Illinois General Assembly - Full Text of HB3392
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Full Text of HB3392  100th General Assembly


Rep. Emanuel Chris Welch

Filed: 3/7/2017





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2    AMENDMENT NO. ______. Amend House Bill 3392 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Assisted Living and Shared Housing Act is
5amended by changing Sections 10, 15, 75, 80, 90, 95, and 110 as
7    (210 ILCS 9/10)
8    Sec. 10. Definitions. For purposes of this Act:
9    "Activities of daily living" means eating, dressing,
10bathing, toileting, transferring, or personal hygiene.
11    "Assisted living establishment" or "establishment" means a
12home, building, residence, or any other place where sleeping
13accommodations are provided for at least 3 unrelated adults, at
14least 80% of whom are 55 years of age or older and where the
15following are provided consistent with the purposes of this



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1        (1) services consistent with a social model that is
2    based on the premise that the resident's unit in assisted
3    living and shared housing is his or her own home;
4        (2) community-based residential care for persons who
5    need assistance with activities of daily living, including
6    personal, supportive, and intermittent health-related
7    services available 24 hours per day, if needed, to meet the
8    scheduled and unscheduled needs of a resident;
9        (3) mandatory services, whether provided directly by
10    the establishment or by another entity arranged for by the
11    establishment, with the consent of the resident or
12    resident's representative; and
13        (4) a physical environment that is a homelike setting
14    that includes the following and such other elements as
15    established by the Department: individual living units
16    each of which shall accommodate small kitchen appliances
17    and contain private bathing, washing, and toilet
18    facilities, or private washing and toilet facilities with a
19    common bathing room readily accessible to each resident.
20    Units shall be maintained for single occupancy except in
21    cases in which 2 residents choose to share a unit.
22    Sufficient common space shall exist to permit individual
23    and group activities.
24    "Assisted living establishment" or "establishment" does
25not mean any of the following:
26        (1) A home, institution, or similar place operated by



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1    the federal government or the State of Illinois.
2        (2) A long term care facility licensed under the
3    Nursing Home Care Act, a facility licensed under the
4    Specialized Mental Health Rehabilitation Act of 2013, a
5    facility licensed under the ID/DD Community Care Act, or a
6    facility licensed under the MC/DD Act. However, a facility
7    licensed under any of those Acts may convert distinct parts
8    of the facility to assisted living. If the facility elects
9    to do so, the facility shall retain the Certificate of Need
10    for its nursing and sheltered care beds that were
11    converted.
12        (3) A hospital, sanitarium, or other institution, the
13    principal activity or business of which is the diagnosis,
14    care, and treatment of human illness and that is required
15    to be licensed under the Hospital Licensing Act.
16        (4) A facility for child care as defined in the Child
17    Care Act of 1969.
18        (5) A community living facility as defined in the
19    Community Living Facilities Licensing Act.
20        (6) A nursing home or sanitarium operated solely by and
21    for persons who rely exclusively upon treatment by
22    spiritual means through prayer in accordance with the creed
23    or tenants of a well-recognized church or religious
24    denomination.
25        (7) A facility licensed by the Department of Human
26    Services as a community-integrated living arrangement as



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1    defined in the Community-Integrated Living Arrangements
2    Licensure and Certification Act.
3        (8) A supportive residence licensed under the
4    Supportive Residences Licensing Act.
5        (9) The portion of a life care facility as defined in
6    the Life Care Facilities Act not licensed as an assisted
7    living establishment under this Act; a life care facility
8    may apply under this Act to convert sections of the
9    community to assisted living.
10        (10) A free-standing hospice facility licensed under
11    the Hospice Program Licensing Act.
12        (11) A shared housing establishment.
13        (12) A supportive living facility as described in
14    Section 5-5.01a of the Illinois Public Aid Code.
15    "Department" means the Department of Public Health.
16    "Director" means the Director of Public Health.
17    "Emergency situation" means imminent danger of death or
18serious physical harm to a resident of an establishment.
19    "Involuntary termination of residency" means the full
20release of any resident from a facility, without the informed
21consent of the resident, freely given and not coerced.
22"Involuntary termination of residency" includes an assisted
23living or shared housing establishment's failure to readmit a
24resident following hospitalization, other medical leave, or
25other absence from the establishment.
26    "License" means any of the following types of licenses



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1issued to an applicant or licensee by the Department:
2        (1) "Probationary license" means a license issued to an
3    applicant or licensee that has not held a license under
4    this Act prior to its application or pursuant to a license
5    transfer in accordance with Section 50 of this Act.
6        (2) "Regular license" means a license issued by the
7    Department to an applicant or licensee that is in
8    substantial compliance with this Act and any rules
9    promulgated under this Act.
10    "Licensee" means a person, agency, association,
11corporation, partnership, or organization that has been issued
12a license to operate an assisted living or shared housing
14    "Licensed health care professional" means a registered
15professional nurse, an advanced practice nurse, a physician
16assistant, and a licensed practical nurse.
17    "Mandatory services" include the following:
18        (1) 3 meals per day available to the residents prepared
19    by the establishment or an outside contractor;
20        (2) housekeeping services including, but not limited
21    to, vacuuming, dusting, and cleaning the resident's unit;
22        (3) personal laundry and linen services available to
23    the residents provided or arranged for by the
24    establishment;
25        (4) security provided 24 hours each day including, but
26    not limited to, locked entrances or building or contract



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1    security personnel;
2        (5) an emergency communication response system, which
3    is a procedure in place 24 hours each day by which a
4    resident can notify building management, an emergency
5    response vendor, or others able to respond to his or her
6    need for assistance; and
7        (6) assistance with activities of daily living as
8    required by each resident.
9    "Negotiated risk" is the process by which a resident, or
10his or her representative, may formally negotiate with
11providers what risks each are willing and unwilling to assume
12in service provision and the resident's living environment. The
13provider assures that the resident and the resident's
14representative, if any, are informed of the risks of these
15decisions and of the potential consequences of assuming these
17    "Owner" means the individual, partnership, corporation,
18association, or other person who owns an assisted living or
19shared housing establishment. In the event an assisted living
20or shared housing establishment is operated by a person who
21leases or manages the physical plant, which is owned by another
22person, "owner" means the person who operates the assisted
23living or shared housing establishment, except that if the
24person who owns the physical plant is an affiliate of the
25person who operates the assisted living or shared housing
26establishment and has significant control over the day to day



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1operations of the assisted living or shared housing
2establishment, the person who owns the physical plant shall
3incur jointly and severally with the owner all liabilities
4imposed on an owner under this Act.
5    "Physician" means a person licensed under the Medical
6Practice Act of 1987 to practice medicine in all of its
8    "Resident" means a person residing in an assisted living or
9shared housing establishment.
10    "Resident's representative" means a person, other than the
11owner, agent, or employee of an establishment or of the health
12care provider unless related to the resident, designated in
13writing by a resident or a court to be his or her
14representative. This designation may be accomplished through
15the Illinois Power of Attorney Act, pursuant to the
16guardianship process under the Probate Act of 1975, or pursuant
17to an executed designation of representative form specified by
18the Department.
19    "Self" means the individual or the individual's designated
21    "Shared housing establishment" or "establishment" means a
22publicly or privately operated free-standing residence for 16
23or fewer persons, at least 80% of whom are 55 years of age or
24older and who are unrelated to the owners and one manager of
25the residence, where the following are provided:
26        (1) services consistent with a social model that is



