SB0987sam001 100TH GENERAL ASSEMBLY

Sen. Wm. Sam McCann

Filed: 3/28/2017

10000SB0987sam001 LRB100 07616 MJP 23783 a

AMENDMENT TO SENATE BILL 987

AMENDMENT NO. ______. Amend Senate Bill 987 by replacing everything after the enacting clause with the following:

"Section 5. The Nursing Home Care Act is amended by changing Section 3-202.05 as follows:

(210 ILCS 45/3-202.05)

Sec. 3-202.05. Staffing ratios effective July 1, 2010 and thereafter.

(a) For the purpose of computing staff to resident ratios, direct care staff shall include:

(1) registered nurses;

(2) licensed practical nurses;

(3) certified nurse assistants;

(4) psychiatric services rehabilitation aides;

(5) rehabilitation and therapy aides;

(6) psychiatric services rehabilitation coordinators;

(7) assistant directors of nursing;

(8) 50% of the Director of Nurses' time; and

(9) 30% of the Social Services Directors' time.

The Department shall, by rule, allow certain facilities subject to 77 Ill. Admin. Code 300.4000 and following (Subpart S) to utilize specialized clinical staff, as defined in rules, to count towards the staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities federally defined as Institutions for Mental Disease. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

(b) Beginning January 1, 2011, and thereafter, light intermediate care shall be staffed at the same staffing ratio as intermediate care.

(c) Facilities shall notify the Department within 60 days after the effective date of this amendatory Act of the 96th General Assembly, in a form and manner prescribed by the Department, of the staffing ratios in effect on the effective date of this amendatory Act of the 96th General Assembly for both intermediate and skilled care and the number of residents receiving each level of care.

(d)(1) Effective July 1, 2010, for each resident needing skilled care, a minimum staffing ratio of 2.5 hours of nursing and personal care each day must be provided; for each resident needing intermediate care, 1.7 hours of nursing and personal care each day must be provided.

(2) Effective January 1, 2011, the minimum staffing ratios shall be increased to 2.7 hours of nursing and personal care each day for a resident needing skilled care and 1.9 hours of nursing and personal care each day for a resident needing intermediate care.

(3) Effective January 1, 2012, the minimum staffing ratios shall be increased to 3.0 hours of nursing and personal care each day for a resident needing skilled care and 2.1 hours of nursing and personal care each day for a resident needing intermediate care.

(4) Effective January 1, 2013, the minimum staffing ratios shall be increased to 3.4 hours of nursing and personal care each day for a resident needing skilled care and 2.3 hours of nursing and personal care each day for a resident needing intermediate care.

(5) Effective January 1, 2014, the minimum staffing ratios shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care.

(e) Ninety days after the effective date of this amendatory Act of the 97th General Assembly, a minimum of 25% of nursing and personal care time shall be provided by licensed nurses, with at least 10% of nursing and personal care time provided by registered nurses. These minimum requirements shall remain in effect until an acuity based registered nurse requirement is promulgated by rule concurrent with the adoption of the Resource Utilization Group classification-based payment methodology, as provided in Section 5-5.2 of the Illinois Public Aid Code. Registered nurses and licensed practical nurses employed by a facility in excess of these requirements may be used to satisfy the remaining 75% of the nursing and personal care time requirements. Notwithstanding this subsection, no staffing requirement in statute in effect on the effective date of this amendatory Act of the 97th General Assembly shall be reduced on account of this subsection.

(f) On and after the effective date of this amendatory Act of the 100th General Assembly, in addition to any other staffing requirements under this Section, a facility licensed under this Act shall comply with the following:

(1) The facility must have and implement a written plan that:

(A) ensures staffing sufficient to meet the minimum staffing requirements described in paragraphs (3) through (8) of this subsection;

(B) ensures staffing sufficient to meet the needs of each resident; and

(C) identifies procedures to obtain required staff when absences occur.

The facility must maintain a written, weekly staffing schedule showing the number and category of staff assigned to each shift and the person to be called in the event of an absence.

(2) The facility must have the number of on-duty nursing staff publicly posted 24 hours each day. The posted staffing forms must (A) be prominently displayed in a public area and readily accessible to residents and visitors; (B) be at least 8.5 x 14 inches and printed in a minimum font size of 16; and (C) include the facility's name, current date, current resident census per shift, the total number and actual hours worked by registered nurses, licensed practical nurses, and nursing assistants directly responsible for resident services per shift, and the minimum staffing standard, nursing assistant to resident ratio, under paragraph (6) of this subsection.

The posted staffing information must be an accurate reflection of the actual staff working each shift.

Upon oral or written request, the facility must make direct care staffing data available to the public for review at a cost not to exceed the community standard. The facility must maintain the posted nurse staffing data for a minimum of 18 months.

(3) Resident service needs must be the primary consideration in determining the number and categories of nursing personnel needed. Nursing staff must be sufficient in quantity and quality to provide nursing services for each resident as needed, including restorative services that enable each resident to achieve and maintain the highest practicable degree of function, self-care, and independence, as determined by the resident's care plan. Sufficient staffing under this paragraph must be provided even though it exceeds other requirements specified by this subsection or specified in a waiver.

