Sen. John G. Mulroe

Filed: 5/11/2017

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 763

2    AMENDMENT NO. ______. Amend House Bill 763 on page 35,
3immediately below line 9, by inserting the following:
 
4    "Section 10. The Alternative Health Care Delivery Act is
5amended by changing Section 35 as follows:
 
6    (210 ILCS 3/35)
7    Sec. 35. Alternative health care models authorized.
8Notwithstanding any other law to the contrary, alternative
9health care models described in this Section may be established
10on a demonstration basis.
11        (1) (Blank).
12        (2) Alternative health care delivery model;
13    postsurgical recovery care center. A postsurgical recovery
14    care center is a designated site which provides
15    postsurgical recovery care for generally healthy patients
16    undergoing surgical procedures that potentially require

 

 

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1    overnight nursing care, pain control, or observation that
2    would otherwise be provided in an inpatient setting.
3    Patients may be discharged from the postsurgical recovery
4    care center in less than 24 hours if the attending
5    physician or the facility's medical director believes the
6    patient has recovered enough to be discharged. A
7    postsurgical recovery care center is either freestanding
8    or a defined unit of an ambulatory surgical treatment
9    center or hospital. No facility, or portion of a facility,
10    may participate in a demonstration program as a
11    postsurgical recovery care center unless the facility has
12    been licensed as an ambulatory surgical treatment center or
13    hospital for at least 2 years before August 20, 1993 (the
14    effective date of Public Act 88-441). The maximum length of
15    stay for patients in a postsurgical recovery care center is
16    not to exceed 48 hours unless the treating physician
17    requests an extension of time from the recovery center's
18    medical director on the basis of medical or clinical
19    documentation that an additional care period is required
20    for the recovery of a patient and the medical director
21    approves the extension of time. In no case, however, shall
22    a patient's length of stay in a postsurgical recovery care
23    center be longer than 72 hours. If a patient requires an
24    additional care period after the expiration of the 72-hour
25    limit, the patient shall be transferred to an appropriate
26    facility. Reports on variances from the 24-hour or 48-hour

 

 

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1    limit shall be sent to the Department for its evaluation.
2    The reports shall, before submission to the Department,
3    have removed from them all patient and physician
4    identifiers. Blood products may be administered in the
5    postsurgical recovery care center model. In order to handle
6    cases of complications, emergencies, or exigent
7    circumstances, every postsurgical recovery care center as
8    defined in this paragraph shall maintain a contractual
9    relationship, including a transfer agreement, with a
10    general acute care hospital. A postsurgical recovery care
11    center shall be no larger than 20 beds. A postsurgical
12    recovery care center shall be located within 15 minutes
13    travel time from the general acute care hospital with which
14    the center maintains a contractual relationship, including
15    a transfer agreement, as required under this paragraph.
16        No postsurgical recovery care center shall
17    discriminate against any patient requiring treatment
18    because of the source of payment for services, including
19    Medicare and Medicaid recipients.
20        The Department shall adopt rules to implement the
21    provisions of Public Act 88-441 concerning postsurgical
22    recovery care centers within 9 months after August 20,
23    1993. Notwithstanding any other law to the contrary, a
24    postsurgical recovery care center model may provide sleep
25    laboratory or similar sleep studies in accordance with
26    applicable State and federal laws and regulations.

 

 

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1        (3) Alternative health care delivery model; children's
2    community-based health care center. A children's
3    community-based health care center model is a designated
4    site that provides nursing care, clinical support
5    services, and therapies for a period of one to 14 days for
6    short-term stays and 120 days to facilitate transitions to
7    home or other appropriate settings for medically fragile
8    children, technology dependent children, and children with
9    special health care needs who are deemed clinically stable
10    by a physician and are younger than 22 years of age. This
11    care is to be provided in a home-like environment that
12    serves no more than 12 children at a time, except that a
13    children's community-based health care center in existence
14    on the effective date of this amendatory Act of the 100th
15    General Assembly that is located in Chicago on grade level
16    for Life Safety Code purposes may provide care to no more
17    than 16 children at a time. Children's community-based
18    health care center services must be available through the
19    model to all families, including those whose care is paid
20    for through the Department of Healthcare and Family
21    Services, the Department of Children and Family Services,
22    the Department of Human Services, and insurance companies
23    who cover home health care services or private duty nursing
24    care in the home.
25        Each children's community-based health care center
26    model location shall be physically separate and apart from

 

 

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1    any other facility licensed by the Department of Public
2    Health under this or any other Act and shall provide the
3    following services: respite care, registered nursing or
4    licensed practical nursing care, transitional care to
5    facilitate home placement or other appropriate settings
6    and reunite families, medical day care, weekend camps, and
7    diagnostic studies typically done in the home setting.
8        Coverage for the services provided by the Department of
9    Healthcare and Family Services under this paragraph (3) is
10    contingent upon federal waiver approval and is provided
11    only to Medicaid eligible clients participating in the home
12    and community based services waiver designated in Section
13    1915(c) of the Social Security Act for medically frail and
14    technologically dependent children or children in
15    Department of Children and Family Services foster care who
16    receive home health benefits.
17        (4) Alternative health care delivery model; community
18    based residential rehabilitation center. A community-based
19    residential rehabilitation center model is a designated
20    site that provides rehabilitation or support, or both, for
21    persons who have experienced severe brain injury, who are
22    medically stable, and who no longer require acute
23    rehabilitative care or intense medical or nursing
24    services. The average length of stay in a community-based
25    residential rehabilitation center shall not exceed 4
26    months. As an integral part of the services provided,

