State of Illinois
2017 and 2018


Introduced 2/15/2018, by Sen. Laura M. Murphy


See Index

    Amends the Department of Human Services Act. Adds additional duties for the Inspector General for the Department of Human Services. Defines "substantiated" to mean that there is clear and convincing evidence (rather than a preponderance) to support the allegation of abuse, neglect, or financial exploitation. Amends the Mental Health and Developmental Disabilities Administrative Act. Defines "nurse-training". Changes the criteria for non-licensed authorized direct care staff. Provides that within one year after the bill's effective date, the Department shall prepare a report that identifies any efficiencies or improvements in Department operations, the oversight of agencies, and the reduction or elimination of duplicative activities. The report shall include a quality assessment of the feasibility of combining the functions of the Division of Developmental Disabilities' Bureau of Quality Management and the Department's Bureau of Accreditation, Licensure, and Certification. Upon the report's completion, the Department shall post the report on the Department's website and submit it to the General Assembly and Governor. Amends the Community-Integrated Living Arrangements Licensure and Certification Act. Provides that using contemporary data gathered on reports of allegations of abuse, neglect, and financial exploitation, the Department shall establish a process by which the Department requires responses from agencies that annually report a number of allegations that are 2 or more standard deviations from the mean for all agencies. Provides that if an agency has documented evidence and has determined that the agency cannot adequately staff a community-integrated living arrangement, then the agency may take immediate steps to close the community-integrated living arrangement. Effective immediately.

LRB100 18946 RLC 34196 b





SB3179LRB100 18946 RLC 34196 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Department of Human Services Act is amended
5by changing Section 1-17 as follows:
6    (20 ILCS 1305/1-17)
7    Sec. 1-17. Inspector General.
8    (a) Nature and purpose. It is the express intent of the
9General Assembly to ensure the health, safety, and financial
10condition of individuals receiving services in this State due
11to mental illness, developmental disability, or both by
12protecting those persons from acts of abuse, neglect, or both
13by service providers. To that end, the Office of the Inspector
14General for the Department of Human Services is created to
15investigate and report upon allegations of the abuse, neglect,
16or financial exploitation of individuals receiving services
17within mental health facilities, developmental disabilities
18facilities, and community agencies operated, licensed, funded
19or certified by the Department of Human Services, but not
20licensed or certified by any other State agency.
21    (b) Definitions. The following definitions apply to this
23    "Adult student with a disability" means an adult student,



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1age 18 through 21, inclusive, with an Individual Education
2Program, other than a resident of a facility licensed by the
3Department of Children and Family Services in accordance with
4the Child Care Act of 1969. For purposes of this definition,
5"through age 21, inclusive", means through the day before the
6student's 22nd birthday.
7    "Agency" or "community agency" means (i) a community agency
8licensed, funded, or certified by the Department, but not
9licensed or certified by any other human services agency of the
10State, to provide mental health service or developmental
11disabilities service, or (ii) a program licensed, funded, or
12certified by the Department, but not licensed or certified by
13any other human services agency of the State, to provide mental
14health service or developmental disabilities service.
15    "Aggravating circumstance" means a factor that is
16attendant to a finding and that tends to compound or increase
17the culpability of the accused.
18    "Allegation" means an assertion, complaint, suspicion, or
19incident involving any of the following conduct by an employee,
20facility, or agency against an individual or individuals:
21mental abuse, physical abuse, sexual abuse, neglect, or
22financial exploitation.
23    "Day" means working day, unless otherwise specified.
24    "Deflection" means a situation in which an individual is
25presented for admission to a facility or agency, and the
26facility staff or agency staff do not admit the individual.



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1"Deflection" includes triage, redirection, and denial of
3    "Department" means the Department of Human Services.
4    "Developmental disability" means "developmental
5disability" as defined in the Mental Health and Developmental
6Disabilities Code.
7    "Egregious neglect" means a finding of neglect as
8determined by the Inspector General that (i) represents a gross
9failure to adequately provide for, or a callused indifference
10to, the health, safety, or medical needs of an individual and
11(ii) results in an individual's death or other serious
12deterioration of an individual's physical condition or mental
14    "Employee" means any person who provides services at the
15facility or agency on-site or off-site. The service
16relationship can be with the individual or with the facility or
17agency. Also, "employee" includes any employee or contractual
18agent of the Department of Human Services or the community
19agency involved in providing or monitoring or administering
20mental health or developmental disability services. This
21includes but is not limited to: owners, operators, payroll
22personnel, contractors, subcontractors, and volunteers.
23    "Facility" or "State-operated facility" means a mental
24health facility or developmental disabilities facility
25operated by the Department.
26    "Financial exploitation" means taking unjust advantage of



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1an individual's assets, property, or financial resources
2through deception, intimidation, or conversion for the
3employee's, facility's, or agency's own advantage or benefit.
4    "Finding" means the Office of Inspector General's
5determination regarding whether an allegation is
6substantiated, unsubstantiated, or unfounded.
7    "Health Care Worker Registry" or "Registry" means the
8Health Care Worker Registry under the Health Care Worker
9Background Check Act.
10    "Individual" means any person receiving mental health
11service, developmental disabilities service, or both from a
12facility or agency, while either on-site or off-site.
13    "Mental abuse" means the use of demeaning, intimidating, or
14threatening words, signs, gestures, or other actions by an
15employee about an individual and in the presence of an
16individual or individuals that results in emotional distress or
17maladaptive behavior, or could have resulted in emotional
18distress or maladaptive behavior, for any individual present.
19    "Mental illness" means "mental illness" as defined in the
20Mental Health and Developmental Disabilities Code.
21    "Mentally ill" means having a mental illness.
22    "Mitigating circumstance" means a condition that (i) is
23attendant to a finding, (ii) does not excuse or justify the
24conduct in question, but (iii) may be considered in evaluating
25the severity of the conduct, the culpability of the accused, or
26both the severity of the conduct and the culpability of the



