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91_HB4275
LRB9111191ACcd
1 AN ACT to amend the Alternative Health Care Delivery Act
2 by changing Sections 30 and 35.
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 30 and 35 as follows:
7 (210 ILCS 3/30)
8 Sec. 30. Demonstration program requirements. The
9 requirements set forth in this Section shall apply to
10 demonstration programs.
11 (a) There shall be no more than:
12 (i) 3 subacute care hospital alternative health
13 care models in the City of Chicago (one of which shall be
14 located on a designated site and shall have been licensed
15 as a hospital under the Illinois Hospital Licensing Act
16 within the 10 years immediately before the application
17 for a license);
18 (ii) 2 subacute care hospital alternative health
19 care models in the demonstration program for each of the
20 following areas:
21 (1) Cook County outside the City of Chicago.
22 (2) DuPage, Kane, Lake, McHenry, and Will
23 Counties.
24 (3) Municipalities with a population greater
25 than 50,000 not located in the areas described in
26 item (i) of subsection (a) and paragraphs (1) and
27 (2) of item (ii) of subsection (a); and
28 (iii) 4 subacute care hospital alternative health
29 care models in the demonstration program for rural areas.
30 In selecting among applicants for these licenses in rural
31 areas, the Health Facilities Planning Board and the
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1 Department shall give preference to hospitals that may be
2 unable for economic reasons to provide continued service to
3 the community in which they are located unless the hospital
4 were to receive an alternative health care model license.
5 (a-5) There shall be no more than a total of 12
6 postsurgical recovery care center alternative health care
7 models in the demonstration program, located as follows:
8 (1) Two in the City of Chicago.
9 (2) Two in Cook County outside the City of Chicago.
10 At least one of these shall be owned or operated by a
11 hospital devoted exclusively to caring for children.
12 (3) Two in Kane, Lake, and McHenry Counties.
13 (4) Four in municipalities with a population of
14 50,000 or more not located in the areas described in
15 paragraphs (1), (2), and (3), 3 of which shall be owned
16 or operated by hospitals, at least 2 of which shall be
17 located in counties with a population of less than
18 175,000, according to the most recent decennial census
19 for which data are available, and one of which shall be
20 owned or operated by an ambulatory surgical treatment
21 center.
22 (5) Two in rural areas, both of which shall be
23 owned or operated by hospitals.
24 There shall be no postsurgical recovery care center
25 alternative health care models located in counties with
26 populations greater than 600,000 but less than 1,000,000. A
27 proposed postsurgical recovery care center must be owned or
28 operated by a hospital if it is to be located within, or will
29 primarily serve the residents of, a health service area in
30 which more than 60% of the gross patient revenue of the
31 hospitals within that health service area are derived from
32 Medicaid and Medicare, according to the most recently
33 available calendar year data from the Illinois Health Care
34 Cost Containment Council. Nothing in this paragraph shall
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1 preclude a hospital and an ambulatory surgical treatment
2 center from forming a joint venture or developing a
3 collaborative agreement to own or operate a postsurgical
4 recovery care center.
5 (a-10) There shall be no more than a total of 8
6 children's respite care center alternative health care models
7 in the demonstration program, which shall be located as
8 follows:
9 (1) One in the City of Chicago.
10 (2) One in Cook County outside the City of Chicago.
11 (3) A total of 2 in the area comprised of DuPage,
12 Kane, Lake, McHenry, and Will counties.
13 (4) A total of 2 in municipalities with a
14 population of 50,000 or more and not located in the
15 areas described in paragraphs (1), (2), or (3).
16 (5) A total of 2 in rural areas, as defined by the
17 Health Facilities Planning Board.
18 No more than one children's respite care model owned and
19 operated by a licensed skilled pediatric facility shall be
20 located in each of the areas designated in this subsection
21 (a-10).
22 (a-15) There shall be an authorized community-based
23 residential rehabilitation center alternative health care
24 model in the demonstration program. The community-based
25 residential rehabilitation center shall be located in the
26 area of Illinois south of Interstate Highway 70.
