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| [ Engrossed ] | [ Senate Amendment 001 ] |
91_SB0117
LRB9101995JSpc
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 no more than 3 community-based
23 residential rehabilitation center alternative health care
24 models in the demonstration program. These community-based
25 residential rehabilitation centers shall be located as
26 follows:
27 (1) one in the area of Illinois situated north of
28 Interstate Highway 80;
29 (2) one is the area of Illinois situated south of
30 Interstate Highway 80 and north of Interstate Highway 70;
31 and
32 (3) one in the area of Illinois situated south of
33 Interstate Highway 70.
34 (b) Alternative health care models shall obtain a
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1 certificate of need from the Illinois Health Facilities
2 Planning Board under the Illinois Health Facilities Planning
3 Act before receiving a license by the Department.
4 Alternative health care models in medically underserved areas
5 shall receive priority in obtaining a certificate of need.
6 (c) An alternative health care model license shall be
7 issued for a period of one year and shall be annually renewed
8 if the facility or program is in substantial compliance with
9 the Department's rules adopted under this Act. A licensed
10 alternative health care model that continues to be in
11 substantial compliance after the conclusion of the
12 demonstration program shall be eligible for annual renewals
13 unless and until a different licensure program for that type
14 of health care model is established by legislation. The
15 Department may issue a provisional license to any alternative
16 health care model that does not substantially comply with the
17 provisions of this Act and the rules adopted under this Act
18 if (i) the Department finds that the alternative health care
19 model has undertaken changes and corrections which upon
20 completion will render the alternative health care model in
21 substantial compliance with this Act and rules and (ii) the
22 health and safety of the patients of the alternative health
23 care model will be protected during the period for which the
24 provisional license is issued. The Department shall advise
25 the licensee of the conditions under which the provisional
26 license is issued, including the manner in which the
27 alternative health care model fails to comply with the
28 provisions of this Act and rules, and the time within which
29 the changes and corrections necessary for the alternative
30 health care model to substantially comply with this Act and
31 rules shall be completed.
32 (d) Alternative health care models shall seek
33 certification under Titles XVIII and XIX of the federal
34 Social Security Act. In addition, alternative health care
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1 models shall provide charitable care consistent with that
2 provided by comparable health care providers in the
3 geographic area.
4 (d-5) The Illinois Department of Public Aid, in
5 cooperation with the Illinois Department of Public Health,
6 shall develop and implement a reimbursement methodology for
7 all facilities participating in the demonstration program.
8 The Illinois Department of Public Aid shall keep a record of
9 services provided under the demonstration program to
10 recipients of medical assistance under the Illinois Public
11 Aid Code and shall submit an annual report of that
12 information to the Illinois Department of Public Health.
13 (e) Alternative health care models shall, to the extent
14 possible, link and integrate their services with nearby
15 health care facilities.
16 (f) Each alternative health care model shall implement a
17 quality assurance program with measurable benefits and at
18 reasonable cost.
19 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
20 eff. 8-20-95.)
21 (210 ILCS 3/35)
22 Sec. 35. Alternative health care models authorized.
23 Notwithstanding any other law to the contrary, alternative
24 health care models described in this Section may be
25 established on a demonstration basis.
26 (1) Alternative health care model; subacute care
27 hospital. A subacute care hospital is a designated site
28 which provides medical specialty care for patients who
29 need a greater intensity or complexity of care than
30 generally provided in a skilled nursing facility but who
31 no longer require acute hospital care. The average length
32 of stay for patients treated in subacute care hospitals
33 shall not be less than 20 days, and for individual
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1 patients, the expected length of stay at the time of
2 admission shall not be less than 10 days. Variations
3 from minimum lengths of stay shall be reported to the
4 Department. There shall be no more than 13 subacute care
5 hospitals authorized to operate by the Department.
6 Subacute care includes physician supervision, registered
7 nursing, and physiological monitoring on a continual
8 basis. A subacute care hospital is either a freestanding
9 building or a distinct physical and operational entity
10 within a hospital or nursing home building. A subacute
11 care hospital shall only consist of beds currently
12 existing in licensed hospitals or skilled nursing
13 facilities, except, in the City of Chicago, on a
14 designated site that was licensed as a hospital under the
15 Illinois Hospital Licensing Act within the 10 years
16 immediately before the application for an alternative
17 health care model license. During the period of operation
18 of the demonstration project, the existing licensed beds
19 shall remain licensed as hospital or skilled nursing
20 facility beds as well as being licensed under this Act.
21 In order to handle cases of complications, emergencies,
22 or exigent circumstances, a subacute care hospital shall
23 maintain a contractual relationship, including a transfer
24 agreement, with a general acute care hospital. If a
25 subacute care model is located in a general acute care
26 hospital, it shall utilize all or a portion of the bed
27 capacity of that existing hospital. In no event shall a
28 subacute care hospital use the word "hospital" in its
29 advertising or marketing activities or represent or hold
30 itself out to the public as a general acute care
31 hospital.