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2    "Neglect" means an employee's, agency's, or facility's
3failure to provide adequate medical care, personal care, or
4maintenance and that, as a consequence, (i) causes an
5individual pain, injury, or emotional distress, (ii) results in
6either an individual's maladaptive behavior or the
7deterioration of an individual's physical condition or mental
8condition, or (iii) places the individual's health or safety at
9substantial risk.
10    "Person with a developmental disability" means a person
11having a developmental disability.
12    "Physical abuse" means an employee's non-accidental and
13inappropriate contact with an individual that causes bodily
14harm. "Physical abuse" includes actions that cause bodily harm
15as a result of an employee directing an individual or person to
16physically abuse another individual.
17    "Recommendation" means an admonition, separate from a
18finding, that requires action by the facility, agency, or
19Department to correct a systemic issue, problem, or deficiency
20identified during an investigation.
21    "Required reporter" means any employee who suspects,
22witnesses, or is informed of an allegation of any one or more
23of the following: mental abuse, physical abuse, sexual abuse,
24neglect, or financial exploitation.
25    "Secretary" means the Chief Administrative Officer of the



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1    "Sexual abuse" means any sexual contact or intimate
2physical contact between an employee and an individual,
3including an employee's coercion or encouragement of an
4individual to engage in sexual behavior that results in sexual
5contact, intimate physical contact, sexual behavior, or
6intimate physical behavior. Sexual abuse also includes (i) an
7employee's actions that result in the sending or showing of
8sexually explicit images to an individual via computer,
9cellular phone, electronic mail, portable electronic device,
10or other media with or without contact with the individual or
11(ii) an employee's posting of sexually explicit images of an
12individual online or elsewhere whether or not there is contact
13with the individual.
14    "Sexually explicit images" includes, but is not limited to,
15any material which depicts nudity, sexual conduct, or
16sado-masochistic abuse, or which contains explicit and
17detailed verbal descriptions or narrative accounts of sexual
18excitement, sexual conduct, or sado-masochistic abuse.
19    "Substantiated" means there is clear and convincing a
20preponderance of the evidence to support the allegation.
21    "Unfounded" means there is not a preponderance of no
22credible evidence to support the allegation.
23    "Unsubstantiated" means there is a preponderance of
24credible evidence, but less than clear and convincing a
25preponderance of evidence to support the allegation.
26    (c) Appointment. The Governor shall appoint, and the Senate



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1shall confirm, an Inspector General. The Inspector General
2shall be appointed for a term of 4 years and shall function
3within the Department of Human Services and report to the
4Secretary and the Governor.
5    (d) Operation and appropriation. The Inspector General
6shall function independently within the Department with
7respect to the operations of the Office, including the
8performance of investigations and issuance of findings and
9recommendations. The appropriation for the Office of Inspector
10General shall be separate from the overall appropriation for
11the Department.
12    (e) Powers and duties. The Inspector General shall
13investigate reports of suspected mental abuse, physical abuse,
14sexual abuse, neglect, or financial exploitation of
15individuals in any mental health or developmental disabilities
16facility or agency and shall have authority to take immediate
17action to prevent any one or more of the following from
18happening to individuals under its jurisdiction: mental abuse,
19physical abuse, sexual abuse, neglect, or financial
20exploitation. Upon written request of an agency of this State,
21the Inspector General may assist another agency of the State in
22investigating reports of the abuse, neglect, or abuse and
23neglect of persons with mental illness, persons with
24developmental disabilities, or persons with both. To comply
25with the requirements of subsection (k) of this Section, the
26Inspector General shall also review all reportable deaths for



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1which there is no allegation of abuse or neglect. Nothing in
2this Section shall preempt any duties of the Medical Review
3Board set forth in the Mental Health and Developmental
4Disabilities Code. The Inspector General shall have no
5authority to investigate alleged violations of the State
6Officials and Employees Ethics Act. Allegations of misconduct
7under the State Officials and Employees Ethics Act shall be
8referred to the Office of the Governor's Executive Inspector
9General for investigation.
10    (f) Limitations. The Inspector General shall not conduct an
11investigation within an agency or facility if that
12investigation would be redundant to or interfere with an
13investigation conducted by another State agency. The Inspector
14General shall have no supervision over, or involvement in, the
15routine programmatic, licensing, funding, or certification
16operations of the Department. Nothing in this subsection limits
17investigations by the Department that may otherwise be required
18by law or that may be necessary in the Department's capacity as
19central administrative authority responsible for the operation
20of the State's mental health and developmental disabilities
22    (g) Rulemaking authority. The Inspector General shall
23promulgate rules establishing minimum requirements for
24reporting allegations as well as for initiating, conducting,
25and completing investigations based upon the nature of the
26allegation or allegations. The rules shall clearly establish



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1that if 2 or more State agencies could investigate an
2allegation, the Inspector General shall not conduct an
3investigation that would be redundant to, or interfere with, an
4investigation conducted by another State agency. The rules
5shall further clarify the method and circumstances under which
6the Office of Inspector General may interact with the
7licensing, funding, or certification units of the Department in
8preventing further occurrences of mental abuse, physical
9abuse, sexual abuse, neglect, egregious neglect, and financial
11    (h) Training programs. The Inspector General shall (i)
12establish a comprehensive program to ensure that every person
13authorized to conduct investigations receives ongoing training
14relative to investigation techniques, communication skills,
15community models of providing long-term services and supports
16for persons with intellectual or developmental disabilities
17and serious mental illnesses, and the appropriate means of
18interacting with persons with intellectual disabilities,
19developmental disabilities, or mental illnesses who are
20receiving services in a community setting receiving treatment
21for mental illness, developmental disability, or both mental
22illness and developmental disability, and (ii) establish and
23conduct periodic training programs for facility and agency
24employees concerning the prevention and reporting of any one or
25more of the following: mental abuse, physical abuse, sexual
26abuse, neglect, egregious neglect, or financial exploitation.



