102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2423

 

Introduced 2/17/2021, by Rep. Robert Rita

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/3-202.05
210 ILCS 45/3-206a new

    Amends the Nursing Home Care Act. Provides that the Department of Public Health shall certify the Temporary Nursing Assistant Training Program that it implemented by emergency rule. Provides that the Department shall deem an individual who has completed a training program and competency assessment under the Temporary Nursing Assistant Training Program as satisfying the requirement of completing a nurse aide training and competency evaluation program approved by the State under specified eligibility provisions. Provides that a person shall be deemed to have completed the eligibility provisions if they have completed all nursing assistant training and competency evaluation program requirements and shall be placed on the State nurse aide registry as "active". Provides that temporary nursing assistants must enroll in an approved certified nursing assistant training program no later than 2 years after completion of the Temporary Nursing Assistant Training Program. Provides that, once enrolled in the certified nursing assistant training program, the individual may work as a nursing assistant in training and continue to practice the same skills he or she did as a temporary nursing assistant and new competencies he or she has learned in his or her certified nursing assistant training. Makes conforming changes.


LRB102 15042 SPS 20397 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB2423LRB102 15042 SPS 20397 b

1    AN ACT concerning regulation.
 
2    WHEREAS, During the COVID-19 pandemic, federal and State
3regulatory and statutory provisions have been waived to assist
4in the hiring of temporary nurse assistants; and
 
5    WHEREAS, Individuals have served admirably and
6compassionately in this capacity and have demonstrated through
7accelerated training and experience competency to transition
8to fully registered status as a nurse aide; and
 
9    WHEREAS, This program created 1,700 jobs in communities
10where people found themselves out of work due to closures and
11gave them a pathway to excel in the healthcare career ladder;
12and
 
13    WHEREAS, Upon the cessation of the program on January
1418th, 2021, many nursing homes have continued to receive
15applications from a number of unemployed individuals wanting
16to join the Temporary Nursing Assistant Training Program; and
 
17    WHEREAS, While nursing homes are experiencing shortages in
18staff, State certification of the Program will provide
19additional help to care for loved ones, create jobs, and
20expand the need of increased workforce in the nursing home
21sector as they transition into a certified nurse assistant
22certification; and
 

 

 

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1    WHEREAS, Temporary nurse assistants are required to
2successfully complete a State-approved training and evaluation
3in order to be employed as a nurse aide in a skilled nursing
4facility; and
 
5    WHEREAS, The purpose of this training is to ensure that
6nurse aides have the education, practical knowledge, and
7skills needed to care for residents of facilities
8participating in the Medicare and Medicaid programs; and
 
9    WHEREAS, As a matter of public policy, the Temporary
10Nursing Assistant Program should take into account training
11and experience acquired during the COVID-19 pandemic to
12transition these individuals to placement on the State's nurse
13aide registry; therefore
 
14    Be it enacted by the People of the State of Illinois,
15represented in the General Assembly:
 
16    Section 5. The Nursing Home Care Act is amended by
17changing Section 3-202.05 and by adding Section 3-206a as
18follows:
 
19    (210 ILCS 45/3-202.05)
20    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and

 

 

HB2423- 3 -LRB102 15042 SPS 20397 b

1thereafter.
2    (a) For the purpose of computing staff to resident ratios,
3direct care staff shall include:
4        (1) registered nurses;
5        (2) licensed practical nurses;
6        (3) certified nurse assistants;
7        (4) psychiatric services rehabilitation aides;
8        (5) rehabilitation and therapy aides;
9        (6) psychiatric services rehabilitation coordinators;
10        (7) assistant directors of nursing;
11        (8) 50% of the Director of Nurses' time; and
12        (9) 30% of the Social Services Directors' time; and .
13        (10) temporary nursing assistants in the Temporary
14    Nursing Assistants Training Program under Section 3-206a.
15    The Department shall, by rule, allow certain facilities
16subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
17S) to utilize specialized clinical staff, as defined in rules,
18to count towards the staffing ratios.
19    Within 120 days of the effective date of this amendatory
20Act of the 97th General Assembly, the Department shall
21promulgate rules specific to the staffing requirements for
22facilities federally defined as Institutions for Mental
23Disease. These rules shall recognize the unique nature of
24individuals with chronic mental health conditions, shall
25include minimum requirements for specialized clinical staff,
26including clinical social workers, psychiatrists,

