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92_HB3536
LRB9206964DJgcA
1 AN ACT in relation to health.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. The Act may be cited as the Local
5 Health Care Accountability Act.
6 Section 5. Findings. The General Assembly finds that:
7 (1) Access to health care services is of vital
8 concern to the people of this State. Notwithstanding
9 public and private efforts to increase access to health
10 care, the people of this State continue to have
11 tremendous unmet health needs.
12 (2) The State has a substantial interest in
13 ensuring that the unmet health needs of its residents are
14 addressed. Health care institutions can help address
15 needs by providing community benefits to the uninsured
16 and underinsured members of their communities. Health
17 care services providers play an important role in
18 providing essential health care services in the
19 communities they serve.
20 (3) Illinois has a proud history of non-profit
21 health care facilities and philanthropic support of
22 medical services, education, and research.
23 (4) Health care facilities in Illinois provide
24 overall high quality care at a reasonable cost. Health
25 care facilities in Illinois have experienced during the
26 1990s substantial declines in occupancy as the health
27 care system has changed. Health care facilities require
28 capital to maintain operations and to modernize
29 facilities and services.
30 (5) Nationally and regionally, private investment
31 is being made that results in the conversion of
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1 not-for-profit and public health care facilities into
2 for-profit health care facilities. There are health care
3 facilities in Illinois that have provided and continue to
4 provide important services to communities that submit
5 that their survival may depend on the ability to enter
6 into agreements that result in the investment of private
7 capital and their conversion to for-profit status.
8 (6) Health care facilities, both for-profit and
9 not-for-profit, are merging and forming networks to
10 achieve integration, stability and efficiency and the
11 presence of such networks affects competition.
12 (7) There are concerns that health care facility
13 networks may engage in practices that affect the quality
14 of medical services for the community as a whole and for
15 the vulnerable members of society in particular. In order
16 to protect the public health and welfare and public and
17 charitable assets, it is necessary to establish standards
18 and procedures for health care facility conversions.
19 (8) Delivery of quality health care services is
20 jeopardized and patients in Illinois health care
21 facilities are being adversely impacted by inadequate and
22 poorly monitored staffing practices.
23 (9) The basic principles of staffing in health care
24 facilities should be focused on the patients' care needs
25 deriving from the severity and complexity of each
26 patient's condition and the services that need to be
27 provided to ensure optimal outcomes.
28 The legislature further concludes that licensing
29 privileges conveyed by this State to health care facilities
30 for the right to conduct intrastate business should be
31 accompanied by concomitant obligations to address unmet
32 health care needs. These obligations should be clearly
33 delineated. Community benefits should become a recognized and
34 accepted obligation of all health care facilities in this
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1 State. Accordingly, every licensed health care facility must
2 provide community benefits in a manner set forth in this Act.
3 Section 10. Purposes. The purposes of this Act are as
4 follows:
5 (1) To ensure accessible, affordable and high
6 quality health care for all Illinois residents.
7 (2) To establish a process to evaluate, monitor and
8 review whether the trend of for-profit corporations
9 gaining an interest in health care facilities will
10 maintain, enhance, or disrupt the delivery of health care
11 in this State and to monitor health care facility
12 performance to ensure that standards for community
13 benefits continue to be met.
14 (3) To establish a review process and criteria for
15 review of conversions which involve for-profit
16 corporations.
17 (4) To establish a review process and criteria for
18 review of conversions which involve only not-for-profit
19 corporations.
20 (5) To clarify the jurisdiction and authority of
21 the Illinois Health Facilities Planning Board and the
22 Illinois Department of Public Health to protect public
23 health and welfare and the jurisdiction and authority of
24 the Illinois Attorney General to preserve and protect
25 public and charitable assets in reviewing both
26 conversions that involve for-profit corporations and
27 conversions that involve only not-for-profit
28 corporations.
29 (6) To provide for independent foundations to hold
30 and distribute proceeds of conversions consistent with
31 the acquiree's original purpose or for the support and
32 promotion of health care and social needs in the affected
33 community.
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1 Section 15. Definitions. For purposes of this Act, unless
2 the context requires otherwise:
3 "Acquiree" means the person or persons who lose any
4 ownership or control in the new health care facility.
5 "Acquiror" means the person or persons who gain an
6 ownership or control in the new health care facility.
7 "Affected community" means any county, township,
8 municipality, or otherwise identifiable geographic region in
9 which an existing health care facility is physically located
10 or whose inhabitants are regularly served by the existing
11 health care facility.
12 "Bad debt" means the unpaid accounts of any individual
13 who has received medical care or is financially responsible
14 for the cost of care rendered to another, if the individual
15 has the ability to pay and has refused to pay.
16 "Board" means the Illinois Health Facilities Planning
17 Board.
18 "Charity care" means health care services provided by a
19 health care facility without charge to a patient and for
20 which the health care facility does not expect and has not
21 expected payment.
22 "Community" means the geographic service area or areas
23 and patient population or populations that a health care
24 facility serves.
25 "Community benefits" means the unreimbursed goods,
26 services, and resources provided by a health care facility
27 that address community-identified health needs and concerns,
28 particularly of those who are uninsured or underserved.
29 Community benefits include but are not limited to the
30 following:
31 (1) Free care.
32 (2) Public education and other programs relating to
33 preventive medicine or the public health of the
34 community.
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1 (3) Health or disease screening programs.
2 (4) Transportation services.
3 (5) Poison control centers.
4 (6) Donated medical supplies and equipment.
5 (7) Unreimbursed costs of providing services to
6 persons participating in any government subsidized health
7 care program.
8 (8) Free or below-cost blood banking services.
9 (9) Free or below-cost assistance, material,
10 equipment, and training to emergency medical services and
11 ambulance services.
12 (10) The costs to implement a basic enrollment
13 program that provides a package of primary care services
14 to uninsured members of the community.
15 (11) Health research, education and training
16 programs, provided that they are related to identified
17 health needs.
18 "Conversion" means any transfer by a person or persons of
19 an ownership or membership interest or authority in a health
20 care facility, or the assets of such a facility, whether by
21 purchase, merger, consolidation, lease, gift, joint venture,
22 sale, or other disposition that results in a change of
23 ownership, control, or possession of 20% or greater of the
24 membership or voting rights or interests of the health care
25 facility, or the removal, addition, or substitution of a
26 partner that results in a new partner gaining or acquiring a
27 controlling interest in the facility, or any change in
28 membership that results in a new person gaining or acquiring
29 a controlling vote in the facility.
30 "Department" means the Illinois Department of Public
31 Health.
32 "Director" means the Director of Public Health.
33 "Employment displacement" means permanent termination of
34 employment, a layoff or furlough of more than 30 days
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1 duration, a significant cut-back in paid work hours, or any
2 other comparable action that impacts employment status,
3 except that the term does not include a discharge or
4 termination for cause.
5 "Existing health care facility" means a health care
6 facility as it exists before an acquisition.
7 "For-profit corporation" means a legal entity formed for
8 the purpose of pecuniary profit or transacting business that
9 has as one of its purposes pecuniary profit.
10 "Free care" means care provided by a health care services
11 provider to patients unable to pay and for which the provider
12 has no expectation of payment from the patient or from any
13 third-party payor.
