[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
90_HB0410 210 ILCS 3/20 210 ILCS 3/30 210 ILCS 3/35 210 ILCS 3/35.1 210 ILCS 3/36 Amends the Alternative Health Care Delivery Act. Provides that the alternative health care delivery model demonstration program shall include recovery care center, rather than postsurgical recovery care center, alternative health care models. Provides that the demonstration models for rural areas may be located in rural areas in Standard Metropolitan Statistical Areas. Requires one of the recovery care centers to be a hospital located in a rural area. Defines terms. Effective immediately. LRB9000941JSgcA LRB9000941JSgcA 1 AN ACT to amend the Alternative Health Care Delivery Act 2 by changing Sections 20, 30, 35, 35.1, and 36. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Alternative Health Care Delivery Act is 6 amended by changing Sections 20, 30, 35, 35.1, and 36 as 7 follows: 8 (210 ILCS 3/20) 9 Sec. 20. Board responsibilities. The State Board of 10 Health shall have the responsibilities set forth in this 11 Section. 12 (a) The Board shall investigate new health care delivery 13 models and recommend to the Governor and the General 14 Assembly, through the Department, those models that should be 15 authorized as alternative health care models for which 16 demonstration programs should be initiated. In its 17 deliberations, the Board shall use the following criteria: 18 (1) The feasibility of operating the model in 19 Illinois, based on a review of the experience in other 20 states including the impact on health professionals of 21 other health care programs or facilities. 22 (2) The potential of the model to meet an unmet 23 need. 24 (3) The potential of the model to reduce health 25 care costs to consumers, costs to third party payors, and 26 aggregate costs to the public. 27 (4) The potential of the model to maintain or 28 improve the standards of health care delivery in some 29 measurable fashion. 30 (5) The potential of the model to provide increased 31 choices or access for patients. -2- LRB9000941JSgcA 1 (b) The Board shall evaluate and make recommendations to 2 the Governor and the General Assembly, through the 3 Department, regarding alternative health care model 4 demonstration programs established under this Act, at the 5 midpoint and end of the period of operation of the 6 demonstration programs. The report shall include, at a 7 minimum, the following: 8 (1) Whether the alternative health care models 9 improved access to health care for their service 10 populations in the State. 11 (2) The quality of care provided by the alternative 12 health care models as may be evidenced by health 13 outcomes, surveillance reports, and administrative 14 actions taken by the Department. 15 (3) The cost and cost effectiveness to the public, 16 third-party payors, and government of the alternative 17 health care models, including the impact of pilot 18 programs on aggregate health care costs in the area. In 19 addition to any other information collected by the Board 20 under this Section, the Board shall collect from 21
postsurgicalrecovery care centers uniform billing data 22 substantially the same as specified in Section 4-2(e) of 23 the Illinois Health Finance Reform Act. To facilitate 24 its evaluation of that data, the Board shall forward a 25 copy of the data to the Illinois Health Care Cost 26 Containment Council. All patient identifiers shall be 27 removed from the data before it is submitted to the Board 28 or Council. 29 (4) The impact of the alternative health care 30 models on the health care system in that area, including 31 changing patterns of patient demand and utilization, 32 financial viability, and feasibility of operation of 33 service in inpatient and alternative models in the area. 34 (5) The implementation by alternative health care -3- LRB9000941JSgcA 1 models of any special commitments made during application 2 review to the Illinois Health Facilities Planning Board. 3 (6) The continuation, expansion, or modification of 4 the alternative health care models. 5 (c) The Board shall advise the Department on the 6 definition and scope of alternative health care models 7 demonstration programs. 8 (d) In carrying out its responsibilities under this 9 Section, the Board shall seek the advice of other Department 10 advisory boards or committees that may be impacted by the 11 alternative health care model or the proposed model of health 12 care delivery. The Board shall also seek input from other 13 interested parties, which may include holding public 14 hearings. 15 (e) The Board shall otherwise advise the Department on 16 the administration of the Act as the Board deems appropriate. 17 (Source: P.A. 87-1188; 88-441.) 18 (210 ILCS 3/30) 19 Sec. 30. Demonstration program requirements. The 20 requirements set forth in this Section shall apply to 21 demonstration programs. 22 (a) There shall be no more than: 23 (i) 3 subacute care hospital alternative health 24 care models in the City of Chicago (one of which shall be 25 located on a designated site and shall have been licensed 26 as a hospital under the Illinois Hospital Licensing Act 27 within the 10 years immediately before the application 28 for a license); 29 (ii) 2 subacute care hospital alternative health 30 care models in the demonstration program for each of the 31 following areas: 32 (1) Cook County outside the City of Chicago. 