(4) Licensed nurse hours must include no less than one registered nurse hour per resident per week. When a registered nurse serves as the administrator in the temporary absence of an administrator, the registered nurse's hours must not be used to meet minimum nursing hours. In facilities with 41 or more beds, the hours of a licensed nurse who serves as facility administrator must not be included in any licensed nurse coverage required by this subsection. The licensed nurse serving as a charge nurse must not be counted toward the minimum staffing requirements under paragraph (6) of this subsection.

(5) The facility must have a licensed charge nurse on each shift 24 hours per day.

A registered nurse must serve as the licensed charge nurse for no less than 8 consecutive hours between the start of day shift and the end of evening shift, 7 days a week.

The director of nursing services may serve as the charge nurse only when the facility has 60 or fewer residents.

The requirements of this paragraph (5) may be waived by the Department. The request for waiver must comply with the provisions of this Act and must be reviewed annually. The waiver shall be considered by the Department if the facility certifies that (i) the facility has been unable to recruit appropriate personnel despite diligent efforts, including offering wages at the community prevailing rate for nursing facilities; (ii) the waiver does not endanger the health or safety of residents; and (iii) a registered nurse or physician is available and obligated to immediately respond to telephone calls from the facility.

(6) The facility must determine the specific time frame for beginning and ending each consecutive 8-hour shift using one of the following options:

(A) Option one shall include (i) a day shift from 5:30 a.m. to 1:30 p.m., (ii) an evening shift from 1:30 p.m. to 9:30 p.m., and (iii) a night shift from 9:30 p.m. to 5:30 a.m.

(B) Option 2 shall include (i) a day shift from 6 a.m. to 2 p.m., (ii) an evening shift from 2 p.m. to 10 p.m., and (iii) a night shift from 10 p.m. to 6 a.m.

(C) Option 3 shall include (i) a day shift from 6:30 a.m. to 2:30 p.m., (ii) an evening shift from 2:30 p.m. to 10:30 p.m., and (iii) a night shift from 10:30 p.m. to 6:30 a.m.

(D) Option 4 shall include (i) a day shift from 7 a.m. to 3 p.m., (ii) an evening shift from 3 p.m. to 11 p.m., and (iii) a night shift from 11 p.m. to 7 a.m.

Each resident must have assigned and be informed of the nursing assistant responsible for his or her care and services on each shift. The numbers listed in this subsection represent the minimum staffing requirement. The numbers do not represent sufficient nursing staff. The number of staff necessary to meet the needs of each resident determines sufficient nursing staff. The number of residents per nursing assistant must not exceed the ratios under this paragraph.

On and after January 1, 2018, the number of residents per nursing assistant must not exceed the following ratios: for day shifts, there shall be at least one nursing assistant per 7 residents; for evening shifts, there shall be at least one nursing assistant per 9.5 residents; for night shifts, there shall be at least one nursing assistant per 17 residents.

Each facility must submit a quarterly staffing report to the Department using the Department's approved method and format. The report must provide an accurate daily account of resident census and nursing assistant staffing levels for each shift. The facility must submit the report to the Department no later than the end of the month immediately following the end of each calendar quarter. The report must specify the shifts in which the minimum staffing standards as set forth in this paragraph were not met. Upon the Department's request, the facility must provide documents to support the quarterly staffing report, including payroll records.

(7) This subsection does not prohibit nursing assistants from providing services to a resident to whom they are not assigned. The facility must ensure that nursing assistants only perform those tasks for which they are competent and qualified to perform and that are permitted by the laws of this State. Nursing assistants with a restricted duty status may be counted toward meeting the minimum staffing ratio as set forth in paragraph (6) of this subsection if the nursing assistant is able to perform 90% of the authorized duties and responsibilities, with or without accommodation, required of a certified nursing assistant.

The facility must ensure that a nursing assistant is not assigned more residents than the number for which the nursing assistant is able to meet the individual service needs. The facility must have a minimum of 2 nursing staff on duty within the facility at all times. Nursing staff must be present at all times in each detached building, distinct and segregated area including those separated by closed doors, and on each level or floor where residents are housed.

Nursing assistants do not include dining assistants. Nursing assistants serving as restorative aides must not be counted toward the minimum staffing requirement under paragraph (6) of this subsection.

(8) A facility must not employ any person as a nursing assistant for longer than 4 months from the date of hire without the person being certified as a certified nursing assistant. The facility must ensure no more than 25% of the nursing assistants assigned to residents per shift pursuant to paragraph (6) of this subsection are uncertified nursing assistants.

(9) The facility must ensure that all nursing assistants administering non-injectable medications are certified as nursing assistants and licensed as medication aides. Documentation of this certification and license must be maintained in the facility. The licensed medication aide assigned to administer medications must not be counted toward meeting the minimum staffing requirements for direct service of residents under paragraph (6) of this subsection.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)

Section 99. Effective date. This Act takes effect July 1, 2017.".