14 "Health care facility" means: an individual, sole
15 proprietor, partnership, association, business trust, or
16 corporation, whether for-profit or not-for-profit, that does
17 any of the following:
18 (1) Provides health care services at an ambulatory
19 surgical treatment center licensed under the Ambulatory
20 Surgical Treatment Center Act; an institution, place,
21 building, or agency licensed under the Hospital Licensing
22 Act; an institution licensed under the Nursing Home Care
23 Act; or a kidney disease treatment center licensed by the
24 State.
25 (2) Provides health care services to a facility
26 identified in paragraph (1).
27 (3) Provides necessary related services, including
28 administrative, food service, janitorial, or maintenance
29 services, to a health care facility identified in
30 paragraph (1).
31 An entity that solely manufactures or provides goods or
32 equipment to a health care facility shall not thereby be
33 deemed a health care facility.
34 "New health care facility" means a health care facility
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1 as it exists after the completion of a conversion.
2 "Not-for-profit corporation" means a legal entity formed
3 for some charitable or benevolent purpose and not for profit
4 that has been exempted from taxation pursuant to the Internal
5 Revenue Code, Section 501(c)(3).
6 "Payment in lieu of taxes" means an agreement with a
7 taxing body that, in the last year immediately before a
8 conversion under this Act, levied real estate taxes on all or
9 any portion of the real estate or leaseholds owned or leased
10 by the for-profit entity seeking a conversion with a
11 not-for-profit entity under this Act.
12 "Taxing body" means a public body that has the legal
13 authority to levy real estate taxes on all or any portion of
14 the real estate or leaseholds owned or leased by any
15 for-profit corporation or for-profit entity seeking approval
16 for a conversion under this Act.
17 "Transacting party" means any person or persons who seek
18 either to transfer or acquire ownership or a controlling
19 interest or controlling authority in a health care facility
20 that would result in a change of ownership, control, or
21 authority of 20% or greater.
22 "Uncompensated care" means a combination of free care,
23 which the health care facility provides at no cost to the
24 patient, bad debt that the health care facility bills for but
25 does not collect, and less than full Medicaid reimbursement
26 amounts.
27 Section 20. Conversion; prior approval process.
28 (a) No conversion may take place involving a
29 not-for-profit corporation as either the acquiror or acquiree
30 without the prior approval of both the Attorney General and
31 the Illinois Health Facilities Planning Board. The parties to
32 the conversion shall file an initial application with the
33 Attorney General and the Board on a form prescribed by the
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1 Attorney General. At a minimum, the form must include the
2 following information with respect to each transacting party
3 and the proposed new health care facility:
4 (1) A detailed summary of the proposed conversion.
5 (2) The names, addresses, and telephone numbers of
6 the transacting parties.
7 (3) The names, addresses, telephone numbers, and
8 occupations of all officers, members of the board of
9 directors, trustees, and executive and senior level
10 management personnel, including, for each position, the
11 person currently holding the position and persons holding
12 the position for the 3 years preceding the date of the
13 application.
14 (4) Articles of incorporation and certificate of
15 incorporation; and bylaws and organizational charts.
16 (5) Organizational structure for existing
17 transacting parties and each partner, affiliate, parent,
18 subsidiary, or related corporate entity in which the
19 acquiror has a 20% or greater ownership interest.
20 (6) Conflict of interest statements, policies, and
21 procedures.
22 (7) Names, addresses, and telephone numbers of
23 professional consultants engaged in connection with the
24 proposed conversion.
25 (8) Copies of audited income statements, balance
26 sheets, and other financial statements for the 3 years
27 immediately preceding the year in which the application
28 is filed, to the extent they have been made public;
29 audited interim financial statements and income
30 statements together with a detailed description of the
31 financing structure of the proposed conversion, including
32 equity contribution, debt restructuring, stock issuance,
33 partnership interests, stock offerings, and the like.
34 (9) A detailed description of real estate issues,
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1 including title reports for land owned and lease
2 agreements concerning the proposed conversion.
3 (10) A detailed description, as each relates to the
4 proposed transaction, for: equipment leases, insurance,
5 regulatory compliance, tax status, pending litigation or
6 regulatory proceedings, pension plan descriptions and
7 employee benefits, environmental reports, assessments,
8 and organizational goals.
9 (11) Copies of reports analyzing the proposed
10 conversion during the preceding 3 years, including, but
11 not limited to, reports by appraisers, accountants,
12 investment bankers, actuaries, and other experts.
13 (12) A description of the manner in which the price
14 was determined, including methods of valuation and data
15 used, and the names and addresses of persons preparing
16 the documents; this information is deemed to be
17 proprietary.
18 (13) Patient statistics for the preceding 3 years
19 and patient projections for the next year, including
20 patient visits, admissions, emergency room visits,
21 clinical visits, and visits to each department of the
22 facility, admissions to nursing care, and visits by
23 affiliated home health care providers.
24 (14) The name and mailing address of each licensed
25 facility in which the for-profit corporation maintains an
26 ownership interest, controlling interest, or operating
27 authority.
28 (15) A list of pending or adjudicated citations,
29 violations, or charges against the facilities brought by
30 any governmental agency or accrediting agency within the
31 preceding 3 years, and the status or disposition of each
32 matter with regard to patient care and charitable asset
33 matters.
34 (16) A list of uncompensated care provided during
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1 the preceding 3 years by each facility, including detail
2 as to how that amount was calculated.
3 (17) Copies of all documents related to
4 identification of all charitable assets, accounting of
5 all charitable assets for the preceding 3 years, and
6 distribution of the charitable assets, including, but not
7 limited to, endowments and restricted, unrestricted, and
8 specific-purpose funds, as each relates to the proposed
9 transaction.
10 (18) A description of charity care and
11 uncompensated care provided by the existing health care
12 facility for the 5 years preceding the date of the
13 application, including the cash value of those services
14 and a description of services provided.
15 (19) A description of bad debt incurred by the
16 existing health care facility for the preceding 5 years
17 for which payment was anticipated but not received.
18 (20) A plan describing how the new health care
19 facility will provide community benefits, as defined by
20 this Act, and charity care during the first 5 years of
21 operation.
22 (21) A description of how the new health care
23 facility will monitor and value charity care services and
24 community benefits.
25 (22) The names of persons currently serving as
26 officers, directors, board members, or senior level
27 managers of the existing health care facility who will or
28 will not maintain any position with the new health care
29 facility, and whether any such person will receive a
30 salary, severance stock offering, or current or deferred
31 compensation as a result of or in relation to the
32 proposed conversion.
33 (23) A plan describing how the new health care
34 facility will be staffed during the first 3 years of
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1 operation.
2 (24) A list of all medical services, departments,
3 clinical services, and administrative services that will
4 be maintained at the new health care facility.
5 (25) A description of criteria established by the
6 board of directors of the existing health care facility
7 for pursuing a proposed conversion with one or more
8 health care providers.
9 (26) All requests for proposals issued by the
10 existing health care facility relating to the pursuit of
11 a proposed conversion.
12 (27) A copy of all proposed contracts or
13 arrangements with management, board members, officers, or
14 directors of the existing health care facility for
15 post-conversion consulting services or covenants not to
16 compete following the completion of the conversion.