33 (2) DuPage, Kane, Lake, McHenry, and Will -4- LRB9000941JSgcA 1 Counties. 2 (3) Municipalities with a population greater 3 than 50,000 not located in the areas described in 4 item (i) of subsection (a) and paragraphs (1) and 5 (2) of item (ii) of subsection (a); and 6 (iii) 4 subacute care hospital alternative health 7 care models in the demonstration program for rural areas. 8 In selecting among applicants for these licenses in rural 9 areas, the Health Facilities Planning Board and the 10 Department shall give preference to hospitals that may be 11 unable for economic reasons to provide continued service to 12 the community in which they are located unless the hospital 13 were to receive an alternative health care model license. 14 (a-5) There shall be no more than a total of 12 15 postsurgicalrecovery care center alternative health care 16 models in the demonstration program, located as follows: 17 (1) Two in the City of Chicago. 18 (2) Two in Cook County outside the City of Chicago. 19 At least one of these shall be owned or operated by a 20 hospital devoted exclusively to caring for children. 21 (3) Two in Kane, Lake, and McHenry Counties. 22 (4) Four in municipalities with a population of 23 50,000 or more not located in the areas described in 24 paragraphs (1), (2), and (3), 3 of which shall be owned 25 or operated by hospitals, at least 2 of which shall be 26 located in counties with a population of less than 27 175,000, according to the most recent decennial census 28 for which data are available, and one of which shall be 29 owned or operated by an ambulatory surgical treatment 30 center. 31 (5) Two in rural areas, which may be located in 32 Standard Metropolitan Statistical Areas, one of which 33 shall be a hospital located in a rural area and both of 34 which shall be owned or operated by hospitals. -5- LRB9000941JSgcA 1 There shall be no postsurgicalrecovery care center 2 alternative health care models located in counties with 3 populations greater than 600,000 but less than 1,000,000. A 4 proposed postsurgicalrecovery care center must be owned or 5 operated by a hospital if it is to be located within, or will 6 primarily serve the residents of, a health service area in 7 which more than 60% of the gross patient revenue of the 8 hospitals within that health service area are derived from 9 Medicaid and Medicare, according to the most recently 10 available calendar year data from the Illinois Health Care 11 Cost Containment Council. Nothing in this paragraph shall 12 preclude a hospital and an ambulatory surgical treatment 13 center from forming a joint venture or developing a 14 collaborative agreement to own or operate a postsurgical15 recovery care center. 16 (a-10) There shall be no more than a total of 8 17 children's respite care center alternative health care models 18 in the demonstration program, which shall be located as 19 follows: 20 (1) One in the City of Chicago. 21 (2) One in Cook County outside the City of Chicago. 22 (3) A total of 2 in the area comprised of DuPage, 23 Kane, Lake, McHenry, and Will counties. 24 (4) A total of 2 in municipalities with a 25 population of 50,000 or more and not located in the 26 areas described in paragraphs (1), (2), or (3). 27 (5) A total of 2 in rural areas, as defined by the 28 Health Facilities Planning Board. 29 No more than one children's respite care model owned and 30 operated by a licensed skilled pediatric facility shall be 31 located in each of the areas designated in this subsection 32 (a-10). 33 (b) Alternative health care models shall obtain a 34 certificate of need from the Illinois Health Facilities -6- LRB9000941JSgcA 1 Planning Board under the Illinois Health Facilities Planning 2 Act before receiving a license by the Department. 3 Alternative health care models in medically underserved areas 4 shall receive priority in obtaining a certificate of need. 5 (c) An alternative health care model license shall be 6 issued for a period of one year and shall be annually renewed 7 if the facility or program is in substantial compliance with 8 the Department's rules adopted under this Act. A licensed 9 alternative health care model that continues to be in 10 substantial compliance after the conclusion of the 11 demonstration program shall be eligible for annual renewals 12 unless and until a different licensure program for that type 13 of health care model is established by legislation. The 14 Department may issue a provisional license to any alternative 15 health care model that does not substantially comply with the 16 provisions of this Act and the rules adopted under this Act 17 if (i) the Department finds that the alternative health care 18 model has undertaken changes and corrections which upon 19 completion will render the alternative health care model in 20 substantial compliance with this Act and rules and (ii) the 21 health and safety of the patients of the alternative health 22 care model will be protected during the period for which the 23 provisional license is issued. The Department shall advise 24 the licensee of the conditions under which the provisional 25 license is issued, including the manner in which the 26 alternative health care model fails to comply with the 27 provisions of this Act and rules, and the time within which 28 the changes and corrections necessary for the alternative 29 health care model to substantially comply with this Act and 30 rules shall be completed. 