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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Alternative Health Care Delivery Act is | ||||||
5 | amended by changing Section 35 as follows:
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6 | (210 ILCS 3/35)
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7 | Sec. 35. Alternative health care models authorized. | ||||||
8 | Notwithstanding
any other law to the contrary, alternative | ||||||
9 | health care models
described in this Section may be established | ||||||
10 | on a demonstration basis.
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11 | (1) Alternative health care model; subacute care | ||||||
12 | hospital. A subacute
care hospital is a designated site | ||||||
13 | which provides medical specialty care for
patients who need | ||||||
14 | a greater intensity or complexity of care than generally
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15 | provided in a skilled nursing facility but who no longer | ||||||
16 | require acute hospital
care. The average length of stay for | ||||||
17 | patients treated in subacute care
hospitals shall not be | ||||||
18 | less than 20 days, and for individual patients, the
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19 | expected length of stay at the time of admission shall not | ||||||
20 | be less than 10
days. Variations from minimum lengths of | ||||||
21 | stay shall be reported to the
Department. There shall be no | ||||||
22 | more than 13 subacute care hospitals
authorized to operate | ||||||
23 | by the Department. Subacute care includes physician
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1 | supervision, registered nursing, and physiological | ||||||
2 | monitoring on a continual
basis. A subacute care hospital | ||||||
3 | is either a freestanding building or a distinct
physical | ||||||
4 | and operational entity within a hospital or nursing home | ||||||
5 | building. A
subacute care hospital shall only consist of | ||||||
6 | beds currently existing in
licensed hospitals or skilled | ||||||
7 | nursing facilities, except, in the City of
Chicago, on a | ||||||
8 | designated site that was licensed as a hospital under the
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9 | Illinois Hospital Licensing Act within the 10 years | ||||||
10 | immediately before the
application for an alternative | ||||||
11 | health care model license. During the period of
operation | ||||||
12 | of the demonstration project, the existing licensed beds | ||||||
13 | shall remain
licensed as hospital or skilled nursing | ||||||
14 | facility beds as well as being licensed
under this Act. In | ||||||
15 | order to handle cases of
complications, emergencies, or | ||||||
16 | exigent circumstances, a subacute care hospital
shall | ||||||
17 | maintain a contractual relationship, including a transfer | ||||||
18 | agreement, with
a general acute care hospital. If a | ||||||
19 | subacute care model is located in a
general acute care | ||||||
20 | hospital, it shall utilize all or a portion of the bed
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21 | capacity of that existing hospital. In no event shall a | ||||||
22 | subacute care hospital
use the word "hospital" in its | ||||||
23 | advertising or marketing activities or represent
or hold | ||||||
24 | itself out to the public as a general acute care hospital.
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25 | (2) Alternative health care delivery model; | ||||||
26 | postsurgical recovery care
center. A postsurgical recovery |
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1 | care center is a designated site which
provides | ||||||
2 | postsurgical recovery care for generally healthy patients
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3 | undergoing surgical procedures that require overnight | ||||||
4 | nursing care, pain
control, or observation that would | ||||||
5 | otherwise be provided in an inpatient
setting. A | ||||||
6 | postsurgical recovery care center is either freestanding | ||||||
7 | or a
defined unit of an ambulatory surgical treatment | ||||||
8 | center or hospital.