17 (28) Copies of documents or descriptions of any
18 proposed plan for an entity to be created for charitable
19 assets, including, but not limited to, endowments and
20 restricted, unrestricted, and specific-purpose funds, the
21 proposed articles of incorporation, by-laws, mission
22 statement, program agenda, method of appointment of board
23 members, qualifications of board members, duties of board
24 members, and conflict of interest policies.
25 (29) A description of all departments and clinical,
26 social, or other services or medical services that will
27 be eliminated or significantly reduced at the new health
28 care facility.
29 (30) A description of staffing levels of all
30 categories of employees, including full-time, part-time,
31 and contractual employees currently employed at or
32 providing services at the existing health care facility,
33 and a description of any anticipated or proposed changes
34 in the current staffing levels.
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1 (31) Signed conflict of interest forms from all
2 officers, directors, trustees, senior level managers,
3 chairpersons or department chairpersons, and medical
4 directors on a form prescribed by the Attorney General.
5 (32) A statement of the expected impact the
6 proposed action will have on the individual workforces of
7 each affected health care facility.
8 (33) A statement that the expected workforce impact
9 has been discussed with the affected employees and, in
10 the case of employees who are represented by a duly
11 certified or recognized bargaining representative, that
12 the health care facility has met its legal obligations to
13 negotiate regarding the impact with that bargaining
14 representative.
15 (34) A separate certification from each member of
16 the governing board and from the chief executive and each
17 operating and financial officer of the corporation that
18 is a party to the proposed conversion, executed under
19 oath:
20 (A) Stating whether that director, chief
21 executive, or operating or financial officer of the
22 corporation is then or may become, within the 3-year
23 period following the completion of the transaction,
24 a member or shareholder in or an officer, employee,
25 agent, or consultant of, or will otherwise derive
26 any compensation or benefits, directly or
27 indirectly, from the acquiring entity or any related
28 party in connection with or as a result of the
29 disposition.
30 (B) Disclosing any financial interest held by
31 that individual or that individual's family or held
32 by any business in which the individual or a member
33 of the individual's family owns a financial interest
34 in any financial transaction within the prior 24
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1 months with any of the parties participating in the
2 conversion.
3 (C) Stating that the market value of the
4 health care facility's assets has not been
5 manipulated to decrease or increase value.
6 (D) Stating that the terms of the transaction
7 are fair and reasonable.
8 (E) Stating that the proceeds of the
9 transaction will be used solely in a manner
10 consistent with the charitable purposes of the
11 not-for-profit corporation.
12 (F) Stating that the conversion will not
13 adversely affect the availability or accessibility
14 of health care services in the county or
15 municipality in which the existing health care
16 facility or facilities are located.
17 This certification requirement is not applicable,
18 however, to any governing board member who votes to
19 oppose the proposed conversion and has submitted a
20 statement to that effect to the Illinois Health
21 Facilities Planning Board and the Attorney General.
22 If the acquiror is a for-profit corporation that has
23 acquired a not-for-profit health care facility under this
24 Act, the application must also include a complete statement
25 of performance during the preceding year with regard to the
26 terms and conditions of approval of conversion and each
27 projection, plan, or description submitted as part of the
28 application for any conversion completed pursuant to an
29 application submitted under this Act and made a part of an
30 approval for the conversion. Two copies each of the initial
31 application must be provided to the Illinois Health
32 Facilities Planning Board and the Attorney General
33 simultaneously by certified United States mail, return
34 receipt requested.
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1 (b) Except for the information determined by the
2 Attorney General to be confidential or proprietary in
3 accordance with subsection (g) of Section 7 of the Freedom of
4 Information Act, the initial application and supporting
5 documentation shall be considered public records and shall be
6 available to the public for inspection upon request. The
7 Attorney General shall provide access to these records at no
8 cost to the public.
9 (c) The Attorney General may charge the parties to the
10 conversion for the cost of providing the public with notice
11 and reasonable access to records relating to the proposed
12 conversion.
13 Section 25. Application review process; Attorney General.
14 (a) The Attorney General shall review all conversion
15 applications involving a not-for-profit corporation as the
16 acquiror or acquiree as follows:
17 (1) Within 10 business days after receipt of 2
18 copies of an initial application, the Attorney General
19 must publish notice of the application in a newspaper of
20 general circulation in the State and shall notify by
21 United States mail any person who has requested notice of
22 the filing of the application. The notice must state that
23 an initial application has been received, the names of
24 the transacting parties, the date by which a person may
25 submit written comments to the Attorney General, and the
26 date, time, and place of the public hearings on the
27 application.
28 (2) No later than 45 days after the Attorney
29 General has received the initial application for approval
30 of a conversion involving a not-for-profit corporation as
31 the acquiror or acquiree, the Attorney General must hold
32 at least one public hearing in the service area of the
33 acquiree health care facility. The number of public
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1 hearings that the Attorney General holds must be
2 appropriate to the size of the community in the health
3 care facility's service area and the nature and value of
4 the conversion to ensure that the community affected by
5 the conversion has a meaningful opportunity to
6 participate in the public hearing process. Upon request,
7 any person must be given an opportunity to submit into
8 the hearing record written comments, documents, and other
9 exhibits and to offer oral testimony.
10 (3) Each party to the conversion must have a
11 representative in attendance at all public hearings
12 convened by the Attorney General under this Section.
13 (4) At least 21 days before the public hearing, the
14 Attorney General must provide written notice of the time
15 and place of the hearing through publication in one or
16 more newspapers of general circulation in the affected
17 communities, to the board of supervisors of the county in
18 which the facility is located, and to all those who
19 requested notice of the transaction.
20 (5) The Attorney General must establish and
21 maintain a summary of written and oral comments made in
22 preparation for and at the public hearing, including all
23 questions posed, and must require answers of the
24 appropriate parties. The summary and answers must be
25 filed in the office of the Attorney General and made
26 available for inspection at all public libraries located
27 in the communities served by the acquiree health care
28 facility. The Attorney General must also make a copy
29 available for inspection upon request.
30 (6) As part of the public hearing process, the
31 Attorney General must solicit comments and input
32 regarding the criteria set forth in subsection (b) of
33 this Section.
34 (7) The Attorney General has the power to subpoena
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1 additional information or witnesses, require and
2 administer oaths, and require sworn statements at any
3 time before making a decision on an application.
4 (8) Within 30 days after receipt of an initial
5 application, the Attorney General must advise the
6 applicants in writing whether the application is complete
7 and, if it is not, must specify the additional
8 information that is required.
9 (9) Upon receipt of the additional information
10 requested, the Attorney General must notify the
11 applicants in writing of the date of the completed
12 application.
13 (10) The Attorney General must approve, approve
14 with conditions directly related to the proposed
15 conversion, or disapprove the application within 120 days
16 after the date of the completed application.
17 (11) Immediately upon making a determination on the
18 application, the Attorney General must transmit a copy of
19 his or her final determination to the Department.
20 (b) In reviewing an application pursuant to this
21 Section, the Attorney General must consider the following
22 criteria:
23 (1) Whether the proposed conversion will harm the
24 public interest in trust property located or administered
25 in this State and given, devised, or bequeathed to the
26 existing health care facility for charitable,
27 educational, or religious purposes.