 

 

HB2423- 4 -LRB102 15042 SPS 20397 b

1psychologists, and direct care staff set forth in paragraphs
2(4) through (6) and any other specialized staff which may be
3utilized and deemed necessary to count toward staffing ratios.
4    Within 120 days of the effective date of this amendatory
5Act of the 97th General Assembly, the Department shall
6promulgate rules specific to the staffing requirements for
7facilities licensed under the Specialized Mental Health
8Rehabilitation Act of 2013. These rules shall recognize the
9unique nature of individuals with chronic mental health
10conditions, shall include minimum requirements for specialized
11clinical staff, including clinical social workers,
12psychiatrists, psychologists, and direct care staff set forth
13in paragraphs (4) through (6) and any other specialized staff
14which may be utilized and deemed necessary to count toward
15staffing ratios.
16    (b) (Blank).
17    (b-5) For purposes of the minimum staffing ratios in this
18Section, all residents shall be classified as requiring either
19skilled care or intermediate care.
20    As used in this subsection:
21    "Intermediate care" means basic nursing care and other
22restorative services under periodic medical direction.
23    "Skilled care" means skilled nursing care, continuous
24skilled nursing observations, restorative nursing, and other
25services under professional direction with frequent medical
26supervision.

 

 

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1    (c) Facilities shall notify the Department within 60 days
2after the effective date of this amendatory Act of the 96th
3General Assembly, in a form and manner prescribed by the
4Department, of the staffing ratios in effect on the effective
5date of this amendatory Act of the 96th General Assembly for
6both intermediate and skilled care and the number of residents
7receiving each level of care.
8    (d)(1) (Blank).
9    (2) (Blank).
10    (3) (Blank).
11    (4) (Blank).
12    (5) Effective January 1, 2014, the minimum staffing ratios
13shall be increased to 3.8 hours of nursing and personal care
14each day for a resident needing skilled care and 2.5 hours of
15nursing and personal care each day for a resident needing
16intermediate care.
17    (e) Ninety days after the effective date of this
18amendatory Act of the 97th General Assembly, a minimum of 25%
19of nursing and personal care time shall be provided by
20licensed nurses, with at least 10% of nursing and personal
21care time provided by registered nurses. These minimum
22requirements shall remain in effect until an acuity based
23registered nurse requirement is promulgated by rule concurrent
24with the adoption of the Resource Utilization Group
25classification-based payment methodology, as provided in
26Section 5-5.2 of the Illinois Public Aid Code. Registered

 

 

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1nurses and licensed practical nurses employed by a facility in
2excess of these requirements may be used to satisfy the
3remaining 75% of the nursing and personal care time
4requirements. Notwithstanding this subsection, no staffing
5requirement in statute in effect on the effective date of this
6amendatory Act of the 97th General Assembly shall be reduced
7on account of this subsection.
8    (f) The Department shall submit proposed rules for
9adoption by January 1, 2020 establishing a system for
10determining compliance with minimum staffing set forth in this
11Section and the requirements of 77 Ill. Adm. Code 300.1230
12adjusted for any waivers granted under Section 3-303.1.
13Compliance shall be determined quarterly by comparing the
14number of hours provided per resident per day using the
15Centers for Medicare and Medicaid Services' payroll-based
16journal and the facility's daily census, broken down by
17intermediate and skilled care as self-reported by the facility
18to the Department on a quarterly basis. The Department shall
19use the quarterly payroll-based journal and the self-reported
20census to calculate the number of hours provided per resident
21per day and compare this ratio to the minimum staffing
22standards required under this Section, as impacted by any
23waivers granted under Section 3-303.1. Discrepancies between
24job titles contained in this Section and the payroll-based
25journal shall be addressed by rule.
26    (g) The Department shall submit proposed rules for

 

 