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1The Inspector General shall ensure all investigators are
2trained on the role of nurses as provided in 59 Ill. Adm. Code
3116. Nothing in this Section shall be deemed to prevent the
4Office of Inspector General from conducting any other training
5as determined by the Inspector General to be necessary or
7    (i) Duty to cooperate.
8        (1) The Inspector General shall at all times be granted
9    access to any facility or agency for the purpose of
10    investigating any allegation, conducting unannounced site
11    visits, monitoring compliance with a written response, or
12    completing any other statutorily assigned duty. The
13    Inspector General shall conduct unannounced site visits to
14    each facility at least annually for the purpose of
15    reviewing and making recommendations on systemic issues
16    relative to preventing, reporting, investigating, and
17    responding to all of the following: mental abuse, physical
18    abuse, sexual abuse, neglect, egregious neglect, or
19    financial exploitation.
20        (2) Any employee who fails to cooperate with an Office
21    of the Inspector General investigation is in violation of
22    this Act. Failure to cooperate with an investigation
23    includes, but is not limited to, any one or more of the
24    following: (i) creating and transmitting a false report to
25    the Office of the Inspector General hotline, (ii) providing
26    false information to an Office of the Inspector General



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1    Investigator during an investigation, (iii) colluding with
2    other employees to cover up evidence, (iv) colluding with
3    other employees to provide false information to an Office
4    of the Inspector General investigator, (v) destroying
5    evidence, (vi) withholding evidence, or (vii) otherwise
6    obstructing an Office of the Inspector General
7    investigation. Additionally, any employee who, during an
8    unannounced site visit or written response compliance
9    check, fails to cooperate with requests from the Office of
10    the Inspector General is in violation of this Act.
11    (j) Subpoena powers. The Inspector General shall have the
12power to subpoena witnesses and compel the production of all
13documents and physical evidence relating to his or her
14investigations and any hearings authorized by this Act. This
15subpoena power shall not extend to persons or documents of a
16labor organization or its representatives insofar as the
17persons are acting in a representative capacity to an employee
18whose conduct is the subject of an investigation or the
19documents relate to that representation. Any person who
20otherwise fails to respond to a subpoena or who knowingly
21provides false information to the Office of the Inspector
22General by subpoena during an investigation is guilty of a
23Class A misdemeanor.
24    (k) Reporting allegations and deaths.
25        (1) Allegations. If an employee witnesses, is told of,
26    or has reason to believe an incident of mental abuse,



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1    physical abuse, sexual abuse, neglect, or financial
2    exploitation has occurred, the employee, agency, or
3    facility shall report the allegation by phone to the Office
4    of the Inspector General hotline according to the agency's
5    or facility's procedures, but in no event later than 4
6    hours after the initial discovery of the incident,
7    allegation, or suspicion of any one or more of the
8    following: mental abuse, physical abuse, sexual abuse,
9    neglect, or financial exploitation. A required reporter as
10    defined in subsection (b) of this Section who knowingly or
11    intentionally fails to comply with these reporting
12    requirements is guilty of a Class A misdemeanor.
13        (2) Deaths. Absent an allegation, a required reporter
14    shall, within 24 hours after initial discovery, report by
15    phone to the Office of the Inspector General hotline each
16    of the following:
17            (i) Any death of an individual occurring within 14
18        calendar days after discharge or transfer of the
19        individual from a residential program or facility.
20            (ii) Any death of an individual occurring within 24
21        hours after deflection from a residential program or
22        facility.
23            (iii) Any other death of an individual occurring at
24        an agency or facility or at any Department-funded site.
25        (3) Retaliation. It is a violation of this Act for any
26    employee or administrator of an agency or facility to take



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1    retaliatory action against an employee who acts in good
2    faith in conformance with his or her duties as a required
3    reporter.
4    (l) Reporting to law enforcement.
5        (1) Reporting criminal acts. Within 24 hours after
6    determining that there is credible evidence indicating
7    that a criminal act may have been committed or that special
8    expertise may be required in an investigation, the
9    Inspector General shall notify the Department of State
10    Police or other appropriate law enforcement authority, or
11    ensure that such notification is made. The Department of
12    State Police shall investigate any report from a
13    State-operated facility indicating a possible murder,
14    sexual assault, or other felony by an employee. All
15    investigations conducted by the Inspector General shall be
16    conducted in a manner designed to ensure the preservation
17    of evidence for possible use in a criminal prosecution.
18        (2) Reporting allegations of adult students with
19    disabilities. Upon receipt of a reportable allegation
20    regarding an adult student with a disability, the
21    Department's Office of the Inspector General shall
22    determine whether the allegation meets the criteria for the
23    Domestic Abuse Program under the Abuse of Adults with
24    Disabilities Intervention Act. If the allegation is
25    reportable to that program, the Office of the Inspector
26    General shall initiate an investigation. If the allegation



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1    is not reportable to the Domestic Abuse Program, the Office
2    of the Inspector General shall make an expeditious referral
3    to the respective law enforcement entity. If the alleged
4    victim is already receiving services from the Department,
5    the Office of the Inspector General shall also make a
6    referral to the respective Department of Human Services'
7    Division or Bureau.
8    (m) Investigative reports. Upon completion of an
9investigation, the Office of Inspector General shall issue an
10investigative report identifying whether the allegations are
11substantiated, unsubstantiated, or unfounded. Within 10
12business days after the transmittal of a completed
13investigative report substantiating an allegation, finding an
14allegation is unsubstantiated, or if a recommendation is made,
15the Inspector General shall provide the investigative report on
16the case to the Secretary and to the director of the facility
17or agency where any one or more of the following occurred:
18mental abuse, physical abuse, sexual abuse, neglect, egregious
19neglect, or financial exploitation. The director of the
20facility or agency shall be responsible for maintaining the
21confidentiality of the investigative report consistent with
22State and federal law. In a substantiated case, the
23investigative report shall include any mitigating or
24aggravating circumstances that were identified during the
25investigation. In an unsubstantiated case, the Inspector
26General shall not issue recommendations to the director of the



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1facility or the agency. If the case involves substantiated
2neglect, the investigative report shall also state whether
3egregious neglect was found. An investigative report may also
4set forth recommendations. All investigative reports prepared
5by the Office of the Inspector General shall be considered
6confidential and shall not be released except as provided by
7the law of this State or as required under applicable federal
8law. Unsubstantiated and unfounded reports shall not be
9disclosed except as allowed under Section 6 of the Abused and
10Neglected Long Term Care Facility Residents Reporting Act. Raw
11data used to compile the investigative report shall not be
12subject to release unless required by law or a court order.
13"Raw data used to compile the investigative report" includes,
14but is not limited to, any one or more of the following: the
15initial complaint, witness statements, photographs,
16investigator's notes, police reports, or incident reports. If
17the allegations are substantiated, the accused shall be
18provided with a redacted copy of the investigative report.
19Death reports where there was no allegation of abuse or neglect
20shall only be released pursuant to applicable State or federal
21law or a valid court order. In all final reports, the
22facility's or agency's director shall be given the opportunity
23to provide written evaluations of the investigative process.
24    (n) Written responses and reconsideration requests.
25        (1) Written responses. Within 30 calendar days from
26    receipt of a substantiated investigative report or an