28 (2) Whether a trustee or trustees of any charitable
29 trust located or administered in this State will be
30 deemed to have exercised reasonable care, diligence, and
31 prudence in performing as a fiduciary in connection with
32 the proposed conversion.
33 (3) Whether the governing board of the
34 not-for-profit entity or entities, whether the acquiror,
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1 acquiree, or both, established appropriate criteria in
2 deciding to pursue a conversion in relation to carrying
3 out its mission and purposes.
4 (4) Whether the governing board of the
5 not-for-profit entity or entities, whether the acquiror,
6 acquiree, or both, formulated and issued appropriate
7 requests for proposals in pursuing a conversion.
8 (5) Whether the governing board of the
9 not-for-profit entity or entities, whether the acquiror,
10 acquiree, or both, considered the proposed conversion as
11 the only alternative or as the best alternative in
12 carrying out its mission and purposes.
13 (6) Whether any conflict of interest exists
14 concerning the proposed conversion relative to members
15 of the governing board of the not-for-profit entity or
16 entities, whether the acquiror, acquiree, or both,
17 officers, directors, senior level managers, or experts or
18 consultants engaged in connection with the proposed
19 conversion, including, but not limited to, attorneys,
20 accountants, investment bankers, actuaries, health care
21 experts, or industry analysts.
22 (7) Whether individuals were provided with
23 contracts or consulting agreements or arrangements that
24 included pecuniary rewards based in whole or in part on
25 the contingency of the completion of the conversion.
26 (8) Whether the governing board of the
27 not-for-profit entity or entities, whether the acquiror,
28 acquiree, or both, exercised due care in engaging
29 consultants with the appropriate level of independence,
30 education, and experience in similar conversions.
31 (9) Whether the governing board of the
32 not-for-profit entity or entities, whether the acquiror,
33 acquiree, or both, exercised due care in accepting
34 assumptions and conclusions provided by consultants
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1 engaged to assist in the proposed conversion.
2 (10) Whether the governing board of the
3 not-for-profit entity or entities, whether the acquiror,
4 acquiree, or both, exercised due care in assigning a
5 value to the existing health care facility and its
6 charitable assets in proceeding to negotiate the proposed
7 conversion.
8 (11) Whether the governing board of the
9 not-for-profit entity or entities, whether the acquiror,
10 acquiree, or both, exposed an inappropriate amount of
11 assets by accepting, in exchange for the proposed
12 conversion, future or contingent value based upon success
13 of the new health care facility.
14 (12) Whether members of the governing board of the
15 not-for-profit entity or entities, whether the acquiror,
16 acquiree, or both, officers, directors, or senior level
17 managers will receive future contracts in existing, new,
18 or affiliated health care facilities or foundations.
19 (13) Whether any members of the governing board of
20 the not-for-profit entity or entities, whether the
21 acquiror, acquiree, or both, will retain any authority in
22 the new health care facility.
23 (14) Whether the governing board of the
24 not-for-profit entity or entities, whether the acquiror,
25 acquiree, or both, accepted fair consideration and value
26 for any management contracts made part of the proposed
27 conversion.
28 (15) Whether individual members of the governing
29 board of the not-for-profit entity or entities, whether
30 the acquiror, acquiree, or both, officers, directors, or
31 senior level managers engaged legal counsel to consider
32 their individual rights or duties in acting in their
33 capacity as a fiduciary in connection with the proposed
34 conversion.
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1 (16) Whether the proposed conversion results in an
2 abandonment of the original purposes of the existing
3 health care facility or whether a resulting entity will
4 depart from the traditional purposes and mission of the
5 existing facility such that a cy pres proceeding would be
6 necessary.
7 (17) Whether the proposed conversion contemplates
8 the appropriate and reasonable fair market value.
9 (18) Whether the proposed conversion was based on
10 appropriate valuation methods, including, but not limited
11 to, market approach, third party report, or fairness
12 opinion.
13 (19) Whether the conversion is proper under the
14 General Not-for-Profit Corporation Act of 1986.
15 (20) Whether the conversion is proper under the
16 applicable State revenue Acts.
17 (21) Whether the proposed conversion jeopardizes
18 the tax status of the existing health care facility.
19 (22) Whether the individuals who represented the
20 existing health care facility in negotiations avoided
21 conflicts of interest.
22 (23) Whether officers, board members, directors, or
23 senior level managers deliberately acted or failed to act
24 in a manner that impacted negatively on the value or
25 purchase price.
26 (24) Whether the formula used in determining the
27 value of the existing health care facility was
28 appropriate and reasonable, which may include, but need
29 not be limited to: factors such as the multiple factors
30 applied to earnings before interest, taxes, depreciation,
31 and amortization; the time period of the evaluation;
32 price/earnings multiples; the projected efficiency
33 differences between the existing health care facility and
34 the new health care facility; and the historic value of
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1 any tax exemptions granted to the existing health care
2 facility.
3 (25) Whether the proposed conversion appropriately
4 provides for the disposition of proceeds of the
5 conversion which may include, but not be limited to the
6 following:
7 (A) Whether an existing entity or a new entity
8 will receive the proceeds.
9 (B) Whether appropriate tax status
10 implications of the entity receiving the proceeds
11 have been considered.
12 (C) Whether the mission statement and program
13 agenda will be or should be closely related with the
14 purpose of the mission of the existing health care
15 facility.
16 (D) Whether any conflicts of interest arise in
17 the proposed handling of the conversion proceeds.
18 (E) Whether the bylaws and articles of
19 incorporation have been prepared for the new entity.
20 (F) Whether the board of any new or continuing
21 entity will be independent from the new health care
22 facility.
23 (G) Whether the method for selecting board
24 members, staff, and consultants is appropriate.
25 (H) Whether the board will comprise an
26 appropriate number of individuals with experience in
27 pertinent areas such as foundations, health care,
28 business, labor, community programs, financial
29 management, legal, accounting, grant making, and
30 public members representing diverse ethnic
31 populations of the affected community.
32 (I) Whether the size of the board and proposed
33 length of board members' terms are sufficient.
34 (26) Whether the transacting parties are in
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1 compliance with the Charitable Trust Act.
2 (27) Whether a right of first refusal to repurchase
3 the assets has been retained.
4 (28) Whether the character, commitment, competence,
5 and standing in the community or other communities served
6 by the transacting parties are satisfactory.
7 (29) Whether a control premium is an appropriate
8 component of the proposed conversion.
9 (30) Whether the value of the assets factored in
10 the conversion is based on past performance or future
11 potential performance.
12 (31) The expected impact the proposed action will
13 have on the individual workforces of each affected health
14 care facility.
15 (32) Whether the expected workforce impact has been
16 discussed with the affected employees and, in the case of
17 employees who are represented by a duly certified or
18 recognized bargaining representative, whether the health
19 care facility has met its legal obligations to negotiate
20 regarding the impact with that bargaining representative.