No facility, or portion of a facility, | ||||||
9 | may participate in a demonstration
program as a | ||||||
10 | postsurgical recovery care center unless the facility has | ||||||
11 | been
licensed as an ambulatory surgical treatment center or | ||||||
12 | hospital for at least 2
years before August 20, 1993 (the | ||||||
13 | effective date of Public Act 88-441). The
maximum length of | ||||||
14 | stay for patients in a
postsurgical recovery care center is | ||||||
15 | not to exceed 48 hours unless the treating
physician | ||||||
16 | requests an extension of time from the recovery center's | ||||||
17 | medical
director on the basis of medical or clinical | ||||||
18 | documentation that an additional
care period is required | ||||||
19 | for the recovery of a patient and the medical director
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20 | approves the extension of time. In no case, however, shall | ||||||
21 | a patient's length
of stay in a postsurgical recovery care | ||||||
22 | center be longer than 72 hours. If a
patient requires an | ||||||
23 | additional care period after the expiration of the 72-hour
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24 | limit, the patient shall be transferred to an appropriate | ||||||
25 | facility. Reports on
variances from the 48-hour limit shall | ||||||
26 | be sent to the Department for its
evaluation. The reports |
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1 | shall, before submission to the Department, have
removed | ||||||
2 | from them all patient and physician identifiers. In order | ||||||
3 | to handle
cases of complications, emergencies, or exigent | ||||||
4 | circumstances, every
postsurgical recovery care center as | ||||||
5 | defined in this paragraph shall maintain a
contractual | ||||||
6 | relationship, including a transfer agreement, with a | ||||||
7 | general acute
care hospital. A postsurgical recovery care | ||||||
8 | center shall be no larger than 20
beds. A postsurgical | ||||||
9 | recovery care center shall be located within 15 minutes
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10 | travel time from the general acute care hospital with which | ||||||
11 | the center
maintains a contractual relationship, including | ||||||
12 | a transfer agreement, as
required under this paragraph.
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13 | No postsurgical recovery care center shall | ||||||
14 | discriminate against any patient
requiring treatment | ||||||
15 | because of the source of payment for services, including
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16 | Medicare and Medicaid recipients.
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17 | The Department shall adopt rules to implement the | ||||||
18 | provisions of Public
Act 88-441 concerning postsurgical | ||||||
19 | recovery care centers within 9 months after
August 20, | ||||||
20 | 1993.
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21 | (3) Alternative health care delivery model; children's | ||||||
22 | community-based
health care center. A children's | ||||||
23 | community-based health care center model is a
designated | ||||||
24 | site that provides nursing care, clinical support | ||||||
25 | services, and
therapies for a period of one to 14 days for | ||||||
26 | short-term stays and 120 days to
facilitate transitions to |
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1 | home or other appropriate settings for medically
fragile | ||||||
2 | children, technology
dependent children, and children with | ||||||
3 | special health care needs who are deemed
clinically stable | ||||||
4 | by a physician and are younger than 22 years of age. This
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5 | care is to be provided in a home-like environment that | ||||||
6 | serves no more than 12
children at a time. Children's | ||||||
7 | community-based health care center
services must be | ||||||
8 | available through the model to all families, including | ||||||
9 | those
whose care is paid for through the Department of | ||||||
10 | Healthcare and Family Services
Public Aid , the Department | ||||||
11 | of
Children and Family Services, the Department of Human | ||||||
12 | Services, and insurance
companies who cover home health | ||||||
13 | care services or private duty nursing care in
the home.
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14 | Each children's community-based health care center | ||||||
15 | model location shall be
physically separate and
apart from | ||||||
16 | any other facility licensed by the Department of Public | ||||||
17 | Health under
this or any other Act and shall provide the | ||||||
18 | following services: respite care,
registered nursing or | ||||||
19 | licensed practical nursing care, transitional care to
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20 | facilitate home placement or other appropriate settings | ||||||
21 | and reunite families,
medical day care, weekend
camps, and | ||||||
22 | diagnostic studies typically done in the home setting.
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23 | Coverage for the services provided by the Illinois
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24 | Department of Healthcare and Family Services
Public
Aid
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25 | under this paragraph (3) is contingent upon federal waiver | ||||||
26 | approval and is
provided only to Medicaid eligible clients |
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1 | participating in the home and
community based services | ||||||
2 | waiver designated in Section 1915(c) of the Social
Security | ||||||
3 | Act for medically frail and technologically dependent | ||||||
4 | children or
children in Department of Children and Family | ||||||
5 | Services foster care who receive
home health benefits.