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1    based on the premise that the resident's unit is his or her
2    own home;
3        (2) community-based residential care for persons who
4    need assistance with activities of daily living, including
5    housing and personal, supportive, and intermittent
6    health-related services available 24 hours per day, if
7    needed, to meet the scheduled and unscheduled needs of a
8    resident; and
9        (3) mandatory services, whether provided directly by
10    the establishment or by another entity arranged for by the
11    establishment, with the consent of the resident or the
12    resident's representative.
13    "Shared housing establishment" or "establishment" does not
14mean any of the following:
15        (1) A home, institution, or similar place operated by
16    the federal government or the State of Illinois.
17        (2) A long term care facility licensed under the
18    Nursing Home Care Act, a facility licensed under the
19    Specialized Mental Health Rehabilitation Act of 2013, a
20    facility licensed under the ID/DD Community Care Act, or a
21    facility licensed under the MC/DD Act. A facility licensed
22    under any of those Acts may, however, convert sections of
23    the facility to assisted living. If the facility elects to
24    do so, the facility shall retain the Certificate of Need
25    for its nursing beds that were converted.
26        (3) A hospital, sanitarium, or other institution, the



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1    principal activity or business of which is the diagnosis,
2    care, and treatment of human illness and that is required
3    to be licensed under the Hospital Licensing Act.
4        (4) A facility for child care as defined in the Child
5    Care Act of 1969.
6        (5) A community living facility as defined in the
7    Community Living Facilities Licensing Act.
8        (6) A nursing home or sanitarium operated solely by and
9    for persons who rely exclusively upon treatment by
10    spiritual means through prayer in accordance with the creed
11    or tenants of a well-recognized church or religious
12    denomination.
13        (7) A facility licensed by the Department of Human
14    Services as a community-integrated living arrangement as
15    defined in the Community-Integrated Living Arrangements
16    Licensure and Certification Act.
17        (8) A supportive residence licensed under the
18    Supportive Residences Licensing Act.
19        (9) A life care facility as defined in the Life Care
20    Facilities Act; a life care facility may apply under this
21    Act to convert sections of the community to assisted
22    living.
23        (10) A free-standing hospice facility licensed under
24    the Hospice Program Licensing Act.
25        (11) An assisted living establishment.
26        (12) A supportive living facility as described in



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1    Section 5-5.01a of the Illinois Public Aid Code.
2    "Total assistance" means that staff or another individual
3performs the entire activity of daily living without
4participation by the resident.
5(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
6    (210 ILCS 9/15)
7    Sec. 15. Assessment and service plan requirements. Prior to
8admission to any establishment covered by this Act, a
9comprehensive assessment that includes an evaluation of the
10prospective resident's physical, cognitive, and psychosocial
11condition shall be completed. At least annually, a
12comprehensive assessment shall be completed, and upon
13identification of a significant change in the resident's
14condition, including, but not limited to, a diagnosis of
15Alzheimer's disease or a related dementia, the resident shall
16be reassessed. The Department may by rule specify circumstances
17under which more frequent assessments of skin integrity and
18nutritional status shall be required. The comprehensive
19assessment shall be completed by a physician. Based on the
20assessment, the resident's interests and preferences,
21dislikes, and any known triggers for behavior that endangers
22the resident or others, a written service plan shall be
23developed and mutually agreed upon by the provider, and the
24resident, and the resident's representative, if any. The
25service plan, which shall be reviewed annually, or more often



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1as the resident's condition, preferences, or service needs
2change, shall serve as a basis for the service delivery
3contract between the provider and the resident. The resident
4and the resident's representative, if any, shall be given a
5copy of the most recent assessment; supplemental assessment, if
6any, done by the establishment; and service plan. Based on the
7assessment, the service plan may provide for the disconnection
8or removal of any appliance.
9(Source: P.A. 91-656, eff. 1-1-01.)
10    (210 ILCS 9/75)
11    Sec. 75. Residency Requirements.
12    (a) No individual shall be accepted for residency or remain
13in residence if the establishment cannot provide or secure
14appropriate services, if the individual requires a level of
15service or type of service for which the establishment is not
16licensed or which the establishment does not provide, or if the
17establishment does not have the staff appropriate in numbers
18and with appropriate skill to provide such services.
19    (b) Only adults may be accepted for residency.
20    (c) A person shall not be accepted for residency if:
21        (1) the person poses a serious threat to himself or
22    herself or to others;
23        (2) the person is not able to communicate his or her
24    needs and no resident representative residing in the
25    establishment, and with a prior relationship to the person,



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1    has been appointed to direct the provision of services;
2        (3) the person requires total assistance with 2 or more
3    activities of daily living;
4        (4) the person requires the assistance of more than one
5    paid caregiver at any given time with an activity of daily
6    living;
7        (5) the person requires more than minimal assistance in
8    moving to a safe area in an emergency;
9        (6) the person has a severe mental illness, which for
10    the purposes of this Section means a condition that is
11    characterized by the presence of a major mental disorder as
12    classified in the Diagnostic and Statistical Manual of
13    Mental Disorders, Fourth Edition (DSM-IV) (American
14    Psychiatric Association, 1994), where the individual is a
15    person with a substantial disability due to mental illness
16    in the areas of self-maintenance, social functioning,
17    activities of community living and work skills, and the
18    disability specified is expected to be present for a period
19    of not less than one year, but does not mean Alzheimer's
20    disease and other forms of dementia based on organic or
21    physical disorders;
22        (7) the person requires intravenous therapy or
23    intravenous feedings unless self-administered or
24    administered by a qualified, licensed health care
25    professional;
26        (8) the person requires gastrostomy feedings unless



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1    self-administered or administered by a licensed health
2    care professional;
3        (9) the person requires insertion, sterile irrigation,
4    and replacement of catheter, except for routine
5    maintenance of urinary catheters, unless the catheter care
6    is self-administered or administered by a licensed health
7    care professional;
8        (10) the person requires sterile wound care unless care
9    is self-administered or administered by a licensed health
10    care professional;
11        (11) the person requires sliding scale insulin
12    administration unless self-performed or administered by a
13    licensed health care professional;
14        (12) the person is a diabetic requiring routine insulin
15    injections unless the injections are self-administered or
16    administered by a licensed health care professional;
17        (13) the person requires treatment of stage 3 or stage
18    4 decubitus ulcers or exfoliative dermatitis;
19        (14) the person requires 5 or more skilled nursing
20    visits per week for conditions other than those listed in
21    items (13) and (15) of this subsection for a period of 3
22    consecutive weeks or more except when the course of
23    treatment is expected to extend beyond a 3 week period for
24    rehabilitative purposes and is certified as temporary by a
25    physician; or
26        (15) other reasons prescribed by the Department by



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1    rule.
2    (d) A resident with a condition listed in items (1) through
3(15) of subsection (c) shall have his or her residency
5    (e) Residency shall be terminated when services available
6to the resident in the establishment are no longer adequate to
7meet the needs of the resident. The establishment shall notify
8the resident and the resident's representative, if any, when
9there is a significant change in the resident's condition that
10affects the establishment's ability to meet the resident's
11needs. The requirements of subsection (c) of Section 80 shall
12then apply. This provision shall not be interpreted as limiting
13the authority of the Department to require the residency
14termination of individuals.
15    (f) Subsection (d) of this Section shall not apply to
16terminally ill residents who receive or would qualify for
17hospice care and such care is coordinated by a hospice program
18licensed under the Hospice Program Licensing Act or other
19licensed health care professional employed by a licensed home
20health agency and the establishment and all parties agree to
21the continued residency.
22    (g) Items (3), (4), (5), and (9) of subsection (c) shall
23not apply to a quadriplegic, paraplegic, or individual with
24neuro-muscular diseases, such as muscular dystrophy and
25multiple sclerosis, or other chronic diseases and conditions as
26defined by rule if the individual is able to communicate his or



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1her needs and does not require assistance with complex medical
2problems, and the establishment is able to accommodate the
3individual's needs. The Department shall prescribe rules
4pursuant to this Section that address special safety and
5service needs of these individuals.
6    (h) For the purposes of items (7) through (10) of
7subsection (c), a licensed health care professional may not be
8employed by the owner or operator of the establishment, its
9parent entity, or any other entity with ownership common to
10either the owner or operator of the establishment or parent
11entity, including but not limited to an affiliate of the owner
12or operator of the establishment. Nothing in this Section is
13meant to limit a resident's right to choose his or her health
14care provider.
15    (i) Subsection (h) is not applicable to residents admitted
16to an assisted living establishment under a life care contract
17as defined in the Life Care Facilities Act if the life care
18facility has both an assisted living establishment and a
19skilled nursing facility. A licensed health care professional
20providing health-related or supportive services at a life care
21assisted living or shared housing establishment must be
22employed by an entity licensed by the Department under the
23Nursing Home Care Act or the Home Health, Home Services, and
24Home Nursing Agency Licensing Act.
25(Source: P.A. 99-143, eff. 7-27-15.)



