Upon the receipt of a complaint forwarded by the Department to the commissioner under this Act, the Illinois Department of Labor shall proceed on the complaint in accordance with this Section.

(d) The State Department of Labor shall deem a complaint filed under this subsection to be withdrawn if notified by an employer that:

(1) the employer received a grievance filed by the employee or an exclusive bargaining representative of the employee alleging the same violation as the violation alleged in a complaint filed under this subsection; or

(2) the employee or the exclusive bargaining representative of the employee has filed a civil complaint against the employer alleging the same violation as the violation alleged in a complaint filed under this subsection.

(e) If the commissioner receives a complaint under subsection (b) that was filed with the Department more than 60 days after the date of the missed meal period or missed rest period alleged in the complaint, the Department of Labor:

(1) shall dismiss the complaint; and

(2) may not investigate the complaint or take any enforcement action with respect to the complaint.

(f) Following an investigation of a complaint filed under subsection (b), if the Department of Labor determines that a civil penalty is appropriate, the commissioner shall provide to the hospital, to the cochairs of the relevant staffing committee, and to the exclusive bargaining representative, if any, a notice of the Department of Labor's intent to assess a civil penalty of $200.

(3) A civil penalty imposed under this Section:

(A) constitutes the liquidated damages of the complainant for the missed meal period or rest period;

(B) may not be combined with a penalty assessed in accordance with all applicable rules or laws;

(C) precludes any other penalty or remedy provided by law for the violation found by the commissioner; and

(D) becomes final if an application for hearing is not requested in a timely manner.

(g) The liquidated damages imposed under this Section shall be paid to the complainant no later than 15 business days after the date on which the order becomes final by operation of law or 15 days after the issuance of a decision on appeal. A hospital shall provide to the commissioner proof of the payment of liquidated damages no later than 30 days after making the payment.

(h) An employee's failure to file a complaint under subsection (b) does not preclude the employee from pursuing any other remedy otherwise available to the employee under any provision of law.

(i) Nothing in this Section creates a private cause of action.

Section 50. Department of Labor.

(a) The Department of Labor shall implement a process for an employee or an employee's exclusive bargaining representative to file a complaint against a hospital under subsection (b) for missed meal periods and rest periods.

(b) The Department shall forward to the Director of Labor any complaint filed under this Act no later than 14 days after the complaint is filed;

(c) No later than 30 days after receiving a complaint under this Act, the Department shall provide notice of the filing of the complaint to the following:

(1) the hospital;

(2) the cochairs of the relevant staffing committee established under this Act; and

(3) the exclusive bargaining representative, if any, of the employee filing the complaint.

Section 55. Hospital nurse staffing committee rules and responsibilities.

(a) For each hospital there shall be established a hospital nurse staffing committee. Each hospital nurse staffing committee shall:

(1) consist of an equal number of hospital nurse managers and direct-care staff;

(2) for the portion of the committee composed of direct-care staff, consist entirely of direct-care registered nurses, except for one position to be filled by a direct-care staff member who is not a registered nurse and whose services are covered by a written hospital-wide nurse staffing plan; and

(3) include at least one direct-care registered nurse from each hospital nurse specialty or unit;

(4) for any of the direct-care registered nurses who work at a hospital who are represented under a collective bargaining agreement, the bargaining unit shall conduct a selection process by which the direct-care registered nurses who work at the hospital select the members of the committee. Nurses who are direct-care registered nurses which have an exclusive bargaining representative, the exclusive bargaining representative shall select the direct-care registered nurses, or members of the committee as follows:

(A) If the direct-care staff member who is not a registered nurse who works at a hospital is represented under a collective bargaining agreement, the bargaining unit shall use the selection process conducted under subparagraph (B) to select that member of the committee, or has an exclusive bargaining representative, the exclusive bargaining representative shall select the direct-care staff member of the committee who is not a registered nurse.