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6 | (4) Alternative health care delivery model; community | ||||||
7 | based residential
rehabilitation center.
A community-based | ||||||
8 | residential rehabilitation center model is a designated
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9 | site that provides rehabilitation or support, or both, for | ||||||
10 | persons who have
experienced severe brain injury, who are | ||||||
11 | medically stable, and who no longer
require acute | ||||||
12 | rehabilitative care or intense medical or nursing | ||||||
13 | services. The
average length of stay in a community-based | ||||||
14 | residential rehabilitation center
shall not exceed 4 | ||||||
15 | months. As an integral part of the services provided,
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16 | individuals are housed in a supervised living setting while | ||||||
17 | having immediate
access to the community. The residential | ||||||
18 | rehabilitation center authorized by
the Department may | ||||||
19 | have more than one residence included under the license.
A | ||||||
20 | residence may be no larger than 12 beds and shall be | ||||||
21 | located as an integral
part of the community. Day treatment | ||||||
22 | or
individualized outpatient services shall be provided | ||||||
23 | for persons who reside in
their own home. Functional | ||||||
24 | outcome goals shall be established for each
individual. | ||||||
25 | Services shall include, but are not limited to, case | ||||||
26 | management,
training and assistance with activities of |
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1 | daily living, nursing
consultation, traditional therapies | ||||||
2 | (physical, occupational, speech),
functional interventions | ||||||
3 | in the residence and community (job placement,
shopping, | ||||||
4 | banking, recreation), counseling, self-management | ||||||
5 | strategies,
productive activities, and multiple | ||||||
6 | opportunities for skill acquisition and
practice | ||||||
7 | throughout the day. The design of individualized program | ||||||
8 | plans shall
be consistent with the outcome goals that are | ||||||
9 | established for each resident.
The programs provided in | ||||||
10 | this setting shall be accredited by the
Commission
on | ||||||
11 | Accreditation of Rehabilitation Facilities (CARF). The | ||||||
12 | program shall have
been accredited by CARF as a Brain | ||||||
13 | Injury Community-Integrative Program for at
least 3 years.
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14 | (5) Alternative health care delivery model; | ||||||
15 | Alzheimer's disease
management center. An Alzheimer's | ||||||
16 | disease management center model is a
designated site that | ||||||
17 | provides a safe and secure setting for care of persons
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18 | diagnosed with Alzheimer's disease. An Alzheimer's disease | ||||||
19 | management center
model shall be a facility separate from | ||||||
20 | any other facility licensed by the
Department of Public | ||||||
21 | Health under this or any other Act. An Alzheimer's
disease | ||||||
22 | management center shall conduct and document an assessment | ||||||
23 | of each
resident every 6 months. The assessment shall | ||||||
24 | include an evaluation of daily
functioning, cognitive | ||||||
25 | status, other medical conditions, and behavioral
problems. | ||||||
26 | An Alzheimer's disease management center shall develop and |
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1 | implement
an ongoing treatment plan for each resident. The | ||||||
2 | treatment
plan shall have defined goals.
The
Alzheimer's | ||||||
3 | disease management center shall treat behavioral problems | ||||||
4 | and mood
disorders using nonpharmacologic approaches such | ||||||
5 | as environmental modification,
task simplification, and | ||||||
6 | other appropriate activities.
