State of Illinois
2021 and 2022


Introduced 2/26/2021, by Sen. Sue Rezin


210 ILCS 85/7  from Ch. 111 1/2, par. 148
210 ILCS 85/10.10
210 ILCS 85/14.5
110 ILCS 975/5  from Ch. 144, par. 2755
35 ILCS 5/232 new

    Amends the Hospital Licensing Act. Requires a hospital to provide a plan of correction to the Department of Public Health within 60 days if the hospital demonstrates a pattern or practice of failing to substantially comply with specified requirements or with the hospital's written staffing plan. Allows the Department to impose specified fines on a hospital for failing to comply with written staffing plans for nursing services or plans of correction. Requires money from fines to be deposited into the Hospital Licensure Fund (instead of the Long Term Care Provider Fund). Contains provisions concerning staffing plans. Amends the Nursing Education Scholarship Law. Provides that the Department of Public Health may award a total of $500,000 annually in nursing education scholarships. Amends the Illinois Income Tax Act. Creates an income tax credit for taxpayers who are employed during the taxable year as nurse educators. Provides that the credit shall be equal to 2.5% of the taxpayer's federal adjusted gross income for the taxable year. Effective immediately, except that provisions amending the Hospital Licensing Act take effect on the first day of the first full calendar month that begins 6 months after the Act becomes law.

LRB102 11387 HLH 16720 b






SB2153LRB102 11387 HLH 16720 b

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. If
10a hospital demonstrates a pattern or practice of failing to
11substantially comply with the requirements of Section 10.10 or
12the hospital's written staffing plan, the hospital shall
13provide a plan of correction to the Department within 60 days.
14The Department may impose fines as follows: (i) if a hospital
15fails to implement a written staffing plan for nursing
16services, a fine not to exceed $500 per occurrence may be
17imposed; (ii) if a hospital demonstrates a pattern or practice
18of failing to substantially comply with a plan of correction
19within 60 days after the plan takes effect, a fine not to
20exceed $500 per occurrence may be imposed; and (iii) if a
21hospital demonstrates for a second or subsequent time a
22pattern or practice of failing to substantially comply with a
23plan of correction within 60 days after the plan takes effect,
24a fine not to exceed $1,000 per occurrence may be imposed.
25Reports of violations of Section 10.10 shall be subject to
26public disclosure under Section 6.14a. Money from fines shall



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



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



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1the cost of service of the subpoena or subpoena duces tecum and
2the fee of the witness be borne by the party at whose instance
3the witness is summoned. In such case, the Department in its
4discretion, may require a deposit to cover the cost of such
5service and witness fees. A subpoena or subpoena duces tecum
6issued as aforesaid shall be served in the same manner as a
7subpoena issued out of a court.
8    (e) Any Circuit Court of this State upon the application
9of the Director, or upon the application of any other party to
10the proceeding, may, in its discretion, compel the attendance
11of witnesses, the production of books, papers, records, or
12memoranda and the giving of testimony before the Director or
13Hearing Officer conducting an investigation or holding a
14hearing authorized by this Act, by an attachment for contempt,
15or otherwise, in the same manner as production of evidence may
16be compelled before the court.
17    (f) The Director or Hearing Officer, or any party in an
18investigation or hearing before the Department, may cause the
19depositions of witnesses within the State to be taken in the
20manner prescribed by law for like depositions in civil actions
21in courts of this State, and to that end compel the attendance
22of witnesses and the production of books, papers, records, or
24(Source: P.A. 99-180, eff. 7-29-15.)
25    (210 ILCS 85/10.10)



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1    Sec. 10.10. Nurse Staffing by Patient Acuity.
2    (a) Findings. The Legislature finds and declares all of
3the following:
4        (1) The State of Illinois has a substantial interest
5    in promoting quality care and improving the delivery of
6    health care services.
7        (2) Evidence-based studies have shown that the basic
8    principles of staffing in the acute care setting should be
9    based on the complexity of patients' care needs aligned
10    with available nursing skills to promote quality patient
11    care consistent with professional nursing standards.
12        (3) Compliance with this Section promotes an
13    organizational climate that values registered nurses'
14    input in meeting the health care needs of hospital
15    patients.
16    (b) Definitions. As used in this Section:
17    "Acuity model" means an assessment tool selected and
18implemented by a hospital, as recommended by a nursing care
19committee, that assesses the complexity of patient care needs
20requiring professional nursing care and skills and aligns
21patient care needs and nursing skills consistent with
22professional nursing standards.
23    "Department" means the Department of Public Health.
24    "Direct patient care" means care provided by a registered
25professional nurse with direct responsibility to oversee or
26carry out medical regimens or nursing care for one or more