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1    investigative report which contains recommendations,
2    absent a reconsideration request, the facility or agency
3    shall file a written response that addresses, in a concise
4    and reasoned manner, the actions taken to: (i) protect the
5    individual; (ii) prevent recurrences; and (iii) eliminate
6    the problems identified. The response shall include the
7    implementation and completion dates of such actions. If the
8    facility's or agency's director have recommendations that
9    differ from or are not identical to the recommendations
10    provided in the investigative report, then the Inspector
11    General must review and consider how these recommendations
12    might accomplish the actions required in this Section. If
13    the written response is not filed within the allotted 30
14    calendar day period, the Secretary shall determine the
15    appropriate corrective action to be taken.
16        (1.5) If, in a final investigative report, the
17    Inspector General recommends that the facility's or
18    agency's director assign or hire additional staff, and if,
19    in the written response, the director indicates additional
20    staff cannot be assigned or hired, then the director may
21    take immediate steps to close the facility or agency.
22        (2) Reconsideration requests. The facility, agency,
23    victim or guardian, or the subject employee may request
24    that the Office of Inspector General reconsider or clarify
25    its finding based upon additional information.
26    (n-5) If an investigative report under this Section is



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1submitted as evidence during the appeals process provided in
2the Unemployment Insurance Act, then the investigator that
3completed the report must attend all appeal hearings and Board
4of Review hearings.
5    (o) Disclosure of the finding by the Inspector General. The
6Inspector General shall disclose the finding of an
7investigation to the following persons: (i) the Governor, (ii)
8the Secretary, (iii) the director of the facility or agency,
9(iv) the alleged victims and their guardians, (v) the
10complainant, and (vi) the accused. This information shall
11include whether the allegations were deemed substantiated,
12unsubstantiated, or unfounded.
13    (p) Secretary review. Upon review of the Inspector
14General's investigative report and any agency's or facility's
15written response, the Secretary shall accept or reject the
16written response and notify the Inspector General of that
17determination. The Secretary may further direct that other
18administrative action be taken, including, but not limited to,
19any one or more of the following: (i) additional site visits,
20(ii) training, (iii) provision of technical assistance
21relative to administrative needs, licensure or certification,
22or (iv) the imposition of appropriate sanctions.
23    (q) Action by facility or agency. Within 30 days of the
24date the Secretary approves the written response or directs
25that further administrative action be taken, the facility or
26agency shall provide an implementation report to the Inspector



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1General that provides the status of the action taken. The
2facility or agency shall be allowed an additional 30 days to
3send notice of completion of the action or to send an updated
4implementation report. If the action has not been completed
5within the additional 30-day 30 day period, the facility or
6agency shall send updated implementation reports every 60 days
7until completion. The Inspector General shall conduct a review
8of any implementation plan that takes more than 120 days after
9approval to complete, and shall monitor compliance through a
10random review of approved written responses, which may include,
11but are not limited to: (i) site visits, (ii) telephone
12contact, and (iii) requests for additional documentation
13evidencing compliance.
14    (r) Sanctions. Sanctions, if imposed by the Secretary under
15Subdivision (p)(iv) of this Section, shall be designed to
16prevent further acts of mental abuse, physical abuse, sexual
17abuse, neglect, egregious neglect, or financial exploitation
18or some combination of one or more of those acts at a facility
19or agency, and may include any one or more of the following:
20        (1) Appointment of on-site monitors.
21        (2) Transfer or relocation of an individual or
22    individuals.
23        (3) Closure of units.
24        (4) Termination of any one or more of the following:
25    (i) Department licensing, (ii) funding, or (iii)
26    certification.



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1    The Inspector General may seek the assistance of the
2Illinois Attorney General or the office of any State's Attorney
3in implementing sanctions.
4    (s) Health Care Worker Registry.
5        (1) Reporting to the Registry. The Inspector General
6    shall report to the Department of Public Health's Health
7    Care Worker Registry, a public registry, the identity and
8    finding of each employee of a facility or agency against
9    whom there is a final investigative report containing a
10    substantiated allegation of physical or sexual abuse,
11    financial exploitation, or egregious neglect of an
12    individual.
13        (2) Notice to employee. Prior to reporting the name of
14    an employee, the employee shall be notified of the
15    Department's obligation to report and shall be granted an
16    opportunity to request an administrative hearing, the sole
17    purpose of which is to determine if the substantiated
18    finding warrants reporting to the Registry. Notice to the
19    employee shall contain a clear and concise statement of the
20    grounds on which the report to the Registry is based, offer
21    the employee an opportunity for a hearing, and identify the
22    process for requesting such a hearing. Notice is sufficient
23    if provided by certified mail to the employee's last known
24    address. If the employee fails to request a hearing within
25    30 days from the date of the notice, the Inspector General
26    shall report the name of the employee to the Registry.



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1    Nothing in this subdivision (s)(2) shall diminish or impair
2    the rights of a person who is a member of a collective
3    bargaining unit under the Illinois Public Labor Relations
4    Act or under any other federal labor statute.
5        (3) Registry hearings. If the employee requests an
6    administrative hearing, the employee shall be granted an
7    opportunity to appear before an administrative law judge to
8    present reasons why the employee's name should not be
9    reported to the Registry. The Department shall bear the
10    burden of presenting evidence that establishes, by a
11    preponderance of the evidence, that the substantiated
12    finding warrants reporting to the Registry. After
13    considering all the evidence presented, the administrative
14    law judge shall make a recommendation to the Secretary as
15    to whether the substantiated finding warrants reporting
16    the name of the employee to the Registry. The Secretary
17    shall render the final decision. The Department and the
18    employee shall have the right to request that the
19    administrative law judge consider a stipulated disposition
20    of these proceedings.
21        (4) Testimony at Registry hearings. A person who makes
22    a report or who investigates a report under this Act shall
23    testify fully in any judicial proceeding resulting from
24    such a report, as to any evidence of abuse or neglect, or
25    the cause thereof. No evidence shall be excluded by reason
26    of any common law or statutory privilege relating to