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1    (210 ILCS 9/80)
2    Sec. 80. Involuntary termination of residency.
3    (a) Residency shall be involuntarily terminated only for
4the following reasons:
5        (1) as provided in Section 75 of this Act;
6        (2) nonpayment of contracted charges after the
7    resident and the resident's representative have received a
8    minimum of 30 days' 30-days written notice of the
9    delinquency and the resident or the resident's
10    representative has had at least 15 days to cure the
11    delinquency; or
12        (3) failure to execute a service delivery contract or
13    to substantially comply with its terms and conditions,
14    failure to comply with the assessment requirements
15    contained in Section 15, or failure to substantially comply
16    with the terms and conditions of the lease agreement.
17    (b) A 30-day 30 day written notice of residency termination
18shall be provided to the resident, the resident's
19representative, or both, the Department, and the long term care
20ombudsman, which shall include the reason for the pending
21action, the date of the proposed move, and a notice, the
22content and form to be set forth by rule, of the resident's
23right to appeal, the steps that the resident or the resident's
24representative must take to initiate an appeal, and a statement
25of the resident's right to continue to reside in the
26establishment until a decision is rendered. The notice shall



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1include a toll free telephone number to initiate an appeal and
2a written hearing request form, together with a postage paid,
3pre-addressed envelope to the Department. If the resident or
4the resident's representative, if any, cannot read English, the
5notice must be provided in a language the individual receiving
6the notice can read or the establishment must provide a
7translator who has been trained to assist the resident or the
8resident's representative in the appeal process. In emergency
9situations as defined in Section 10 of this Act, the 30-day
10provision of the written notice may be waived.
11    (b-5) If an establishment initiates a termination of
12residency due to an emergency situation, then the resident and
13resident's representative, if any, the Department, and the
14Office of State Long Term Care Ombudsman, shall be provided
15with a written notice of residency termination, in a form to be
16specified by the Department, containing all of the information
17specified in subsection (b) prior to the establishment
18initiating a termination of residency.
19    (c) The establishment shall attempt to resolve with the
20resident or the resident's representative, if any,
21circumstances that if not remedied have the potential of
22resulting in an involuntary termination of residency and shall
23document those efforts in the resident's file. This action may
24occur prior to or during the 30 day notice period, but must
25occur prior to the termination of the residency. In emergency
26situations as defined in Section 10 of this Act, the



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1requirements of this subsection may be waived.
2    (d) A request for a hearing shall stay an involuntary
3termination of residency until a decision has been rendered by
4the Department, according to a process adopted by rule. During
5this time period, the establishment may not terminate or reduce
6any service without the consent of the resident or the
7resident's representative, if any for the purpose of making it
8more difficult or impossible for the resident to remain in the
10    (e) The establishment shall offer the resident and the
11resident's representative, if any, residency termination and
12relocation assistance including information on available
13alternative placement. Residents, and the residents'
14representatives, if any, shall be involved in planning the move
15and shall choose among the available alternative placements
16except when an emergency situation makes prior resident
17involvement impossible. Emergency placements are deemed
18temporary until the resident's input can be sought in the final
19placement decision. No resident shall be forced to remain in a
20temporary or permanent placement.
21    (f) The Department shall may offer assistance to the
22establishment and the resident in the preparation of residency
23termination and relocation plans to assure safe and orderly
24transition and to protect the resident's health, safety,
25welfare, and rights. In nonemergencies, and where possible in
26emergencies, the transition plan shall be designed and



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1implemented in advance of transfer or residency termination.
2    (g) An establishment may not initiate a termination of
3residency due to an emergency situation if (1) a resident has
4been hospitalized and the resident's physician states that
5returning to the establishment would not create an imminent
6danger of death or serious physical harm to a resident; or (2)
7the emergency can be negated by changes in staffing,
8activities, health care, personal care, or rooming
9accommodations, consistent with the license of the
10establishment. The Department may not find an establishment to
11be in violation of Section 75 of this Act for failing to
12initiate an emergency discharge in these circumstances.
13    (h) If the Department determines that an involuntary
14termination of residency does not meet the requirements of this
15Act, the Department shall issue a written decision stating that
16the involuntary termination of residency is denied. If the
17action of the establishment giving rise to the request for
18hearings is the establishment's failure to readmit the resident
19following hospitalization, other medical leave of absence, or
20other absence, the Department shall order the immediate
21readmission of the resident to the establishment.
22    (i) If an order to readmit is entered pursuant to
23subsection (h), the establishment shall immediately comply. A
24surveyor shall make an on-site inspection of the
25establishment's compliance with the order within 3 days of the
26order's entry, unless the resident notifies the Department in



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1writing that there is compliance. As used in this subsection,
2"compliance" means the resident is living in the establishment
3or the establishment and the resident have agreed on a schedule
4for readmission. If the resident or resident's representative
5notifies the Department that the establishment is not complying
6with an agreed-upon schedule, or that the establishment is not
7complying with the representation described in subsection (k),
8a surveyor shall make an on-site inspection to determine
9compliance within 3 days of the notification.
10    (j) An establishment that does not readmit a resident after
11the Department has ordered readmission shall be assessed a
12daily fine of $250, beginning on the day of the surveyor's
13inspection. The fine shall be imposed for every day thereafter,
14until the establishment notifies the Department that it is in
15compliance with the order and a surveyor makes an on-site
16inspection to determine if there is compliance or the resident
17confirms to the Department that there is compliance, as defined
18in subsection (i) of this Section. The on-site inspection shall
19be made within 3 days of the notification by the establishment.
20    (k) Once a notice of appeal is filed, the Department shall
21hold a hearing unless the notice of appeal is withdrawn. If the
22notice of appeal is withdrawn based upon a representation made
23by the establishment to the resident and the Department,
24including the hearing officer, that a resident who has been
25previously denied readmission will be readmitted, failure to
26comply with the representation shall be considered a failure to



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1comply with a Department order pursuant to subsection (h) and
2shall result in the imposition of a daily fine as provided in
3subsection (j) of this Section.
4    (l) In addition to any other penalty, an establishment that
5has improperly terminated the residency of a resident shall be
6assessed no less than a Type 1 violation. The establishment
7shall be required to submit an acceptable plan of correction to
8the Department within 30 days after the violation is affirmed.
9As used in this subsection, "improperly terminated that
10residency" does not include issuing a notice of residency
11termination that the Department finds does not meet the
12statutory requirements for termination of residency if the
13establishment complied with the procedural requirements of
14this Act.
15    (m) A long term care ombudsman may request a hearing on
16behalf of a resident and secure representation of a resident
17if, in the judgment of the long term care ombudsman, doing so
18is in the best interests of the resident and the resident does
19not object.
20(Source: P.A. 91-656, eff. 1-1-01.)
21    (210 ILCS 9/90)
22    Sec. 90. Contents of service delivery contract. A contract
23between an establishment and a resident must be entitled
24"assisted living establishment contract" or "shared housing
25establishment contract" as applicable, shall be printed in no