(B) If none of the direct-care registered nurses who work at a hospital are represented by an exclusive bargaining representative, the direct-care registered nurses belonging to a hospital nurse specialty or unit shall select the members of the committee who are direct-care registered nurses from the specialty or unit to serve on the committee.

(C) If none of the direct-care staff working at the hospital who are not registered nurses are represented by an exclusive bargaining representative, the direct-care registered nurses who are members of the staffing committee shall select the direct-care staff who are not registered nurses to serve on the committee.

(5) If the direct-care registered nurses who work at a hospital are not represented under a collective bargaining agreement, the direct-care registered nurses belonging to a hospital nurse specialty or unit shall select each member of the committee who is a direct-care registered nurse from that specialty or unit.

(b) A hospital nurse staffing committee shall develop a written hospital-wide nurse staffing plan in accordance with this Act. The committee's primary goals in developing the staffing plan shall be to ensure that the hospital is staffed to meet the health care needs of patients. The committee shall review and modify the staffing plan in accordance with all applicable laws and rules.

(c) A majority of the members of a hospital nurse staffing committee constitutes a quorum for the transaction of business.

(d) A hospital nurse staffing committee shall have two cochairs. One cochair shall be a hospital nurse manager elected by the members of the committee who are hospital nurse managers and one cochair shall be a direct-care registered nurse elected by the members of the committee who are direct-care staff.

(e) A decision made by a hospital nurse staffing committee must be made by a vote of a majority of the members of the committee as follows:

(1) If a quorum of members present at a meeting comprises an unequal number of hospital nurse managers and direct-care staff, only an equal number of hospital nurse managers and direct-care staff may vote.

(2) If the committee is unable to reach an agreement on the staffing plan, either cochair of the committee may invoke a 30-day period during which the committee shall continue to develop the staffing plan. During the 30-day period, the hospital shall respond in a timely manner to reasonable requests from members of the committee for data that will enable the committee to reach a resolution. If at the end of the 30-day period, the committee remains unable to reach an agreement on the staffing plan, one of the cochairs shall notify the Department of Public Health of the impasse.

(3) Upon receiving notification under this subsection, the Department of Public Health shall provide the committee with a mediator to assist the committee in reaching an agreement on the staffing plan. Mediation conducted under this paragraph must be consistent with the requirements for implementing and reviewing staffing plans.

(4) If the committee is unable to reach an agreement on the staffing plan after 90 days of mediation, the Department may impose a civil penalty against the hospital as described under this Act.

(g) A hospital nurse staffing committee shall meet:

(1) at least once every 4 months; and

(2) at any time and place specified by either cochair.

(g) A hospital nurse staffing committee meeting must be open to the hospital nursing staff as observers and, upon invitation by either cochair, other observers or presenters. At any time, either cochair may exclude persons described in this subsection from a committee meeting for purposes related to deliberation and voting.

(h) Hospital nurse staffing committee meetings must:

(A) include motions made and outcomes of votes taken;

(B) summarize discussions; and

(c) be made available in a timely manner to hospital nursing staff and other hospital staff upon request.

(i) A hospital shall release a member of a hospital nurse staffing committee described in the member's assignment, and provide the member with paid time, to attend committee meetings.

Section 60. Hospital-wide nurse staffing plans.

(a) Each hospital shall implement a written hospital-wide staffing plan for nursing services that:

(1) meets the requirements of this Section and any applicable statute;

(2) includes any staffing-related terms and conditions that were previously adopted through any applicable collective bargaining agreement, including meal breaks and rest breaks, unless a term or condition is in direct conflict with an applicable statute or administrative rule; and

(3) has been developed and approved by the hospital nurse staffing committee.

