(210 ILCS 3/20)
Sec. 20.
Board responsibilities.
The State Board of Health shall have the
responsibilities set forth in this Section.
(a) The Board shall investigate new health care delivery models and
recommend to the Governor and the General Assembly, through the Department,
those models that should be authorized as alternative health care models for
which demonstration programs should be initiated. In its deliberations, the
Board shall use the following criteria:
(1) The feasibility of operating the model in |
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Illinois, based on a review of the experience in other states including the impact on health professionals of other health care programs or facilities.
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(2) The potential of the model to meet an unmet need.
(3) The potential of the model to reduce health care
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costs to consumers, costs to third party payors, and aggregate costs to the public.
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(4) The potential of the model to maintain or
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improve the standards of health care delivery in some measurable fashion.
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(5) The potential of the model to provide increased
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choices or access for patients.
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(b) The Board shall evaluate and make recommendations to the Governor and
the General Assembly, through the Department, regarding alternative health care
model demonstration programs established under this Act, at the midpoint and
end of the period of operation of the demonstration programs. The report shall
include, at a minimum, the following:
(1) Whether the alternative health care models
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improved access to health care for their service populations in the State.
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(2) The quality of care provided by the alternative
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health care models as may be evidenced by health outcomes, surveillance reports, and administrative actions taken by the Department.
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(3) The cost and cost effectiveness to the public,
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third‑party payors, and government of the alternative health care models, including the impact of pilot programs on aggregate health care costs in the area. In addition to any other information collected by the Board under this Section, the Board shall collect from postsurgical recovery care centers uniform billing data substantially the same as specified in Section 4‑2(e) of the Illinois Health Finance Reform Act. To facilitate its evaluation of that data, the Board shall forward a copy of the data to the Illinois Health Care Cost Containment Council. All patient identifiers shall be removed from the data before it is submitted to the Board or Council.
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(4) The impact of the alternative health care models
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on the health care system in that area, including changing patterns of patient demand and utilization, financial viability, and feasibility of operation of service in inpatient and alternative models in the area.
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(5) The implementation by alternative health care
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models of any special commitments made during application review to the Illinois Health Facilities Planning Board.
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(6) The continuation, expansion, or modification of
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the alternative health care models.
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(c) The Board shall advise the Department on the definition and scope of
alternative health care models demonstration programs.
(d) In carrying out its responsibilities under this Section, the
Board shall seek the advice of other Department advisory boards or committees
that may be impacted by the alternative health care model or the proposed
model of health care delivery. The Board shall also seek input from other
interested parties, which may include holding public hearings.
(e) The Board shall otherwise advise the Department on the administration of
the Act as the Board deems appropriate.
(Source: P.A. 87‑1188; 88‑441.)
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(210 ILCS 3/25)
Sec. 25.
Department responsibilities.
The Department shall have the
responsibilities set forth in this Section.
(a) The Department shall adopt rules for each alternative health care model
authorized under this Act that shall include but not be limited to the
following:
(1) Further definition of the alternative health |
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(2) The definition and scope of the demonstration
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program, including the implementation date and period of operation, not to exceed 5 years.
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(3) License application information required by the
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(4) The care of patients in the alternative health
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(5) Rights afforded to patients of the alternative
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(6) Physical plant requirements.
(7) License application and renewal fees, which may
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cover the cost of administering the demonstration program.
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(8) Information that may be necessary for the Board
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and the Department to monitor and evaluate the alternative health care model demonstration program.
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(9) Administrative fines that may be assessed by the
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Department for violations of this Act or the rules adopted under this Act.
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(b) The Department shall issue, renew, deny, suspend, or revoke licenses for
alternative health care models.
(c) The Department shall perform licensure inspections of alternative health
care models as deemed necessary by the Department to ensure compliance with
this Act or rules.
(d) The Department shall deposit application fees, renewal fees, and fines
into the Regulatory Evaluation and Basic Enforcement Fund.
(e) The Department shall assist the Board in performing the
Board's
responsibilities under this Act.