10000HB3392ham001- 22 -LRB100 09446 MJP 21847 a

1less than 12 point type, and shall include at least the
2following elements in the body or through supporting documents
3or attachments:
4        (1) the name, street address, and mailing address of
5    the establishment;
6        (2) the name and mailing address of the owner or owners
7    of the establishment and, if the owner or owners are not
8    natural persons, the type of business entity of the owner
9    or owners;
10        (3) the name and mailing address of the managing agent
11    of the establishment, whether hired under a management
12    agreement or lease agreement, if the managing agent is
13    different from the owner or owners;
14        (4) the name and address of at least one natural person
15    who is authorized to accept service on behalf of the owners
16    and managing agent;
17        (5) a statement describing the license status of the
18    establishment and the license status of all providers of
19    health-related or supportive services to a resident under
20    arrangement with the establishment;
21        (6) the duration of the contract;
22        (7) the base rate to be paid by the resident and a
23    description of the services to be provided as part of this
24    rate;
25        (8) a description of any additional services to be
26    provided for an additional fee by the establishment



10000HB3392ham001- 23 -LRB100 09446 MJP 21847 a

1    directly or by a third party provider under arrangement
2    with the establishment;
3        (9) the fee schedules outlining the cost of any
4    additional services;
5        (10) a description of the process through which the
6    contract may be modified, amended, or terminated;
7        (11) a description of the establishment's complaint
8    resolution process available to residents and notice of the
9    availability of the Department on Aging's Senior Helpline
10    for complaints;
11        (12) the name of the resident's designated
12    representative, if any;
13        (13) the resident's obligations in order to maintain
14    residency and receive services including compliance with
15    all assessments required under Section 15;
16        (14) the billing and payment procedures and
17    requirements;
18        (15) a statement affirming the resident's freedom to
19    receive services from service providers with whom the
20    establishment does not have a contractual arrangement,
21    which may also disclaim liability on the part of the
22    establishment for those services;
23        (16) a statement that medical assistance under Article
24    V or Article VI of the Illinois Public Aid Code is not
25    available for payment for services provided in an
26    establishment, excluding contracts executed with residents



10000HB3392ham001- 24 -LRB100 09446 MJP 21847 a

1    residing in licensed establishments participating in the
2    Department on Aging's Comprehensive Care in Residential
3    Settings Demonstration Project;
4        (17) a statement detailing the admission, risk
5    management, and residency termination criteria and
6    procedures;
7        (18) a written explanation, prepared by the Office of
8    State Long Term Care Ombudsman, of statement listing the
9    rights specified in Sections 80 and Section 95, including
10    an acknowledgement by the establishment and acknowledging
11    that, by contracting with the assisted living or shared
12    housing establishment, the resident does not forfeit those
13    rights;
14        (19) a statement detailing the Department's annual
15    on-site review process including what documents contained
16    in a resident's personal file shall be reviewed by the
17    on-site reviewer as defined by rule; and
18        (20) a statement outlining whether the establishment
19    charges a community fee and, if so, the amount of the fee
20    and whether it is refundable; if the fee is refundable, the
21    contract must describe the conditions under which it is
22    refundable and how the amount of the refund is determined;
23    and .
24        (21) educational material from the Office of State Long
25    Term Care Ombudsman, written in consultation with a State
26    association dedicated to Alzheimer's care, support, and



10000HB3392ham001- 25 -LRB100 09446 MJP 21847 a

1    research with information on Alzheimer's disease and
2    dementia for residents who have been diagnosed with a
3    dementia, including signs and symptoms, stages, and
4    behaviors, and on a statewide helpline with resources for
5    those affected by Alzheimer's and other dementia operated
6    by a State association dedicated to Alzheimer's care,
7    support, and research; receipt of these educational
8    materials shall require signatures of acknowledgement of
9    receipt by a representative of the establishment, the
10    resident, and the resident's representative, if any.
11(Source: P.A. 93-775, eff. 1-1-05; 94-256, eff. 7-19-05.)
12    (210 ILCS 9/95)
13    Sec. 95. Resident rights. No resident shall be deprived of
14any rights, benefits, or privileges guaranteed by law, the
15Constitution of the State of Illinois, or the Constitution of
16the United States solely on account of his or her status as a
17resident of an establishment, nor shall a resident forfeit any
18of the following rights:
19        (1) the right to retain and use personal property and a
20    place to store personal items that is locked and secure;
21        (2) the right to refuse services and to be advised of
22    the consequences of that refusal;
23        (3) the right to respect for bodily privacy and dignity
24    at all times, especially during care and treatment;
25        (4) the right to the free exercise of religion;



10000HB3392ham001- 26 -LRB100 09446 MJP 21847 a

1        (5) the right to privacy with regard to mail, phone
2    calls, and visitors;
3        (6) the right to uncensored access to the State
4    Ombudsman or his or her designee;
5        (7) the right to be free of retaliation for criticizing
6    the establishment or making complaints to appropriate
7    agencies;
8        (8) the right to be free of chemical and physical
9    restraints;
10        (9) the right to be free of abuse or neglect or to
11    refuse to perform labor;
12        (10) the right to confidentiality of the resident's
13    medical records;
14        (11) the right of access and the right to copy the
15    resident's personal files maintained by the establishment;
16        (12) the right to 24 hours access to the establishment;
17        (13) the right to a minimum of 90 days' 90-days notice
18    of a planned establishment closure;
19        (14) the right to a minimum of 30 days' 30-days notice
20    of an involuntary residency termination, except where the
21    resident poses a threat to himself or others, or in other
22    emergency situations, and the right to appeal such
23    termination; if an establishment withdraws a notice of
24    involuntary termination of residency, then the resident
25    has the right to maintain residency at the establishment;
26    and



10000HB3392ham001- 27 -LRB100 09446 MJP 21847 a

1        (15) the right to a 30-day notice of delinquency and at
2    least 15 days right to cure delinquency; .
3        (16) the right to not be unlawfully transferred or
4    discharged;
5        (17) the right to retain residency during any hospital
6    stay totaling 10 days or less following a hospital
7    admission; and
8        (18) the right not to be charged for any period during
9    which the resident was unlawfully denied residency.
10(Source: P.A. 91-656, eff. 1-1-01.)
11    (210 ILCS 9/110)
12    Sec. 110. Powers and duties of the Department.
13    (a) The Department shall conduct an annual unannounced
14on-site visit at each assisted living and shared housing
15establishment to determine compliance with applicable
16licensure requirements and standards. Additional visits may be
17conducted without prior notice to the assisted living or shared
18housing establishment.
19    (b) Upon receipt of information that may indicate the
20failure of the assisted living or shared housing establishment
21or a service provider to comply with a provision of this Act,
22the Department shall investigate the matter or make appropriate
23referrals to other government agencies and entities having
24jurisdiction over the subject matter of the possible violation.
25The Department may also make referrals to any public or private



10000HB3392ham001- 28 -LRB100 09446 MJP 21847 a

1agency that the Department considers available for appropriate
2assistance to those involved. The Department may oversee and
3coordinate the enforcement of State consumer protection
4policies affecting residents residing in an establishment
5licensed under this Act.
6    (c) The Department shall establish by rule complaint
7receipt, investigation, resolution, and involuntary residency
8termination procedures. Resolution procedures shall provide
9for on-site review and evaluation of an assisted living or
10shared housing establishment found to be in violation of this
11Act within a specified period of time based on the gravity and
12severity of the violation and any pervasive pattern of
13occurrences of the same or similar violations.
14    (d) (Blank).
15    (e) The Department shall by rule establish penalties and
16sanctions, which shall include, but need not be limited to, the
17creation of a schedule of graduated penalties and sanctions to
18include closure.
19    (f) The Department shall by rule establish procedures for
20disclosure of information to the public, which shall include,
21but not be limited to, ownership, licensure status, frequency
22of complaints, disposition of substantiated complaints, and
23disciplinary actions.
24    (g) (Blank).
25    (h) Beginning January 1, 2000, the Department shall begin
26drafting rules necessary for the administration of this Act.