(b) If the nurse-to-patient ratios in this Act apply, the hospital nurse staffing committee:

(1) may consider:

(A) the specialized qualifications and competencies of the nursing staff, and the skill mix and level of competency necessary to ensure that the hospital is staffed to meet the health care needs of patients;

(B) the size of the hospital and a measurement of hospital unit activity that quantifies the rate of admissions, discharges, and transfers for each hospital unit and the time required for a direct-care registered nurse belonging to a hospital unit to complete admissions, discharges, and transfers for that hospital unit; and

(C) the unit's general and predominant patient population as defined by the Medicare Severity Diagnosis Related Groups adopted by the Centers for Medicare and Medicaid Services, or by other measures for patients who are not classified in the Medicare Severity Diagnosis Related Groups;

(2) must:

(A) base the staffing plan on total diagnoses for each hospital unit and the nursing staff required to manage that set of diagnoses;

(B) be consistent with nationally recognized evidence-based standards and guidelines established by professional nursing specialty organizations, if any;

(C) recognize differences in patient acuity;

(D) establish minimum numbers of nursing staff, including licensed practical nurses and certified nursing assistants, required on specified shifts, provided that at least one registered nurse and one other nursing staff member is on duty in a unity when a patient is present;

(E) include a formal process for evaluating and initiating limitations on admission or diversion of patients to another hospital when, in the judgment of a direct-care registered nurse or nurse manager, there is an inability to meet patient care needs or a risk of harm to patients; and

(F) consider tasks not related to providing direct care, including meal breaks and rest breaks;

(3) may not base nursing staff requirements solely on external benchmarking data; and

(4) must comply with this Act.

(c) A hospital must maintain and post, in a physical location or online, a list of on-call nursing staff or staffing agencies to provide replacement nursing staff in the event of a vacancy. The list of on-call nursing staff or staffing agencies must be sufficient to provide for replacement nursing staff.

(d) An employer may not impose upon unionized nursing staff any changes in wages, hours, or other terms and conditions of employment under a staffing plan unless the employer first provides notice to and, upon request, bargains with the union as the exclusive collective bargaining representative of the nursing staff in the bargaining unit.

A staffing plan does not create, preempt, or modify a collective bargaining agreement or re- quire a union or employer to bargain over the staffing plan while a collective bargaining agreement is in effect.

A hospital shall submit to the Illinois Department of Labor nurse staffing plan adopted in accordance with this Section and submit any changes to the plan no later than 30 days after approval of the changes by the hospital nurse staffing committee.

Section 65. Prior staffing plan approval.

(a) Prior to July 1, 2025, a hospital nurse staffing committee established under existing laws, rules, or regulations may approve a staffing plan that is:

(1) consistent with nationally recognized nurse staffing standards or benchmarks;

(2) consistent with a tool that measures patient acuity and intensity and that has been calibrated to the hospital unit, as defined by the hospital nurse staffing committee; or

(3) approved after the hospital nurse staffing committee has considered:

(A) the specialized qualifications and competencies of the staff in the unit;

(B) the historic acuity and intensity of the patients in the unit;

(C) nationally recognized nurse staffing standards, if any; and

(D) patients' access to care.

Section 70. Staffing plan review requirements.

(a) A hospital nurse staffing committee established under this Act shall review the written hospital-wide staffing plan developed by the committee and shall review the nurse staffing plan:

(1) at least once every year; and

(2) at any other date and time specified by either cochair of the committee.

(b) In reviewing a staffing plan, a hospital nurse staffing committee shall consider:

(1) patient outcomes;

(2) complaints regarding staffing, including complaints about a delay in direct care nursing or an absence of direct care nursing;

(3) the number of hours of nursing care provided through a hospital unit compared with the number of patients served by the hospital unit during a 24-hour period;

(4) the aggregate hours of mandatory overtime worked by the nursing staff;

(5) the aggregate hours of voluntary overtime worked by the nursing staff;

(6) the percentage of shifts for each hospital unit for which staffing differed from what is required by the staffing plan;

(7) the number of meal breaks and rest breaks missed by direct-care staff; and

(8) any other matter determined by the committee to be necessary to ensure that the hospital is staffed to meet the health care needs of patients.