(f) The Department shall conduct a study to determine the feasibility, the
potential risks and benefits to patients, and the potential effect on the
health care delivery system of authorizing recovery care of nonsurgical
patients in postsurgical recovery center demonstration models. The Department
shall report the findings
of the study
to the General Assembly no later than November 1, 1998.
The Director shall appoint an advisory committee with representation from
the Illinois Hospital and Health Systems Association,
the Illinois State Medical Society, and the Illinois Freestanding Surgery
Center Association,
a physician who is
board certified in internal medicine, a consumer, and other representatives
deemed appropriate by the Director. The advisory committee shall advise the
Department as it carries out the study.
(g) Before November 1, 1998 the Department shall initiate a process to
request public comments on how postsurgical recovery centers admitting
nonsurgical patients should be regulated.
(Source: P.A. 90‑600, eff. 6‑25‑98; 90‑655, eff. 7‑30‑98.)
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(210 ILCS 3/30)
Sec. 30.
Demonstration program requirements.
The requirements set forth in
this Section shall apply to demonstration programs.
(a) There shall be no more than:
(i) 3 subacute care hospital alternative health care |
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models in the City of Chicago (one of which shall be located on a designated site and shall have been licensed as a hospital under the Illinois Hospital Licensing Act within the 10 years immediately before the application for a license);
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(ii) 2 subacute care hospital alternative health
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care models in the demonstration program for each of the following areas:
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(1) Cook County outside the City of Chicago.
(2) DuPage, Kane, Lake, McHenry, and Will
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(3) Municipalities with a population greater
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than 50,000 not located in the areas described in item (i) of subsection (a) and paragraphs (1) and (2) of item (ii) of subsection (a); and
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(iii) 4 subacute care hospital alternative health
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care models in the demonstration program for rural areas.
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In selecting among applicants for these
licenses in rural areas, the Health Facilities Planning Board and the
Department shall give preference to hospitals that may be unable for economic
reasons to provide continued service to the community in which they are located
unless the hospital were to receive an alternative health care model license.
(a‑5) There shall be no more than a total of 12 postsurgical
recovery care
center alternative health care models in the demonstration program, located as
follows:
(1) Two in the City of Chicago.
(2) Two in Cook County outside the City of Chicago.
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At least one of these shall be owned or operated by a hospital devoted exclusively to caring for children.
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(3) Two in Kane, Lake, and McHenry Counties.
(4) Four in municipalities with a population of
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50,000 or more not located in the areas described in paragraphs (1), (2), and (3), 3 of which shall be owned or operated by hospitals, at least 2 of which shall be located in counties with a population of less than 175,000, according to the most recent decennial census for which data are available, and one of which shall be owned or operated by an ambulatory surgical treatment center.
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(5) Two in rural areas, both of which shall be owned
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or operated by hospitals.
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There shall be no postsurgical recovery care center alternative health care
models located in counties with populations greater than 600,000 but less
than 1,000,000. A proposed postsurgical recovery care center must be owned or
operated by a hospital if it is to be located within, or will primarily serve
the residents of, a health service area in which more than 60% of the gross
patient revenue of the hospitals within that health service area are derived
from Medicaid and Medicare, according to the most recently available calendar
year data from the Illinois Health Care Cost Containment Council. Nothing in
this paragraph shall preclude a hospital and an ambulatory surgical treatment
center from forming a joint venture or developing a collaborative agreement to
own or operate a postsurgical recovery care center.
(a‑10) There shall be no more than a total of 8 children's respite care
center alternative health care models in the demonstration program, which shall
be located as follows:
(1) One in the City of Chicago.
(2) One in Cook County outside the City of Chicago.
(3) A total of 2 in the area comprised of DuPage,
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Kane, Lake, McHenry, and Will counties.
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(4) A total of 2 in municipalities with a population
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of 50,000 or more and not located in the areas described in paragraphs (1), (2), or (3).
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(5) A total of 2 in rural areas, as defined by the
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Health Facilities Planning Board.
