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90_HB0410
210 ILCS 3/20
210 ILCS 3/30
210 ILCS 3/35
210 ILCS 3/35.1
210 ILCS 3/36
Amends the Alternative Health Care Delivery Act. Provides
that the alternative health care delivery model demonstration
program shall include recovery care center, rather than
postsurgical recovery care center, alternative health care
models. Provides that the demonstration models for rural
areas may be located in rural areas in Standard Metropolitan
Statistical Areas. Requires one of the recovery care centers
to be a hospital located in a rural area. Defines terms.
Effective immediately.
LRB9000941JSgcA
LRB9000941JSgcA
1 AN ACT to amend the Alternative Health Care Delivery Act
2 by changing Sections 20, 30, 35, 35.1, and 36.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Alternative Health Care Delivery Act is
6 amended by changing Sections 20, 30, 35, 35.1, and 36 as
7 follows:
8 (210 ILCS 3/20)
9 Sec. 20. Board responsibilities. The State Board of
10 Health shall have the responsibilities set forth in this
11 Section.
12 (a) The Board shall investigate new health care delivery
13 models and recommend to the Governor and the General
14 Assembly, through the Department, those models that should be
15 authorized as alternative health care models for which
16 demonstration programs should be initiated. In its
17 deliberations, the Board shall use the following criteria:
18 (1) The feasibility of operating the model in
19 Illinois, based on a review of the experience in other
20 states including the impact on health professionals of
21 other health care programs or facilities.
22 (2) The potential of the model to meet an unmet
23 need.
24 (3) The potential of the model to reduce health
25 care costs to consumers, costs to third party payors, and
26 aggregate costs to the public.
27 (4) The potential of the model to maintain or
28 improve the standards of health care delivery in some
29 measurable fashion.
30 (5) The potential of the model to provide increased
31 choices or access for patients.
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1 (b) The Board shall evaluate and make recommendations to
2 the Governor and the General Assembly, through the
3 Department, regarding alternative health care model
4 demonstration programs established under this Act, at the
5 midpoint and end of the period of operation of the
6 demonstration programs. The report shall include, at a
7 minimum, the following:
8 (1) Whether the alternative health care models
9 improved access to health care for their service
10 populations in the State.
11 (2) The quality of care provided by the alternative
12 health care models as may be evidenced by health
13 outcomes, surveillance reports, and administrative
14 actions taken by the Department.
15 (3) The cost and cost effectiveness to the public,
16 third-party payors, and government of the alternative
17 health care models, including the impact of pilot
18 programs on aggregate health care costs in the area. In
19 addition to any other information collected by the Board
20 under this Section, the Board shall collect from
21 postsurgical recovery care centers uniform billing data
22 substantially the same as specified in Section 4-2(e) of
23 the Illinois Health Finance Reform Act. To facilitate
24 its evaluation of that data, the Board shall forward a
25 copy of the data to the Illinois Health Care Cost
26 Containment Council. All patient identifiers shall be
27 removed from the data before it is submitted to the Board
28 or Council.
29 (4) The impact of the alternative health care
30 models on the health care system in that area, including
31 changing patterns of patient demand and utilization,
32 financial viability, and feasibility of operation of
33 service in inpatient and alternative models in the area.
34 (5) The implementation by alternative health care
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1 models of any special commitments made during application
2 review to the Illinois Health Facilities Planning Board.
3 (6) The continuation, expansion, or modification of
4 the alternative health care models.
5 (c) The Board shall advise the Department on the
6 definition and scope of alternative health care models
7 demonstration programs.
8 (d) In carrying out its responsibilities under this
9 Section, the Board shall seek the advice of other Department
10 advisory boards or committees that may be impacted by the
11 alternative health care model or the proposed model of health
12 care delivery. The Board shall also seek input from other
13 interested parties, which may include holding public
14 hearings.
15 (e) The Board shall otherwise advise the Department on
16 the administration of the Act as the Board deems appropriate.
17 (Source: P.A. 87-1188; 88-441.)
18 (210 ILCS 3/30)
19 Sec. 30. Demonstration program requirements. The
20 requirements set forth in this Section shall apply to
21 demonstration programs.
