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| [ Introduced ] | [ Senate Amendment 001 ] |
91_SB0117eng SB117 Engrossed LRB9101995JSpc 1 AN ACT to amend the Alternative Health Care Delivery Act 2 by changing Sections 30 and 35. 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 30 and 35 as follows: 7 (210 ILCS 3/30) 8 Sec. 30. Demonstration program requirements. The 9 requirements set forth in this Section shall apply to 10 demonstration programs. 11 (a) There shall be no more than: 12 (i) 3 subacute care hospital alternative health 13 care models in the City of Chicago (one of which shall be 14 located on a designated site and shall have been licensed 15 as a hospital under the Illinois Hospital Licensing Act 16 within the 10 years immediately before the application 17 for a license); 18 (ii) 2 subacute care hospital alternative health 19 care models in the demonstration program for each of the 20 following areas: 21 (1) Cook County outside the City of Chicago. 22 (2) DuPage, Kane, Lake, McHenry, and Will 23 Counties. 24 (3) Municipalities with a population greater 25 than 50,000 not located in the areas described in 26 item (i) of subsection (a) and paragraphs (1) and 27 (2) of item (ii) of subsection (a); and 28 (iii) 4 subacute care hospital alternative health 29 care models in the demonstration program for rural areas. 30 In selecting among applicants for these licenses in rural 31 areas, the Health Facilities Planning Board and the SB117 Engrossed -2- LRB9101995JSpc 1 Department shall give preference to hospitals that may be 2 unable for economic reasons to provide continued service to 3 the community in which they are located unless the hospital 4 were to receive an alternative health care model license. 5 (a-5) There shall be no more than a total of 12 6 postsurgical recovery care center alternative health care 7 models in the demonstration program, located as follows: 8 (1) Two in the City of Chicago. 9 (2) Two in Cook County outside the City of Chicago. 10 At least one of these shall be owned or operated by a 11 hospital devoted exclusively to caring for children. 12 (3) Two in Kane, Lake, and McHenry Counties. 13 (4) Four in municipalities with a population of 14 50,000 or more not located in the areas described in 15 paragraphs (1), (2), and (3), 3 of which shall be owned 16 or operated by hospitals, at least 2 of which shall be 17 located in counties with a population of less than 18 175,000, according to the most recent decennial census 19 for which data are available, and one of which shall be 20 owned or operated by an ambulatory surgical treatment 21 center. 22 (5) Two in rural areas, both of which shall be 23 owned or operated by hospitals. 24 There shall be no postsurgical recovery care center 25 alternative health care models located in counties with 26 populations greater than 600,000 but less than 1,000,000. A 27 proposed postsurgical recovery care center must be owned or 28 operated by a hospital if it is to be located within, or will 29 primarily serve the residents of, a health service area in 30 which more than 60% of the gross patient revenue of the 31 hospitals within that health service area are derived from 32 Medicaid and Medicare, according to the most recently 33 available calendar year data from the Illinois Health Care 34 Cost Containment Council. Nothing in this paragraph shall SB117 Engrossed -3- LRB9101995JSpc 1 preclude a hospital and an ambulatory surgical treatment 2 center from forming a joint venture or developing a 3 collaborative agreement to own or operate a postsurgical 4 recovery care center. 5 (a-10) There shall be no more than a total of 8 6 children's respite care center alternative health care models 7 in the demonstration program, which shall be located as 8 follows: 9 (1) One in the City of Chicago. 10 (2) One in Cook County outside the City of Chicago. 11 (3) A total of 2 in the area comprised of DuPage, 12 Kane, Lake, McHenry, and Will counties. 13 (4) A total of 2 in municipalities with a 14 population of 50,000 or more and not located in the 15 areas described in paragraphs (1), (2), or (3). 16 (5) A total of 2 in rural areas, as defined by the 17 Health Facilities Planning Board. 18 No more than one children's respite care model owned and 19 operated by a licensed skilled pediatric facility shall be 20 located in each of the areas designated in this subsection 21 (a-10). 22 (a-15) There shall be an authorized community-based 23 residential rehabilitation center alternative health care 24 model in the demonstration program. The community-based 25 residential rehabilitation center shall be located in the 26 area of Illinois south of Interstate Highway 70. 27 (b) Alternative health care models shall obtain a 28 certificate of need from the Illinois Health Facilities 29 Planning Board under the Illinois Health Facilities Planning 30 Act before receiving a license by the Department. If, after 31 obtaining its initial certificate of need, an alternative 32 health care delivery model that is a community-based 33 residential rehabilitation center seeks to increase the bed 34 capacity of that center, it must obtain a certificate of need SB117 Engrossed -4- LRB9101995JSpc 1 from the Illinois Health Facilities Planning Board before 2 increasing the bed capacity. Alternative health care models 3 in medically underserved areas shall receive priority in 4 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 SB117 Engrossed -5- LRB9101995JSpc 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 SB117 Engrossed -6- LRB9101995JSpc 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 postsurgical recovery care center. A postsurgical 33 recovery care center is a designated site which provides 34 postsurgical recovery care for generally healthy patients SB117 Engrossed -7- LRB9101995JSpc 1 undergoing surgical procedures that require overnight 2 nursing care, pain control, or observation that would 3 otherwise be provided in an inpatient setting. A 4 postsurgical recovery care center is either freestanding 