32 (2) Alternative health care delivery model;
33 postsurgical recovery care center. A postsurgical
34 recovery care center is a designated site which provides
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1 postsurgical recovery care for generally healthy patients
2 undergoing surgical procedures that require overnight
3 nursing care, pain control, or observation that would
4 otherwise be provided in an inpatient setting. A
5 postsurgical recovery care center is either freestanding
6 or a defined unit of an ambulatory surgical treatment
7 center or hospital. No facility, or portion of a
8 facility, may participate in a demonstration program as a
9 postsurgical recovery care center unless the facility has
10 been licensed as an ambulatory surgical treatment center
11 or hospital for at least 2 years before August 20, 1993
12 (the effective date of Public Act 88-441). The maximum
13 length of stay for patients in a postsurgical recovery
14 care center is not to exceed 48 hours unless the treating
15 physician requests an extension of time from the recovery
16 center's medical director on the basis of medical or
17 clinical documentation that an additional care period is
18 required for the recovery of a patient and the medical
19 director approves the extension of time. In no case,
20 however, shall a patient's length of stay in a
21 postsurgical recovery care center be longer than 72
22 hours. If a patient requires an additional care period
23 after the expiration of the 72-hour limit, the patient
24 shall be transferred to an appropriate facility. Reports
25 on variances from the 48-hour limit shall be sent to the
26 Department for its evaluation. The reports shall, before
27 submission to the Department, have removed from them all
28 patient and physician identifiers. In order to handle
29 cases of complications, emergencies, or exigent
30 circumstances, every postsurgical recovery care center as
31 defined in this paragraph shall maintain a contractual
32 relationship, including a transfer agreement, with a
33 general acute care hospital. A postsurgical recovery
34 care center shall be no larger than 20 beds. A
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1 postsurgical recovery care center shall be located within
2 15 minutes travel time from the general acute care
3 hospital with which the center maintains a contractual
4 relationship, including a transfer agreement, as required
5 under this paragraph.
6 No postsurgical recovery care center shall
7 discriminate against any patient requiring treatment
8 because of the source of payment for services, including
9 Medicare and Medicaid recipients.
10 The Department shall adopt rules to implement the
11 provisions of Public Act 88-441 concerning postsurgical
12 recovery care centers within 9 months after August 20,
13 1993.
14 (3) Alternative health care delivery model;
15 children's respite care center. A children's childrens'
16 respite care center model is a designated site that
17 provides respite for medically frail, technologically
18 dependent, clinically stable children, up to age 18, for
19 a period of one to 14 days. This care is to be provided
20 in a home-like environment that serves no more than 10
21 children at a time. Children's respite care center
22 services must be available through the model to all
23 families, including those whose care is paid for through
24 the Illinois Department of Public Aid or the Illinois
25 Department of Children and Family Services. Each respite
26 care model location shall be a facility physically
27 separate and apart from any other facility licensed by
28 the Department of Public Health under this or any other
29 Act and shall provide, at a minimum, the following
30 services: out-of-home respite care; hospital to home
31 training for families and caregivers; short term
32 transitional care to facilitate placement and training
33 for foster care parents; parent and family support
34 groups.
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1 Coverage for the services provided by the Illinois
2 Department of Public Aid under this paragraph (3) is
3 contingent upon federal waiver approval and is provided only
4 to Medicaid eligible clients participating in the home and
5 community based services waiver designated in Section 1915(c)
6 of the Social Security Act for medically frail and
7 technologically dependent children.
8 (4) Alternative health care delivery model;
9 community based residential rehabilitation center. A
10 community-based residential rehabilitation center model
11 is a designated site that provides rehabilitation or
12 support, or both, for persons who have experienced severe
13 brain injury, who are medically stable, and who no longer
14 require acute rehabilitative care or intense medical or
15 nursing services. The average length of stay in a
16 community-based residential rehabilitation center shall
17 not exceed 4 months. As an integral part of the services
18 provided, individuals are housed in a supervised living
19 setting while having immediate access to the community.
20 There may be no more than 3 freestanding community-based
21 residential rehabilitation centers authorized to operate
22 by the Department. A residential rehabilitation center
23 may have more than one residence included in the license.
24 A residence may be no larger than 12 beds and shall be
25 located as an integral part of the community. Day
26 treatment or individualized outpatient services shall be
27 provided for persons who reside in their own home.
28 Functional outcome goals shall be established for each
29 individual. Services shall include, but are not limited
30 to, case management, training and assistance with
31 activities of daily living, nursing consultation,
32 traditional therapies (physical, occupational, speech),
33 functional interventions in the residence and community
34 (job placement, shopping, banking, recreation),
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1 counseling, self-management strategies, productive
2 activities, and multiple opportunities for skill
3 acquisition and practice throughout the day. The design
4 of individualized program plans shall be consistent with
5 the outcome goals that are established for each resident.
6 Programs provided in these settings shall be accredited
7 by the Commission on Accreditation of Rehabilitation
8 Facilities (CARF). Any program seeking to participate in
9 a demonstration program as a community-based residential
10 rehabilitation center shall have been accredited by CARF
11 as a Brain Injury Community-Integrative Program for at
12 least 3 years.
13 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393,
14 eff. 8-20-95; revised 10-31-98.)
15 Section 99. Effective date. This Act takes effect upon
16 becoming law.