Public Act 103-0886
 
SB0774 EnrolledLRB103 03230 AMQ 48236 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Assisted Living and Shared Housing Act is
amended by changing Sections 10 and 70 and by adding Section 79
as follows:
 
    (210 ILCS 9/10)
    Sec. 10. Definitions. For purposes of this Act:
    "Activities of daily living" means eating, dressing,
bathing, toileting, transferring, or personal hygiene.
    "Assisted living establishment" or "establishment" means a
home, building, residence, or any other place where sleeping
accommodations are provided for at least 3 unrelated adults,
at least 80% of whom are 55 years of age or older and where the
following are provided consistent with the purposes of this
Act:
        (1) services consistent with a social model that is
    based on the premise that the resident's unit in assisted
    living and shared housing is his or her own home;
        (2) community-based residential care for persons who
    need assistance with activities of daily living, including
    personal, supportive, and intermittent health-related
    services available 24 hours per day, if needed, to meet
    the scheduled and unscheduled needs of a resident;
        (3) mandatory services, whether provided directly by
    the establishment or by another entity arranged for by the
    establishment, with the consent of the resident or
    resident's representative; and
        (4) a physical environment that is a homelike setting
    that includes the following and such other elements as
    established by the Department: individual living units
    each of which shall accommodate small kitchen appliances
    and contain private bathing, washing, and toilet
    facilities, or private washing and toilet facilities with
    a common bathing room readily accessible to each resident.
    Units shall be maintained for single occupancy except in
    cases in which 2 residents choose to share a unit.
    Sufficient common space shall exist to permit individual
    and group activities.
    "Assisted living establishment" or "establishment" does
not mean any of the following:
        (1) A home, institution, or similar place operated by
    the federal government or the State of Illinois.
        (2) A long term care facility licensed under the
    Nursing Home Care Act, a facility licensed under the
    Specialized Mental Health Rehabilitation Act of 2013, a
    facility licensed under the ID/DD Community Care Act, or a
    facility licensed under the MC/DD Act. However, a facility
    licensed under any of those Acts may convert distinct
    parts of the facility to assisted living. If the facility
    elects to do so, the facility shall retain the Certificate
    of Need for its nursing and sheltered care beds that were
    converted.
        (3) A hospital, sanitarium, or other institution, the
    principal activity or business of which is the diagnosis,
    care, and treatment of human illness and that is required
    to be licensed under the Hospital Licensing Act.
        (4) A facility for child care as defined in the Child
    Care Act of 1969.
        (5) A community living facility as defined in the
    Community Living Facilities Licensing Act.
        (6) A nursing home or sanitarium operated solely by
    and for persons who rely exclusively upon treatment by
    spiritual means through prayer in accordance with the
    creed or tenants of a well-recognized church or religious
    denomination.
        (7) A facility licensed by the Department of Human
    Services as a community-integrated living arrangement as
    defined in the Community-Integrated Living Arrangements
    Licensure and Certification Act.
        (8) A supportive residence licensed under the
    Supportive Residences Licensing Act.
        (9) The portion of a life care facility as defined in
    the Life Care Facilities Act not licensed as an assisted
    living establishment under this Act; a life care facility
    may apply under this Act to convert sections of the
    community to assisted living.
        (10) A free-standing hospice facility licensed under
    the Hospice Program Licensing Act.
        (11) A shared housing establishment.
        (12) A supportive living facility as described in
    Section 5-5.01a of the Illinois Public Aid Code.
    "Certified medication aide" means a person who has met the
qualifications for certification under Section 79 and assists
with medication administration while under the supervision of
a registered professional nurse as authorized by Section 50-75
of the Nurse Practice Act in an assisted living establishment.
    "Department" means the Department of Public Health.
    "Director" means the Director of Public Health.
    "Emergency situation" means imminent danger of death or
serious physical harm to a resident of an establishment.
    "License" means any of the following types of licenses
issued to an applicant or licensee by the Department:
        (1) "Probationary license" means a license issued to
    an applicant or licensee that has not held a license under
    this Act prior to its application or pursuant to a license
    transfer in accordance with Section 50 of this Act.