31 (d) Alternative health care models shall seek 32 certification under Titles XVIII and XIX of the federal 33 Social Security Act. In addition, alternative health care 34 models shall provide charitable care consistent with that -7- LRB9000941JSgcA 1 provided by comparable health care providers in the 2 geographic area. 3 (d-5) The Illinois Department of Public Aid, in 4 cooperation with the Illinois Department of Public Health, 5 shall develop and implement a reimbursement methodology for 6 all facilities participating in the demonstration program. 7 The Illinois Department of Public Aid shall keep a record of 8 services provided under the demonstration program to 9 recipients of medical assistance under the Illinois Public 10 Aid Code and shall submit an annual report of that 11 information to the Illinois Department of Public Health. 12 (e) Alternative health care models shall, to the extent 13 possible, link and integrate their services with nearby 14 health care facilities. 15 (f) Each alternative health care model shall implement a 16 quality assurance program with measurable benefits and at 17 reasonable cost. 18 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393, 19 eff. 8-20-95.) 20 (210 ILCS 3/35) 21 Sec. 35. Alternative health care models authorized. 22 Notwithstanding any other law to the contrary, alternative 23 health care models described in this Section may be 24 established on a demonstration basis. 25 (1) Alternative health care model; subacute care 26 hospital. A subacute care hospital is a designated site 27 which provides medical specialty care for patients who 28 need a greater intensity or complexity of care than 29 generally provided in a skilled nursing facility but who 30 no longer require acute hospital care. The average length 31 of stay for patients treated in subacute care hospitals 32 shall not be less than 20 days, and for individual 33 patients, the expected length of stay at the time of -8- LRB9000941JSgcA 1 admission shall not be less than 10 days. Variations 2 from minimum lengths of stay shall be reported to the 3 Department. There shall be no more than 13 subacute care 4 hospitals authorized to operate by the Department. 5 Subacute care includes physician supervision, registered 6 nursing, and physiological monitoring on a continual 7 basis. A subacute care hospital is either a freestanding 8 building or a distinct physical and operational entity 9 within a hospital or nursing home building. A subacute 10 care hospital shall only consist of beds currently 11 existing in licensed hospitals or skilled nursing 12 facilities, except, in the City of Chicago, on a 13 designated site that was licensed as a hospital under the 14 Illinois Hospital Licensing Act within the 10 years 15 immediately before the application for an alternative 16 health care model license. During the period of operation 17 of the demonstration project, the existing licensed beds 18 shall remain licensed as hospital or skilled nursing 19 facility beds as well as being licensed under this Act. 20 In order to handle cases of complications, emergencies, 21 or exigent circumstances, a subacute care hospital shall 22 maintain a contractual relationship, including a transfer 23 agreement, with a general acute care hospital. If a 24 subacute care model is located in a general acute care 25 hospital, it shall utilize all or a portion of the bed 26 capacity of that existing hospital. In no event shall a 27 subacute care hospital use the word "hospital" in its 28 advertising or marketing activities or represent or hold 29 itself out to the public as a general acute care 30 hospital. 31 (2) Alternative health care delivery model; 32 postsurgicalrecovery care center. A recovery care center 33 is (i) a designated site that provides recovery care for 34 generally healthy patients undergoing procedures that -9- LRB9000941JSgcA 1 require admission for nursing care, pain control, 2 observation, or treatment that would otherwise be 3 provided in an inpatient setting or (ii) a designated 4 site that provides recovery care for patients usually 5 undergoing outpatient procedures that may otherwise 6 require a periodic short-term inpatient stay should side 7 effects of the procedure require overnight nursing care 8 or observation. Such procedures shall be authorized by 9 the consulting committee of the recovery care center. A10 postsurgical recovery care center is a designated site11 which provides postsurgical recovery care for generally12 healthy patients undergoing surgical procedures that13 require overnight nursing care, pain control, or14 observation that would otherwise be provided in an15 inpatient setting.A postsurgicalrecovery care center is 16 either freestanding or a defined unit of an ambulatory 17 surgical treatment center or hospital. Except