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2    "Nursing care committee" means a an existing or newly
3created hospital-wide committee or committees of nurses whose
4functions, in part or in whole, contribute to the development,
5recommendation, and review of the hospital's nurse staffing
6plan established pursuant to subsection (d).
7    "Registered professional nurse" means a person licensed as
8a Registered Nurse under the Nurse Practice Act.
9    "Written staffing plan for nursing care services" means a
10written plan for guiding the assignment of patient care
11nursing staff based on multiple nurse and patient
12considerations that yield minimum staffing levels for
13inpatient care units and the adopted acuity model aligning
14patient care needs with nursing skills required for quality
15patient care consistent with professional nursing standards.
16    (c) Written staffing plan.
17        (1) Every hospital shall implement a written
18    hospital-wide staffing plan, prepared recommended by a
19    nursing care committee or committees, that provides for
20    minimum direct care professional registered
21    nurse-to-patient staffing needs for each inpatient care
22    unit, including inpatient emergency departments. If the
23    staffing plan prepared by the nursing care committee is
24    not adopted by the hospital, or if substantial changes are
25    proposed to it, the chief nursing officer shall either:
26    (i) provide a written explanation to the committee of the



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



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



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1        submitted under subparagraphs (A) and (B) of this
2        paragraph (2.5), including the ability to determine if
3        a specific written report is resolved or should be
4        dismissed.
5        (3) The written staffing plan shall be posted in a
6    conspicuous and accessible location for both patients and
7    direct care staff, as required under the Hospital Report
8    Card Act. A copy of the written staffing plan shall be
9    provided to any member of the general public upon request.
10    (d) Nursing care committee.
11        (1) Every hospital shall have a nursing care committee
12    that meets at least 6 times per year. A hospital shall
13    appoint members of a committee whereby at least 55% 50% of
14    the members are registered professional nurses providing
15    direct inpatient patient care, one of whom shall be
16    selected annually by the direct inpatient care nurses to
17    serve as co-chair of the committee.
18        (2) (Blank). A nursing care committee's
19    recommendations must be given significant regard and
20    weight in the hospital's adoption and implementation of a
21    written staffing plan.
22        (2.5) A nursing care committee shall prepare and
23    recommend to hospital administration the hospital's
24    written hospital-wide staffing plan. If the staffing plan
25    is not adopted by the hospital, the chief nursing officer
26    shall provide a written statement to the committee prior



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



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1                (ii) complaints regarding staffing, including
2            complaints about a delay in direct care nursing or
3            an absence of direct care nursing;
4                (iii) the number of hours of nursing care
5            provided through an inpatient hospital unit
6            compared with the number of inpatients served by
7            the hospital unit during a 24-hour period;
8                (iv) the aggregate hours of overtime worked by
9            the nursing staff;
10                (v) the extent to which actual nurse staffing
11            for each hospital inpatient unit differs from the
12            staffing specified by the staffing plan; and
13                (vi) any other matter or change to the
14            staffing plan determined by the committee to
15            ensure that the hospital is staffed to meet the
16            health care needs of patients.
17        (4) A nursing care committee must issue a written
18    report addressing address the items described in
19    subparagraphs (A) through (D) of paragraph (3)
20    semi-annually. A written copy of this report shall be made
21    available to direct inpatient care nurses by making
22    available a paper copy of the report, distributing it
23    electronically, or posting it on the hospital's website.
24        (5) A nursing care committee must issue a written
25    report at least annually to the hospital governing board
26    that addresses items including, but not limited to: the



