97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5051

 

Introduced 2/7/2012, by Rep. David R. Leitch

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 3/10
210 ILCS 3/35
210 ILCS 3/85 new

    Amends the Alternative Health Care Delivery Act. Sets forth a definition for "postsurgical recovery care center model". Provides that a postsurgical recovery care center model may provide sleep laboratory or similar sleep studies in accordance with applicable State and federal laws and regulations. Requires the Department of Public Health to enforce by rule certain provisions concerning patient care with respect to each postsurgical recovery care center model. Sets forth policies and procedures concerning patient care, including the administration, storage, and monitoring of non-emergent blood transfusions given in a postsurgical recovery care center model.


LRB097 14990 RPM 60032 b

 

 

A BILL FOR

 

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1    AN ACT concerning public health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Alternative Health Care Delivery Act is
5amended by changing Sections 10 and 35 and by adding Section 85
6as follows:
 
7    (210 ILCS 3/10)
8    Sec. 10. Definitions. In this Act, unless the context
9otherwise requires:
10    "Alternative health care model" means a facility or program
11authorized under Section 35 of this Act.
12    "Board" means the State Board of Health.
13    "Department" means the Illinois Department of Public
14Health.
15    "Demonstration program" means a program to license and
16study alternative health care models authorized under this Act.
17    "Director" means the Director of Public Health.
18    "Postsurgical recovery care center model" means a
19designated site that provides postsurgical recovery care for
20generally healthy patients undergoing surgical procedures who
21require post-operative nursing care, pain control, or
22observation that would otherwise be provided in an in-patient
23setting.

 

 

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1(Source: P.A. 87-1188.)
 
2    (210 ILCS 3/35)
3    Sec. 35. Alternative health care models authorized.
4Notwithstanding any other law to the contrary, alternative
5health care models described in this Section may be established
6on a demonstration basis.
7        (1) (Blank).
8        (2) Alternative health care delivery model;
9    postsurgical recovery care center. A postsurgical recovery
10    care center is a designated site which provides
11    postsurgical recovery care for generally healthy patients
12    undergoing surgical procedures that require overnight
13    nursing care, pain control, or observation that would
14    otherwise be provided in an inpatient setting. A
15    postsurgical recovery care center is either freestanding
16    or a defined unit of an ambulatory surgical treatment
17    center or hospital. No facility, or portion of a facility,
18    may participate in a demonstration program as a
19    postsurgical recovery care center unless the facility has
20    been licensed as an ambulatory surgical treatment center or
21    hospital for at least 2 years before August 20, 1993 (the
22    effective date of Public Act 88-441). The maximum length of
23    stay for patients in a postsurgical recovery care center is
24    not to exceed 48 hours unless the treating physician
25    requests an extension of time from the recovery center's

 

 

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1    medical director on the basis of medical or clinical
2    documentation that an additional care period is required
3    for the recovery of a patient and the medical director
4    approves the extension of time. In no case, however, shall
5    a patient's length of stay in a postsurgical recovery care
6    center be longer than 72 hours. If a patient requires an
7    additional care period after the expiration of the 72-hour
8    limit, the patient shall be transferred to an appropriate
9    facility. Reports on variances from the 48-hour limit shall
10    be sent to the Department for its evaluation. The reports
11    shall, before submission to the Department, have removed
12    from them all patient and physician identifiers. In order
13    to handle cases of complications, emergencies, or exigent
14    circumstances, every postsurgical recovery care center as
15    defined in this paragraph shall maintain a contractual
16    relationship, including a transfer agreement, with a
17    general acute care hospital. A postsurgical recovery care
18    center shall be no larger than 20 beds. A postsurgical
19    recovery care center shall be located within 15 minutes
20    travel time from the general acute care hospital with which
21    the center maintains a contractual relationship, including
22    a transfer agreement, as required under this paragraph.
23        No postsurgical recovery care center shall
24    discriminate against any patient requiring treatment
25    because of the source of payment for services, including
26    Medicare and Medicaid recipients.

 

 

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1        The Department shall adopt rules to implement the
2    provisions of Public Act 88-441 concerning postsurgical
3    recovery care centers within 9 months after August 20,
4    1993. Notwithstanding any other law to the contrary, a
5    postsurgical recovery care center model may provide sleep
6    laboratory or similar sleep studies in accordance with
7    applicable State and federal laws and regulations.
8        (3) Alternative health care delivery model; children's
9    community-based health care center. A children's
10    community-based health care center model is a designated
11    site that provides nursing care, clinical support
12    services, and therapies for a period of one to 14 days for
13    short-term stays and 120 days to facilitate transitions to
14    home or other appropriate settings for medically fragile
15    children, technology dependent children, and children with
16    special health care needs who are deemed clinically stable
17    by a physician and are younger than 22 years of age. This
18    care is to be provided in a home-like environment that
19    serves no more than 12 children at a time. Children's
20    community-based health care center services must be
21    available through the model to all families, including
22    those whose care is paid for through the Department of
23    Healthcare and Family Services, the Department of Children
24    and Family Services, the Department of Human Services, and
25    insurance companies who cover home health care services or
26    private duty nursing care in the home.