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No more than one children's respite care model owned and operated by a
licensed skilled pediatric facility shall be located in each of the areas
designated in this subsection (a‑10).
(a‑15) There shall be an authorized community‑based residential
rehabilitation center alternative health care model in the demonstration
program. The community‑based residential rehabilitation center shall be
located in the area of Illinois south of Interstate Highway 70.
(a‑20) There shall be an authorized
Alzheimer's disease management center alternative health care model in the
demonstration program. The Alzheimer's disease management center shall be
located in Will
County, owned by a
not‑for‑profit entity, and endorsed by a resolution approved by the county
board before the effective date of this amendatory Act of the 91st General
Assembly.
(b) Alternative health care models, other than a model authorized under
subsection (a‑20), shall obtain a certificate of
need from the Illinois Health Facilities Planning Board under the Illinois
Health Facilities Planning Act before receiving a license by the
Department.
If, after obtaining its initial certificate of need, an alternative health
care delivery model that is a community based residential rehabilitation center
seeks to
increase the bed capacity of that center, it must obtain a certificate of need
from the Illinois Health Facilities Planning Board before increasing the bed
capacity. Alternative
health care models in medically underserved areas
shall receive priority in obtaining a certificate of need.
(c) An alternative health care model license shall be issued for a
period of one year and shall be annually renewed if the facility or
program is in substantial compliance with the Department's rules
adopted under this Act. A licensed alternative health care model that continues
to be in substantial compliance after the conclusion of the demonstration
program shall be eligible for annual renewals unless and until a different
licensure program for that type of health care model is established by
legislation. The Department may issue a provisional license to any
alternative health care model that does not substantially comply with the
provisions of this Act and the rules adopted under this Act if (i)
the Department finds that the alternative health care model has undertaken
changes and corrections which upon completion will render the alternative
health care model in substantial compliance with this Act and rules and
(ii) the health and safety of the patients of the alternative
health care model will be protected during the period for which the provisional
license is issued. The Department shall advise the licensee of
the conditions under which the provisional license is issued, including
the manner in which the alternative health care model fails to comply with
the provisions of this Act and rules, and the time within which the changes
and corrections necessary for the alternative health care model to
substantially comply with this Act and rules shall be completed.
(d) Alternative health care models shall seek certification under Titles
XVIII and XIX of the federal Social Security Act. In addition, alternative
health care models shall provide charitable care consistent with that provided
by comparable health care providers in the geographic area.
(d‑5) The Illinois Department of Public Aid, in cooperation with the
Illinois Department of
Public Health, shall develop and implement a reimbursement methodology for all
facilities participating in the demonstration program. The Illinois Department
of Public Aid shall keep a record of services provided under the demonstration
program to recipients of medical assistance under the Illinois Public Aid Code
and shall submit an annual report of that information to the Illinois
Department of Public Health.
(e) Alternative health care models shall, to the extent possible,
link and integrate their services with nearby health care facilities.
(f) Each alternative health care model shall implement a quality
assurance program with measurable benefits and at reasonable cost.
(Source: P.A. 91‑65, eff. 7‑9‑99; 91‑838, eff. 6‑16‑00.)
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(210 ILCS 3/35)
Sec. 35.
Alternative health care models authorized.
Notwithstanding
any other law to the contrary, alternative health care models
described in this Section may be established on a demonstration basis.