for a 18 demonstration site in a rural area as described in 19 Section 30, no facility, or portion of a facility, may 20 participate in a demonstration program as a postsurgical21 recovery care center unless the facility has been 22 licensed as an ambulatory surgical treatment center or 23 hospital for at least 2 years before August 20, 1993 (the 24 effective date of Public Act 88-441). The maximum length 25 of stay for patients in a postsurgicalrecovery care 26 center is not to exceed 48 hours unless the treating 27 physician requests an extension of time from the recovery 28 center's medical director on the basis of medical or 29 clinical documentation that an additional care period is 30 required for the recovery of a patient and the medical 31 director approves the extension of time. In no case, 32 however, shall a patient's length of stay in a 33 postsurgicalrecovery care center be longer than 72 34 hours. If a patient requires an additional care period -10- LRB9000941JSgcA 1 after the expiration of the 72-hour limit, the patient 2 shall be transferred to an appropriate facility. Reports 3 on variances from the 48-hour limit shall be sent to the 4 Department for its evaluation. The reports shall, before 5 submission to the Department, have removed from them all 6 patient and physician identifiers. In order to handle 7 cases of complications, emergencies, or exigent 8 circumstances, every postsurgicalrecovery care center as 9 defined in this paragraph shall maintain a contractual 10 relationship, including a transfer agreement, with a 11 general acute care hospital. A postsurgicalrecovery 12 care center shall be no larger than 20 beds. A 13 postsurgicalrecovery care center shall be located within 14 15 minutes travel time from the general acute care 15 hospital with which the center maintains a contractual 16 relationship, including a transfer agreement, as required 17 under this paragraph. 18 No postsurgicalrecovery care center shall 19 discriminate against any patient requiring treatment 20 because of the source of payment for services, including 21 Medicare and Medicaid recipients. 22 The Department shall adopt rules to implement the 23 provisions of Public Act 88-441 concerning postsurgical24 recovery care centers within 9 months after August 20, 25 1993. 26 (3) Alternative health care delivery model; 27 children's respite care center. A childrens' respite 28 care center model is a designated site that provides 29 respite for medically frail, technologically dependent, 30 clinically stable children, up to age 18, for a period of 31 one to 14 days. This care is to be provided in a 32 home-like environment that serves no more than 10 33 children at a time. Children's respite care center 34 services must be available through the model to all -11- LRB9000941JSgcA 1 families, including those whose care is paid for through 2 the Illinois Department of Public Aid or the Illinois 3 Department of Children and Family Services. Each respite 4 care model location shall be a facility physically 5 separate and apart from any other facility licensed by 6 the Department of Public Health under this or any other 7 Act and shall provide, at a minimum, the following 8 services: out-of-home respite care; hospital to home 9 training for families and caregivers; short term 10 transitional care to facilitate placement and training 11 for foster care parents; parent and family support 12 groups. 13 Coverage for the services provided by the Illinois 14 Department of Public Aid under this paragraph (3) is 15 contingent upon federal waiver approval and is provided only 16 to Medicaid eligible clients participating in the home and 17 community based services waiver designated in Section 1915(c) 18 of the Social Security Act for medically frail and 19 technologically dependent children. 20 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393, 21 eff. 8-20-95.) 22 (210 ILCS 3/35.1) 23 Sec. 35.1. Scope of Program for Recovery Centers. Once 24 the Department has authorized a total of 12 postsurgical25 recovery care centers under this Act, no new centers shall be 26 authorized for the duration of the demonstration program. 27 (Source: P.A. 89-393, eff. 8-20-95.) 28 (210 ILCS 3/36) 29 Sec. 36. Use of name; patient transfers; consulting 30 committee. No facility or person shall hold itself out to the 31 public as a "recovery care center" or "postsurgical recovery32 care center"unless it is licensed as a postsurgicalrecovery -12- LRB9000941JSgcA 1 care center under this Act. 2 The Department shall establish by rule criteria for 3 patient transfers to postsurgicalrecovery care models. Each 4 facility licensed as a postsurgicalrecovery care center 5 shall establish a qualified consulting committee to review 6 the types of surgical procedures performed in ambulatory 7 surgical treatment centers and hospitals which intend to 8 transfer patients to the recovery care center. The committee 9 shall recommend appropriate procedures for approval by the 10 Department of Public Health. Action on these recommendations 11 by the Department shall not be unreasonably withheld. 12 (Source: P.A. 88-490.) 13 Section 99. Effective date. This Act takes effect upon 14 becoming law.
[ Top ]