27 (a-20) There shall be no more than 10 birth center
28 alternative health care models in the demonstration program,
29 located as follows:
30 (1) Four in the area comprising Cook, DuPage, Kane,
31 Lake, McHenry, and Will counties, one of which shall be
32 owned or operated by a hospital and one of which shall be
33 owned or operated by a federally qualified health center.
34 (2) Three in municipalities with a population of
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1 50,000 or more not located in the area described in
2 subparagraph (1) of this paragraph, one of which shall be
3 owned or operated by a hospital and one of which shall be
4 owned or operated by a federally qualified health center.
5 (3) Three in rural areas, one of which shall be
6 owned or operated by a hospital and one of which shall be
7 owned or operated by a federally qualified health center.
8 The first 3 birth centers authorized to operate by the
9 Department shall be located in or predominantly serve the
10 residents of a health professional shortage area as
11 determined by the United States Department of Health and
12 Human Services. There shall be no more than 2 birth centers
13 authorized to operate in any single health planning area for
14 obstetric services as determined under the Illinois Health
15 Facilities Planning Act. If a birth center is located
16 outside of a health professional shortage area, (i) the birth
17 center shall be located in a health planning area with a
18 demonstrated need for obstetrical service beds, as determined
19 by the Illinois Health Facilities Planning Board or (ii)
20 there must be a reduction in the existing number of
21 obstetrical service beds in the planning area so that the
22 establishment of the birth center does not result in an
23 increase in the total number of obstetrical service beds in
24 the health planning area.
25 (b) Alternative health care models shall obtain a
26 certificate of need from the Illinois Health Facilities
27 Planning Board under the Illinois Health Facilities Planning
28 Act before receiving a license by the Department. If, after
29 obtaining its initial certificate of need, an alternative
30 health care delivery model that is a community based
31 residential rehabilitation center seeks to increase the bed
32 capacity of that center, it must obtain a certificate of need
33 from the Illinois Health Facilities Planning Board before
34 increasing the bed capacity. Alternative health care models
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1 in medically underserved areas shall receive priority in
2 obtaining a certificate of need.
3 (c) An alternative health care model license shall be
4 issued for a period of one year and shall be annually renewed
5 if the facility or program is in substantial compliance with
6 the Department's rules adopted under this Act. A licensed
7 alternative health care model that continues to be in
8 substantial compliance after the conclusion of the
9 demonstration program shall be eligible for annual renewals
10 unless and until a different licensure program for that type
11 of health care model is established by legislation. The
12 Department may issue a provisional license to any alternative
13 health care model that does not substantially comply with the
14 provisions of this Act and the rules adopted under this Act
15 if (i) the Department finds that the alternative health care
16 model has undertaken changes and corrections which upon
17 completion will render the alternative health care model in
18 substantial compliance with this Act and rules and (ii) the
19 health and safety of the patients of the alternative health
20 care model will be protected during the period for which the
21 provisional license is issued. The Department shall advise
22 the licensee of the conditions under which the provisional
23 license is issued, including the manner in which the
24 alternative health care model fails to comply with the
25 provisions of this Act and rules, and the time within which
26 the changes and corrections necessary for the alternative
27 health care model to substantially comply with this Act and
28 rules shall be completed.
29 (d) Alternative health care models shall seek
30 certification under Titles XVIII and XIX of the federal
31 Social Security Act. In addition, alternative health care
32 models shall provide charitable care consistent with that
33 provided by comparable health care providers in the
34 geographic area.
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1 (d-5) The Illinois Department of Public Aid, in
2 cooperation with the Illinois Department of Public Health,
3 shall develop and implement a reimbursement methodology for
4 all facilities participating in the demonstration program.
5 The Illinois Department of Public Aid shall keep a record of
6 services provided under the demonstration program to
7 recipients of medical assistance under the Illinois Public
8 Aid Code and shall submit an annual report of that
9 information to the Illinois Department of Public Health.
10 (e) Alternative health care models shall, to the extent
11 possible, link and integrate their services with nearby
12 health care facilities.
13 (f) Each alternative health care model shall implement a
14 quality assurance program with measurable benefits and at
15 reasonable cost.