 

 

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1    individuals are housed in a supervised living setting while
2    having immediate access to the community. The residential
3    rehabilitation center authorized by the Department may
4    have more than one residence included under the license. A
5    residence may be no larger than 12 beds and shall be
6    located as an integral part of the community. Day treatment
7    or individualized outpatient services shall be provided
8    for persons who reside in their own home. Functional
9    outcome goals shall be established for each individual.
10    Services shall include, but are not limited to, case
11    management, training and assistance with activities of
12    daily living, nursing consultation, traditional therapies
13    (physical, occupational, speech), functional interventions
14    in the residence and community (job placement, shopping,
15    banking, recreation), counseling, self-management
16    strategies, productive activities, and multiple
17    opportunities for skill acquisition and practice
18    throughout the day. The design of individualized program
19    plans shall be consistent with the outcome goals that are
20    established for each resident. The programs provided in
21    this setting shall be accredited by the Commission on
22    Accreditation of Rehabilitation Facilities (CARF). The
23    program shall have been accredited by CARF as a Brain
24    Injury Community-Integrative Program for at least 3 years.
25        (5) Alternative health care delivery model;
26    Alzheimer's disease management center. An Alzheimer's

 

 

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1    disease management center model is a designated site that
2    provides a safe and secure setting for care of persons
3    diagnosed with Alzheimer's disease. An Alzheimer's disease
4    management center model shall be a facility separate from
5    any other facility licensed by the Department of Public
6    Health under this or any other Act. An Alzheimer's disease
7    management center shall conduct and document an assessment
8    of each resident every 6 months. The assessment shall
9    include an evaluation of daily functioning, cognitive
10    status, other medical conditions, and behavioral problems.
11    An Alzheimer's disease management center shall develop and
12    implement an ongoing treatment plan for each resident. The
13    treatment plan shall have defined goals. The Alzheimer's
14    disease management center shall treat behavioral problems
15    and mood disorders using nonpharmacologic approaches such
16    as environmental modification, task simplification, and
17    other appropriate activities. All staff must have
18    necessary training to care for all stages of Alzheimer's
19    Disease. An Alzheimer's disease management center shall
20    provide education and support for residents and
21    caregivers. The education and support shall include
22    referrals to support organizations for educational
23    materials on community resources, support groups, legal
24    and financial issues, respite care, and future care needs
25    and options. The education and support shall also include a
26    discussion of the resident's need to make advance

 

 

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1    directives and to identify surrogates for medical and legal
2    decision-making. The provisions of this paragraph
3    establish the minimum level of services that must be
4    provided by an Alzheimer's disease management center. An
5    Alzheimer's disease management center model shall have no
6    more than 100 residents. Nothing in this paragraph (5)
7    shall be construed as prohibiting a person or facility from
8    providing services and care to persons with Alzheimer's
9    disease as otherwise authorized under State law.
10        (6) Alternative health care delivery model; birth
11    center. A birth center shall be exclusively dedicated to
12    serving the childbirth-related needs of women and their
13    newborns and shall have no more than 10 beds. A birth
14    center is a designated site that is away from the mother's
15    usual place of residence and in which births are planned to
16    occur following a normal, uncomplicated, and low-risk
17    pregnancy. A birth center shall offer prenatal care and
18    community education services and shall coordinate these
19    services with other health care services available in the
20    community.
21            (A) A birth center shall not be separately licensed
22        if it is one of the following:
23                (1) A part of a hospital; or
24                (2) A freestanding facility that is physically
25            distinct from a hospital but is operated under a
26            license issued to a hospital under the Hospital

 

 

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1            Licensing Act.
2            (B) A separate birth center license shall be
3        required if the birth center is operated as:
4                (1) A part of the operation of a federally
5            qualified health center as designated by the
6            United States Department of Health and Human
7            Services; or
8                (2) A facility other than one described in
9            subparagraph (A)(1), (A)(2), or (B)(1) of this
10            paragraph (6) whose costs are reimbursable under
11            Title XIX of the federal Social Security Act.
12        In adopting rules for birth centers, the Department
13    shall consider: the American Association of Birth Centers'
14    Standards for Freestanding Birth Centers; the American
15    Academy of Pediatrics/American College of Obstetricians
16    and Gynecologists Guidelines for Perinatal Care; and the
17    Regionalized Perinatal Health Care Code. The Department's
18    rules shall stipulate the eligibility criteria for birth
19    center admission. The Department's rules shall stipulate
20    the necessary equipment for emergency care according to the
21    American Association of Birth Centers' standards and any
22    additional equipment deemed necessary by the Department.
23    The Department's rules shall provide for a time period
24    within which each birth center not part of a hospital must
25    become accredited by either the Commission for the
26    Accreditation of Freestanding Birth Centers or The Joint