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1    communications between the alleged perpetrator of abuse or
2    neglect, or the individual alleged as the victim in the
3    report, and the person making or investigating the report.
4    Testimony at hearings is exempt from the confidentiality
5    requirements of subsection (f) of Section 10 of the Mental
6    Health and Developmental Disabilities Confidentiality Act.
7        (5) Employee's rights to collateral action. No
8    reporting to the Registry shall occur and no hearing shall
9    be set or proceed if an employee notifies the Inspector
10    General in writing, including any supporting
11    documentation, that he or she is formally contesting an
12    adverse employment action resulting from a substantiated
13    finding by complaint filed with the Illinois Civil Service
14    Commission, or which otherwise seeks to enforce the
15    employee's rights pursuant to any applicable collective
16    bargaining agreement. If an action taken by an employer
17    against an employee as a result of a finding of physical
18    abuse, sexual abuse, or egregious neglect is overturned
19    through an action filed with the Illinois Civil Service
20    Commission or under any applicable collective bargaining
21    agreement and if that employee's name has already been sent
22    to the Registry, the employee's name shall be removed from
23    the Registry.
24        (6) Removal from Registry. At any time after the report
25    to the Registry, but no more than once in any 12-month
26    period, an employee may petition the Department in writing



SB3179- 22 -LRB100 18946 RLC 34196 b

1    to remove his or her name from the Registry. Upon receiving
2    notice of such request, the Inspector General shall conduct
3    an investigation into the petition. Upon receipt of such
4    request, an administrative hearing will be set by the
5    Department. At the hearing, the employee shall bear the
6    burden of presenting evidence that establishes, by a
7    preponderance of the evidence, that removal of the name
8    from the Registry is in the public interest. The parties
9    may jointly request that the administrative law judge
10    consider a stipulated disposition of these proceedings.
11    (t) Review of Administrative Decisions. The Department
12shall preserve a record of all proceedings at any formal
13hearing conducted by the Department involving Health Care
14Worker Registry hearings. Final administrative decisions of
15the Department are subject to judicial review pursuant to
16provisions of the Administrative Review Law.
17    (u) Quality Care Board. There is created, within the Office
18of the Inspector General, a Quality Care Board to be composed
19of 7 members appointed by the Governor with the advice and
20consent of the Senate. One of the members shall be designated
21as chairman by the Governor. Of the initial appointments made
22by the Governor, 4 Board members shall each be appointed for a
23term of 4 years and 3 members shall each be appointed for a
24term of 2 years. Upon the expiration of each member's term, a
25successor shall be appointed for a term of 4 years. In the case
26of a vacancy in the office of any member, the Governor shall



SB3179- 23 -LRB100 18946 RLC 34196 b

1appoint a successor for the remainder of the unexpired term.
2    Members appointed by the Governor shall be qualified by
3professional knowledge or experience in the area of law,
4investigatory techniques, or in the area of care of the
5mentally ill or care of persons with developmental
6disabilities. Two members appointed by the Governor shall be
7persons with a disability or a parent of a person with a
8disability. Members shall serve without compensation, but
9shall be reimbursed for expenses incurred in connection with
10the performance of their duties as members.
11    The Board shall meet quarterly, and may hold other meetings
12on the call of the chairman. Four members shall constitute a
13quorum allowing the Board to conduct its business. The Board
14may adopt rules and regulations it deems necessary to govern
15its own procedures.
16    The Board shall monitor and oversee the operations,
17policies, and procedures of the Inspector General to ensure the
18prompt and thorough investigation of allegations of neglect and
19abuse. In fulfilling these responsibilities, the Board may do
20the following:
21        (1) Provide independent, expert consultation to the
22    Inspector General on policies and protocols for
23    investigations of alleged abuse, neglect, or both abuse and
24    neglect.
25        (2) Review existing regulations relating to the
26    operation of facilities.



SB3179- 24 -LRB100 18946 RLC 34196 b

1        (3) Advise the Inspector General as to the content of
2    training activities authorized under this Section.
3        (4) Recommend policies concerning methods for
4    improving the intergovernmental relationships between the
5    Office of the Inspector General and other State or federal
6    offices.
7    (v) Annual report. The Inspector General shall provide to
8the General Assembly and the Governor, no later than January 1
9of each year, a summary of reports and investigations made
10under this Act for the prior fiscal year with respect to
11individuals receiving mental health or developmental
12disabilities services. The report shall detail the imposition
13of sanctions, if any, and the final disposition of any
14corrective or administrative action directed by the Secretary.
15The summaries shall not contain any confidential or identifying
16information of any individual, but shall include objective data
17identifying any trends in the number of reported allegations,
18the timeliness of the Office of the Inspector General's
19investigations, and their disposition, for each facility and
20Department-wide, for the most recent 3-year time period. The
21report shall also identify, by facility, the staff-to-patient
22ratios taking account of direct care staff only. The report
23shall also include detailed recommended administrative actions
24and matters for consideration by the General Assembly.
25    (w) Program audit. The Auditor General shall conduct a
26program audit of the Office of the Inspector General on an



SB3179- 25 -LRB100 18946 RLC 34196 b

1as-needed basis, as determined by the Auditor General. The
2audit shall specifically include the Inspector General's
3compliance with the Act and effectiveness in investigating
4reports of allegations occurring in any facility or agency. The
5Auditor General shall conduct the program audit according to
6the provisions of the Illinois State Auditing Act and shall
7report its findings to the General Assembly no later than
8January 1 following the audit period.
9    (x) Nothing in this Section shall be construed to mean that
10an individual is a victim of abuse or neglect because of health
11care services appropriately provided or not provided by health
12care professionals.
13    (y) Nothing in this Section shall require a facility,
14including its employees, agents, medical staff members, and
15health care professionals, to provide a service to an
16individual in contravention of that individual's stated or
17implied objection to the provision of that service on the
18ground that that service conflicts with the individual's
19religious beliefs or practices, nor shall the failure to
20provide a service to an individual be considered abuse under
21this Section if the individual has objected to the provision of
22that service based on his or her religious beliefs or
24(Source: P.A. 99-143, eff. 7-27-15; 99-323, eff. 8-7-15;
2599-642, eff. 7-28-16; 100-313, eff. 8-24-17; 100-432, eff.
268-25-17; revised 9-27-17.)