16 (Source: P.A. 91-65, eff. 7-9-99.)
17 (210 ILCS 3/35)
18 Sec. 35. Alternative health care models authorized.
19 Notwithstanding any other law to the contrary, alternative
20 health care models described in this Section may be
21 established on a demonstration basis.
22 (1) Alternative health care model; subacute care
23 hospital. A subacute care hospital is a designated site
24 which provides medical specialty care for patients who
25 need a greater intensity or complexity of care than
26 generally provided in a skilled nursing facility but who
27 no longer require acute hospital care. The average length
28 of stay for patients treated in subacute care hospitals
29 shall not be less than 20 days, and for individual
30 patients, the expected length of stay at the time of
31 admission shall not be less than 10 days. Variations
32 from minimum lengths of stay shall be reported to the
33 Department. There shall be no more than 13 subacute care
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1 hospitals authorized to operate by the Department.
2 Subacute care includes physician supervision, registered
3 nursing, and physiological monitoring on a continual
4 basis. A subacute care hospital is either a freestanding
5 building or a distinct physical and operational entity
6 within a hospital or nursing home building. A subacute
7 care hospital shall only consist of beds currently
8 existing in licensed hospitals or skilled nursing
9 facilities, except, in the City of Chicago, on a
10 designated site that was licensed as a hospital under the
11 Illinois Hospital Licensing Act within the 10 years
12 immediately before the application for an alternative
13 health care model license. During the period of operation
14 of the demonstration project, the existing licensed beds
15 shall remain licensed as hospital or skilled nursing
16 facility beds as well as being licensed under this Act.
17 In order to handle cases of complications, emergencies,
18 or exigent circumstances, a subacute care hospital shall
19 maintain a contractual relationship, including a transfer
20 agreement, with a general acute care hospital. If a
21 subacute care model is located in a general acute care
22 hospital, it shall utilize all or a portion of the bed
23 capacity of that existing hospital. In no event shall a
24 subacute care hospital use the word "hospital" in its
25 advertising or marketing activities or represent or hold
26 itself out to the public as a general acute care
27 hospital.
28 (2) Alternative health care delivery model;
29 postsurgical recovery care center. A postsurgical
30 recovery care center is a designated site which provides
31 postsurgical recovery care for generally healthy patients
32 undergoing surgical procedures that require overnight
33 nursing care, pain control, or observation that would
34 otherwise be provided in an inpatient setting. A
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1 postsurgical recovery care center is either freestanding
2 or a defined unit of an ambulatory surgical treatment
3 center or hospital. No facility, or portion of a
4 facility, may participate in a demonstration program as a
5 postsurgical recovery care center unless the facility has
6 been licensed as an ambulatory surgical treatment center
7 or hospital for at least 2 years before August 20, 1993
8 (the effective date of Public Act 88-441). The maximum
9 length of stay for patients in a postsurgical recovery
10 care center is not to exceed 48 hours unless the treating
11 physician requests an extension of time from the recovery
12 center's medical director on the basis of medical or
13 clinical documentation that an additional care period is
14 required for the recovery of a patient and the medical
15 director approves the extension of time. In no case,
16 however, shall a patient's length of stay in a
17 postsurgical recovery care center be longer than 72
18 hours. If a patient requires an additional care period
19 after the expiration of the 72-hour limit, the patient
20 shall be transferred to an appropriate facility. Reports
21 on variances from the 48-hour limit shall be sent to the
22 Department for its evaluation. The reports shall, before
23 submission to the Department, have removed from them all
24 patient and physician identifiers. In order to handle
25 cases of complications, emergencies, or exigent
26 circumstances, every postsurgical recovery care center as
27 defined in this paragraph shall maintain a contractual
28 relationship, including a transfer agreement, with a
29 general acute care hospital. A postsurgical recovery
30 care center shall be no larger than 20 beds. A
31 postsurgical recovery care center shall be located within
32 15 minutes travel time from the general acute care
33 hospital with which the center maintains a contractual
34 relationship, including a transfer agreement, as required
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1 under this paragraph.