22 (a) There shall be no more than:
23 (i) 3 subacute care hospital alternative health
24 care models in the City of Chicago (one of which shall be
25 located on a designated site and shall have been licensed
26 as a hospital under the Illinois Hospital Licensing Act
27 within the 10 years immediately before the application
28 for a license);
29 (ii) 2 subacute care hospital alternative health
30 care models in the demonstration program for each of the
31 following areas:
32 (1) Cook County outside the City of Chicago.
33 (2) DuPage, Kane, Lake, McHenry, and Will
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1 Counties.
2 (3) Municipalities with a population greater
3 than 50,000 not located in the areas described in
4 item (i) of subsection (a) and paragraphs (1) and
5 (2) of item (ii) of subsection (a); and
6 (iii) 4 subacute care hospital alternative health
7 care models in the demonstration program for rural areas.
8 In selecting among applicants for these licenses in rural
9 areas, the Health Facilities Planning Board and the
10 Department shall give preference to hospitals that may be
11 unable for economic reasons to provide continued service to
12 the community in which they are located unless the hospital
13 were to receive an alternative health care model license.
14 (a-5) There shall be no more than a total of 12
15 postsurgical recovery care center alternative health care
16 models in the demonstration program, located as follows:
17 (1) Two in the City of Chicago.
18 (2) Two in Cook County outside the City of Chicago.
19 At least one of these shall be owned or operated by a
20 hospital devoted exclusively to caring for children.
21 (3) Two in Kane, Lake, and McHenry Counties.
22 (4) Four in municipalities with a population of
23 50,000 or more not located in the areas described in
24 paragraphs (1), (2), and (3), 3 of which shall be owned
25 or operated by hospitals, at least 2 of which shall be
26 located in counties with a population of less than
27 175,000, according to the most recent decennial census
28 for which data are available, and one of which shall be
29 owned or operated by an ambulatory surgical treatment
30 center.
31 (5) Two in rural areas, which may be located in
32 Standard Metropolitan Statistical Areas, one of which
33 shall be a hospital located in a rural area and both of
34 which shall be owned or operated by hospitals.
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1 There shall be no postsurgical recovery care center
2 alternative health care models located in counties with
3 populations greater than 600,000 but less than 1,000,000. A
4 proposed postsurgical recovery care center must be owned or
5 operated by a hospital if it is to be located within, or will
6 primarily serve the residents of, a health service area in
7 which more than 60% of the gross patient revenue of the
8 hospitals within that health service area are derived from
9 Medicaid and Medicare, according to the most recently
10 available calendar year data from the Illinois Health Care
11 Cost Containment Council. Nothing in this paragraph shall
12 preclude a hospital and an ambulatory surgical treatment
13 center from forming a joint venture or developing a
14 collaborative agreement to own or operate a postsurgical
15 recovery care center.
16 (a-10) There shall be no more than a total of 8
17 children's respite care center alternative health care models
18 in the demonstration program, which shall be located as
19 follows:
20 (1) One in the City of Chicago.
21 (2) One in Cook County outside the City of Chicago.
22 (3) A total of 2 in the area comprised of DuPage,
23 Kane, Lake, McHenry, and Will counties.
24 (4) A total of 2 in municipalities with a
25 population of 50,000 or more and not located in the
26 areas described in paragraphs (1), (2), or (3).
27 (5) A total of 2 in rural areas, as defined by the
28 Health Facilities Planning Board.
29 No more than one children's respite care model owned and
30 operated by a licensed skilled pediatric facility shall be
31 located in each of the areas designated in this subsection
32 (a-10).
33 (b) Alternative health care models shall obtain a
34 certificate of need from the Illinois Health Facilities
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1 Planning Board under the Illinois Health Facilities Planning
2 Act before receiving a license by the Department.
3 Alternative health care models in medically underserved areas
4 shall receive priority in obtaining a certificate of need.
5 (c) An alternative health care model license shall be
6 issued for a period of one year and shall be annually renewed
7 if the facility or program is in substantial compliance with
8 the Department's rules adopted under this Act. A licensed
9 alternative health care model that continues to be in
10 substantial compliance after the conclusion of the
11 demonstration program shall be eligible for annual renewals
12 unless and until a different licensure program for that type
13 of health care model is established by legislation. The
14 Department may issue a provisional license to any alternative
15 health care model that does not substantially comply with the
16 provisions of this Act and the rules adopted under this Act
17 if (i) the Department finds that the alternative health care
18 model has undertaken changes and corrections which upon
19 completion will render the alternative health care model in
20 substantial compliance with this Act and rules and (ii) the
21 health and safety of the patients of the alternative health
22 care model will be protected during the period for which the
23 provisional license is issued. The Department shall advise
24 the licensee of the conditions under which the provisional
25 license is issued, including the manner in which the
26 alternative health care model fails to comply with the
27 provisions of this Act and rules, and the time within which
28 the changes and corrections necessary for the alternative
29 health care model to substantially comply with this Act and
30 rules shall be completed.