(1) Alternative health care model; subacute care |
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hospital. A subacute care hospital is a designated site which provides medical specialty care for patients who need a greater intensity or complexity of care than generally provided in a skilled nursing facility but who no longer require acute hospital care. The average length of stay for patients treated in subacute care hospitals shall not be less than 20 days, and for individual patients, the expected length of stay at the time of admission shall not be less than 10 days. Variations from minimum lengths of stay shall be reported to the Department. There shall be no more than 13 subacute care hospitals authorized to operate by the Department. Subacute care includes physician supervision, registered nursing, and physiological monitoring on a continual basis. A subacute care hospital is either a freestanding building or a distinct physical and operational entity within a hospital or nursing home building. A subacute care hospital shall only consist of beds currently existing in licensed hospitals or skilled nursing facilities, except, in the City of Chicago, on a designated site that was licensed as a hospital under the Illinois Hospital Licensing Act within the 10 years immediately before the application for an alternative health care model license. During the period of operation of the demonstration project, the existing licensed beds shall remain licensed as hospital or skilled nursing facility beds as well as being licensed under this Act. In order to handle cases of complications, emergencies, or exigent circumstances, a subacute care hospital shall maintain a contractual relationship, including a transfer agreement, with a general acute care hospital. If a subacute care model is located in a general acute care hospital, it shall utilize all or a portion of the bed capacity of that existing hospital. In no event shall a subacute care hospital use the word "hospital" in its advertising or marketing activities or represent or hold itself out to the public as a general acute care hospital.
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(2) Alternative health care delivery model;
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postsurgical recovery care center. A postsurgical recovery care center is a designated site which provides postsurgical recovery care for generally healthy patients undergoing surgical procedures that require overnight nursing care, pain control, or observation that would otherwise be provided in an inpatient setting. A postsurgical recovery care center is either freestanding or a defined unit of an ambulatory surgical treatment center or hospital. No facility, or portion of a facility, may participate in a demonstration program as a postsurgical recovery care center unless the facility has been licensed as an ambulatory surgical treatment center or hospital for at least 2 years before August 20, 1993 (the effective date of Public Act 88‑441). The maximum length of stay for patients in a postsurgical recovery care center is not to exceed 48 hours unless the treating physician requests an extension of time from the recovery center's medical director on the basis of medical or clinical documentation that an additional care period is required for the recovery of a patient and the medical director approves the extension of time. In no case, however, shall a patient's length of stay in a postsurgical recovery care center be longer than 72 hours. If a patient requires an additional care period after the expiration of the 72‑hour limit, the patient shall be transferred to an appropriate facility. Reports on variances from the 48‑hour limit shall be sent to the Department for its evaluation. The reports shall, before submission to the Department, have removed from them all patient and physician identifiers. In order to handle cases of complications, emergencies, or exigent circumstances, every postsurgical recovery care center as defined in this paragraph shall maintain a contractual relationship, including a transfer agreement, with a general acute care hospital. A postsurgical recovery care center shall be no larger than 20 beds. A postsurgical recovery care center shall be located within 15 minutes travel time from the general acute care hospital with which the center maintains a contractual relationship, including a transfer agreement, as required under this paragraph.
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No postsurgical recovery care center shall
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discriminate against any patient requiring treatment because of the source of payment for services, including Medicare and Medicaid recipients.
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The Department shall adopt rules to implement the
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provisions of Public Act 88‑441 concerning postsurgical recovery care centers within 9 months after August 20, 1993.
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(3) Alternative health care delivery model;
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children's community‑based health care center. A children's community‑based health care center model is a designated site that provides nursing care, clinical support services, and therapies for a period of one to 14 days for short‑term stays and 120 days to facilitate transitions to home or other appropriate settings for medically fragile children, technology dependent children, and children with special health care needs who are deemed clinically stable by a physician and are younger than 22 years of age. This care is to be provided in a home‑like environment that serves no more than 12 children at a time. Children's community‑based health care center services must be available through the model to all families, including those whose care is paid for through the Department of Public Aid, the Department of Children and Family Services, the Department of Human Services, and insurance companies who cover home health care services or private duty nursing care in the home.
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Each children's community‑based health care center
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model location shall be physically separate and apart from any other facility licensed by the Department of Public Health under this or any other Act and shall provide the following services: respite care, registered nursing or licensed practical nursing care, transitional care to facilitate home placement or other appropriate settings and reunite families, medical day care, weekend camps, and diagnostic studies typically done in the home setting.
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Coverage for the services provided by the Illinois
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Department of Public Aid under this paragraph (3) is contingent upon federal waiver approval and is provided only to Medicaid eligible clients participating in the home and community based services waiver designated in Section 1915(c) of the Social Security Act for medically frail and technologically dependent children or children in Department of Children and Family Services foster care who receive home health benefits.