2 No postsurgical recovery care center shall
3 discriminate against any patient requiring treatment
4 because of the source of payment for services, including
5 Medicare and Medicaid recipients.
6 The Department shall adopt rules to implement the
7 provisions of Public Act 88-441 concerning postsurgical
8 recovery care centers within 9 months after August 20,
9 1993.
10 (3) Alternative health care delivery model;
11 children's respite care center. A children's respite
12 care center model is a designated site that provides
13 respite for medically frail, technologically dependent,
14 clinically stable children, up to age 18, for a period of
15 one to 14 days. This care is to be provided in a
16 home-like environment that serves no more than 10
17 children at a time. Children's respite care center
18 services must be available through the model to all
19 families, including those whose care is paid for through
20 the Illinois Department of Public Aid or the Illinois
21 Department of Children and Family Services. Each respite
22 care model location shall be a facility physically
23 separate and apart from any other facility licensed by
24 the Department of Public Health under this or any other
25 Act and shall provide, at a minimum, the following
26 services: out-of-home respite care; hospital to home
27 training for families and caregivers; short term
28 transitional care to facilitate placement and training
29 for foster care parents; parent and family support
30 groups.
31 Coverage for the services provided by the Illinois
32 Department of Public Aid under this paragraph (3) is
33 contingent upon federal waiver approval and is provided
34 only to Medicaid eligible clients participating in the
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1 home and community based services waiver designated in
2 Section 1915(c) of the Social Security Act for medically
3 frail and technologically dependent children.
4 (4) Alternative health care delivery model;
5 community based residential rehabilitation center. A
6 community-based residential rehabilitation center model
7 is a designated site that provides rehabilitation or
8 support, or both, for persons who have experienced severe
9 brain injury, who are medically stable, and who no longer
10 require acute rehabilitative care or intense medical or
11 nursing services. The average length of stay in a
12 community-based residential rehabilitation center shall
13 not exceed 4 months. As an integral part of the services
14 provided, individuals are housed in a supervised living
15 setting while having immediate access to the community.
16 The residential rehabilitation center authorized by the
17 Department may have more than one residence included
18 under the license. A residence may be no larger than 12
19 beds and shall be located as an integral part of the
20 community. Day treatment or individualized outpatient
21 services shall be provided for persons who reside in
22 their own home. Functional outcome goals shall be
23 established for each individual. Services shall include,
24 but are not limited to, case management, training and
25 assistance with activities of daily living, nursing
26 consultation, traditional therapies (physical,
27 occupational, speech), functional interventions in the
28 residence and community (job placement, shopping,
29 banking, recreation), counseling, self-management
30 strategies, productive activities, and multiple
31 opportunities for skill acquisition and practice
32 throughout the day. The design of individualized program
33 plans shall be consistent with the outcome goals that are
34 established for each resident. The programs provided in
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1 this setting shall be accredited by the Commission on
2 Accreditation of Rehabilitation Facilities (CARF). The
3 program shall have been accredited by CARF as a Brain
4 Injury Community-Integrative Program for at least 3
5 years.
6 (5) Alternative health care delivery model; birth
7 center. A birth center shall have no more than 10 beds.
8 A birth center is a designated site that is away from the
9 mother's usual place of residence and in which births are
10 planned to occur following a normal, uncomplicated, and
11 low-risk pregnancy. A birth center shall offer prenatal
12 care and community education services and shall
13 coordinate these services with other health care services
14 available in the community. A birth center shall be one
15 or more of the following:
16 (A) A part of a hospital.