31 (d) Alternative health care models shall seek
32 certification under Titles XVIII and XIX of the federal
33 Social Security Act. In addition, alternative health care
34 models shall provide charitable care consistent with that
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1 provided by comparable health care providers in the
2 geographic area.
3 (d-5) The Illinois Department of Public Aid, in
4 cooperation with the Illinois Department of Public Health,
5 shall develop and implement a reimbursement methodology for
6 all facilities participating in the demonstration program.
7 The Illinois Department of Public Aid shall keep a record of
8 services provided under the demonstration program to
9 recipients of medical assistance under the Illinois Public
10 Aid Code and shall submit an annual report of that
11 information to the Illinois Department of Public Health.
12 (e) Alternative health care models shall, to the extent
13 possible, link and integrate their services with nearby
14 health care facilities.
15 (f) Each alternative health care model shall implement a
16 quality assurance program with measurable benefits and at
17 reasonable cost.
18 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
19 eff. 8-20-95.)
20 (210 ILCS 3/35)
21 Sec. 35. Alternative health care models authorized.
22 Notwithstanding any other law to the contrary, alternative
23 health care models described in this Section may be
24 established on a demonstration basis.
25 (1) Alternative health care model; subacute care
26 hospital. A subacute care hospital is a designated site
27 which provides medical specialty care for patients who
28 need a greater intensity or complexity of care than
29 generally provided in a skilled nursing facility but who
30 no longer require acute hospital care. The average length
31 of stay for patients treated in subacute care hospitals
32 shall not be less than 20 days, and for individual
33 patients, the expected length of stay at the time of
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1 admission shall not be less than 10 days. Variations
2 from minimum lengths of stay shall be reported to the
3 Department. There shall be no more than 13 subacute care
4 hospitals authorized to operate by the Department.
5 Subacute care includes physician supervision, registered
6 nursing, and physiological monitoring on a continual
7 basis. A subacute care hospital is either a freestanding
8 building or a distinct physical and operational entity
9 within a hospital or nursing home building. A subacute
10 care hospital shall only consist of beds currently
11 existing in licensed hospitals or skilled nursing
12 facilities, except, in the City of Chicago, on a
13 designated site that was licensed as a hospital under the
14 Illinois Hospital Licensing Act within the 10 years
15 immediately before the application for an alternative
16 health care model license. During the period of operation
17 of the demonstration project, the existing licensed beds
18 shall remain licensed as hospital or skilled nursing
19 facility beds as well as being licensed under this Act.
20 In order to handle cases of complications, emergencies,
21 or exigent circumstances, a subacute care hospital shall
22 maintain a contractual relationship, including a transfer
23 agreement, with a general acute care hospital. If a
24 subacute care model is located in a general acute care
25 hospital, it shall utilize all or a portion of the bed
26 capacity of that existing hospital. In no event shall a
27 subacute care hospital use the word "hospital" in its
28 advertising or marketing activities or represent or hold
29 itself out to the public as a general acute care
30 hospital.
