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1    AN ACT concerning nursing.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:

5    Section 1-1. This Article may be referred to as the Nurse
6Staffing Improvement Act.
7    Section 1-5. The Hospital Licensing Act is amended by
8changing Sections 7, 10.10, and 14.5 as follows:
9    (210 ILCS 85/7)  (from Ch. 111 1/2, par. 148)
10    Sec. 7. (a) The Director after notice and opportunity for
11hearing to the applicant or licensee may deny, suspend, or
12revoke a permit to establish a hospital or deny, suspend, or
13revoke a license to open, conduct, operate, and maintain a
14hospital in any case in which he finds that there has been a
15substantial failure to comply with the provisions of this Act,
16the Hospital Report Card Act, or the Illinois Adverse Health
17Care Events Reporting Law of 2005 or the standards, rules, and
18regulations established by virtue of any of those Acts. The
19Department may impose fines on hospitals, not to exceed $500
20per occurrence, for failing to (1) initiate a criminal
21background check on a patient that meets the criteria for



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1hospital-initiated background checks or (2) report the death
2of a person known to be a resident of a facility licensed under
3the ID/DD Community Care Act or the MC/DD Act to the coroner or
4medical examiner within 24 hours as required by Section 6.09a
5of this Act. In assessing whether to impose such a fine for
6failure to initiate a criminal background check, the
7Department shall consider various factors including, but not
8limited to, whether the hospital has engaged in a pattern or
9practice of failing to initiate criminal background checks.
10Money from fines shall be deposited into the Long Term Care
11Provider Fund.
12    (a-5) If a hospital demonstrates a pattern or practice of
13failing to substantially comply with the requirements of
14Section 10.10 or the hospital's written staffing plan, the
15hospital shall provide a plan of correction to the Department
16within 60 days. The Department may impose fines as follows:
17(i) if a hospital fails to implement a written staffing plan
18for nursing services, a fine not to exceed $500 per occurrence
19may be imposed; (ii) if a hospital demonstrates a pattern or
20practice of failing to substantially comply with a plan of
21correction within 60 days after the plan takes effect, a fine
22not to exceed $500 per occurrence may be imposed; and (iii) if
23a hospital demonstrates for a second or subsequent time a
24pattern or practice of failing to substantially comply with a
25plan of correction within 60 days after the plan takes effect,
26a fine not to exceed $1,000 per occurrence may be imposed.



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1Reports of violations of Section 10.10 shall be subject to
2public disclosure under Section 6.14a. Money from fines within
3this subsection (a-5) shall be deposited into the Hospital
4Licensure Fund, and money from fines for violations of Section
510.10 shall be used for scholarships under the Nursing
6Education Scholarship Law.
7    (b) Such notice shall be effected by registered mail or by
8personal service setting forth the particular reasons for the
9proposed action and fixing a date, not less than 15 days from
10the date of such mailing or service, at which time the
11applicant or licensee shall be given an opportunity for a
12hearing. Such hearing shall be conducted by the Director or by
13an employee of the Department designated in writing by the
14Director as Hearing Officer to conduct the hearing. On the
15basis of any such hearing, or upon default of the applicant or
16licensee, the Director shall make a determination specifying
17his findings and conclusions. In case of a denial to an
18applicant of a permit to establish a hospital, such
19determination shall specify the subsection of Section 6 under
20which the permit was denied and shall contain findings of fact
21forming the basis of such denial. A copy of such determination
22shall be sent by registered mail or served personally upon the
23applicant or licensee. The decision denying, suspending, or
24revoking a permit or a license shall become final 35 days after
25it is so mailed or served, unless the applicant or licensee,
26within such 35 day period, petitions for review pursuant to