(c) Upon reviewing a staffing plan, a hospital nurse staffing committee shall:

(1) report whether the staffing plan ensures that the hospital is staffed to meet the health care needs of patients; and

(2) modify the staffing plan, if necessary, to ensure that the hospital is staffed to meet the health care needs of patients.

Section 75. Staffing investigations.

(a) For purposes of ensuring compliance with all applicable laws and rules, the Illinois Department of Labor shall:

(1) within 60 days after receiving a complaint against a hospital for violating a provision of this Act, conduct an on-site investigation of the hospital; and

(2) within 60 days after issuing an order requiring a hospital to implement a plan to correct a violation of this Act, conduct an investigation of the hospital to ensure compliance with the plan.

(b) When conducting an investigation of a hospital to ensure compliance with this Act, the Department shall, if the Department provides notice of the investigation to the hospital, provide notice of the investigation to the cochairs of the hospital nurse staffing committee established under this Act and other applicable laws and rules.

(c) Following an investigation conducted under this Section, the Department shall provide in writing a report of the Department's findings to the hospital and the cochairs of the hospital nurse staffing committee.

(d) When conducting an investigation of a hospital to ensure compliance with all applicable laws and rules, the Department may:

(1) take evidence;

(2) take the depositions of witnesses in the manner provided by law in civil cases;

(3) compel the appearance of witnesses in the manner provided by law in civil cases;

(4) require answers to interrogatories; and

(5) compel the production of books, papers, accounts, documents, and testimony pertaining to the matter under investigation.

Section 80. Complaint procedures.

(a) As used in this Section, "valid complaint" means a complaint containing an allegation that, if assumed to be true, is a violation of this Act.

(b) To ensure compliance with all applicable laws and rules, the Illinois Department of Labor shall:

(1) establish a method by which a hospital staff person or an exclusive bargaining representative of a hospital staff person may submit a complaint through the Department's website regarding any violation of this Act;

(2) no later than 14 days after receiving a complaint, send a copy of the complaint to the exclusive bargaining representative, if any, of the staff person or staff persons who filed the complaint;

(3) no later than 30 days after receiving a valid complaint of a violation of this Act, open an investigation of the hospital and provide a notice of the investigation to the hospital and the cochairs of the relevant staffing committee established under this Act, or other lawfully established committees, and to the exclusive bargaining representative, if any, of the staff person or staff persons filing the complaint. The notice must include a summary of the complaint that does not include the complainant's name or the specific date, shift, or unit but does include the calendar week in which the complaint arose;

(4) not later than 80 days after opening the investigation, conclude the investigation and provide a written report on the complaint to the hospital, the cochairs of the hospital staffing committee, and the exclusive bargaining representative, if any, of the staff person or staff persons filing the complaint. The report:

(A) shall include a summary of the complaint;

(B) shall include the nature of the alleged violation or violations;

(C) shall include the Department's findings and factual bases for the findings;

(D) shall include other information the Department determines is appropriate to include in the report; and

(E) may not include the name of any complainant, the name of any patient, or the names of any individuals that the Department interviewed in investigating the complaint;

(5) if the Department issues a warning or imposes one or more civil penalties based on the report described in this Section, the Department shall provide a notice of the civil penalty that complies with all applicable laws and rules, and to the hospital, the cochairs of the applicable hospital staffing committee, and the exclusive bargaining representative, if any, of the staff person or staff persons who filed the complaint; and

(6) in determining whether to impose a civil penalty, consider all relevant evidence, including, but not limited to, witness testimony, written documents, and the observations of the investigator.

(c) A hospital subject to a valid complaint shall provide to the Department, no later than 20 days after receiving the notice under of this Section:

(1) the staffing plan that is the subject of the complaint;

(2) if relevant to the complaint, documents that show the scheduled staffing and the actual staffing on the unit that is the subject of the complaint during the period of time specified in the complaint; and

(3) documents that show the actions described in this Act, if any, that the hospital took to comply with the staffing plan or to address the issue raised by the complaint.