 

 

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1    Commission.
2        A birth center shall be certified to participate in the
3    Medicare and Medicaid programs under Titles XVIII and XIX,
4    respectively, of the federal Social Security Act. To the
5    extent necessary, the Illinois Department of Healthcare
6    and Family Services shall apply for a waiver from the
7    United States Health Care Financing Administration to
8    allow birth centers to be reimbursed under Title XIX of the
9    federal Social Security Act.
10        A birth center that is not operated under a hospital
11    license shall be located within a ground travel time
12    distance from the general acute care hospital with which
13    the birth center maintains a contractual relationship,
14    including a transfer agreement, as required under this
15    paragraph, that allows for an emergency caesarian delivery
16    to be started within 30 minutes of the decision a caesarian
17    delivery is necessary. A birth center operating under a
18    hospital license shall be located within a ground travel
19    time distance from the licensed hospital that allows for an
20    emergency caesarian delivery to be started within 30
21    minutes of the decision a caesarian delivery is necessary.
22        The services of a medical director physician, licensed
23    to practice medicine in all its branches, who is certified
24    or eligible for certification by the American College of
25    Obstetricians and Gynecologists or the American Board of
26    Osteopathic Obstetricians and Gynecologists or has

 

 

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1    hospital obstetrical privileges are required in birth
2    centers. The medical director in consultation with the
3    Director of Nursing and Midwifery Services shall
4    coordinate the clinical staff and overall provision of
5    patient care. The medical director or his or her physician
6    designee shall be available on the premises or within a
7    close proximity as defined by rule. The medical director
8    and the Director of Nursing and Midwifery Services shall
9    jointly develop and approve policies defining the criteria
10    to determine which pregnancies are accepted as normal,
11    uncomplicated, and low-risk, and the anesthesia services
12    available at the center. No general anesthesia may be
13    administered at the center.
14        If a birth center employs certified nurse midwives, a
15    certified nurse midwife shall be the Director of Nursing
16    and Midwifery Services who is responsible for the
17    development of policies and procedures for services as
18    provided by Department rules.
19        An obstetrician, family practitioner, or certified
20    nurse midwife shall attend each woman in labor from the
21    time of admission through birth and throughout the
22    immediate postpartum period. Attendance may be delegated
23    only to another physician or certified nurse midwife.
24    Additionally, a second staff person shall also be present
25    at each birth who is licensed or certified in Illinois in a
26    health-related field and under the supervision of the

 

 

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1    physician or certified nurse midwife in attendance, has
2    specialized training in labor and delivery techniques and
3    care of newborns, and receives planned and ongoing training
4    as needed to perform assigned duties effectively.
5        The maximum length of stay in a birth center shall be
6    consistent with existing State laws allowing a 48-hour stay
7    or appropriate post-delivery care, if discharged earlier
8    than 48 hours.
9        A birth center shall participate in the Illinois
10    Perinatal System under the Developmental Disability
11    Prevention Act. At a minimum, this participation shall
12    require a birth center to establish a letter of agreement
13    with a hospital designated under the Perinatal System. A
14    hospital that operates or has a letter of agreement with a
15    birth center shall include the birth center under its
16    maternity service plan under the Hospital Licensing Act and
17    shall include the birth center in the hospital's letter of
18    agreement with its regional perinatal center.
19        A birth center may not discriminate against any patient
20    requiring treatment because of the source of payment for
21    services, including Medicare and Medicaid recipients.
22        No general anesthesia and no surgery may be performed
23    at a birth center. The Department may by rule add birth
24    center patient eligibility criteria or standards as it
25    deems necessary. The Department shall by rule require each
26    birth center to report the information which the Department

 

 

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1    shall make publicly available, which shall include, but is
2    not limited to, the following:
3            (i) Birth center ownership.
4            (ii) Sources of payment for services.
5            (iii) Utilization data involving patient length of
6        stay.
7            (iv) Admissions and discharges.
8            (v) Complications.
9            (vi) Transfers.
10            (vii) Unusual incidents.
11            (viii) Deaths.
12            (ix) Any other publicly reported data required
13        under the Illinois Consumer Guide.
14            (x) Post-discharge patient status data where
15        patients are followed for 14 days after discharge from
16        the birth center to determine whether the mother or
17        baby developed a complication or infection.
18        Within 9 months after the effective date of this
19    amendatory Act of the 95th General Assembly, the Department
20    shall adopt rules that are developed with consideration of:
21    the American Association of Birth Centers' Standards for
22    Freestanding Birth Centers; the American Academy of
23    Pediatrics/American College of Obstetricians and
24    Gynecologists Guidelines for Perinatal Care; and the
25    Regionalized Perinatal Health Care Code.
26        The Department shall adopt other rules as necessary to

 

 

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1    implement the provisions of this amendatory Act of the 95th
2    General Assembly within 9 months after the effective date
3    of this amendatory Act of the 95th General Assembly.
4(Source: P.A. 97-135, eff. 7-14-11; 97-987, eff. 1-1-13.)".