        (2) "Regular license" means a license issued by the
    Department to an applicant or licensee that is in
    substantial compliance with this Act and any rules
    promulgated under this Act.
    "Licensee" means a person, agency, association,
corporation, partnership, or organization that has been issued
a license to operate an assisted living or shared housing
establishment.
    "Licensed health care professional" means a registered
professional nurse, an advanced practice registered nurse, a
physician assistant, and a licensed practical nurse.
    "Mandatory services" include the following:
        (1) 3 meals per day available to the residents
    prepared by the establishment or an outside contractor;
        (2) housekeeping services including, but not limited
    to, vacuuming, dusting, and cleaning the resident's unit;
        (3) personal laundry and linen services available to
    the residents provided or arranged for by the
    establishment;
        (4) security provided 24 hours each day including, but
    not limited to, locked entrances or building or contract
    security personnel;
        (5) an emergency communication response system, which
    is a procedure in place 24 hours each day by which a
    resident can notify building management, an emergency
    response vendor, or others able to respond to his or her
    need for assistance; and
        (6) assistance with activities of daily living as
    required by each resident.
    "Negotiated risk" is the process by which a resident, or
his or her representative, may formally negotiate with
providers what risks each are willing and unwilling to assume
in service provision and the resident's living environment.
The provider assures that the resident and the resident's
representative, if any, are informed of the risks of these
decisions and of the potential consequences of assuming these
risks.
    "Owner" means the individual, partnership, corporation,
association, or other person who owns an assisted living or
shared housing establishment. In the event an assisted living
or shared housing establishment is operated by a person who
leases or manages the physical plant, which is owned by
another person, "owner" means the person who operates the
assisted living or shared housing establishment, except that
if the person who owns the physical plant is an affiliate of
the person who operates the assisted living or shared housing
establishment and has significant control over the day to day
operations of the assisted living or shared housing
establishment, the person who owns the physical plant shall
incur jointly and severally with the owner all liabilities
imposed on an owner under this Act.
    "Physician" means a person licensed under the Medical
Practice Act of 1987 to practice medicine in all of its
branches.
    "Program" means the Certified Medication Aide Program.
    "Qualified establishment" means an assisted living and
shared housing establishment licensed by the Department of
Public Health.
    "Resident" means a person residing in an assisted living
or shared housing establishment.
    "Resident's representative" means a person, other than the
owner, agent, or employee of an establishment or of the health
care provider unless related to the resident, designated in
writing by a resident to be his or her representative. This
designation may be accomplished through the Illinois Power of
Attorney Act, pursuant to the guardianship process under the
Probate Act of 1975, or pursuant to an executed designation of
representative form specified by the Department.
    "Self" means the individual or the individual's designated
representative.
    "Shared housing establishment" or "establishment" means a
publicly or privately operated free-standing residence for 16
or fewer persons, at least 80% of whom are 55 years of age or
older and who are unrelated to the owners and one manager of
the residence, where the following are provided:
        (1) services consistent with a social model that is
    based on the premise that the resident's unit is his or her
    own home;
        (2) community-based residential care for persons who
    need assistance with activities of daily living, including
    housing and personal, supportive, and intermittent
    health-related services available 24 hours per day, if
    needed, to meet the scheduled and unscheduled needs of a
    resident; and
        (3) mandatory services, whether provided directly by
    the establishment or by another entity arranged for by the
    establishment, with the consent of the resident or the
    resident's representative.
    "Shared housing establishment" or "establishment" does not
mean any of the following:
        (1) A home, institution, or similar place operated by
    the federal government or the State of Illinois.
        (2) A long term care facility licensed under the
    Nursing Home Care Act, a facility licensed under the
    Specialized Mental Health Rehabilitation Act of 2013, a
    facility licensed under the ID/DD Community Care Act, or a
    facility licensed under the MC/DD Act. A facility licensed
    under any of those Acts may, however, convert sections of
    the facility to assisted living. If the facility elects to
    do so, the facility shall retain the Certificate of Need
    for its nursing beds that were converted.