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1Section 13.
2    (c) The procedure governing hearings authorized by this
3Section shall be in accordance with rules promulgated by the
4Department and approved by the Hospital Licensing Board. A
5full and complete record shall be kept of all proceedings,
6including the notice of hearing, complaint, and all other
7documents in the nature of pleadings, written motions filed in
8the proceedings, and the report and orders of the Director and
9Hearing Officer. All testimony shall be reported but need not
10be transcribed unless the decision is appealed pursuant to
11Section 13. A copy or copies of the transcript may be obtained
12by any interested party on payment of the cost of preparing
13such copy or copies.
14    (d) The Director or Hearing Officer shall upon his own
15motion, or on the written request of any party to the
16proceeding, issue subpoenas requiring the attendance and the
17giving of testimony by witnesses, and subpoenas duces tecum
18requiring the production of books, papers, records, or
19memoranda. All subpoenas and subpoenas duces tecum issued
20under the terms of this Act may be served by any person of full
21age. The fees of witnesses for attendance and travel shall be
22the same as the fees of witnesses before the Circuit Court of
23this State, such fees to be paid when the witness is excused
24from further attendance. When the witness is subpoenaed at the
25instance of the Director, or Hearing Officer, such fees shall
26be paid in the same manner as other expenses of the Department,



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1and when the witness is subpoenaed at the instance of any other
2party to any such proceeding the Department may require that
3the cost of service of the subpoena or subpoena duces tecum and
4the fee of the witness be borne by the party at whose instance
5the witness is summoned. In such case, the Department in its
6discretion, may require a deposit to cover the cost of such
7service and witness fees. A subpoena or subpoena duces tecum
8issued as aforesaid shall be served in the same manner as a
9subpoena issued out of a court.
10    (e) Any Circuit Court of this State upon the application
11of the Director, or upon the application of any other party to
12the proceeding, may, in its discretion, compel the attendance
13of witnesses, the production of books, papers, records, or
14memoranda and the giving of testimony before the Director or
15Hearing Officer conducting an investigation or holding a
16hearing authorized by this Act, by an attachment for contempt,
17or otherwise, in the same manner as production of evidence may
18be compelled before the court.
19    (f) The Director or Hearing Officer, or any party in an
20investigation or hearing before the Department, may cause the
21depositions of witnesses within the State to be taken in the
22manner prescribed by law for like depositions in civil actions
23in courts of this State, and to that end compel the attendance
24of witnesses and the production of books, papers, records, or
26(Source: P.A. 99-180, eff. 7-29-15.)



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1    (210 ILCS 85/10.10)
2    Sec. 10.10. Nurse Staffing by Patient Acuity.
3    (a) Findings. The Legislature finds and declares all of
4the following:
5        (1) The State of Illinois has a substantial interest
6    in promoting quality care and improving the delivery of
7    health care services.
8        (2) Evidence-based studies have shown that the basic
9    principles of staffing in the acute care setting should be
10    based on the complexity of patients' care needs aligned
11    with available nursing skills to promote quality patient
12    care consistent with professional nursing standards.
13        (3) Compliance with this Section promotes an
14    organizational climate that values registered nurses'
15    input in meeting the health care needs of hospital
16    patients.
17    (b) Definitions. As used in this Section:
18    "Acuity model" means an assessment tool selected and
19implemented by a hospital, as recommended by a nursing care
20committee, that assesses the complexity of patient care needs
21requiring professional nursing care and skills and aligns
22patient care needs and nursing skills consistent with
23professional nursing standards.
24    "Department" means the Department of Public Health.
25    "Direct patient care" means care provided by a registered



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1professional nurse with direct responsibility to oversee or
2carry out medical regimens or nursing care for one or more
4    "Nursing care committee" means a an existing or newly
5created hospital-wide committee or committees of nurses whose
6functions, in part or in whole, contribute to the development,
7recommendation, and review of the hospital's nurse staffing
8plan established pursuant to subsection (d).
9    "Registered professional nurse" means a person licensed as
10a Registered Nurse under the Nurse Practice Act.
11    "Written staffing plan for nursing care services" means a
12written plan for guiding the assignment of patient care
13nursing staff based on multiple nurse and patient
14considerations that yield minimum staffing levels for
15inpatient care units and the adopted acuity model aligning
16patient care needs with nursing skills required for quality
17patient care consistent with professional nursing standards.
18    (c) Written staffing plan.
19        (1) Every hospital shall implement a written
20    hospital-wide staffing plan, prepared recommended by a
21    nursing care committee or committees, that provides for
22    minimum direct care professional registered
23    nurse-to-patient staffing needs for each inpatient care
24    unit, including inpatient emergency departments. If the
25    staffing plan prepared by the nursing care committee is
26    not adopted by the hospital, or if substantial changes are