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1adoption by January 1, 2020 establishing monetary penalties
2for facilities not in compliance with minimum staffing
3standards under this Section. No monetary penalty may be
4issued for noncompliance during the implementation period,
5which shall be July 1, 2020 through September 30, 2020. If a
6facility is found to be noncompliant during the implementation
7period, the Department shall provide a written notice
8identifying the staffing deficiencies and require the facility
9to provide a sufficiently detailed correction plan to meet the
10statutory minimum staffing levels. Monetary penalties shall be
11imposed beginning no later than January 1, 2021 and quarterly
12thereafter and shall be based on the latest quarter for which
13the Department has data. Monetary penalties shall be
14established based on a formula that calculates on a daily
15basis the cost of wages and benefits for the missing staffing
16hours. All notices of noncompliance shall include the
17computations used to determine noncompliance and establishing
18the variance between minimum staffing ratios and the
19Department's computations. The penalty for the first offense
20shall be 125% of the cost of wages and benefits for the missing
21staffing hours. The penalty shall increase to 150% of the cost
22of wages and benefits for the missing staffing hours for the
23second offense and 200% the cost of wages and benefits for the
24missing staffing hours for the third and all subsequent
25offenses. The penalty shall be imposed regardless of whether
26the facility has committed other violations of this Act during

 

 

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1the same period that the staffing offense occurred. The
2penalty may not be waived, but the Department shall have the
3discretion to determine the gravity of the violation in
4situations where there is no more than a 10% deviation from the
5staffing requirements and make appropriate adjustments to the
6penalty. The Department is granted discretion to waive the
7penalty when unforeseen circumstances have occurred that
8resulted in call-offs of scheduled staff. This provision shall
9be applied no more than 6 times per quarter. Nothing in this
10Section diminishes a facility's right to appeal.
11(Source: P.A. 101-10, eff. 6-5-19.)
 
12    (210 ILCS 45/3-206a new)
13    Sec. 3-206a. Certification of temporary nursing
14assistants.
15    (a) The Department shall certify the Temporary Nursing
16Assistant Training Program that it implemented by emergency
17rule under 77 Ill. Adm. Code 395.2.
18    (b) Notwithstanding the State-approved nurse aide training
19programs, the Department shall deem an individual as
20satisfying the requirement of completing a nurse aide training
21and competency evaluation program approved by the State if:
22        (1) the individual successfully completed a training
23    program and competency assessment under the Temporary
24    Nursing Assistant Training Program, including online
25    training and an online examination;

 

 

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1        (2) the individual completed a minimum of 80 hours of
2    temporary nursing assistant or supervised practical nurse
3    aide training, on-the-job training apprenticeship, or
4    regular in-services nurse aide education during the
5    declared COVID-19 emergency under the supervision of a
6    licensed or registered nurse; or
7        (3) the individual's competency has been established
8    by one of the following:
9            (A) successful completion of the State temporary
10        nursing assistant examination;
11            (B) certification by a site administrator
12        responsible for assessing the individual's competency
13        skills as part of an approved apprenticeship program;
14        or
15            (C) through an assessment in all areas of required
16        nurse aide training as provided for in 42 CFR
17        483.152(b) by the hiring entity.
18    (c) Individuals who meet the eligibility provisions in
19subsection (b) shall be deemed to have completed all nursing
20assistant training and competency evaluation program
21requirements and shall be placed on the State nurse aide
22registry as "active".
23    (d) Temporary nursing assistants must enroll in an
24approved certified nursing assistant training program within 2
25years of completion of the Temporary Nursing Assistant
26Training Program.

 

 

HB2423- 10 -LRB102 15042 SPS 20397 b

1    The individual shall receive one hour of credit for every
2hour employed as a temporary nursing assistant, up to 40
3hours.
4    Once enrolled in the certified nursing assistant training
5program, the individual may work as a nursing assistant in
6training and continue to practice the same skills he or she did
7as a temporary nursing assistant and new competencies he or
8she has learned in his or her certified nursing assistant
9training.
10    (e) The Department shall incorporate this Section as part
11of the State-approved nurse aide training programs.