        (3) A hospital, sanitarium, or other institution, the
    principal activity or business of which is the diagnosis,
    care, and treatment of human illness and that is required
    to be licensed under the Hospital Licensing Act.
        (4) A facility for child care as defined in the Child
    Care Act of 1969.
        (5) A community living facility as defined in the
    Community Living Facilities Licensing Act.
        (6) A nursing home or sanitarium operated solely by
    and for persons who rely exclusively upon treatment by
    spiritual means through prayer in accordance with the
    creed or tenants of a well-recognized church or religious
    denomination.
        (7) A facility licensed by the Department of Human
    Services as a community-integrated living arrangement as
    defined in the Community-Integrated Living Arrangements
    Licensure and Certification Act.
        (8) A supportive residence licensed under the
    Supportive Residences Licensing Act.
        (9) A life care facility as defined in the Life Care
    Facilities Act; a life care facility may apply under this
    Act to convert sections of the community to assisted
    living.
        (10) A free-standing hospice facility licensed under
    the Hospice Program Licensing Act.
        (11) An assisted living establishment.
        (12) A supportive living facility as described in
    Section 5-5.01a of the Illinois Public Aid Code.
    "Total assistance" means that staff or another individual
performs the entire activity of daily living without
participation by the resident.
(Source: P.A. 99-180, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
    (210 ILCS 9/70)
    Sec. 70. Service requirements. An establishment must
provide all mandatory services and may provide optional
services, including medication reminders, supervision of
self-administered medication and medication administration as
defined by this Section and nonmedical services defined by
rule, whether provided directly by the establishment or by
another entity arranged for by the establishment with the
consent of the resident or the resident's representative.
    For the purposes of this Section, "medication reminders"
means reminding residents to take pre-dispensed,
self-administered medication, observing the resident, and
documenting whether or not the resident took the medication.
    For the purposes of this Section, "supervision of
self-administered medication" means assisting the resident
with self-administered medication using any combination of the
following: reminding residents to take medication, reading the
medication label to residents, checking the self-administered
medication dosage against the label of the medication,
confirming that residents have obtained and are taking the
dosage as prescribed, and documenting in writing that the
resident has taken (or refused to take) the medication. If
residents are physically unable to open the container, the
container may be opened for them. Supervision of
self-administered medication shall be under the direction of a
licensed health care professional or, in the case of a
certified medication aide, under the supervision and
delegation of a registered nurse as authorized by Section
50-75 of the Nurse Practice Act.
    For the purposes of this Section, "medication
administration" refers to a licensed health care professional
employed by an establishment engaging in administering insulin
and vitamin B-12 injections, oral medications, topical
treatments, eye and ear drops, or nitroglycerin patches. A
certified medication aide may administer medications under the
supervision and delegation of a registered nurse as authorized
by Section 50-75 of the Nurse Practice Act, except (i)
Schedule II controlled substances as set forth in the Illinois
Controlled Substances Act and (ii) any subcutaneous,
intramuscular, intradermal, or intravenous medication
Non-licensed staff may not administer any medication.
    The Department shall specify by rule procedures for
medication reminders, supervision of self-administered
medication, and medication administration.
    Nothing in this Act shall preclude a physician licensed
under the Medical Practice Act of 1987 from providing services
within the scope of his or her license to any resident.
(Source: P.A. 96-353, eff. 8-13-09.)
 
    (210 ILCS 9/79 new)
    Sec. 79. Certified Medication Aide Program.
    (a) The Department shall administer and enforce a
Certified Medication Aide Program and regulate certified
medication aides. To be approved as an establishment qualified
to participate in the program, an establishment must satisfy
all of the following requirements:
        (1) Be licensed and in good standing as an assisted
    living or shared housing establishment by the Department.
        (2) Certify that the employment of a certified
    medication aide will not replace or diminish the
    employment of registered nurses or licensed practical
    nurses at the establishment.