(d) In conducting an investigation, the Department shall review any document:

(1) related to the complaint that is provided by the exclusive bargaining representative that filed the complaint or by the hospital staff person who filed the complaint and the person's exclusive bargaining representative, if any; and

(2) provided by the hospital in response to the complaint.

(e) In conducting an investigation, the Department may:

(1) make an on-site inspection of the unit that is the subject of the complaint;

(2) interview a manager for the unit and any other staff persons with information relevant to the complaint;

(3) interview the cochairs of the relevant staffing committee;

(4) interview the staff person or staff persons who filed the complaint unless the individual declines to be interviewed; and

(5) compel the production of books, papers, accounts, documents, and testimony pertaining to the complaint, other than documents that are privileged or not otherwise subject to disclosure.

(f) A complaint by a hospital staff person or the staff person's exclusive bargaining representative must be filed no later than 60 days after the date of the violation alleged in the complaint. The Department may not investigate a complaint or take any enforcement action with respect to a complaint that has not been filed timely.

Section 85. Penalties.

(a) The Department of Labor shall impose civil penalties in the manner provided for, or suspend or revoke a license of a hospital, for a violation of any provision of this Act. The Department shall adopt by rule a schedule establishing the amount of civil penalty that may be imposed for a violation of this Act when there is a reasonable belief that safe patient care has been or may be negatively impacted, except that a civil penalty may not exceed $5,000.

(b) The Department may suspend or revoke the license of a hospital, in the manner provided by law or rule, for a violation described in this Act.

(c) Each violation of a written hospital-wide staffing plan shall be considered a separate violation and there is no limit on the number times that a penalty may be imposed for repeated violations of the same provision.

(d) The Department may not impose a civil penalty for a violation of a nurse staffing plan, a hospital professional and technical staffing plan, or a hospital service staffing plan if the hospital took the following actions:

(1) scheduled staff in accordance with the staffing plan;

(2) sought volunteers from all available qualified employees to work extra time;

(3) contacted qualified employees who made themselves available to work extra time;

(4) solicited per diem staff to work; and

(5) contacted contracted temporary agencies, that the hospital regularly uses, if temporary staff from such agencies are permitted to work in the hospital by law or any applicable collective bargaining agreement.

(e) The Department shall maintain for public inspection records of any civil penalties or license suspensions or revocations imposed on hospitals penalized under this Section.

Section 90. Violations.

(a) Following the receipt of a complaint and completion of an investigation described in this Act, for a violation described in this Section, the Department of Public Health shall:

(1) issue a warning for the first violation in a 4 year period;

(2) impose a civil penalty of $1,750 for the second violation of the same provision in a 4 year period;

(3) impose a civil penalty of $2,500 for the third violation of the same provision in a 4 year period; and

(d) impose a civil penalty of $5,000 for the fourth and subsequent violations of the same provision in a 4 year period.

(b) The Department shall take the actions described in subsection (a) for the following violations by a hospital of this Act:

(1) failure to establish a hospital professional and technical staffing committee or a hospital service staffing committee;

(2) failure to create a professional and technical staffing plan or a hospital service staffing plan;

(3) failure to adopt a nurse staffing plan by agreement or after binding arbitration;

(4) failure to comply with the staffing level in the nurse staffing plan, including the nurse-to-patient staffing ratios prescribed in this Act, if applicable, and the failure to comply is not an allowed deviation described in this Act;

(5) failure to comply with the staffing level in the professional and technical staffing plan or the hospital service staffing plan and the failure to comply is not an allowed deviation as described in this Act;

(6) failure to comply with the staffing requirements for certified nursing assistants in this Act and the failure is not an allowed deviation this Act; or

(7) requiring a nursing staff, except as allowed by applicable law or rule to work:

(A) beyond an agreed-upon prearranged shift regardless of the length of the shift;

(B) more than 48 hours in any hospital-defined work week;

(C) more than 12 hours in a 24-hour period; or

(D) during the 10-hour period immediately following the 12th hour worked during a 24-hour period.