21 (33) Whether a separate certification has been
22 submitted from each member of the governing board and
23 from the chief executive and operating and financial
24 officers of the corporation that is a party to the
25 proposed conversion, executed under oath:
26 (A) Stating whether that director, chief
27 executive, or operating or financial officer of the
28 corporation is then or may become, within the 3-year
29 period following the completion of the transaction,
30 a member or shareholder in or an officer, employee,
31 agent, or consultant of, or will otherwise derive
32 any compensation or benefits, directly or
33 indirectly, from the acquiring entity or any related
34 party in connection with or as a result of the
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1 disposition.
2 (B) Disclosing any financial interest held by
3 that individual or that individual's family or held
4 by any business in which the individual or a member
5 of the individual's family owns a financial interest
6 in any financial transaction within the prior 24
7 months with any of the parties participating in the
8 conversion.
9 (C) Stating that the market value of the
10 health care facility's assets has not been
11 manipulated to decrease or increase value.
12 (D) Stating that the terms of the transaction
13 are fair and reasonable.
14 (E) Stating that the proceeds of the
15 transaction will be used solely in a manner
16 consistent with the charitable purposes of the
17 not-for-profit corporation.
18 (F) Stating that the conversion will not
19 adversely affect the availability or accessibility
20 of health care services in the county or
21 municipality in which the existing health care
22 facility or facilities are located.
23 This certification requirement is not applicable,
24 however, to any governing board member who votes to
25 oppose the proposed conversion and has submitted a
26 statement to that effect to the Illinois Health
27 Facilities Planning Board and the Attorney General.
28 Section 30. Application review process; Health Facilities
29 Planning Board.
30 (a) The Illinois Health Facilities Planning Board must
31 review all proposed conversions involving a health care
32 facility in which a not-for-profit corporation is the
33 acquiror or acquiree as follows:
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1 (1) Upon receipt of a determination by the Attorney
2 General concerning a proposed conversion, the Board must,
3 within 10 business days, publish notice of the
4 application in a newspaper of general circulation in the
5 State stating that an initial application for conversion
6 has been submitted, the names of the parties to the
7 transaction, the date by which a person may submit
8 written comments to the Board, and the date, time, and
9 location of a public hearing regarding the application
10 for conversion.
11 (2) No later than 45 days after receipt of a
12 determination by the Attorney General concerning the
13 proposed conversion, the Board must hold at least one
14 public hearing in the service area of the acquiree health
15 care facility. The number of public hearings that the
16 Board holds must be appropriate to the size of the
17 community in the health care facility's service area and
18 the nature and value of the conversion to ensure that the
19 community affected by the conversion has a meaningful
20 opportunity to participate in the public hearing process.
21 Upon request, any person must be given an opportunity to
22 submit into the hearing record written comments,
23 documents, and other exhibits and to offer oral
24 testimony. Each party to the conversion must have a
25 representative in attendance at all public hearings
26 convened by the Board under this Section.
27 (3) At least 21 days before the public hearing, the
28 Board must provide written notice of the time and place
29 of the hearing through publication in one or more
30 newspapers of general circulation in the affected
31 communities, to the board of supervisors of the county in
32 which the facility is located, and to all those who
33 requested notice of the transaction.
34 (4) The Board must establish and maintain a summary
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1 of written and oral comments made in preparation for and
2 at the public hearing, including all questions posed, and
3 must require answers of the appropriate parties. The
4 summary and answers must be filed in the office of the
5 Board and in the public library of the public library
6 system for the community served by the health care
7 facility. A copy shall be made available upon request to
8 the Board.
9 (5) As part of the public hearing process, the
10 Board must solicit comments and input regarding the
11 potential risks and benefits of the conversion on health
12 access and services, as set forth in subsection (b) of
13 this Section.
14 (6) The Board has the power to subpoena additional
15 information or witnesses, require and administer oaths,
16 and require sworn statements at any time before making a
17 decision on an application.
18 (7) Within 20 days following the receipt of a
19 written determination approving a proposed conversion by
20 the Attorney General, the Board must advise the applicant
21 in writing whether the initial application for conversion
22 is complete and, if it is not, must specify the
23 additional information required.
24 (8) The Board must, upon receipt of the information
25 requested, notify the applicant in writing of the
26 official date of completion of the initial application.
27 (9) The Board must approve, approve with conditions
28 directly related to the proposed conversion, or
29 disapprove the initial application for conversion within
30 90 days after the date the completed application for
31 conversion was submitted.
32 (b) In reviewing an application for conversion under
33 this Section, the Board must consider the following criteria:
34 (1) Whether the character, commitment, competence,
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1 and standing in the community, or any other communities
2 served by the proposed parties to the transaction, are
3 satisfactory.
4 (2) Whether sufficient safeguards are included to
5 ensure the affected community's continued access to
6 affordable health care.
7 (3) Whether the parties to the transaction have
8 provided clear and convincing evidence that the new
9 health care facility will provide health care and
10 appropriate access with respect to traditionally
11 underserved populations in the affected community.
12 (4) Whether procedures are in place to ensure that
13 ownership interests will not be used as incentives for
14 patient referrals to the health care facility by
15 physicians and other employees of the health care
16 facility.
17 (5) Whether the parties to the transaction have
18 made a commitment to ensure the continuation of
19 collective bargaining rights, if applicable, and
20 retention of the workforce.
21 (6) Whether the parties to the transaction have
22 appropriately accounted for employment needs at the
23 health care facility and addressed workforce retraining
24 needed as a consequence of any proposed restructuring.
25 (7) Whether the proposed conversion demonstrates
26 that the public interest will be served, considering the
27 essential medical services needed to provide safe and
28 adequate treatment, appropriate access, and balanced
29 health care delivery to the residents of the State.
30 (8) Whether the acquiror has demonstrated that it
31 has satisfactorily met the terms and conditions of
32 approval for any previous conversion pursuant to an
33 application submitted under this Act.
34 (9) Whether health care employee staffing levels
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1 will be adversely affected, and what impact the staffing
2 levels will have on the quality of care provided by the
3 facility.
4 Section 35. Payment in lieu of taxes agreement. A
5 conversion under this Act must require the not-for-profit
6 corporation to have a payment in lieu of taxes agreement with
7 each taxing body requiring the not-for-profit corporation to
8 pay each taxing body, in each year after the effective date
9 of the conversion, the sums of money that were paid as real
10 estate taxes in the year immediately preceding the conversion
11 by the for-profit entity that was acquired.
12 Section 40. Solely for-profit corporations; Health
13 Facilities Planning Board. The Board shall review all
14 proposed conversions involving for-profit corporations as
15 acquirors and acquirees in accordance with the procedures and
16 review criteria set forth in Section 30 of this Act.
17 Section 45. Reports; use of experts; costs. The Illinois
18 Health Facilities Planning Board or the Attorney General may,
19 in carrying out their responsibilities under this Act, engage
20 experts or consultants including, but not limited to,
21 actuaries, investment bankers, accountants, attorneys, and
22 industry analysts. All copies of reports prepared by experts
23 and consultants, and the costs associated therewith, shall be
24 made available to the parties to the conversion and the
25 public. All costs incurred under this Section shall be the
26 responsibility of one or more of the parties to the
27 conversion in an amount to be determined by the Attorney
28 General or the Director as he or she deems appropriate. No
29 application for a conversion made under this Act shall be
30 considered complete unless an agreement has been executed
31 with the Attorney General or the Director for the payment of
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1 costs in accordance with this Section.