 

 

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1        Each children's community-based health care center
2    model location shall be physically separate and apart from
3    any other facility licensed by the Department of Public
4    Health under this or any other Act and shall provide the
5    following services: respite care, registered nursing or
6    licensed practical nursing care, transitional care to
7    facilitate home placement or other appropriate settings
8    and reunite families, medical day care, weekend camps, and
9    diagnostic studies typically done in the home setting.
10        Coverage for the services provided by the Department of
11    Healthcare and Family Services under this paragraph (3) is
12    contingent upon federal waiver approval and is provided
13    only to Medicaid eligible clients participating in the home
14    and community based services waiver designated in Section
15    1915(c) of the Social Security Act for medically frail and
16    technologically dependent children or children in
17    Department of Children and Family Services foster care who
18    receive home health benefits.
19        (4) Alternative health care delivery model; community
20    based residential rehabilitation center. A community-based
21    residential rehabilitation center model is a designated
22    site that provides rehabilitation or support, or both, for
23    persons who have experienced severe brain injury, who are
24    medically stable, and who no longer require acute
25    rehabilitative care or intense medical or nursing
26    services. The average length of stay in a community-based

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    Regionalized Perinatal Health Care Code.
2        The Department shall adopt other rules as necessary to
3    implement the provisions of this amendatory Act of the 95th
4    General Assembly within 9 months after the effective date
5    of this amendatory Act of the 95th General Assembly.
6(Source: P.A. 97-135, eff. 7-14-11.)
 
7    (210 ILCS 3/85 new)
8    Sec. 85. Patient care.
9    (a) The Department shall enforce by rule the provisions of
10this Section with respect to each postsurgical recovery care
11center model.
12    (b) All persons shall be admitted to the postsurgical
13recovery care center model by a member of the medical staff and
14shall be under the professional care of a member of the medical
15staff.
16    (c) No medication, treatment or diagnostic test shall be
17administered to a patient except on the written order of a
18member of the medical staff. Verbal orders shall be signed
19before the medical staff member leaves the postsurgical
20recovery care center model. Telephone orders shall be
21countersigned within 24 hours after issuance.
22    (d) Policies and procedures must be developed and
23implemented that address the following:
24        (1) An initial nursing assessment shall be performed by
25    a registered nurse on admission of the patient to the

 

 

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1    Model.
2        (2) A nursing care plan shall be developed and
3    implemented that addresses the needs of the patient and is
4    coordinated with the patient's medical management plan.
5        (3) Visiting rules shall be developed that protect the
6    health, safety, and privacy of the patients. Visiting rules
7    shall include the following:
8            (A) Visiting hours shall be communicated to the
9        patient and posted in areas visible to all persons
10        entering the postsurgical recovery care center model.
11            (B) No visitor shall knowingly be admitted who has
12        a known infectious disease, who has recently recovered
13        from such a disease, or who has recently had contact
14        with such a disease.
15            (C) Smoking by visitors shall be prohibited except
16        in specially designated areas.
17        (4) Policies and procedures concerning emergency care
18    and transfers shall include the following:
19            (A) Policies and procedures shall be developed
20        that establish the extent of emergency treatment to be
21        provided in the postsurgical recovery care center
22        model, including basic life support procedures and
23        transfer arrangements for patients who require care
24        beyond the scope provided by the postsurgical recovery
25        care center model.
26            (B) There shall be monitoring equipment, suction

 

 

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1        apparatus, oxygen, and cardiopulmonary resuscitation
2        equipment available in the postsurgical recovery care
3        center model.
4            (C) Patient transfers to a hospital shall be by a
5        licensed ambulance service.
6            (D) Appropriate medical records and a summary of
7        the events precipitating the transfer must accompany
8        the patient.
9            (E) The postsurgical recovery care center model
10        must have a written disaster plan of operation with
11        procedures to be followed in the event of fire, natural
12        disaster, or other threat to patient safety.
13        (5) Policies and procedures shall be developed and
14    implemented concerning the administration, storage, and
15    disposal of medications.
16        (6) Policies and procedures shall be developed and
17    implemented concerning the administration, storage, and
18    monitoring of non-emergent blood transfusions given in the
19    postsurgical recovery care center model.
20    (e) Written discharge instructions shall be provided to
21each patient based upon the patient's health care needs and the
22medical staff's instructions.
23    (f) Patients shall be discharged only on the written signed
24order of a member of the medical staff.