10000HB3392ham001- 29 -LRB100 09446 MJP 21847 a

1    (i) The Department shall by rule provide for a prohibition
2on conflicts of interest for surveyors and all persons who
3conduct involuntary transfer or discharge hearings. As used in
4this subsection, "conflict of interest" includes, but is not
5limited to, (1) the existence of any professional relationship
6within 2 years prior to conducting the survey or the hearing or
7(2) a financial relationship between a surveyor or person
8conducting an involuntary transfer or discharge hearing or his
9or her immediate family and an establishment regulated by the
10Department. As used in this subsection, "immediate family"
11means a husband or wife, natural or adoptive parents, children,
12siblings, stepparents, stepchildren, stepbrothers,
13stepsisters, father-in-law, mother-in-law, brothers-in-law,
14sisters-in-law, grandparents, and grandchildren.
15(Source: P.A. 96-975, eff. 7-2-10.)
16    Section 10. The Nursing Home Care Act is amended by
17changing Sections 1-111, 1-114.005, 1-128, 2-104, 2-111,
183-202.05, 3-209, 3-305, 3-401, 3-401.1, 3-402, 3-404, 3-405,
193-410, 3-411, and 3-413 and by adding Sections 3-305.6,
203-413.1, and 3-424 as follows:
21    (210 ILCS 45/1-111)  (from Ch. 111 1/2, par. 4151-111)
22    Sec. 1-111. "Discharge" means the full release of any
23resident from a facility. "Discharge" includes a nursing
24facility's failure to readmit following hospitalization, other



10000HB3392ham001- 30 -LRB100 09446 MJP 21847 a

1medical leave, or other absence.
2(Source: P.A. 81-223.)
3    (210 ILCS 45/1-114.005)
4    Sec. 1-114.005. High risk designation. "High risk
5designation" means a violation of a provision of the Illinois
6Administrative Code or statute that has been identified by the
7Department through rulemaking or designated in statute to be
8inherently necessary to protect the health, safety, and welfare
9of a resident. "High risk designation" includes an unlawful
10discharge of a resident.
11(Source: P.A. 96-1372, eff. 7-29-10.)
12    (210 ILCS 45/1-128)  (from Ch. 111 1/2, par. 4151-128)
13    Sec. 1-128. "Transfer" means a change in status of a
14resident's living arrangements from one facility to another
15facility. "Transfer" includes a nursing facility's failure to
16readmit a resident following hospitalization, other medical
17leave, or other absence, resulting in the resident being moved
18to another institutional setting.
19(Source: P.A. 81-223.)
20    (210 ILCS 45/2-104)  (from Ch. 111 1/2, par. 4152-104)
21    Sec. 2-104. (a) A resident shall be permitted to retain the
22services of his own personal physician at his own expense or
23under an individual or group plan of health insurance, or under



10000HB3392ham001- 31 -LRB100 09446 MJP 21847 a

1any public or private assistance program providing such
2coverage. However, the facility is not liable for the
3negligence of any such personal physician. Every resident shall
4be permitted to obtain from his own physician or the physician
5attached to the facility complete and current information
6concerning his medical diagnosis, treatment and prognosis in
7terms and language the resident can reasonably be expected to
8understand. Every resident shall be permitted to participate in
9the planning of his total care and medical treatment to the
10extent that his condition permits. No resident shall be
11subjected to experimental research or treatment without first
12obtaining his informed, written consent. The conduct of any
13experimental research or treatment shall be authorized and
14monitored by an institutional review board appointed by the
15Director. The membership, operating procedures and review
16criteria for the institutional review board shall be prescribed
17under rules and regulations of the Department and shall comply
18with the requirements for institutional review boards
19established by the federal Food and Drug Administration. No
20person who has received compensation in the prior 3 years from
21an entity that manufactures, distributes, or sells
22pharmaceuticals, biologics, or medical devices may serve on the
23institutional review board.
24    The institutional review board may approve only research or
25treatment that meets the standards of the federal Food and Drug
26Administration with respect to (i) the protection of human



10000HB3392ham001- 32 -LRB100 09446 MJP 21847 a

1subjects and (ii) financial disclosure by clinical
2investigators. The Office of State Long Term Care Ombudsman and
3the State Protection and Advocacy organization shall be given
4an opportunity to comment on any request for approval before
5the board makes a decision. Those entities shall not be
6provided information that would allow a potential human subject
7to be individually identified, unless the board asks the
8Ombudsman for help in securing information from or about the
9resident. The board shall require frequent reporting of the
10progress of the approved research or treatment and its impact
11on residents, including immediate reporting of any adverse
12impact to the resident, the resident's representative, the
13Office of the State Long Term Care Ombudsman, and the State
14Protection and Advocacy organization. The board may not approve
15any retrospective study of the records of any resident about
16the safety or efficacy of any care or treatment if the resident
17was under the care of the proposed researcher or a business
18associate when the care or treatment was given, unless the
19study is under the control of a researcher without any business
20relationship to any person or entity who could benefit from the
21findings of the study.
22    No facility shall permit experimental research or
23treatment to be conducted on a resident, or give access to any
24person or person's records for a retrospective study about the
25safety or efficacy of any care or treatment, without the prior
26written approval of the institutional review board. No nursing



10000HB3392ham001- 33 -LRB100 09446 MJP 21847 a

1home administrator, or person licensed by the State to provide
2medical care or treatment to any person, may assist or
3participate in any experimental research on or treatment of a
4resident, including a retrospective study, that does not have
5the prior written approval of the board. Such conduct shall be
6grounds for professional discipline by the Department of
7Financial and Professional Regulation.
8    The institutional review board may exempt from ongoing
9review research or treatment initiated on a resident before the
10individual's admission to a facility and for which the board
11determines there is adequate ongoing oversight by another
12institutional review board. Nothing in this Section shall
13prevent a facility, any facility employee, or any other person
14from assisting or participating in any experimental research on
15or treatment of a resident, if the research or treatment began
16before the person's admission to a facility, until the board
17has reviewed the research or treatment and decided to grant or
18deny approval or to exempt the research or treatment from
19ongoing review.
20    The institutional review board requirements of this
21subsection (a) do not apply to investigational drugs,
22biological products, or devices used by a resident with a
23terminal illness as set forth in the Right to Try Act.
24    (b) All medical treatment and procedures shall be
25administered as ordered by a physician. All new physician
26orders shall be reviewed by the facility's director of nursing



10000HB3392ham001- 34 -LRB100 09446 MJP 21847 a

1or charge nurse designee within 24 hours after such orders have
2been issued to assure facility compliance with such orders.
3    All physician's orders and plans of treatment shall have
4the authentication of the physician. For the purposes of this
5subsection (b), "authentication" means an original written
6signature or an electronic signature system that allows for the
7verification of a signer's credentials. A stamp signature, with
8or without initials, is not sufficient.
9    According to rules adopted by the Department, every woman
10resident of child-bearing age shall receive routine
11obstetrical and gynecological evaluations as well as necessary
12prenatal care.
13    (c) Every resident shall be permitted to refuse medical
14treatment and to know the consequences of such action, unless
15such refusal would be harmful to the health and safety of
16others and such harm is documented by a physician in the
17resident's clinical record. The resident's refusal shall free
18the facility from the obligation to provide the treatment. If a
19resident's refusal of treatment does not endanger other
20residents or staff, then the refusal of treatment is not
21grounds for discharge.
22    (d) Every resident, resident's guardian, or parent if the
23resident is a minor shall be permitted to inspect and copy all
24his clinical and other records concerning his care and
25maintenance kept by the facility or by his physician. The
26facility may charge a reasonable fee for duplication of a