2 Section 50. Investigations; notice to attend; court order
3 to appear; contempt.
4 (a) The Director or the Attorney General may conduct
5 investigations in discharging the duties required under this
6 Act. For purposes of any such investigation, the Director or
7 the Attorney General may require any person, agent, trustee,
8 fiduciary, consultant, institution, association, or
9 corporation directly related to the proposed conversion to
10 appear at the time and place designated by the Director or
11 the Attorney General, and then and there under oath to
12 produce for the use of the Director or the Attorney General,
13 or both, all documents and other information relating
14 directly to the proposed conversion that the Director or the
15 Attorney General may require.
16 (b) Whenever the Director or the Attorney General deems
17 it necessary to require the attendance of any person as
18 provided in subsection (a) of this Section, the Director or
19 the Attorney General shall issue a notice to appear setting
20 forth the time and place when attendance is required and
21 shall cause the notice to be delivered or sent by registered
22 or certified mail to the person at least 14 days before the
23 date stated in the notice for the appearance.
24 (c) If any person receiving notice pursuant to this
25 Section fails to appear or fails to produce documents or
26 information as requested, the Director or the Attorney
27 General may issue a notice to show cause and may commence
28 contempt proceedings in the circuit court of the county in
29 which the person was requested to appear or produce documents
30 or information. The court may order the person to comply with
31 the request of the Director or the Attorney General. Any
32 failure or refusal to comply with the order of the court may
33 be punished by the exercise of the court's contempt powers.
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1 Section 55. Gag rules prohibited. A health care facility
2 may not refuse to contract with, or compensate for covered
3 services, an otherwise eligible provider solely because that
4 provider has in good faith communicated with one or more of
5 his or her patients regarding the provisions, terms, or
6 requirements for services of the health care provider's
7 products as they relate to the needs of that provider's
8 patients.
9 Section 60. Prior approval; closing or significant
10 reduction of medical services.
11 (a) A health care facility emergency department or
12 primary care service that has been in existence for at least
13 one year and that significantly serves uninsured or
14 underinsured individuals and families may not be eliminated
15 or significantly reduced without the prior approval of the
16 Director in accordance with this Section.
17 (b) Before eliminating or significantly reducing an
18 emergency room department or primary care service that has
19 been in existence for at least one year and that
20 significantly serves uninsured or underinsured individuals
21 and families, the health care facility must provide a written
22 plan to the Director describing the impact of such a proposal
23 on access to health care services for traditionally
24 underserved populations, the delivery of those services to
25 the affected community, and other licensed health care
26 facilities and providers in the affected community or in the
27 State.
28 (c) Notwithstanding any other provision of Illinois law,
29 the Director has the sole authority to review all plans
30 submitted under this Section and to issue a determination
31 within 90 days, or the request shall be deemed to have been
32 approved. If the Director deems it appropriate, the Director
33 may issue a public notice and receive written public comment
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1 for 60 days following the date of receipt of the proposal.
2 Section 65. Limits to acquisitions; community benefits
3 requirements; filings prohibited.
4 (a) A for-profit corporation, or its subsidiaries or
5 affiliates, that applies for and receives approval for a
6 conversion of a health care facility in accordance with this
7 Act may not be permitted to apply for approval for a
8 conversion of a second health care facility in this State for
9 a period of 3 years after the initial conversion is approved
10 and implemented.
11 (b) Notwithstanding subsection (a) of this Section, a
12 for-profit corporation, together with its subsidiaries and
13 affiliates, may apply for and receive approval for a
14 conversion of 2 affiliated health care facilities in this
15 State provided that (i) one of the 2 health care facilities'
16 licenses was issued before the effective date of this Act and
17 (ii) that license involves a specialty rehabilitation
18 hospital that has a maximum of 90 beds. A conversion
19 undertaken under this subsection shall be considered one
20 conversion for purposes of this Section.
21 (c) If a for-profit corporation applies to hold, own, or
22 acquire an ownership or controlling interest greater than 20%
23 in more than one health care facility one year after the
24 approval and implementation of a prior license, all
25 provisions of this Act must be met, and, in addition to the
26 review process and criteria set forth herein, the Department
27 has the sole authority to determine, in its sound discretion:
28 (1) Whether the for-profit corporation provided
29 community benefits as required or promised in connection
30 with obtaining and holding a license or interest therein
31 during the previous license period.
32 (2) Whether all terms and conditions of the prior
33 license have been met.
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1 (3) Whether all federal, State, and local laws,
2 ordinances, and regulations have been complied with
3 relative to any prior license.
4 (4) Whether the for-profit corporation planned,
5 implemented, monitored, and reviewed a community benefit
6 program during the prior license period.
7 (5) Whether the for-profit corporation provided an
8 appropriate amount of charity care necessary to maintain
9 or enhance a safe and accessible health care delivery
10 system in the affected community and the State.
11 (6) Whether the for-profit corporation maintained,
12 enhanced, or disrupted the essential medical services in
13 the affected community and the State.
14 (7) Whether the for-profit corporation demonstrated
15 a substantial linkage between the health care facility
16 and the affected community by providing one or more of
17 the following benefits: uncompensated care, charity care,
18 cash or in-kind donations to community programs,
19 education and training of professionals in community
20 health issues, relevant research initiatives, or
21 essential but unprofitable medical services if needed in
22 the affected community.
23 (d) The Director may hold a public hearing to solicit
24 input to assess the performance of a for-profit corporation
25 or its affiliates or subsidiaries in providing community
26 benefits in the affected community or the State.
27 (e) The Director has the sole authority to deny a
28 for-profit corporation, or its affiliates, subsidiaries, or
29 successors, permission to hold one or more than one license
30 and, for good cause, may prohibit a for-profit corporation or
31 its affiliates, subsidiaries, or successors from filing an
32 application pursuant to this Act for a period not to exceed
33 10 years.
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1 Section 70. Licensing fees. Nothing contained in this Act
2 shall be deemed to affect any licensing fees set forth in the
3 Ambulatory Surgical Treatment Center Act, the Hospital
4 Licensing Act, or the Nursing Home Care Act.
5 Section 75. No derogation of the Attorney General.
6 (a) No provision of this Act shall derogate from or
7 limit the common law or statutory authority of the Attorney
8 General, including the authority to investigate at any time
9 charitable trusts for the purpose of determining and
10 ascertaining whether they are being administered in
11 accordance with law and the terms and purposes thereof.
12 (b) No provision of this Act shall be construed as a
13 limitation on the application of the doctrine of cy pres or
14 any other legal doctrine applicable to charitable assets or
15 charitable trusts.
16 Section 80. Distribution of proceeds from acquisition;
17 independent foundation.
18 (a) In the event of the approval of a conversion
19 involving a not-for-profit corporation and a for-profit
20 corporation that results in a new entity as provided in
21 subdivision (b)(25)(A) of Section 25, it shall be required
22 that the proceeds from the sale and any endowments and
23 restricted, unrestricted, and specific-purpose funds be
24 transferred to a charitable foundation operated by a board of
25 directors (hereinafter referred to as "the foundation
26 board").