31 (2) Alternative health care delivery model;
32 postsurgical recovery care center. A recovery care center
33 is (i) a designated site that provides recovery care for
34 generally healthy patients undergoing procedures that
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1 require admission for nursing care, pain control,
2 observation, or treatment that would otherwise be
3 provided in an inpatient setting or (ii) a designated
4 site that provides recovery care for patients usually
5 undergoing outpatient procedures that may otherwise
6 require a periodic short-term inpatient stay should side
7 effects of the procedure require overnight nursing care
8 or observation. Such procedures shall be authorized by
9 the consulting committee of the recovery care center. A
10 postsurgical recovery care center is a designated site
11 which provides postsurgical recovery care for generally
12 healthy patients undergoing surgical procedures that
13 require overnight nursing care, pain control, or
14 observation that would otherwise be provided in an
15 inpatient setting. A postsurgical recovery care center is
16 either freestanding or a defined unit of an ambulatory
17 surgical treatment center or hospital. Except for a
18 demonstration site in a rural area as described in
19 Section 30, no facility, or portion of a facility, may
20 participate in a demonstration program as a postsurgical
21 recovery care center unless the facility has been
22 licensed as an ambulatory surgical treatment center or
23 hospital for at least 2 years before August 20, 1993 (the
24 effective date of Public Act 88-441). The maximum length
25 of stay for patients in a postsurgical recovery care
26 center is not to exceed 48 hours unless the treating
27 physician requests an extension of time from the recovery
28 center's medical director on the basis of medical or
29 clinical documentation that an additional care period is
30 required for the recovery of a patient and the medical
31 director approves the extension of time. In no case,
32 however, shall a patient's length of stay in a
33 postsurgical recovery care center be longer than 72
34 hours. If a patient requires an additional care period
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1 after the expiration of the 72-hour limit, the patient
2 shall be transferred to an appropriate facility. Reports
3 on variances from the 48-hour limit shall be sent to the
4 Department for its evaluation. The reports shall, before
5 submission to the Department, have removed from them all
6 patient and physician identifiers. In order to handle
7 cases of complications, emergencies, or exigent
8 circumstances, every postsurgical recovery care center as
9 defined in this paragraph shall maintain a contractual
10 relationship, including a transfer agreement, with a
11 general acute care hospital. A postsurgical recovery
12 care center shall be no larger than 20 beds. A
13 postsurgical recovery care center shall be located within
14 15 minutes travel time from the general acute care
15 hospital with which the center maintains a contractual
16 relationship, including a transfer agreement, as required
17 under this paragraph.
18 No postsurgical recovery care center shall
19 discriminate against any patient requiring treatment
20 because of the source of payment for services, including
21 Medicare and Medicaid recipients.
22 The Department shall adopt rules to implement the
23 provisions of Public Act 88-441 concerning postsurgical
24 recovery care centers within 9 months after August 20,
25 1993.
26 (3) Alternative health care delivery model;
27 children's respite care center. A childrens' respite
28 care center model is a designated site that provides
29 respite for medically frail, technologically dependent,
30 clinically stable children, up to age 18, for a period of
31 one to 14 days. This care is to be provided in a
32 home-like environment that serves no more than 10
33 children at a time. Children's respite care center
34 services must be available through the model to all
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1 families, including those whose care is paid for through
2 the Illinois Department of Public Aid or the Illinois
3 Department of Children and Family Services. Each respite
4 care model location shall be a facility physically
5 separate and apart from any other facility licensed by
6 the Department of Public Health under this or any other
7 Act and shall provide, at a minimum, the following
8 services: out-of-home respite care; hospital to home
9 training for families and caregivers; short term
10 transitional care to facilitate placement and training
11 for foster care parents; parent and family support
12 groups.
13 Coverage for the services provided by the Illinois
14 Department of Public Aid under this paragraph (3) is
15 contingent upon federal waiver approval and is provided only
16 to Medicaid eligible clients participating in the home and
17 community based services waiver designated in Section 1915(c)
18 of the Social Security Act for medically frail and
19 technologically dependent children.
20 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
21 eff. 8-20-95.)
22 (210 ILCS 3/35.1)
23 Sec. 35.1. Scope of Program for Recovery Centers. Once
24 the Department has authorized a total of 12 postsurgical
25 recovery care centers under this Act, no new centers shall be
26 authorized for the duration of the demonstration program.
27 (Source: P.A. 89-393, eff. 8-20-95.)
28 (210 ILCS 3/36)
29 Sec. 36. Use of name; patient transfers; consulting
30 committee. No facility or person shall hold itself out to the
31 public as a "recovery care center" or "postsurgical recovery
32 care center" unless it is licensed as a postsurgical recovery
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1 care center under this Act.
2 The Department shall establish by rule criteria for
3 patient transfers to postsurgical recovery care models. Each
4 facility licensed as a postsurgical recovery care center
5 shall establish a qualified consulting committee to review
6 the types of surgical procedures performed in ambulatory
7 surgical treatment centers and hospitals which intend to
8 transfer patients to the recovery care center. The committee
9 shall recommend appropriate procedures for approval by the
10 Department of Public Health. Action on these recommendations
11 by the Department shall not be unreasonably withheld.
12 (Source: P.A. 88-490.)
13 Section 99. Effective date. This Act takes effect upon
14 becoming law.