10000HB3392ham001- 35 -LRB100 09446 MJP 21847 a

2(Source: P.A. 99-270, eff. 1-1-16.)
3    (210 ILCS 45/2-111)  (from Ch. 111 1/2, par. 4152-111)
4    Sec. 2-111. A resident shall not be transferred or
5discharged in violation of this Act. A resident may not be
6charged for any period during which the resident was unlawfully
7denied the right to reside in a facility. A resident may be
8discharged from a facility after he gives the administrator, a
9physician, or a nurse of the facility written notice of his
10desire to be discharged. If a guardian has been appointed for a
11resident or if the resident is a minor, the resident shall be
12discharged upon written consent of his guardian or if the
13resident is a minor, his parent unless there is a court order
14to the contrary. In such cases, upon the resident's discharge,
15the facility is relieved from any responsibility for the
16resident's care, safety or well-being. A resident has the right
17to not be unlawfully transferred or discharged. An unlawful
18transfer or discharge is, at minimum, a type A violation.
19(Source: P.A. 81-223.)
20    (210 ILCS 45/3-202.05)
21    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
23    (a) For the purpose of computing staff to resident ratios,
24direct care staff shall include:



10000HB3392ham001- 36 -LRB100 09446 MJP 21847 a

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



10000HB3392ham001- 37 -LRB100 09446 MJP 21847 a

1promulgate rules specific to the staffing requirements for
2facilities licensed under the Specialized Mental Health
3Rehabilitation Act of 2013. These rules shall recognize the
4unique nature of individuals with chronic mental health
5conditions, shall include minimum requirements for specialized
6clinical staff, including clinical social workers,
7psychiatrists, psychologists, and direct care staff set forth
8in paragraphs (4) through (6) and any other specialized staff
9which may be utilized and deemed necessary to count toward
10staffing ratios.
11    (b) (Blank). Beginning January 1, 2011, and thereafter,
12light intermediate care shall be staffed at the same staffing
13ratio as intermediate care.
14    (b-5) For purposes of the minimum staffing ratios in this
15Section, all residents shall be classified as requiring either
16skilled care or intermediate care.
17    As used in this subsection:
18    "Skilled care" means skilled nursing care, continuous
19skilled nursing observations, restorative nursing, and other
20services under professional direction with frequent medical
22    "Intermediate care" means basic nursing care and other
23restorative services under periodic medical direction.
24    (c) Facilities shall notify the Department within 60 days
25after the effective date of this amendatory Act of the 96th
26General Assembly, in a form and manner prescribed by the



10000HB3392ham001- 38 -LRB100 09446 MJP 21847 a

1Department, of the staffing ratios in effect on the effective
2date of this amendatory Act of the 96th General Assembly for
3both intermediate and skilled care and the number of residents
4receiving each level of care.
5    (d)(1) Effective July 1, 2010, for each resident needing
6skilled care, a minimum staffing ratio of 2.5 hours of nursing
7and personal care each day must be provided; for each resident
8needing intermediate care, 1.7 hours of nursing and personal
9care each day must be provided.
10    (2) Effective January 1, 2011, the minimum staffing ratios
11shall be increased to 2.7 hours of nursing and personal care
12each day for a resident needing skilled care and 1.9 hours of
13nursing and personal care each day for a resident needing
14intermediate care.
15    (3) Effective January 1, 2012, the minimum staffing ratios
16shall be increased to 3.0 hours of nursing and personal care
17each day for a resident needing skilled care and 2.1 hours of
18nursing and personal care each day for a resident needing
19intermediate care.
20    (4) Effective January 1, 2013, the minimum staffing ratios
21shall be increased to 3.4 hours of nursing and personal care
22each day for a resident needing skilled care and 2.3 hours of
23nursing and personal care each day for a resident needing
24intermediate care.
25    (5) Effective January 1, 2014, the minimum staffing ratios
26shall be increased to 3.8 hours of nursing and personal care



10000HB3392ham001- 39 -LRB100 09446 MJP 21847 a

1each day for a resident needing skilled care and 2.5 hours of
2nursing and personal care each day for a resident needing
3intermediate care.
4    (e) Ninety days after the effective date of this amendatory
5Act of the 97th General Assembly, a minimum of 25% of nursing
6and personal care time shall be provided by licensed nurses,
7with at least 10% of nursing and personal care time provided by
8registered nurses. These minimum requirements shall remain in
9effect until an acuity based registered nurse requirement is
10promulgated by rule concurrent with the adoption of the
11Resource Utilization Group classification-based payment
12methodology, as provided in Section 5-5.2 of the Illinois
13Public Aid Code. Registered nurses and licensed practical
14nurses employed by a facility in excess of these requirements
15may be used to satisfy the remaining 75% of the nursing and
16personal care time requirements. Notwithstanding this
17subsection, no staffing requirement in statute in effect on the
18effective date of this amendatory Act of the 97th General
19Assembly shall be reduced on account of this subsection.
20    (f) The Department shall adopt rules by January 1, 2018
21establishing a system for determining compliance with minimum
22direct care staffing standards. Compliance shall be determined
23at least quarterly using the Center for Medicare and Medicaid
24Services' payroll-based journal and nursing home facility
25census and payroll data, which shall be obtained quarterly by
26the Department. The Department shall, at minimum, use the



10000HB3392ham001- 40 -LRB100 09446 MJP 21847 a

1quarterly payroll-based journal and census data to calculate
2the number of hours provided per resident day, and compare this
3ratio to the minimums required by this Section.
4    (g) The Department shall adopt rules by January 1, 2018
5establishing financial penalties for facilities out of
6compliance with minimum staffing standards. Monetary penalties
7shall be imposed beginning no later than October 1, 2018, and
8quarterly thereafter, for the latest quarter for which the
9Department has data. Monetary penalties shall be established
10based on a formula that calculates the cost of wages and
11benefits for the missing staff hours, and in no circumstances
12shall be less than twice the calculated cost of wages and
13benefits for the missing staff hours during the quarter, or the
14minimum penalty for a Type B violation, whichever is greater.
15The penalty shall be imposed regardless of whether the facility
16has committed other violations of this Act during the quarter.
17The penalty may not be waived. Nothing in this Section shall
18preclude a facility from being given a high risk designation
19for failure to comply with this Section that, when cited with
20other violations of this Act, increases the
21otherwise-applicable penalty.
22    (h) A violation of the minimum staffing requirements under
23this Section is, at minimum, a Type B violation.
24(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
25    (210 ILCS 45/3-209)  (from Ch. 111 1/2, par. 4153-209)



10000HB3392ham001- 41 -LRB100 09446 MJP 21847 a

1    Sec. 3-209. Every facility shall conspicuously post for
2display in an area of its offices accessible to residents,
3employees, and visitors the following:
4    (1) Its current license;
5    (2) A description, provided by the Department, of complaint
6procedures established under this Act and the name, address,
7and telephone number of a person authorized by the Department
8to receive complaints;
9    (3) A copy of any order pertaining to the facility issued
10by the Department or a court; and
11    (4) A list of the material available for public inspection
12under Section 3-210.
13    (5) A facility that has received a notice of violation for
14having violated the minimum staffing requirements of Section
153-202.05 shall display for 3 months following the date that the
16notice of violation was issued, a notice that it did not have
17enough staff to meet the needs of the facility's residents
18during the quarter cited in the notice of violation.
19(Source: P.A. 81-1349.)
20    (210 ILCS 45/3-305)  (from Ch. 111 1/2, par. 4153-305)
21    Sec. 3-305. The license of a facility which is in violation
22of this Act or any rule adopted thereunder may be subject to
23the penalties or fines levied by the Department as specified in
24this Section.
25    (1) A licensee who commits a Type "AA" violation as defined