(c) If a staff person at a hospital is unable to attend a staffing committee meeting because the staff person was not released from other hospital duties to attend the meeting, in violation of this Act, the Department shall:

(1) issue a warning for the first violation; and

(2) impose a civil penalty of $500 for a second and each subsequent violation.

(d) A direct-care staff person, a hospital professional or technical staff person, or a hospital service staff person, or an exclusive bargaining representative of a direct-care staff person, a hospital professional or technical staff person, or a hospital service staff person, may elect to enforce meal break and rest break violations under this Act and other applicable laws and rules by filing a complaint with the Department in accordance with this Act.

Section 95. Public records. The Illinois Department of Labor shall post on a website maintained by the Department:

(1) reports of audits described in this Act of the hospital staffing plans received by the Department;

(2) any report of this Act made pursuant to an investigation under this Act;

(3) any order requiring a hospital to implement a plan to correct a violation;

(4) any order imposing a civil penalty against a hospital or suspending or revoking the license of a hospital pursuant; and

(5) any other matter recommended by the Illinois Nursing Workforce Center and Advisory Board.

Section 100. Long term care facilities.

(a) Licenses for long term care facilities must be obtained from the Department of Public Health.

(b) Applications shall be upon such forms and shall contain such information as the Department or may reasonably require, which may include affirmative evidence of ability to comply with such reasonable standards and rules as may lawfully be prescribed.

(c) Each application submitted to the Department must be accompanied by the application fee or the annual renewal fee, as applicable. If the license is denied, the fee shall be refunded to the applicant. If the license is issued, the fee shall be paid into the State Treasury to the credit of the Department of Public Health for the purpose of carrying out the functions of the Department.

(d) Except as otherwise provided in this Act, for hospitals with:

(1) fewer than 26 beds, the annual license fee shall be $1,250;

(2) 26 beds or more but fewer than 50 beds, the annual license fee shall be $1,850;

(3) 50 or more beds but fewer than 100 beds, the annual license fee shall be $3,800;

(4) 100 beds or more but fewer than 200 beds, the annual license fee shall be $6,525;

(5) 200 or more beds, but fewer than 500 beds, the annual license fee shall be $8,500; and

(6) 500 or more beds, the annual license fee shall be $12,070.

(e) A hospital shall pay an annual fee of $750 for each hospital satellite endorsed under the hospital's license.

(f) The Department of Public Health may charge a reduced hospital fee or hospital satellite fee if the Department determines that charging the standard fee constitutes a significant financial burden to the facility.

(g) For long term care facilities with:

(1) one to 15 beds, the application fee shall be $2,000 and the annual renewal fee shall be $1,000;

(2) 16 to 49 beds, the application fee shall be $3,000 and the annual renewal fee shall be $1,500;

(3) 50 to 99 beds, the application fee shall be $4,000 and the annual renewal fee shall be $2,000;

(4) 100 to 150 beds, the application fee shall be $5,000 and the annual renewal fee shall be $2,500; and

(5) More than 150 beds, the application fee shall be $6,000 and the annual renewal fee shall be $3,000.

(h) For ambulatory surgical centers, the annual license fee shall be:

(1) $1,750 for certified and high complexity noncertified ambulatory surgical centers with more than 2 procedure rooms.

(2) $1,250 for certified and high complexity noncertified ambulatory surgical centers with no more than 2 procedure rooms.

(3) $1,000 for moderate complexity noncertified ambulatory surgical centers.

(i) For birthing centers, the annual license fee shall be $750.

(j) For outpatient renal dialysis facilities, the annual license fee shall be $2,000.

(k) The Department shall prescribe by rule the fee for licensing an extended stay center, not to exceed:

(1) an application fee of $25,000; and

(2) an annual renewal fee of $5,000.

(l) During the time the license remains in force, a holder is not required to pay inspection fees to any county, city, or other municipality.