SB3179- 26 -LRB100 18946 RLC 34196 b

1    Section 10. The Mental Health and Developmental
2Disabilities Administrative Act is amended by changing Section
315.4 and by adding Section 18.8 as follows:
4    (20 ILCS 1705/15.4)
5    Sec. 15.4. Authorization for nursing delegation to permit
6direct care staff to administer medications.
7    (a) This Section applies to (i) all residential programs
8for persons with a developmental disability in settings of 16
9persons or fewer that are funded or licensed by the Department
10of Human Services and that distribute or administer
11medications, (ii) all intermediate care facilities for persons
12with developmental disabilities with 16 beds or fewer that are
13licensed by the Department of Public Health, and (iii) all day
14programs certified to serve persons with developmental
15disabilities by the Department of Human Services. The
16Department of Human Services shall develop a training program
17for authorized direct care staff to administer medications
18under the supervision and monitoring of a registered
19professional nurse. The training program for authorized direct
20care staff shall include educational and oversight components
21for staff who work in day programs that are similar to those
22for staff who work in residential programs. This training
23program shall be developed in consultation with professional
24associations representing (i) physicians licensed to practice



SB3179- 27 -LRB100 18946 RLC 34196 b

1medicine in all its branches, (ii) registered professional
2nurses, and (iii) pharmacists.
3    (b) For the purposes of this Section:
4    "Authorized direct care staff" means non-licensed persons
5who have successfully completed a medication administration
6training program approved by the Department of Human Services
7and conducted by a nurse-trainer. This authorization is
8specific to an individual receiving service in a specific
9agency and does not transfer to another agency.
10    "Medications" means oral and topical medications, insulin
11in an injectable form, oxygen, epinephrine auto-injectors, and
12vaginal and rectal creams and suppositories. "Oral" includes
13inhalants and medications administered through enteral tubes,
14utilizing aseptic technique. "Topical" includes eye, ear, and
15nasal medications. Any controlled substances must be packaged
16specifically for an identified individual.
17    "Insulin in an injectable form" means a subcutaneous
18injection via an insulin pen pre-filled by the manufacturer.
19Authorized direct care staff may administer insulin, as ordered
20by a physician, advanced practice registered nurse, or
21physician assistant, if: (i) the staff has successfully
22completed a Department-approved advanced training program
23specific to insulin administration developed in consultation
24with professional associations listed in subsection (a) of this
25Section, and (ii) the staff consults with the registered nurse,
26prior to administration, of any insulin dose that is determined



SB3179- 28 -LRB100 18946 RLC 34196 b

1based on a blood glucose test result. The authorized direct
2care staff shall not: (i) calculate the insulin dosage needed
3when the dose is dependent upon a blood glucose test result, or
4(ii) administer insulin to individuals who require blood
5glucose monitoring greater than 3 times daily, unless directed
6to do so by the registered nurse.
7    "Nurse-training" means a registered professional nurse or
8advanced practice registered nurse who has successfully
9completed the Department's nurse-trainer training program and
10is in possession of one year of clinical registered
11professional nursing experience within the last 5 years, at
12least 90 days of which shall preferably have been developmental
13disabilities experience.
14    "Nurse-trainer training program" means a standardized,
15competency-based medication administration train-the-trainer
16program provided by the Department of Human Services and
17conducted by a Department of Human Services master
18nurse-trainer for the purpose of training nurse-trainers to
19train persons employed or under contract to provide direct care
20or treatment to individuals receiving services to administer
21medications and provide self-administration of medication
22training to individuals under the supervision and monitoring of
23the nurse-trainer. The program incorporates adult learning
24styles, teaching strategies, classroom management, and a
25curriculum overview, including the ethical and legal aspects of
26supervising those administering medications.



SB3179- 29 -LRB100 18946 RLC 34196 b

1    "Self-administration of medications" means an individual
2administers his or her own medications. To be considered
3capable to self-administer their own medication, individuals
4must, at a minimum, be able to identify their medication by
5size, shape, or color, know when they should take the
6medication, and know the amount of medication to be taken each
8    "Training program" means a standardized medication
9administration training program approved by the Department of
10Human Services and conducted by a registered professional nurse
11for the purpose of training persons employed or under contract
12to provide direct care or treatment to individuals receiving
13services to administer medications and provide
14self-administration of medication training to individuals
15under the delegation and supervision of a nurse-trainer. The
16program incorporates adult learning styles, teaching
17strategies, classroom management, curriculum overview,
18including ethical-legal aspects, and standardized
19competency-based evaluations on administration of medications
20and self-administration of medication training programs.
21    (c) Training and authorization of non-licensed direct care
22staff by nurse-trainers must meet the requirements of this
24        (1) Prior to training non-licensed direct care staff to
25    administer medication, the nurse-trainer shall perform the
26    following for each individual to whom medication will be



SB3179- 30 -LRB100 18946 RLC 34196 b

1    administered by non-licensed direct care staff:
2            (A) An assessment of the individual's health
3        history and physical and mental status.
4            (B) An evaluation of the medications prescribed.
5        (2) Non-licensed authorized direct care staff shall
6    meet the following criteria:
7            (A) Be 18 years of age or older.
8            (B) Have completed high school or have a high
9        school equivalency certificate.
10            (C) Have demonstrated functional literacy.
11            (D) Have successfully completed the 40-hour
12        classroom training for direct care staff required by
13        the Division of Developmental Disabilities
14        satisfactorily completed the Health and Safety
15        component of a Department of Human Services authorized
16        direct care staff training program.
17            (E) Have successfully completed competency-based
18        training as provided in 59 Ill. Adm. Code 116.40(d) the
19        training program, pass the written portion of the
20        comprehensive exam, and score 100% on the
21        competency-based assessment specific to the individual
22        and his or her medications.
23            (F) (Blank). Have received additional
24        competency-based assessment by the nurse-trainer as
25        deemed necessary by the nurse-trainer whenever a
26        change of medication occurs or a new individual that