27 (b) The Governor shall appoint the initial foundation
28 board and shall approve, modify, or reject proposed by-laws
29 or articles of incorporation provided by the parties to the
30 transaction or the initial foundation board.
31 (c) The foundation board shall consist of no fewer than
32 7 and no more than 11 members and the Executive Director of
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1 the foundation, who shall serve ex-officio. The foundation
2 board may include one or more members with experience in
3 matters of finance, law, business, labor, investments,
4 community purpose, charitable giving, and health care, and
5 shall be representative of the diversity of the population of
6 the affected community. Not more than 3 members of the
7 foundation board may be prior board members of the existing
8 health care facility.
9 (d) The terms of foundation board members shall be 4
10 years, but the initial terms shall be 2, 3, and 4 years, as
11 determined by lot, so that the terms are staggered.
12 Foundation board members shall be limited to serving 2 full
13 terms. The foundation board shall elect a chairperson from
14 among its members, and other officers it deems necessary. The
15 foundation board members shall serve without compensation.
16 (e) Control of the distribution of the proceeds of the
17 funds is vested solely in the foundation board.
18 (f) Vacancies occurring on the foundation board shall be
19 filled by a majority vote of the remaining board members.
20 Section 85. Powers and duties of the board. The
21 foundation board is vested with full power, authority, and
22 jurisdiction over the foundation and may perform all acts
23 necessary or convenient in the exercise of any power,
24 authority, or jurisdiction over the foundation.
25 Section 90. Immunity of board members, officers, and
26 employees. Members of the foundation board and officers and
27 employees of the foundation are immune from personal
28 liability, either jointly or severally, for any debt or
29 obligation created or incurred by the foundation unless their
30 conduct is deemed to be gross negligence or wanton, willful,
31 or reckless.
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1 Section 95. Implementation.
2 (a) The Governor may take all steps necessary to
3 effectuate the purposes of this Act, and the foundation board
4 must be appointed no more than 60 days after the completion
5 of the conversion. The board must act promptly to appoint an
6 executive director, hire the staff deemed necessary, and
7 acquire necessary facilities and supplies to begin the
8 operation of the foundation.
9 (b) The foundation board must conduct a public hearing
10 to solicit comments on the proposed mission statement,
11 program agenda, corporate structure and strategic planning.
12 The foundation board must hold a public hearing within 180
13 days after establishment of the board and on an annual basis
14 thereafter.
15 Section 100. Annual report. The foundation board must
16 submit an annual report and a copy of Internal Revenue
17 Service form 990 to the Governor, the Attorney General, and
18 the General Assembly.
19 Section 105. General powers and limitations. For the
20 purpose of exercising the specific powers granted in this
21 chapter and effectuating the other purposes of this Act, the
22 foundation may do all of the following:
23 (1) Sue and be sued.
24 (2) Have a corporate seal and alter it at will.
25 (3) Make, amend, and repeal rules relating to the
26 conduct of the business of the foundation.
27 (4) Enter into contracts relating to the
28 administration of the foundation.
29 (5) Rent, lease, buy, or sell property in its own
30 name, and construct or repair buildings necessary to
31 provide space for its operations.
32 (6) Hire personnel, consultants, and experts and
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1 set salaries.
2 (7) Perform all other functions and exercise all
3 other powers that are necessary, appropriate, or
4 convenient to administer the foundation.
5 Section 110. Whistleblower protections.
6 (a) A person subject to the provisions of this Act may
7 not discharge, demote, threaten, or otherwise discriminate
8 against any person or employee with respect to compensation,
9 terms, conditions, or privileges of employment as a reprisal
10 because the person or employer (or any person acting pursuant
11 to the request of the employee) provided or attempted to
12 provide information to the Director or his or her designee or
13 to the Attorney General or his or her designee regarding
14 possible violations of this Act.
15 (b) Any person or employee or former employee subject to
16 the provisions of this Act who believes that he or she has
17 been discharged or discriminated against in violation of
18 subsection (a) of this Section may file a civil action within
19 3 years after the date of the discharge or discrimination.
20 (c) If a court of competent jurisdiction finds by a
21 preponderance of the evidence that a violation of this
22 Section has occurred, the court may grant the relief it deems
23 appropriate, including the following:
24 (1) Reinstatement of the employee to the employee's
25 former position.
26 (2) Compensatory damages, costs, and reasonable
27 attorneys fees.
28 (3) Other relief to remedy past discrimination.
29 (d) The protections of this Section do not apply to any
30 employee or person who:
31 (1) deliberately causes or participates in the
32 alleged violation of the law or a regulation; or
33 (2) knowingly or recklessly provides substantially
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1 false information to the Director or his or her designee
2 or to the Attorney General or his or her designee.
3 Section 115. Failure to comply; penalties. If any person
4 knowingly violates or fails to comply with any provision of
5 this Act or willingly or knowingly gives false or incorrect
6 information, the Director or the Attorney General may, after
7 notice and an opportunity for a fair and prompt hearing,
8 deny, suspend, or revoke a license or, instead of suspension
9 or revocation of a license, may order the licensee to admit
10 no additional persons to the health care facility, to provide
11 health services to no additional persons through the health
12 care facility, or to take corrective action necessary to
13 secure compliance under this Act. Nothing in this Section
14 shall be construed as precluding the prosecution of any
15 person who violates this Act under applicable State, county,
16 or municipal statutes, laws, or ordinances.
17 Section 120. Powers of the Department. The Department may
18 adopt rules consistent with this Act, including measurable
19 standards, as necessary to accomplish the purposes of this
20 Act.
21 Section 125. Powers of the Attorney General. The Attorney
22 General has the power to decide whether any information
23 required by this Act is confidential or proprietary under
24 subsection (g) of Section 7 of the Freedom of Information
25 Act. Those determinations shall be made before any public
26 notice of an initial application or any public availability
27 of the information.
28 Section 135. Community benefits; basic requirements.
29 (a) Every health care facility that receives a license
30 from this State must provide community benefits to the
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1 community or communities it serves.
2 (b) Within 18 months after the effective date of this
3 Act, every health care facility must develop, in
4 collaboration with the community:
5 (1) An organizational mission statement that
6 identifies the facility's commitment to developing,
7 adopting, and implementing a community benefits program.
8 (2) A description of the process for approval of
9 the mission statement by the health care facility's
10 governing board.
11 (3) A declaration that senior management of the
12 health care facility will be responsible for oversight
13 and implementation of the community benefits plan.
14 (4) A community health assessment that evaluates
15 the health needs and resources of the community served by
16 the facility.
17 (5) A community benefits plan designed to achieve
18 the following outcomes:
19 (A) Increase access to health care for members
20 of the target community or communities.
21 (B) Address critical health care needs of
22 members of the target community or communities.
23 (C) Foster measurable improvements in health
24 for members of the target community or communities.
25 Section 140. Community health assessment
26 (a) Before adopting a community benefits plan, every
27 health care facility subject to this Act must identify and
28 prioritize the health needs of the community it serves. The
29 facility also must identify health resources within the
30 community. As part of the assessment, the health care
31 facility must solicit comment from and meet with community
32 groups, local government officials, health related
33 organizations, and health care providers, with particular
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1 attention given to those persons who are themselves
2 underserved and those who work with underserved populations.