(m) Any health care facility license may be endorsed to permit operation at more than one location. If so, the applicable license fee shall be the sum of the license fees that would be applicable if each location were separately licensed. The Department may include hospital satellites on a hospital's license in accordance with rules adopted by the Department.

(n) Licenses for health maintenance organizations shall be obtained from the Department of Public Health.

(o) Notwithstanding any other provisions, all moneys received for approved applications under this Act shall be deposited in the Long Term Care Ombudsman Fund.

(p) As used in this Section:

"Hospital satellite" has the meaning prescribed by the Department by rule.

"Procedure room" means a room where surgery or invasive procedures are performed.

Section 105. Hospital-wide staffing plan variances. Upon request of a hospital, the Illinois Department of Labor may grant a variance to the written hospital-wide staffing plan requirements described in this Act if the variance is necessary to ensure that the hospital is staffed to meet the health care needs of patients.

Section 110. Emergency staffing variances.

(a) As used in this Section, "epidemic" means the occurrence of a group of similar conditions of public health importance in a community or region that are in excess of normal expectancy and that are from a common or propagated source.

(b) Notwithstanding any other provision of law, a hospital is not required to follow a written hospital-wide staffing plan developed and approved by the hospital nurse staffing committee upon the occurrence of:

(1) a national emergency or State emergency declaration requiring the implementation of a facility disaster plan and crisis standards of care;

(2) sudden unforeseen adverse weather conditions; or

(3) an infectious disease epidemic suffered by hospital staff.

(c) No later than 30 days after a hospital deviates from a written hospital-wide staffing plan under this Section, the hospital incident command shall report to the cochairs of the hospital nurse staffing committee an assessment of the nurse staffing needs arising from the national or State emergency declaration as follows:

(1) Upon receipt of the report described in this subsection, the hospital nurse staffing committee shall convene to develop a contingency nurse staffing plan to address the needs arising from the national or State emergency declaration. The contingency nurse staffing plan must include crisis standards of care.

(2) The hospital's deviation from the written hospital-wide staffing plan may not be in effect for more than 90 days without the approval of the hospital nurse staffing committee.

(3) Upon the occurrence of a national or State emergency declaration, or circumstances not described in this Act, either cochair of the hospital nurse staffing committee may require the hospital nurse staffing committee to meet to review, and potentially modify, the staffing plan in response to the emergency declaration or circumstances.

Section 115. Nurse staff advisory board.

(a) The Nurse Staffing Advisory Board is established within the Department of Public Health, consisting the following members appointed by the Governor:

(1) 6 must be hospital nurse managers;

(2) 3 must be direct-care registered nurses who work in hospitals;

(3) 3 must be patient-care nurses who work in hospitals; and

(4) One must be either a direct-care registered nurse who works in a hospital or a direct-care staff member who is not a registered nurse and whose services are covered by a written hospital wide staffing plan that meets the requirements of this Act.

To the extent practicable, Board members shall be appointed to ensure that the Board is represented by members from hospitals where direct-care staff are represented under a collective bargaining agreement and hospitals where direct-care staff are not represented by a collective bargaining agreement and by hospitals of different sizes, types, and geographic locations.

The term of office of each Board member is 3 years, except each member serves at the pleasure of the Governor. Before the expiration of the term of a member, the Governor shall appoint a successor whose term begins January 1 of the next calendar year. A member is eligible for reappointment but may not serve more than 2 consecutive terms. If there is a vacancy for any cause, the Governor shall make an appointment to become immediately effective for the unexpired term.

(b) The Board shall:

(1) provide advice to the Department on the administration of this Act;

(2) identify trends, opportunities, and concerns related to nurse staffing;

(3) make recommendations to the Department on the basis of those trends, opportunities, and concerns; and

(4) review the Department's enforcement powers and processes under this Act.