10000HB3392ham001- 42 -LRB100 09446 MJP 21847 a

1in Section 1-128.5 is automatically issued a conditional
2license for a period of 6 months to coincide with an acceptable
3plan of correction and assessed a fine up to $25,000 per
5    (1.5) A licensee who commits a Type "A" violation as
6defined in Section 1-129 is automatically issued a conditional
7license for a period of 6 months to coincide with an acceptable
8plan of correction and assessed a fine of up to $12,500 per
10    (2) A licensee who commits a Type "B" violation as defined
11in Section 1-130 shall be assessed a fine of up to $1,100 per
12violation or the penalty specified in subsection (g) of Section
133-202.05, whichever is greater.
14    (2.5) A licensee who commits 10 or more Type "C"
15violations, as defined in Section 1-132, in a single survey
16shall be assessed a fine of up to $250 per violation. A
17licensee who commits one or more Type "C" violations with a
18high risk designation, as defined by rule, shall be assessed a
19fine of up to $500 per violation.
20    (3) A licensee who commits a Type "AA" or Type "A"
21violation as defined in Section 1-128.5 or 1-129 which
22continues beyond the time specified in paragraph (a) of Section
233-303 which is cited as a repeat violation shall have its
24license revoked and shall be assessed a fine of 3 times the
25fine computed per resident per day under subsection (1).
26    (4) A licensee who fails to satisfactorily comply with an



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1accepted plan of correction for a Type "B" violation or an
2administrative warning issued pursuant to Sections 3-401
3through 3-413 or the rules promulgated thereunder shall be
4automatically issued a conditional license for a period of not
5less than 6 months. A second or subsequent acceptable plan of
6correction shall be filed. A fine shall be assessed in
7accordance with subsection (2) when cited for the repeat
8violation. This fine shall be computed for all days of the
9violation, including the duration of the first plan of
10correction compliance time.
11    (5) For the purpose of computing a penalty under
12subsections (2) through (4), the number of residents per day
13shall be based on the average number of residents in the
14facility during the 30 days preceding the discovery of the
16    (6) When the Department finds that a provision of Article
17II has been violated with regard to a particular resident, the
18Department shall issue an order requiring the facility to
19reimburse the resident for injuries incurred, or $100,
20whichever is greater. In the case of a violation involving any
21action other than theft of money belonging to a resident,
22reimbursement shall be ordered only if a provision of Article
23II has been violated with regard to that or any other resident
24of the facility within the 2 years immediately preceding the
25violation in question.
26    (7) For purposes of assessing fines under this Section, a



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1repeat violation shall be a violation which has been cited
2during one inspection of the facility for which an accepted
3plan of correction was not complied with or a new citation of
4the same rule if the licensee is not substantially addressing
5the issue routinely throughout the facility.
6    (7.5) If an occurrence results in more than one type of
7violation as defined in this Act (that is, a Type "AA", Type
8"A", Type "B", or Type "C" violation), the Department shall
9assess only one fine, which shall not exceed the maximum fine
10that may be assessed for the most serious type of violation
11charged. For purposes of the preceding sentence, a Type "AA"
12violation is the most serious type of violation that may be
13charged, followed by a Type "A", Type "B", or Type "C"
14violation, in that order.
15    (8) The minimum and maximum fines that may be assessed
16pursuant to this Section shall be twice those otherwise
17specified for any facility that willfully makes a misstatement
18of fact to the Department, or willfully fails to make a
19required notification to the Department, if that misstatement
20or failure delays the start of a surveyor or impedes a survey.
21    (9) High risk designation. If the Department finds that a
22facility has violated a provision of the Illinois
23Administrative Code that has a high risk designation, or that a
24facility has violated the same provision of the Illinois
25Administrative Code 3 or more times in the previous 12 months,
26the Department may assess a fine of up to 2 times the maximum



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1fine otherwise allowed.
2    (10) If a licensee has paid a civil monetary penalty
3imposed pursuant to the Medicare and Medicaid Certification
4Program for the equivalent federal violation giving rise to a
5fine under this Section, the Department shall offset the fine
6by the amount of the civil monetary penalty. The offset may not
7reduce the fine by more than 75% of the original fine, however.
8(Source: P.A. 98-104, eff. 7-22-13.)
9    (210 ILCS 45/3-305.6 new)
10    Sec. 3-305.6. Failure to readmit a resident. A facility
11that fails to comply with an order of the Department to readmit
12a resident, shall be assessed a daily fine of $250. The fine
13shall be assessed beginning on the date of the surveyor
14inspection required by Section 3-413.1. The fine shall be
15imposed for every day thereafter until the facility notifies
16the Department that the facility is in compliance with the
17order and a surveyor makes an on-site inspection that confirms
18compliance or the resident or resident's representative
19confirms to the Department in writing that there is compliance.
20The on-site inspection shall be made within 3 days of the
21notification by the facility.
22    As used in this Section, "compliance with the order" means
23a resident is living in a facility, or a facility and a
24resident have agreed on a schedule for readmission. If a
25resident subsequently notifies the Department that a facility



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1is not complying with an agreed-upon schedule, a surveyor shall
2make an on-site inspection to determine compliance within 3
3days of the notification.
4    (210 ILCS 45/3-401)  (from Ch. 111 1/2, par. 4153-401)
5    Sec. 3-401. A facility may involuntarily transfer or
6discharge a resident only for one or more of the following
8        (a) the facility is unable to meet the medical needs of
9    the resident, as documented in the resident's clinical
10    record by his or her physician for medical reasons;
11        (b) for the resident's physical safety;
12        (c) for the physical safety of other residents, the
13    facility staff or facility visitors; or
14        (d) for either late payment or nonpayment for the
15    resident's stay, except as prohibited by Titles XVIII and
16    XIX of the federal Social Security Act. For purposes of
17    this Section, "late payment" means non-receipt of payment
18    after submission of a bill. If payment is not received
19    within 45 days after submission of a bill, a facility may
20    send a notice to the resident and responsible party
21    requesting payment within 30 days. If payment is not
22    received within such 30 days, the facility may thereupon
23    institute transfer or discharge proceedings by sending a
24    notice of transfer or discharge to the resident and
25    responsible party by registered or certified mail. The



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1    notice shall state, in addition to the requirements of
2    Section 3-403 of this Act, that the responsible party has
3    the right to pay the amount of the bill in full up to the
4    date the transfer or discharge is to be made and then the
5    resident shall have the right to remain in the facility.
6    Such payment shall terminate the transfer or discharge
7    proceedings. This subsection does not apply to those
8    residents whose care is provided for under the Illinois
9    Public Aid Code. The Department shall adopt rules setting
10    forth the criteria and procedures to be applied in cases of
11    involuntary transfer or discharge permitted under this
12    Section.
13    Prior to issuing the notice of transfer or discharge of a
14resident under subsection (a), (b), or (c) of this Section, an
15attending physician shall conduct an in-person assessment,
16with the findings documented in the resident's clinical record.
17    In the absence of other bases for transfer or discharge
18listed in this Section, and unless it has complied with the
19prior notice and other procedural requirements of this Act, a
20facility may not refuse to readmit a resident following a
21medical leave of absence if the resident's need for care does
22not exceed the provisions of the facility's license.
23(Source: P.A. 91-357, eff. 7-29-99.)
24    (210 ILCS 45/3-401.1)  (from Ch. 111 1/2, par. 4153-401.1)
25    Sec. 3-401.1. (a) A facility participating in the Medical



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1Assistance Program is prohibited from failing or refusing to
2retain as a resident any person because he or she is a
3recipient of or an applicant for the Medical Assistance
4Program. A resident who is in the process of appealing the
5denial of his or her application for the Medical Assistance
6Program is considered to be a Medicaid applicant under this
8    (a-5) After the effective date of this amendatory Act of
91997, a facility of which only a distinct part is certified to
10participate in the Medical Assistance Program may refuse to
11retain as a resident any person who resides in a part of the
12facility that does not participate in the Medical Assistance
13Program and who is unable to pay for his or her care in the
14facility without Medical Assistance only if:
15        (1) the facility, no later than at the time of
16    admission and at the time of the resident's contract
17    renewal, explains to the resident (unless he or she is
18    incompetent), and to the resident's representative, and to
19    the person making payment on behalf of the resident for the
20    resident's stay, in writing, that the facility may
21    discharge the resident if the resident is no longer able to
22    pay for his or her care in the facility without Medical
23    Assistance;
24        (2) the resident (unless he or she is incompetent), the
25    resident's representative, and the person making payment
26    on behalf of the resident for the resident's stay,