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(4) Alternative health care delivery model;
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community based residential rehabilitation center. A community‑based residential rehabilitation center model is a designated site that provides rehabilitation or support, or both, for persons who have experienced severe brain injury, who are medically stable, and who no longer require acute rehabilitative care or intense medical or nursing services. The average length of stay in a community‑based residential rehabilitation center shall not exceed 4 months. As an integral part of the services provided, individuals are housed in a supervised living setting while having immediate access to the community. The residential rehabilitation center authorized by the Department may have more than one residence included under the license. A residence may be no larger than 12 beds and shall be located as an integral part of the community. Day treatment or individualized outpatient services shall be provided for persons who reside in their own home. Functional outcome goals shall be established for each individual. Services shall include, but are not limited to, case management, training and assistance with activities of daily living, nursing consultation, traditional therapies (physical, occupational, speech), functional interventions in the residence and community (job placement, shopping, banking, recreation), counseling, self‑management strategies, productive activities, and multiple opportunities for skill acquisition and practice throughout the day. The design of individualized program plans shall be consistent with the outcome goals that are established for each resident. The programs provided in this setting shall be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The program shall have been accredited by CARF as a Brain Injury Community‑Integrative Program for at least 3 years.
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(5) Alternative health care delivery model;
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Alzheimer's disease management center. An Alzheimer's disease management center model is a designated site that provides a safe and secure setting for care of persons diagnosed with Alzheimer's disease. An Alzheimer's disease management center model shall be a facility separate from any other facility licensed by the Department of Public Health under this or any other Act. An Alzheimer's disease management center shall conduct and document an assessment of each resident every 6 months. The assessment shall include an evaluation of daily functioning, cognitive status, other medical conditions, and behavioral problems. An Alzheimer's disease management center shall develop and implement an ongoing treatment plan for each resident. The treatment plan shall have defined goals. The Alzheimer's disease management center shall treat behavioral problems and mood disorders using nonpharmacologic approaches such as environmental modification, task simplification, and other appropriate activities. All staff must have necessary training to care for all stages of Alzheimer's Disease. An Alzheimer's disease management center shall provide education and support for residents and caregivers. The education and support shall include referrals to support organizations for educational materials on community resources, support groups, legal and financial issues, respite care, and future care needs and options. The education and support shall also include a discussion of the resident's need to make advance directives and to identify surrogates for medical and legal decision‑making. The provisions of this paragraph establish the minimum level of services that must be provided by an Alzheimer's disease management center. An Alzheimer's disease management center model shall have no more than 100 residents. Nothing in this paragraph (5) shall be construed as prohibiting a person or facility from providing services and care to persons with Alzheimer's disease as otherwise authorized under State law.
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(Source: P.A. 93‑402, eff. 1‑1‑04.)
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(210 ILCS 3/45)
Sec. 45.
License denial, suspension, or revocation.
A license may be
denied, suspended, or revoked, or the renewal of a license may be denied, for
any of the following reasons:
(1) Violation of any provision of this Act or the |
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rules adopted by the Department under this Act.
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(2) Conviction of the owner or operator of the
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alternative health care model (i) of a felony or (ii) of any other crime under the laws of any state or of the United States arising out of or in connection with the operation of a health care facility. The record of conviction or a certified copy of it shall be conclusive evidence of conviction.
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(3) An encumbrance on a health care license issued
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in Illinois or any other state to the owner or operator of the alternative health care model.
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(4) Revocation of any facility license issued by the
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Department during the previous 5 years or surrender or expiration of the license during the pendency of action by the Department to revoke or suspend the license during the previous 5 years, if (i) the prior license was issued to the individual applicant or a controlling owner or controlling combination of owners of the applicant or (ii) any affiliate of the individual applicant or controlling owner of the applicant or affiliate of the applicant was a controlling owner of the prior license.
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(Source: P.A. 87‑1188.)
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