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1    items described in paragraph (3); changes made based on
2    committee recommendations and the impact of such changes;
3    and recommendations for future changes related to nurse
4    staffing.
5    (e) Nothing in this Section 10.10 shall be construed to
6limit, alter, or modify any of the terms, conditions, or
7provisions of a collective bargaining agreement entered into
8by the hospital.
9    (f) No hospital may discipline, discharge, or take any
10other adverse employment action against an employee solely
11because the employee expresses a concern or complaint
12regarding an alleged violation of this Section or concerns
13related to nurse staffing.
14    (g) Any employee of a hospital may file a complaint with
15the Department regarding an alleged violation of this Section.
16The Department must forward notification of the alleged
17violation to the hospital in question within 10 business days
18after the complaint is filed. Upon receiving a complaint of a
19violation of this Section, the Department may take any action
20authorized under Sections 7 or 9 of this Act.
21(Source: P.A. 96-328, eff. 8-11-09; 97-423, eff. 1-1-12;
2297-813, eff. 7-13-12.)
23    (210 ILCS 85/14.5)
24    Sec. 14.5. Hospital Licensure Fund.
25    (a) There is created in the State treasury the Hospital



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



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

8    Section 5-5. The Nursing Education Scholarship Law is
9amended by changing Section 5 as follows:
10    (110 ILCS 975/5)  (from Ch. 144, par. 2755)
11    Sec. 5. Nursing education scholarships. Beginning with the
12fall term of the 2004-2005 academic year, the Department, in
13accordance with rules and regulations promulgated by it for
14this program, shall provide scholarships to individuals
15selected from among those applicants who qualify for
16consideration by showing:
17        (1) that he or she has been a resident of this State
18    for at least one year prior to application, and is a
19    citizen or a lawful permanent resident alien of the United
20    States;
21        (2) that he or she is enrolled in or accepted for
22    admission to an associate degree in nursing program,
23    hospital-based diploma in nursing program, baccalaureate



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



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1    Unless otherwise indicated, scholarships shall be awarded
2to recipients at approved institutions for a period of up to 2
3years if the recipient is enrolled in an associate degree in
4nursing program, up to 3 years if the recipient is enrolled in
5a hospital-based diploma in nursing program, up to 4 years if
6the recipient is enrolled in a baccalaureate degree in nursing
7program, up to 5 years if the recipient is enrolled in a
8graduate degree in nursing program, and up to one year if the
9recipient is enrolled in a certificate in practical nursing
10program. At least 40% of the scholarships awarded shall be for
11recipients who are pursuing baccalaureate degrees in nursing,
1230% of the scholarships awarded shall be for recipients who
13are pursuing associate degrees in nursing or a diploma in
14nursing, 10% of the scholarships awarded shall be for
15recipients who are pursuing a certificate in practical
16nursing, and 20% of the scholarships awarded shall be for
17recipients who are pursuing a graduate degree in nursing.
18    Beginning with the fall term of the 2021-2022 academic
19year and continuing through the 2024-2025 academic year,
20subject to appropriation from the Hospital Licensure Fund, in
21addition to any other funds available to the Department for
22such scholarships, the Department may award a total of
23$500,000 annually in scholarships under this Section.
24(Source: P.A. 100-513, eff. 1-1-18.)




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1    Section 10-5. The Illinois Income Tax Act is amended by
2adding Section 232 as follows:
3    (35 ILCS 5/232 new)
4    Sec. 232. Credit for nurse educators.
5    (a) For taxable years beginning on or after January 1,
62021, any taxpayer who is employed during the taxable year as a
7nurse educator is entitled to a credit against the tax imposed
8by subsections (a) and (b) of Section 201 in an amount equal to
92.5% of the taxpayer's federal adjusted gross income for the
10taxable year. As used in this Section "nurse educator" has the
11meaning given to that term in Section 3 of the Nursing
12Education Scholarship Law.
13    (b) In no event shall a credit under this Section reduce a
14taxpayer's liability to less than zero. If the amount of
15credit exceeds the tax liability for the year, the excess may
16be carried forward and applied to the tax liability for the 5
17taxable years following the excess credit year. The tax credit
18shall be applied to the earliest year for which there is a tax
19liability. If there are credits for more than one year that are
20available to offset liability, the earlier credit shall be
21applied first.
22    (c) This Section is exempt from the provisions of Section



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