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1    acknowledge in writing that they have received the written
2    explanation.
3    (a-10) For the purposes of this Section, a recipient or
4applicant shall be considered a resident in the facility during
5any hospital stay totaling 10 days or less following a hospital
6admission. The Department of Healthcare and Family Services
7shall recoup funds from a facility when, as a result of the
8facility's refusal to readmit a recipient after
9hospitalization for 10 days or less, the recipient incurs
10hospital bills in an amount greater than the amount that would
11have been paid by that Department (formerly the Illinois
12Department of Public Aid) for care of the recipient in the
13facility. The amount of the recoupment shall be the difference
14between the Department of Healthcare and Family Services'
15(formerly the Illinois Department of Public Aid's) payment for
16hospital care and the amount that Department would have paid
17for care in the facility.
18    (b) A facility which violates this Section shall be guilty
19of a business offense and fined not less than $500 nor more
20than $1,000 for the first offense and not less than $1,000 nor
21more than $5,000 for each subsequent offense.
22(Source: P.A. 95-331, eff. 8-21-07.)
23    (210 ILCS 45/3-402)  (from Ch. 111 1/2, par. 4153-402)
24    Sec. 3-402. Involuntary transfer or discharge of a resident
25from a facility shall be preceded by the discussion required



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1under Section 3-408 and by a minimum written notice of 30 21
2days, except in one of the following instances:
3    (a) When an emergency transfer or discharge is ordered by
4the resident's attending physician because of the resident's
5health care needs upon an attending physician completing an
6in-person assessment.
7    (b) When the transfer or discharge is mandated by the
8physical safety of other residents, the facility staff, or
9facility visitors, as documented in the clinical record. The
10Department, the Office of State Long Term Care Ombudsman, and
11the resident's managed care organization, if applicable, shall
12be notified prior to any such involuntary transfer or
13discharge. The Department shall immediately offer transfer, or
14discharge and relocation assistance to residents transferred
15or discharged under this subparagraph (b), and the Department
16may place relocation teams as provided in Section 3-419 of this
18    (c) When an identified offender is within the provisional
19admission period defined in Section 1-120.3. If the Identified
20Offender Report and Recommendation prepared under Section
212-201.6 shows that the identified offender poses a serious
22threat or danger to the physical safety of other residents, the
23facility staff, or facility visitors in the admitting facility
24and the facility determines that it is unable to provide a safe
25environment for the other residents, the facility staff, or
26facility visitors, the facility shall transfer or discharge the



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1identified offender within 3 days after its receipt of the
2Identified Offender Report and Recommendation.
3(Source: P.A. 96-1372, eff. 7-29-10.)
4    (210 ILCS 45/3-404)  (from Ch. 111 1/2, par. 4153-404)
5    Sec. 3-404. A request for a hearing made under Section
63-403 shall stay a transfer or discharge pending a hearing or
7appeal of the decision, unless a condition which would have
8allowed transfer or discharge in less than 30 21 days as
9described under paragraphs (a) and (b) of Section 3-402
10develops in the interim.
11(Source: P.A. 81-223.)
12    (210 ILCS 45/3-405)  (from Ch. 111 1/2, par. 4153-405)
13    Sec. 3-405. A copy of the notice required by Section 3-402
14shall be placed in the resident's clinical record and a copy
15shall be transmitted to the Department, the resident, and the
16resident's representative, if any, the resident's managed care
17organization, if applicable, and the Office of State Long Term
18Care Ombudsman.
19(Source: P.A. 97-820, eff. 7-17-12.)
20    (210 ILCS 45/3-410)  (from Ch. 111 1/2, par. 4153-410)
21    Sec. 3-410. A resident subject to involuntary transfer or
22discharge from a facility, the resident's guardian or if the
23resident is a minor, his parent shall have the opportunity to



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1file a request for a hearing with the Department within 10 days
2following receipt of the written notice of the involuntary
3transfer or discharge by the facility. A long term care
4ombudsman may request a hearing on behalf of the resident, and
5secure representation for the resident, if, in the judgment of
6the long term care ombudsman, doing so is in the best interests
7of the resident, and the resident does not object.
8(Source: P.A. 81-223.)
9    (210 ILCS 45/3-411)  (from Ch. 111 1/2, par. 4153-411)
10    Sec. 3-411. The Department of Public Health, when the basis
11for involuntary transfer or discharge is other than action by
12the Department of Healthcare and Family Services (formerly
13Department of Public Aid) with respect to the Title XIX
14Medicaid recipient, shall hold a hearing at the resident's
15facility not later than 10 days after a hearing request is
16filed, and render a decision within 14 days after the filing of
17the hearing request. Once a request for a hearing is filed, the
18Department shall hold a hearing unless the request is withdrawn
19by the resident. If the request for a hearing is withdrawn
20based upon a representation made by the facility to the
21resident and the Department, including the hearing officer,
22that a resident who has been denied readmission will be
23readmitted, and the resident or resident representative
24notifies the Department that the facility is still denying
25readmission, failure to readmit is considered failure to comply



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1with a Department order to readmit pursuant to Section 3-305.6,
2including the imposition of a daily fine under Section 3-305.6.
3(Source: P.A. 95-331, eff. 8-21-07.)
4    (210 ILCS 45/3-413)  (from Ch. 111 1/2, par. 4153-413)
5    Sec. 3-413. If the Department determines that a transfer or
6discharge is authorized under Section 3-401, the resident shall
7not be required to leave the facility before the 34th day
8following receipt of the notice required under Section 3-402,
9or the 10th day following receipt of the Department's decision,
10whichever is later, unless a condition which would have allowed
11transfer or discharge in less than 30 21 days as described
12under paragraphs (a) and (b) of Section 3-402 develops in the
14(Source: P.A. 81-223.)
15    (210 ILCS 45/3-413.1 new)
16    Sec. 3-413.1. Denial of transfer or discharge. If the
17Department determines that a transfer or discharge is not
18authorized under Section 3-401, then the Department shall issue
19a written decision stating that the transfer or discharge is
20denied. If the action of the facility giving rise to the
21request for hearings is the facility's failure to readmit the
22resident following hospitalization, other medical leave of
23absence, or other absence, then the Department shall order the
24immediate readmission of the resident to the facility. The



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1facility shall comply with the order immediately. A surveyor
2shall make an on-site inspection of the facility's compliance
3with the order within 3 days of the order's entry unless the
4resident notifies the Department in writing that there is
6    (210 ILCS 45/3-424 new)
7    Sec. 3-424. Conflict of interest. The Department shall
8adopt rules providing for a prohibition on conflicts of
9interest for surveyors and all persons who conduct involuntary
10transfer or discharge hearings. As used in this Section,
11"conflict of interest" includes, but is not limited to, the
12existence of any professional relationship within 2 years prior
13to conducting the survey or the hearing, or a financial
14relationship between (1) a surveyor or person conducting an
15involuntary transfer or discharge hearing or their immediate
16family, and (2) a facility regulated by the Department. As used
17in this Section, "immediate family" means husband or wife,
18natural or adoptive parents, children, siblings, stepparents,
19stepchildren, stepbrothers, stepsisters, father-in-law,
20mother-in-law, brothers-in-law, sisters-in-law, grandparents,
21and grandchildren.
22    Section 99. Effective date. This Act takes effect upon
23becoming law.".