        (3) Certify that a registered nurse will be on duty
    and present in the establishment to delegate and supervise
    the administration of medication by a certified medication
    aide at all times.
        (4) Certify that, with the exception of licensed
    health care professionals, only certified medication aides
    will be employed in the capacity of administering
    medication.
        (5) Provide information regarding patient safety,
    efficiency, and errors as determined by the Department.
    Failure to submit any required report may be grounds for
discipline or sanctions as prescribed by the Department. The
Department shall submit a report regarding patient safety,
efficiency, and errors, as determined by rule, to the General
Assembly no later than 2 years after the effective date of this
amendatory Act of the 103rd General Assembly.
    (b) No person shall practice as a medication aide or hold
himself or herself out as a certified medication aide in this
State unless he or she is certified in accordance with this
Section. Nothing in this Section shall be construed as
preventing or restricting the practice, services, or
activities of:
        (1) any person licensed in this State by any other law
    from engaging in the profession or occupation for which he
    or she is licensed;
        (2) any person employed as a medication aide by the
    government of the United States, if such person practices
    as a medication aide solely under the direction or control
    of the organization by which he or she is employed; or
        (3) any person pursuing a course of study leading to a
    certificate in medication aide at an accredited or
    approved educational program if such activities and
    services constitute a part of a supervised course of study
    and if such person is designated by a title which clearly
    indicates his or her status as a student or trainee.
    Nothing in this Section shall be construed to limit the
delegation of tasks or duties by a physician, dentist,
advanced practice registered nurse, or podiatric physician as
authorized by law.
    (c) A certified medication aide may only practice in a
qualified establishment. Certified medication aides must be
supervised by and receive delegation by a registered nurse, as
authorized by Section 50-75 of the Nurse Practice Act, that is
on duty and present in the establishment at all times.
Certified medication aides shall not have a direct-care
assignment when scheduled to work as a certified medication
aide, but may assist residents as needed. Certified medication
aides shall not administer any medication until a physician
has conducted an initial assessment of the resident.
    Certified medication aides shall not administer any
Schedule II controlled substances as set forth in the Illinois
Controlled Substances Act and may not administer any
subcutaneous, intramuscular, intradermal, or intravenous
medication.
    (d) In addition to any other penalty provided by law, any
person who practices, offers to practice, attempts to
practice, or holds oneself out to practice as a medication
aide without being certified in accordance with this Section
shall pay a civil penalty to the Department as determined by
the Department. The Department has the authority and power to
investigate any and all uncertified activity. The civil
penalty shall be paid within 60 days after the date of the
order imposing the civil penalty. The order shall constitute a
judgment and may be filed and execution had thereon in the same
manner as any judgment from any court of record.
    (e) Applications for original certification shall be made
to the Department in writing on forms prescribed by the
Department and shall be accompanied by the required fee, which
shall not be refundable. The application shall require such
information that, in the judgment of the Department, enables
the Department to pass on the qualifications of the applicant
for certification.
    (f) The Department shall authorize examinations of
applicants for a certificate under this Section at the times
and places as it may designate. The examination shall be of a
character to give a fair test of the qualifications of the
applicant to practice as a medication aide.
    Applicants for examination as a medication aide shall be
required to pay, either to the Department or the designated
testing service, a fee covering the cost of providing the
examination. Failure to appear for the examination on the
scheduled date, at the time and place specified, after the
applicant's application for examination has been received and
acknowledged by the Department or the designated testing
service, shall result in the forfeiture of the examination
fee.
    If an applicant fails to pass an examination for
certification in accordance with this Section within 3 years
after filing his or her application, then the application
shall be denied. The applicant may thereafter make a new
application accompanied by the required fee; however, the
applicant shall meet all requirements in effect at the time of
subsequent application before obtaining certification. The
Department may employ consultants for the purposes of
preparing and conducting examinations.