17 (B) A freestanding facility that is physically
18 distinct from a hospital but is operated under a
19 license issued to a hospital under the Hospital
20 Licensing Act.
21 (C) A part of the operation of a federally
22 qualified health center as designated by the United
23 States Department of Health and Human Services.
24 (D) An entity or facility whose costs are
25 reimbursable under Title XIX of the federal Social
26 Security Act.
27 The Department shall adopt rules that establish standards
28 equivalent to those of the National Association of
29 Childbearing Centers' Standards for Freestanding Birth
30 Centers for all birth centers. The Department's rules shall
31 provide for a time period for each birth center not part of a
32 hospital to become accredited by the Commission for the
33 Accreditation of Freestanding Birth Centers.
34 A birth center shall be certified to participate in the
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1 Medicare and Medicaid programs under Titles XVIII and XIX,
2 respectively, of the federal Social Security Act. To the
3 extent necessary, the Illinois Department of Public Aid shall
4 apply for a waiver from the United States Health Care
5 Financing Administration to allow birth centers to be
6 reimbursed under Title XIX of the federal Social Security
7 Act.
8 A birth center shall be located within 15 minutes travel
9 time, except for a birth center located in a rural area that
10 has been designated as a health professional shortage area as
11 determined by the United States Department of Health and
12 Human Services and that has a demonstrated need for
13 obstetrical service beds as determined by the Illinois Health
14 Facilities Planning Board where the travel time may not
15 exceed 30 minutes, from the general acute care hospital with
16 which the birth center maintains a contractual relationship,
17 including a transfer agreement, as required under this
18 paragraph. The services of a consultant physician who is
19 certified or eligible for certification by the American Board
20 of Obstetrics and Gynecology or the American Board of
21 Osteopathic Obstetricians and Gynecologists or has hospital
22 obstetrical privileges are required in birth centers that do
23 not have a physician on the clinical staff who is certified
24 or eligible for certification by the American Board of
25 Obstetrics and Gynecology or the American Board of
26 Osteopathic Obstetricians and Gynecologists or has hospital
27 obstetrical privileges. A consultant physician may be
28 available either on the premises or by phone. If a birth
29 center employs certified nurse midwives, a certified nurse
30 midwife shall be the Director of Nursing for Midwifery
31 Services who is responsible for the development of policies
32 and procedures for services as provided by Department rules.
33 An obstetrician, family practitioner, or certified nurse
34 midwife shall attend each woman in labor from the time of
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1 admission through birth and throughout the immediate post
2 partum period. Attendance may be delegated only to another
3 physician or certified nurse midwife. Additionally, a second
4 staff person shall also be present at each birth who is under
5 the supervision of the physician or certified nurse midwife
6 in attendance, has specialized training in labor and delivery
7 techniques and care of newborns, and receives planned and
8 ongoing training as needed to perform assigned duties
9 effectively. The maximum length of stay for patients in a
10 birth center is not to exceed 24 hours unless the treating
11 provider requests additional days from the birth center's
12 medical director on the basis of medical or clinical
13 documentation that an additional care period is required for
14 the recovery of a patient. Reports on variances from the 24
15 hour limit shall be sent to the Department for evaluation.
16 Before submission to the Department, all patient and
17 physician identifiers must be removed from the reports. The
18 birth center shall participate in the Illinois Perinatal
19 System under the Developmental Disability Prevention Act. At
20 a minimum, this participation shall require birth centers to
21 establish a letter of agreement with a hospital designated
22 under the Perinatal System. A hospital that operates or has
23 a letter of agreement with a birth center shall include the
24 birth center under its maternity service plan under the
25 Hospital Licensing Act and shall include the birth center in
26 the hospital's letter of agreement with its regional
27 perinatal center.
28 No birth center shall discriminate against any patient
29 requiring treatment because of the source of payment for
30 services, including Medicare and Medicaid recipients.
31 Within 9 months after the effective date of this
32 amendatory Act of the 91st General Assembly, the Department
33 shall adopt rules that are consistent with standards
34 developed by the American College of Obstetrics and
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1 Gynecology and operation and research protocols developed in
2 cooperation with obstetric departments and related
3 institutional review boards. Obstetric departments and
4 related institutional review boards shall collect and review
5 birth center information as necessary to assess the safety
6 and birth outcomes at the birth centers.
7 The Department shall adopt other rules to implement the
8 provisions of this amendatory Act of the 91st General
9 Assembly within 9 months after the effective date of this
10 amendatory Act of the 91st General Assembly.
11 (Source: P.A. 91-65, eff. 7-9-99; 91-357, eff. 7-29-99.)