(c) Upon request, the Department shall provide the Board with written hospital-wide staffing plans, reviews conducted, information obtained during an audit, and complaints filed and investigations conducted as described in this Act as follows:

(1) The Department may not provide the Board with any information under this subsection that is id entifiable with a specific hospital unless the information is publicly available.

(2) Hospital-wide staffing plans provided to the Board under this Section are confidential and not subject to public disclosure.

(d) A majority of the members of the Board constitutes a quorum for the transaction of business.

(e) The Board shall have 2 cochairs selected by the Governor. One cochair shall be a hospital nurse manager and one cochair shall be a patient care technician or certified nursing assistant.

(f) Official action by the Board requires the approval of a majority of the members of the Board.

(g) The Board shall meet:

(1) at least once every 3 months; and

(2) at any time and place specified by the call of both cochairs.

(h) The Board may adopt rules necessary for the operation of the Board.

(i) The Board shall submit a report on the administration of this Act to the General Assembly no later than September 15 of each year. The Board may include in its report recommendations for legislation.

(j) Members of the Board are not entitled to compensation, but may be reimbursed for actual and necessary travel and other expenses incurred by them in the performance of their official duties in the manner and amounts provided for. Claims for expenses shall be paid out of funds appropriated to the Department for purposes of the Board.

Section 120. Record keeping. A hospital shall keep and maintain records necessary to demonstrate compliance with this Act. For purposes of this Section, the Department of Public Health shall adopt rules specifying the content of the records and the form and manner of keeping, maintaining, and disposing of the records. A hospital must provide records kept and maintained under this Section to the Department of Public Health upon request.

Section 125. Department of Labor rulemaking.

(a) The Director of Labor may adopt rules prescribing such minimum conditions of employment, excluding minimum wages, in any occupation as may be necessary for the preservation of the health of employees. The rules may include, but are not limited to, minimum meal periods and rest periods, and maximum hours of work, but not less than 8 hours per day or 40 hours per workweek; however, after 40 hours of work in one workweek overtime may be paid, but in no case at a rate higher than one and one-half times the regular rate of pay of the employees when computed without benefits of commissions, overrides, bonuses, and similar benefits.

As used in this subsection, "workweek" means a fixed period of time established by an employer that reflects a regularly recurring period of 168 hours or 7 consecutive 24-hour periods. A workweek may begin on any day of the week and any hour of the day and need not coincide with a calendar week. The beginning of the workweek may be changed if the change is intended to be permanent and is not designed to evade overtime requirements.

(b) Rules adopted by the Director of Labor under this Section do not apply to individuals employed by this State or a unit of local government if other provisions of law or collective bargaining agreements prescribe rules pertaining to conditions of employment referred to in this Section, including meal periods, rest periods, maximum hours of work, and overtime.

(c) Except as provided, rules adopted by the Department of Labor under this Section regarding meal periods and rest periods do not apply to nurses who provide acute care in hospital settings if provisions of collective bargaining agreements entered into by the nurses prescribe rules concerning meal periods and rest periods.

(d) The Director of Labor shall adopt rules regarding meal periods for employees who serve food or beverages, receive tips, and report the tips to the employer as follows:

(1) In rules adopted by the Director of Labor under this subsection, the Director shall permit an employee to waive a meal period, except that, an employer may not coerce an employee into waiving a meal period.

(2) Notwithstanding any other provision, in addition to any other penalty provided by law, the Director may assess a civil penalty not to exceed $2,000 against an employer that the commissioner finds has coerced an employee into waiving a meal period in violation of this Section. Each violation is a separate and distinct offense. In the case of a continuing violation, each day's continuance is a separate and distinct violation.

(3) Civil penalties authorized by this Section shall be imposed in the manner provided for under Illinois law. All sums collected as penalties under this Section shall be applied and paid over as provided.

Section 130. Rulemaking. The Department of Public Health may adopt any rules necessary for implementation of this Act, except when this Act authorizes another State department to adopt rules relating to this Act.

Section 999. Effective date. This Act takes effect upon becoming law.