    (g) An applicant for certification by examination to
practice as a certified medication aide must:
        (1) submit a completed written application on forms
    provided by the Department and fees as established by the
    Department;
        (2) be age 18 or older;
        (3) have a high school diploma or a high school
    equivalency certificate;
        (4) demonstrate the ability to speak, read, and write
    the English language, as determined by rule;
        (5) demonstrate competency in math, as determined by
    rule;
        (6) be currently certified in good standing as a
    certified nursing assistant and provide proof of 2,000
    hours of practice as a certified nursing assistant within
    3 years before application for a certificate under this
    Section;
        (7) submit to the criminal history records check
    required under Section 46 of the Health Care Worker
    Background Check Act;
        (8) be currently certified to perform cardiopulmonary
    resuscitation by the American Heart Association or
    American Red Cross;
        (9) have successfully completed a course of study
    approved by the Department as defined by rule; to be
    approved, the program must include a minimum of 60 hours
    of classroom-based medication aide education, a minimum of
    10 hours of simulation laboratory study, and a minimum of
    30 hours of registered nurse-supervised clinical practicum
    with progressive responsibility of patient medication
    assistance;
        (10) have successfully completed the Medication Aide
    Certification Examination or other examination authorized
    by the Department; and
        (11) submit proof of employment by a qualifying
    establishment.
    (h) The expiration date for each certification to practice
as a certified medication aide shall be set by rule.
    (i) No person shall use the title "certified medication
aide" unless he or she holds a valid certificate issued by the
Department in accordance with this Section.
    (j) The Department shall propose rules to implement the
provisions of this Section within 180 days after the effective
date of this amendatory Act of the 103rd General Assembly.
 
    (225 ILCS 65/Art. 80 rep.)
    Section 10. The Nurse Practice Act is amended by repealing
Article 80.
 
    Section 15. The Illinois Public Aid Code is amended by
changing Section 5-5.01a as follows:
 
    (305 ILCS 5/5-5.01a)
    Sec. 5-5.01a. Supportive living facilities program.
    (a) The Department shall establish and provide oversight
for a program of supportive living facilities that seek to
promote resident independence, dignity, respect, and
well-being in the most cost-effective manner.
    A supportive living facility is (i) a free-standing
facility or (ii) a distinct physical and operational entity
within a mixed-use building that meets the criteria
established in subsection (d). A supportive living facility
integrates housing with health, personal care, and supportive
services and is a designated setting that offers residents
their own separate, private, and distinct living units.
    Sites for the operation of the program shall be selected
by the Department based upon criteria that may include the
need for services in a geographic area, the availability of
funding, and the site's ability to meet the standards.
    (b) Beginning July 1, 2014, subject to federal approval,
the Medicaid rates for supportive living facilities shall be
equal to the supportive living facility Medicaid rate
effective on June 30, 2014 increased by 8.85%. Once the
assessment imposed at Article V-G of this Code is determined
to be a permissible tax under Title XIX of the Social Security
Act, the Department shall increase the Medicaid rates for
supportive living facilities effective on July 1, 2014 by
9.09%. The Department shall apply this increase retroactively
to coincide with the imposition of the assessment in Article
V-G of this Code in accordance with the approval for federal
financial participation by the Centers for Medicare and
Medicaid Services.
    The Medicaid rates for supportive living facilities
effective on July 1, 2017 must be equal to the rates in effect
for supportive living facilities on June 30, 2017 increased by
2.8%.
    The Medicaid rates for supportive living facilities
effective on July 1, 2018 must be equal to the rates in effect
for supportive living facilities on June 30, 2018.
    Subject to federal approval, the Medicaid rates for
supportive living services on and after July 1, 2019 must be at
least 54.3% of the average total nursing facility services per
diem for the geographic areas defined by the Department while
maintaining the rate differential for dementia care and must
be updated whenever the total nursing facility service per
diems are updated. Beginning July 1, 2022, upon the
implementation of the Patient Driven Payment Model, Medicaid
rates for supportive living services must be at least 54.3% of
the average total nursing services per diem rate for the
geographic areas. For purposes of this provision, the average
total nursing services per diem rate shall include all add-ons
for nursing facilities for the geographic area provided for in
Section 5-5.2. The rate differential for dementia care must be
maintained in these rates and the rates shall be updated
whenever nursing facility per diem rates are updated.