SB3179- 31 -LRB100 18946 RLC 34196 b

1        requires medication administration enters the program.
2        (3) Authorized direct care staff shall be re-evaluated
3    by a nurse-trainer at least annually or more frequently at
4    the discretion of the registered professional nurse. Any
5    necessary retraining shall be to the extent that is
6    necessary to ensure competency of the authorized direct
7    care staff to administer medication.
8        (4) Authorization of direct care staff to administer
9    medication shall be revoked if, in the opinion of the
10    registered professional nurse, the authorized direct care
11    staff is no longer competent to administer medication.
12        (5) The registered professional nurse shall assess an
13    individual's health status at least annually or more
14    frequently at the discretion of the registered
15    professional nurse.
16    (d) Medication self-administration shall meet the
17following requirements:
18        (1) As part of the normalization process, in order for
19    each individual to attain the highest possible level of
20    independent functioning, all individuals shall be
21    permitted to participate in their total health care
22    program. This program shall include, but not be limited to,
23    individual training in preventive health and
24    self-medication procedures.
25            (A) Every program shall adopt written policies and
26        procedures for assisting individuals in obtaining



SB3179- 32 -LRB100 18946 RLC 34196 b

1        preventative health and self-medication skills in
2        consultation with a registered professional nurse,
3        advanced practice registered nurse, physician
4        assistant, or physician licensed to practice medicine
5        in all its branches.
6            (B) Individuals shall be evaluated to determine
7        their ability to self-medicate by the nurse-trainer
8        through the use of the Department's required,
9        standardized screening and assessment instruments.
10            (C) When the results of the screening and
11        assessment indicate an individual not to be capable to
12        self-administer his or her own medications, programs
13        shall be developed in consultation with the Community
14        Support Team or Interdisciplinary Team to provide
15        individuals with self-medication administration.
16        (2) Each individual shall be presumed to be competent
17    to self-administer medications if:
18            (A) authorized by an order of a physician licensed
19        to practice medicine in all its branches, an advanced
20        practice registered nurse, or a physician assistant;
21        and
22            (B) approved to self-administer medication by the
23        individual's Community Support Team or
24        Interdisciplinary Team, which includes a registered
25        professional nurse or an advanced practice registered
26        nurse.



SB3179- 33 -LRB100 18946 RLC 34196 b

1    (e) Quality Assurance.
2        (1) A registered professional nurse, advanced practice
3    registered nurse, licensed practical nurse, physician
4    licensed to practice medicine in all its branches,
5    physician assistant, or pharmacist shall review the
6    following for all individuals:
7            (A) Medication orders.
8            (B) Medication labels, including medications
9        listed on the medication administration record for
10        persons who are not self-medicating to ensure the
11        labels match the orders issued by the physician
12        licensed to practice medicine in all its branches,
13        advanced practice registered nurse, or physician
14        assistant.
15            (C) Medication administration records for persons
16        who are not self-medicating to ensure that the records
17        are completed appropriately for:
18                (i) medication administered as prescribed;
19                (ii) refusal by the individual; and
20                (iii) full signatures provided for all
21            initials used.
22        (2) Reviews shall occur at least quarterly, but may be
23    done more frequently at the discretion of the registered
24    professional nurse or advanced practice registered nurse.
25        (3) A quality assurance review of medication errors and
26    data collection for the purpose of monitoring and



SB3179- 34 -LRB100 18946 RLC 34196 b

1    recommending corrective action shall be conducted within 7
2    days and included in the required annual review.
3    (f) Programs using authorized direct care staff to
4administer medications are responsible for documenting and
5maintaining records on the training that is completed.
6    (g) The absence of this training program constitutes a
7threat to the public interest, safety, and welfare and
8necessitates emergency rulemaking by the Departments of Human
9Services and Public Health under Section 5-45 of the Illinois
10Administrative Procedure Act.
11    (h) Direct care staff who fail to qualify for delegated
12authority to administer medications pursuant to the provisions
13of this Section shall be given additional education and testing
14to meet criteria for delegation authority to administer
15medications. Any direct care staff person who fails to qualify
16as an authorized direct care staff after initial training and
17testing must within 3 months be given another opportunity for
18retraining and retesting. A direct care staff person who fails
19to meet criteria for delegated authority to administer
20medication, including, but not limited to, failure of the
21written test on 2 occasions shall be given consideration for
22shift transfer or reassignment, if possible. No employee shall
23be terminated for failure to qualify during the 3-month time
24period following initial testing. Refusal to complete training
25and testing required by this Section may be grounds for
26immediate dismissal.



SB3179- 35 -LRB100 18946 RLC 34196 b

1    (i) No authorized direct care staff person delegated to
2administer medication shall be subject to suspension or
3discharge for errors resulting from the staff person's acts or
4omissions when performing the functions unless the staff
5person's actions or omissions constitute willful and wanton
6conduct. Nothing in this subsection is intended to supersede
7paragraph (4) of subsection (c).
8    (j) A registered professional nurse, advanced practice
9registered nurse, physician licensed to practice medicine in
10all its branches, or physician assistant shall be on duty or on
11call at all times in any program covered by this Section.
12    (k) The employer shall be responsible for maintaining
13liability insurance for any program covered by this Section.
14    (l) Any direct care staff person who qualifies as
15authorized direct care staff pursuant to this Section shall be
16granted consideration for a one-time additional salary
17differential. The Department shall determine and provide the
18necessary funding for the differential in the base. This
19subsection (l) is inoperative on and after June 30, 2000.
20(Source: P.A. 99-78, eff. 7-20-15; 99-143, eff. 7-27-15;
2199-581, eff. 1-1-17; 100-50, eff. 1-1-18; 100-513, eff. 1-1-18;
22revised 9-22-17.)
23    (20 ILCS 1705/18.8 new)
24    Sec. 18.8. Streamlined Department oversight. Within one
25year after the effective date of this amendatory Act of the



SB3179- 36 -LRB100 18946 RLC 34196 b

1100th General Assembly, the Department shall prepare a report
2that identifies any efficiencies or improvements in Department
3operations, the oversight of agencies, and the reduction or
4elimination of duplicative activities. The report shall
5include a quality assessment of the feasibility of combining
6the functions of the Division of Developmental Disabilities'
7Bureau of Quality Management and the Department's Bureau of
8Accreditation, Licensure, and Certification. Upon the report's
9completion, the Department shall post the report on the
10Department's website and submit the report to the General
11Assembly and Governor.
12    Section 15. The Community-Integrated Living Arrangements
13Licensure and Certification Act is amended by changing Section
144 and by adding Section 9.3 as follows:
15    (210 ILCS 135/4)  (from Ch. 91 1/2, par. 1704)
16    Sec. 4. (a) Any community mental health or developmental
17services agency who wishes to develop and support a variety of
18community-integrated living arrangements may do so pursuant to
19a license issued by the Department under this Act. However,
20programs established under or otherwise subject to the Child
21Care Act of 1969, the Nursing Home Care Act, the Specialized
22Mental Health Rehabilitation Act of 2013, the ID/DD Community
23Care Act, or the MC/DD Act, as now or hereafter amended, shall
24remain subject thereto, and this Act shall not be construed to