5 or a defined unit of an ambulatory surgical treatment 6 center or hospital. No facility, or portion of a 7 facility, may participate in a demonstration program as a 8 postsurgical recovery care center unless the facility has 9 been licensed as an ambulatory surgical treatment center 10 or hospital for at least 2 years before August 20, 1993 11 (the effective date of Public Act 88-441). The maximum 12 length of stay for patients in a postsurgical recovery 13 care center is not to exceed 48 hours unless the treating 14 physician requests an extension of time from the recovery 15 center's medical director on the basis of medical or 16 clinical documentation that an additional care period is 17 required for the recovery of a patient and the medical 18 director approves the extension of time. In no case, 19 however, shall a patient's length of stay in a 20 postsurgical recovery care center be longer than 72 21 hours. If a patient requires an additional care period 22 after the expiration of the 72-hour limit, the patient 23 shall be transferred to an appropriate facility. Reports 24 on variances from the 48-hour limit shall be sent to the 25 Department for its evaluation. The reports shall, before 26 submission to the Department, have removed from them all 27 patient and physician identifiers. In order to handle 28 cases of complications, emergencies, or exigent 29 circumstances, every postsurgical recovery care center as 30 defined in this paragraph shall maintain a contractual 31 relationship, including a transfer agreement, with a 32 general acute care hospital. A postsurgical recovery 33 care center shall be no larger than 20 beds. A 34 postsurgical recovery care center shall be located within SB117 Engrossed -8- LRB9101995JSpc 1 15 minutes travel time from the general acute care 2 hospital with which the center maintains a contractual 3 relationship, including a transfer agreement, as required 4 under this paragraph. 5 No postsurgical recovery care center shall 6 discriminate against any patient requiring treatment 7 because of the source of payment for services, including 8 Medicare and Medicaid recipients. 9 The Department shall adopt rules to implement the 10 provisions of Public Act 88-441 concerning postsurgical 11 recovery care centers within 9 months after August 20, 12 1993. 13 (3) Alternative health care delivery model; 14 children's respite care center. A children'schildrens'15 respite care center model is a designated site that 16 provides respite for medically frail, technologically 17 dependent, clinically stable children, up to age 18, for 18 a period of one to 14 days. This care is to be provided 19 in a home-like environment that serves no more than 10 20 children at a time. Children's respite care center 21 services must be available through the model to all 22 families, including those whose care is paid for through 23 the Illinois Department of Public Aid or the Illinois 24 Department of Children and Family Services. Each respite 25 care model location shall be a facility physically 26 separate and apart from any other facility licensed by 27 the Department of Public Health under this or any other 28 Act and shall provide, at a minimum, the following 29 services: out-of-home respite care; hospital to home 30 training for families and caregivers; short term 31 transitional care to facilitate placement and training 32 for foster care parents; parent and family support 33 groups. 34 Coverage for the services provided by the Illinois SB117 Engrossed -9- LRB9101995JSpc 1 Department of Public Aid under this paragraph (3) is 2 contingent upon federal waiver approval and is provided only 3 to Medicaid eligible clients participating in the home and 4 community-based services waiver designated in Section 1915(c) 5 of the Social Security Act for medically frail and 6 technologically dependent children. 7 (4) Alternative health care delivery model; 8 community-based residential rehabilitation center. A 9 community-based residential rehabilitation center model 10 is a designated site that provides rehabilitation or 11 support, or both, for persons who have experienced severe 12 brain injury, who are medically stable, and who no longer 13 require acute rehabilitative care or intense medical or 14 nursing services. The average length of stay in a 15 community-based residential rehabilitation center shall 16 not exceed 4 months. As an integral part of the services 17 provided, individuals are housed in a supervised living 18 setting while having immediate access to the community. 19 The residential rehabilitation center authorized by the 20 Department may have more than one residence included 21 under the license. A residence may be no larger than 12 22 beds and shall be located as an integral part of the 23 community. Day treatment or individualized outpatient 24 services shall be provided for persons who reside in 25 their own home. Functional outcome goals shall be 26 established for each individual. Services shall include, 27 but are not limited to, case management, training and 28 assistance with activities of daily living, nursing 29 consultation, traditional therapies (physical, 30 occupational, speech), functional interventions in the 31 residence and community (job placement, shopping, 32 banking, recreation), counseling, self-management 33 strategies, productive activities, and multiple 34 opportunities for skill acquisition and practice SB117 Engrossed -10- LRB9101995JSpc 1 throughout the day. The design of individualized program 2 plans shall be consistent with the outcome goals that are 3 established for each resident. The programs provided in 4 this setting shall be accredited by the Commission on 5 Accreditation of Rehabilitation Facilities (CARF). The 6 program shall have been accredited by CARF as a Brain 7 Injury Community-Integrative Program for at least 3 8 years. 9 (Source: P.A. 88-441; 88-490; 88-670, eff. 12-2-94; 89-393, 10 eff. 8-20-95; revised 10-31-98.) 11 Section 99. Effective date. This Act takes effect upon 12 becoming law.