    Subject to federal approval, beginning January 1, 2024,
the dementia care rate for supportive living services must be
no less than the non-dementia care supportive living services
rate multiplied by 1.5.
    (c) The Department may adopt rules to implement this
Section. Rules that establish or modify the services,
standards, and conditions for participation in the program
shall be adopted by the Department in consultation with the
Department on Aging, the Department of Rehabilitation
Services, and the Department of Mental Health and
Developmental Disabilities (or their successor agencies).
    (d) Subject to federal approval by the Centers for
Medicare and Medicaid Services, the Department shall accept
for consideration of certification under the program any
application for a site or building where distinct parts of the
site or building are designated for purposes other than the
provision of supportive living services, but only if:
        (1) those distinct parts of the site or building are
    not designated for the purpose of providing assisted
    living services as required under the Assisted Living and
    Shared Housing Act;
        (2) those distinct parts of the site or building are
    completely separate from the part of the building used for
    the provision of supportive living program services,
    including separate entrances;
        (3) those distinct parts of the site or building do
    not share any common spaces with the part of the building
    used for the provision of supportive living program
    services; and
        (4) those distinct parts of the site or building do
    not share staffing with the part of the building used for
    the provision of supportive living program services.
    (e) Facilities or distinct parts of facilities which are
selected as supportive living facilities and are in good
standing with the Department's rules are exempt from the
provisions of the Nursing Home Care Act and the Illinois
Health Facilities Planning Act.
    (f) Section 9817 of the American Rescue Plan Act of 2021
(Public Law 117-2) authorizes a 10% enhanced federal medical
assistance percentage for supportive living services for a
12-month period from April 1, 2021 through March 31, 2022.
Subject to federal approval, including the approval of any
necessary waiver amendments or other federally required
documents or assurances, for a 12-month period the Department
must pay a supplemental $26 per diem rate to all supportive
living facilities with the additional federal financial
participation funds that result from the enhanced federal
medical assistance percentage from April 1, 2021 through March
31, 2022. The Department may issue parameters around how the
supplemental payment should be spent, including quality
improvement activities. The Department may alter the form,
methods, or timeframes concerning the supplemental per diem
rate to comply with any subsequent changes to federal law,
changes made by guidance issued by the federal Centers for
Medicare and Medicaid Services, or other changes necessary to
receive the enhanced federal medical assistance percentage.
    (g) All applications for the expansion of supportive
living dementia care settings involving sites not approved by
the Department on January 1, 2024 (the effective date of
Public Act 103-102) this amendatory Act of the 103rd General
Assembly may allow new elderly non-dementia units in addition
to new dementia care units. The Department may approve such
applications only if the application has: (1) no more than one
non-dementia care unit for each dementia care unit and (2) the
site is not located within 4 miles of an existing supportive
living program site in Cook County (including the City of
Chicago), not located within 12 miles of an existing
supportive living program site in DuPage County, Kane County,
Lake County, McHenry County, or Will County, or not located
within 25 miles of an existing supportive living program site
in any other county.
    (f) Subject to federal approval, the Department shall
allow a certified medication aide to administer medication in
a supportive living facility. For purposes of this subsection,
"certified medication aide" means a person who has met the
qualifications for certification under Section 79 of the
Assisted Living and Shared Housing Act and assists with
medication administration while under the supervision of a
registered professional nurse as authorized by Section 50-75
of the Nurse Practice Act. The Department may adopt rules to
implement this subsection.
(Source: P.A. 102-43, eff. 7-6-21; 102-699, eff. 4-19-22;
103-102, Article 20, Section 20-5, eff. 1-1-24; 103-102,
Article 100, Section 100-5, eff. 1-1-24; revised 12-15-23.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 8/9/2024