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1    proposed to it, the chief nursing officer shall either:
2    (i) provide a written explanation to the committee of the
3    reasons the plan was not adopted; or (ii) provide a
4    written explanation of any substantial changes made to the
5    proposed plan prior to it being adopted by the hospital.
6    The written hospital-wide staffing plan shall include, but
7    need not be limited to, the following considerations:
8            (A) The complexity of complete care, assessment on
9        patient admission, volume of patient admissions,
10        discharges and transfers, evaluation of the progress
11        of a patient's problems, ongoing physical assessments,
12        planning for a patient's discharge, assessment after a
13        change in patient condition, and assessment of the
14        need for patient referrals.
15            (B) The complexity of clinical professional
16        nursing judgment needed to design and implement a
17        patient's nursing care plan, the need for specialized
18        equipment and technology, the skill mix of other
19        personnel providing or supporting direct patient care,
20        and involvement in quality improvement activities,
21        professional preparation, and experience.
22            (C) Patient acuity and the number of patients for
23        whom care is being provided.
24            (D) The ongoing assessments of a unit's patient
25        acuity levels and nursing staff needed shall be
26        routinely made by the unit nurse manager or his or her



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1        designee.
2            (E) The identification of additional registered
3        nurses available for direct patient care when
4        patients' unexpected needs exceed the planned workload
5        for direct care staff.
6        (2) In order to provide staffing flexibility to meet
7    patient needs, every hospital shall identify an acuity
8    model for adjusting the staffing plan for each inpatient
9    care unit.
10        (2.5) Each hospital shall implement the staffing plan
11    and assign nursing personnel to each inpatient care unit,
12    including inpatient emergency departments, in accordance
13    with the staffing plan.
14            (A) A registered nurse may report to the nursing
15        care committee any variations where the nurse
16        personnel assignment in an inpatient care unit is not
17        in accordance with the adopted staffing plan and may
18        make a written report to the nursing care committee
19        based on the variations.
20            (B) Shift-to-shift adjustments in staffing levels
21        required by the staffing plan may be made by the
22        appropriate hospital personnel overseeing inpatient
23        care operations. If a registered nurse in an inpatient
24        care unit objects to a shift-to-shift adjustment, the
25        registered nurse may submit a written report to the
26        nursing care committee.



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1            (C) The nursing care committee shall develop a
2        process to examine and respond to written reports
3        submitted under subparagraphs (A) and (B) of this
4        paragraph (2.5), including the ability to determine if
5        a specific written report is resolved or should be
6        dismissed.
7        (3) The written staffing plan shall be posted in a
8    conspicuous and accessible location for both patients and
9    direct care staff, as required under the Hospital Report
10    Card Act. A copy of the written staffing plan shall be
11    provided to any member of the general public upon request.
12    (d) Nursing care committee.
13        (1) Every hospital shall have a nursing care committee
14    that meets at least 6 times per year. A hospital shall
15    appoint members of a committee whereby at least 55% 50% of
16    the members are registered professional nurses providing
17    direct inpatient patient care, one of whom shall be
18    selected annually by the direct inpatient care nurses to
19    serve as co-chair of the committee.
20        (2) (Blank). A nursing care committee's
21    recommendations must be given significant regard and
22    weight in the hospital's adoption and implementation of a
23    written staffing plan.
24        (2.5) A nursing care committee shall prepare and
25    recommend to hospital administration the hospital's
26    written hospital-wide staffing plan. If the staffing plan