All staff must have | ||||||
7 | necessary
training to care for all stages of Alzheimer's | ||||||
8 | Disease. An
Alzheimer's disease
management center shall | ||||||
9 | provide education and support for residents and
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10 | caregivers. The
education and support shall include | ||||||
11 | referrals to support organizations for
educational | ||||||
12 | materials on community resources, support groups, legal | ||||||
13 | and
financial issues, respite care, and future care needs | ||||||
14 | and options. The
education and support shall also include a | ||||||
15 | discussion of the resident's need to
make advance | ||||||
16 | directives and to identify surrogates for medical and legal
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17 | decision-making. The provisions of this paragraph | ||||||
18 | establish the minimum level
of services that must be | ||||||
19 | provided by an Alzheimer's disease management
center. An | ||||||
20 | Alzheimer's disease management center model shall have no | ||||||
21 | more
than 100 residents. Nothing in this paragraph (5) | ||||||
22 | shall be construed as
prohibiting a person or facility from | ||||||
23 | providing services and care to persons
with Alzheimer's | ||||||
24 | disease as otherwise authorized under State law.
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25 | (6) Alternative health care model; long term acute care | ||||||
26 | hospital conversion. A long term acute care hospital |
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1 | conversion is a Long Term Acute Care Hospital (LTACH) | ||||||
2 | created by converting a facility or a portion of a facility | ||||||
3 | previously licensed as a long-term care facility under the | ||||||
4 | Nursing Home Care Act. This model shall allow for a maximum | ||||||
5 | of 4 such LTACH conversions, one of which shall be located | ||||||
6 | in the area of Illinois within the St. Louis Metropolitan | ||||||
7 | Statistical Area. The LTACH conversions shall each have no | ||||||
8 | more than 60 beds and provide services to patients whose | ||||||
9 | medical condition requires long-term medical care as | ||||||
10 | described in Section 1886(d)(i)(B)(n) of the Social | ||||||
11 | Security Act as hospitals that have an average Medicare | ||||||
12 | inpatient length of stay greater than 25 days. The LTACH | ||||||
13 | conversion shall provide extended medical and | ||||||
14 | rehabilitative care, such as but not limited to | ||||||
15 | comprehensive rehabilitation, respiratory therapy, cancer | ||||||
16 | treatment, head trauma treatment, and pain management, for | ||||||
17 | patients who are clinically complex and may suffer from | ||||||
18 | multiple acute or chronic conditions. Facilities licensed | ||||||
19 | under this model shall be exempt from the requirements of | ||||||
20 | the Illinois Health Facilities Planning Act. The | ||||||
21 | Department shall adopt rules specifying criteria, | ||||||
22 | standards, and procedures for the establishment, | ||||||
23 | licensure, and operation of LTACH conversions as | ||||||
24 | authorized under this Act. These rules shall create a new | ||||||
25 | category of licensure, which shall be consistent with the | ||||||
26 | LTACH requirements under the applicable provisions of the |
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1 | Social Security Act to ensure that the LTACH conversions | ||||||
2 | can be certified under Medicare to provide such services. | ||||||
3 | The Department shall also adopt rules that identify the | ||||||
4 | applicable building codes for licensure of LTACH | ||||||
5 | conversions. The rules shall allow existing licensed and | ||||||
6 | certified buildings to be reviewed under "existing | ||||||
7 | construction" standards in the applicable codes. For | ||||||
8 | purposes of this Act, the facility must maintain a 2-hour | ||||||
9 | separation in accordance with the applicable construction | ||||||
10 | codes, for purposes of fire safety. This separation may be | ||||||
11 | vertical, horizontal, or a combination of both. For the | ||||||
12 | purpose of defining a horizontal building separation, a | ||||||
13 | barrier of 2.5 inches or more of concrete, or any other | ||||||
14 | tested assembly that has a rating of 2 hours or more, will | ||||||
15 | be acceptable.
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16 | The Department shall adopt the rules implementing this | ||||||
17 | model within 6 months after the effective date of this | ||||||
18 | amendatory Act of the 95th General Assembly. If the | ||||||
19 | Department fails to adopt rules by the required date, the | ||||||
20 | Department shall proceed with licensure utilizing the | ||||||
21 | applicable Medicare conditions of participation. | ||||||
22 | (Source: P.A. 93-402, eff. 1-1-04; revised 12-15-05.)
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.
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