SB3179- 37 -LRB100 18946 RLC 34196 b

1limit the application of those Acts.
2    (b) The system of licensure established under this Act
3shall be for the purposes of:
4        (1) ensuring Insuring that all recipients residing in
5    community-integrated living arrangements are receiving
6    appropriate community-based services, including treatment,
7    training and habilitation or rehabilitation;
8        (2) ensuring Insuring that recipients' rights are
9    protected and that all programs provided to and placements
10    arranged for recipients comply with this Act, the Mental
11    Health and Developmental Disabilities Code, and applicable
12    Department rules and regulations;
13        (3) maintaining Maintaining the integrity of
14    communities by requiring regular monitoring and inspection
15    of placements and other services provided in
16    community-integrated living arrangements.
17    The licensure system shall be administered by a quality
18assurance unit within the Department which shall be
19administratively independent of units responsible for funding
20of agencies or community services.
21    (c) As a condition of being licensed by the Department as a
22community mental health or developmental services agency under
23this Act, the agency shall certify to the Department that:
24        (1) all All recipients residing in
25    community-integrated living arrangements are receiving
26    appropriate community-based services, including treatment,



SB3179- 38 -LRB100 18946 RLC 34196 b

1    training and habilitation or rehabilitation;
2        (2) all All programs provided to and placements
3    arranged for recipients are supervised by the agency; and
4        (3) all All programs provided to and placements
5    arranged for recipients comply with this Act, the Mental
6    Health and Developmental Disabilities Code, and applicable
7    Department rules and regulations.
8    (d) An applicant for licensure as a community mental health
9or developmental services agency under this Act shall submit an
10application pursuant to the application process established by
11the Department by rule and shall pay an application fee in an
12amount established by the Department, which amount shall not be
13more than $200.
14    (e) If an applicant meets the requirements established by
15the Department to be licensed as a community mental health or
16developmental services agency under this Act, after payment of
17the licensing fee, the Department shall issue a license valid
18for 3 years from the date thereof unless suspended or revoked
19by the Department or voluntarily surrendered by the agency.
20    (f) Upon application to the Department, the Department may
21issue a temporary permit to an applicant for up to a 2-year
22period to allow the holder of such permit reasonable time to
23become eligible for a license under this Act.
24    (g)(1) The Department may conduct site visits to an agency
25licensed under this Act, or to any program or placement
26certified by the agency, and inspect the records or premises,



SB3179- 39 -LRB100 18946 RLC 34196 b

1or both, of such agency, program or placement as it deems
2appropriate, for the purpose of determining compliance with
3this Act, the Mental Health and Developmental Disabilities
4Code, and applicable Department rules and regulations. The
5Department shall conduct inspections of the records and
6premises of each community-integrated living arrangement
7certified under this Act at least once every 2 years.
8    (2) If the Department determines that an agency licensed
9under this Act is not in compliance with this Act or the rules
10and regulations promulgated under this Act, the Department
11shall serve a notice of violation upon the licensee. Each
12notice of violation shall be prepared in writing and shall
13specify the nature of the violation, the statutory provision or
14rule alleged to have been violated, and that the licensee
15submit a plan of correction to the Department if required. The
16notice shall also inform the licensee of any other action which
17the Department might take pursuant to this Act and of the right
18to a hearing.
19    (g-5) As determined by the Department, a disproportionate
20number or percentage of licensure complaints; a
21disproportionate number or percentage of substantiated cases
22of abuse, neglect, or exploitation involving an agency; an
23apparent unnatural death of an individual served by an agency;
24any egregious or life-threatening abuse or neglect within an
25agency; or any other significant event as determined by the
26Department shall initiate a review of the agency's license by



SB3179- 40 -LRB100 18946 RLC 34196 b

1the Department, as well as a review of its service agreement
2for funding. The Department shall adopt rules to establish the
3process by which the determination to initiate a review shall
4be made and the timeframe to initiate a review upon the making
5of such determination.
6    (g-6) Using contemporary data gathered on reports of
7allegations of abuse, neglect, and financial exploitation, the
8Department shall establish a process by which the Department
9requires responses from agencies that annually report a number
10of allegations that are 2 or more standard deviations from the
11mean for all agencies.
12    (h) Upon the expiration of any license issued under this
13Act, a license renewal application shall be required of and a
14license renewal fee in an amount established by the Department
15shall be charged to a community mental health or developmental
16services agency, provided that such fee shall not be more than
18    (i) A public or private agency, association, partnership,
19corporation, or organization that has had a license revoked
20under subsection (b) of Section 6 of this Act may not apply for
21or possess a license under a different name.
22(Source: P.A. 99-180, eff. 7-29-15; 100-58, eff. 8-11-17;
23100-313, eff. 8-24-17; revised 9-28-17.)
24    (210 ILCS 135/9.3 new)
25    Sec. 9.3. Emergency closure of a community-integrated



SB3179- 41 -LRB100 18946 RLC 34196 b

1living arrangement due to inadequate staffing. If an agency has
2documented evidence and has determined that the agency cannot
3adequately staff a community-integrated living arrangement,
4then the agency may take immediate steps to close the
5community-integrated living arrangement. The agency shall work
6with the Department under established processes and procedures
7to ensure residents at the closing of the community-integrated
8living arrangement receive services at another
9community-integrated living arrangement or through another
11    Section 99. Effective date. This Act takes effect upon
12becoming law.



SB3179- 42 -LRB100 18946 RLC 34196 b

2 Statutes amended in order of appearance
3    20 ILCS 1305/1-17
4    20 ILCS 1705/15.4
5    20 ILCS 1705/18.8 new
6    210 ILCS 135/4from Ch. 91 1/2, par. 1704
7    210 ILCS 135/9.3 new