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1    is not adopted by the hospital, the chief nursing officer
2    shall provide a written statement to the committee prior
3    to a staffing plan being adopted by the hospital that: (A)
4    explains the reasons the committee's proposed staffing
5    plan was not adopted; and (B) describes the changes to the
6    committee's proposed staffing or any alternative to the
7    committee's proposed staffing plan.
8        (3) A nursing care committee's committee or
9    committees' committees shall recommend a written staffing
10    plan for the hospital shall be based on the principles
11    from the staffing components set forth in subsection (c).
12    In particular, a committee or committees shall provide
13    input and feedback on the following:
14            (A) Selection, implementation, and evaluation of
15        minimum staffing levels for inpatient care units.
16            (B) Selection, implementation, and evaluation of
17        an acuity model to provide staffing flexibility that
18        aligns changing patient acuity with nursing skills
19        required.
20            (C) Selection, implementation, and evaluation of a
21        written staffing plan incorporating the items
22        described in subdivisions (c)(1) and (c)(2) of this
23        Section.
24            (D) Review the nurse following: nurse-to-patient
25        staffing plans guidelines for all inpatient areas; and
26        current acuity tools and measures in use. The nursing



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1        care committee's review shall consider:
2                (i) patient outcomes;
3                (ii) complaints regarding staffing, including
4            complaints about a delay in direct care nursing or
5            an absence of direct care nursing;
6                (iii) the number of hours of nursing care
7            provided through an inpatient hospital unit
8            compared with the number of inpatients served by
9            the hospital unit during a 24-hour period;
10                (iv) the aggregate hours of overtime worked by
11            the nursing staff;
12                (v) the extent to which actual nurse staffing
13            for each hospital inpatient unit differs from the
14            staffing specified by the staffing plan; and
15                (vi) any other matter or change to the
16            staffing plan determined by the committee to
17            ensure that the hospital is staffed to meet the
18            health care needs of patients.
19        (4) A nursing care committee must issue a written
20    report addressing address the items described in
21    subparagraphs (A) through (D) of paragraph (3)
22    semi-annually. A written copy of this report shall be made
23    available to direct inpatient care nurses by making
24    available a paper copy of the report, distributing it
25    electronically, or posting it on the hospital's website.
26        (5) A nursing care committee must issue a written



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1    report at least annually to the hospital governing board
2    that addresses items including, but not limited to: the
3    items described in paragraph (3); changes made based on
4    committee recommendations and the impact of such changes;
5    and recommendations for future changes related to nurse
6    staffing.
7    (e) Nothing in this Section 10.10 shall be construed to
8limit, alter, or modify any of the terms, conditions, or
9provisions of a collective bargaining agreement entered into
10by the hospital.
11    (f) No hospital may discipline, discharge, or take any
12other adverse employment action against an employee solely
13because the employee expresses a concern or complaint
14regarding an alleged violation of this Section or concerns
15related to nurse staffing.
16    (g) Any employee of a hospital may file a complaint with
17the Department regarding an alleged violation of this Section.
18The Department must forward notification of the alleged
19violation to the hospital in question within 10 business days
20after the complaint is filed. Upon receiving a complaint of a
21violation of this Section, the Department may take any action
22authorized under Sections 7 or 9 of this Act.
23(Source: P.A. 96-328, eff. 8-11-09; 97-423, eff. 1-1-12;
2497-813, eff. 7-13-12.)
25    (210 ILCS 85/14.5)



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1    Sec. 14.5. Hospital Licensure Fund.
2    (a) There is created in the State treasury the Hospital
3Licensure Fund. The Fund is created for the purpose of
4providing funding for the administration of the licensure
5program and patient safety and quality initiatives for
6hospitals, including, without limitation, the implementation
7of the Illinois Adverse Health Care Events Reporting Law of
9    (b) The Fund shall consist of the following:
10        (1) fees collected pursuant to Sections Section 5 and
11    7 of the Hospital Licensing Act;
12        (2) federal matching funds received by the State as a
13    result of expenditures made by the Department that are
14    attributable to moneys deposited in the Fund;
15        (3) interest earned on moneys deposited in the Fund;
16    and
17        (4) other moneys received for the Fund from any other
18    source, including interest earned thereon.
19    (c) Disbursements from the Fund shall be made only for:
20        (1) initially, the implementation of the Illinois
21    Adverse Health Care Events Reporting Law of 2005;
22        (2) subsequently, programs, information, or
23    assistance, including measures to address public
24    complaints, designed to measurably improve quality and
25    patient safety; and
26        (2.5) from fines for violations of Section 10.10,



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1    scholarships under the Nursing Education Scholarship Law;
2    and
3        (3) the reimbursement of moneys collected by the
4    Department through error or mistake.
5    (d) The uses described in paragraph (2) of subsection (c)
6shall be developed in conjunction with a statewide
7organization representing a majority of hospitals.
8(Source: P.A. 98-683, eff. 6-30-14.)

10    Section 5-5. The Nursing Education Scholarship Law is
11amended by changing Section 5 as follows:
12    (110 ILCS 975/5)  (from Ch. 144, par. 2755)
13    Sec. 5. Nursing education scholarships. Beginning with the
14fall term of the 2004-2005 academic year, the Department, in
15accordance with rules and regulations promulgated by it for
16this program, shall provide scholarships to individuals
17selected from among those applicants who qualify for
18consideration by showing:
19        (1) that he or she has been a resident of this State
20    for at least one year prior to application, and is a
21    citizen or a lawful permanent resident alien of the United
22    States;
23        (2) that he or she is enrolled in or accepted for



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1    admission to an associate degree in nursing program,
2    hospital-based diploma in nursing program, baccalaureate
3    degree in nursing program, graduate degree in nursing
4    program, or practical nursing program at an approved
5    institution; and
6        (3) that he or she agrees to meet the nursing
7    employment obligation.
8    If in any year the number of qualified applicants exceeds
9the number of scholarships to be awarded, the Department
10shall, in consultation with the Illinois Nursing Workforce
11Center Advisory Board, consider the following factors in
12granting priority in awarding scholarships:
13            (A) Financial need, as shown on a standardized
14        financial needs assessment form used by an approved
15        institution, of students who will pursue their
16        education on a full-time or close to full-time basis
17        and who already have a certificate in practical
18        nursing, a diploma in nursing, or an associate degree
19        in nursing and are pursuing a higher degree.
20            (B) A student's status as a registered nurse who
21        is pursuing a graduate degree in nursing to pursue
22        employment in an approved institution that educates
23        licensed practical nurses and that educates registered
24        nurses in undergraduate and graduate nursing programs.
25            (C) A student's merit, as shown through his or her
26        grade point average, class rank, and other academic



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1        and extracurricular activities. The Department may add
2        to and further define these merit criteria by rule.
3    Unless otherwise indicated, scholarships shall be awarded
4to recipients at approved institutions for a period of up to 2
5years if the recipient is enrolled in an associate degree in
6nursing program, up to 3 years if the recipient is enrolled in
7a hospital-based diploma in nursing program, up to 4 years if
8the recipient is enrolled in a baccalaureate degree in nursing
9program, up to 5 years if the recipient is enrolled in a
10graduate degree in nursing program, and up to one year if the
11recipient is enrolled in a certificate in practical nursing
12program. At least 40% of the scholarships awarded shall be for
13recipients who are pursuing baccalaureate degrees in nursing,
1430% of the scholarships awarded shall be for recipients who
15are pursuing associate degrees in nursing or a diploma in
16nursing, 10% of the scholarships awarded shall be for
17recipients who are pursuing a certificate in practical
18nursing, and 20% of the scholarships awarded shall be for
19recipients who are pursuing a graduate degree in nursing.
20    Beginning with the fall term of the 2021-2022 academic
21year and continuing through the 2024-2025 academic year,
22subject to appropriation from the Hospital Licensure Fund, in
23addition to any other funds available to the Department for
24such scholarships, the Department may award a total of
25$500,000 annually in scholarships under this Section.
26(Source: P.A. 100-513, eff. 1-1-18.)



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2    Section 99-99. Effective date. This Act takes effect upon
3becoming law.