3 (b) The Department shall compile available public health
4 data, including statistics on the State's unmet health care
5 needs. In preparing its community health assessment, a health
6 care facility must use available public health data.
7 (c) Health care facilities are encouraged to collaborate
8 with other health care institutions in conducting community
9 health assessments and may make use of existing studies and
10 plans in completing their own community health assessments.
11 (d) Before finalizing the community health assessment,
12 the health care facility must make available to the public a
13 copy of the community health assessment for review and
14 comment.
15 (e) Once finalized, the community health assessment must
16 be updated at least every 3 years.
17 Section 145. Community benefits plan.
18 (a) Every health care facility must adopt, annually, a
19 plan for providing community benefits.
20 (b) The community benefits plan must be drafted with
21 input from the community.
22 (c) The community benefits plan must include, at a
23 minimum:
24 (1) A list of the services the health care facility
25 intends to provide in the following year to address
26 community health needs identified in the community health
27 assessment. Each listed service must be categorized as
28 one of the following:
29 (A) Free care.
30 (B) Other services for vulnerable populations.
31 (C) Health research, education, and training
32 programs.
33 (D) Community benefits that address public
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1 health needs.
2 (E) Non-quantifiable services, such as local
3 governance and preferential hiring policies that
4 benefit those who are uninsured or underserved.
5 (2) A description of the target community or
6 communities that the plan is intended to benefit.
7 (3) An estimate of the economic value of the
8 community benefits that the health care facility intends
9 to provide under the plan.
10 (4) A report summarizing the process used to elicit
11 community participation in the community health
12 assessment and community benefits plan design, and
13 ongoing implementation and oversight.
14 (5) A list of individuals, organizations, and
15 government officials consulted during development of the
16 plan and a description of any provisions made for the
17 promotion of ongoing participation by community members
18 in the implementation of the plan.
19 (6) A statement identifying the health care needs
20 of the communities that were considered in developing the
21 plan.
22 (7) A statement describing the intended impact on
23 health outcomes attributable to the plan, including short
24 and long-term measurable goals and objectives.
25 (8) Mechanisms to evaluate the plan's
26 effectiveness, including a method for soliciting comments
27 by community members.
28 (9) The name and title of the person who is
29 responsible for implementing the community benefits plan.
30 (d) Every health care facility must submit its community
31 benefits plan to the Department before implementing the plan.
32 (e) Every health care facility must make its community
33 benefits plan available to the public for review and comment
34 before implementation.
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1 (f) Every insurer must submit its community benefits
2 plan to the Administration before implementing the plan.
3 (g) Every insurer must make its community benefits plan
4 available to the public for review and comment before
5 implementation.
6 Section 150. Annual report.
7 (a) Within 120 days after the end of a health care
8 facility's fiscal year, the health care facility must submit
9 to the Department an annual report detailing its community
10 benefits efforts in the preceding calendar year. The annual
11 report must include the following:
12 (1) The health care facility's mission statement.
13 (2) The amounts and types of community benefits
14 provided, on a form to be developed by the Department.
15 (3) A statement of the health care facility's
16 impact on health outcomes attributable to the plan,
17 including a description of the health care facility's
18 progress toward meeting its short-term and long-term
19 goals and objectives.
20 (4) An evaluation of the plan's effectiveness,
21 including a description of the method by which community
22 members' comments have been solicited.
23 (5) The health care facility's audited financial
24 statement.
25 (b) Every health care facility must prepare a statement
26 announcing that its annual community benefits report is
27 available to the public. The statement must be posted in
28 prominent locations throughout the health care facility's
29 premises, including the emergency room waiting area, the
30 admissions waiting area, and the business office. The
31 statement must also be included in any written material that
32 discusses the admissions or free care criteria of the health
33 care facility. A copy of the report must be given free of
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1 charge to anyone who requests it. Information provided must
2 be calculated in accordance with generally accepted
3 accounting standards. This information must be calculated for
4 each individual health care facility within a system and not
5 on an aggregate basis, though both calculations may be
6 submitted. Every health care facility must also file a
7 calculation of its cost-to-charge ratio with its annual
8 report.
9 (c) Any person who disagrees with a community benefits
10 report may file a dissenting report with the Department.
11 Dissenting reports must be filed within 60 days after the
12 filing of the community benefits report, and shall become
13 public records.
14 Section 155. Free care. Every health care facility that
15 provides free care in full or partial fulfillment of its
16 community benefits obligation must develop a written notice
17 describing its free care program and explaining how to apply
18 for free care. The notice must be in appropriate languages
19 and conspicuously posted throughout the health care
20 facility's premises, including the general waiting area, the
21 emergency room waiting area, and the business office. Every
22 health care facility that provides free care in full or
23 partial fulfillment of its community benefits obligation must
24 report the value of that care, provided that the value of the
25 care may not include any bad debt costs.
26 Section 160. Subsidized care; sliding scale fees. In
27 determining sliding scale fees or other payment schedules for
28 uninsured persons, a health care facility must base those
29 fees on the income of the uninsured person. If the sliding
30 scale fee is below actual costs, the health care facility may
31 include the difference in its community benefits computation.
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1 Section 165. Monitoring and enforcement of community
2 benefits.
3 (a) The Department shall assess a civil penalty of not
4 less than $1,000 per day, for each day that the plan or
5 report is not filed as required, against a health care
6 facility that fails to file a community benefits plan or a
7 timely annual community benefits report.
8 (b) The Department shall revoke or decline to renew the
9 license of a health care facility that fails to provide
10 community benefits as required by this Act. The Department
11 may issue a provisional license for a period of up to one
12 year to a health care facility that has had its license
13 revoked or not renewed.
14 (c) Before taking any punitive action under this
15 Section, the Department must hold an adjudicative hearing,
16 giving the affected parties at least 14 days notice. Any
17 person who filed a dissenting report to the facility's
18 community benefits report has standing to testify at the
19 hearing.
20 (d) Any punitive measure taken by the Department
21 following the hearing shall be considered a final action for
22 purposes of appeal. Any final action by the Department shall
23 be subject to judicial review under the Administrative Review
24 Law.
25 (e) The Attorney General may bring a civil action to
26 enforce the collection of any monetary penalty imposed under
27 this Section.
28 Section 170. Department report to General Assembly. The
29 Department shall submit a report to the General Assembly on
30 September 1 of each year that contains the following:
31 (1) The name of each health care facility, if any,
32 that did not file a community benefits report in the
33 preceding year.
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1 (2) The name of each person who filed a dissenting
2 report to a health care facility's community benefits
3 report, and the substance of the complaint.
4 (3) A list of the most common activities performed
5 by health care facilities in fulfillment of their
6 community benefits obligations.
7 (4) The dollar value of the community benefits
8 activities performed by health care facilities, expressed
9 in both aggregate and individual terms.
10 (5) The amount of net patient revenue for each
11 health care facility.
12 The Department's report must be made available to the
13 public.
14 Section 200. Definitions. In the Sections following this
15 Section and preceding Section 300:
16 "Right of first refusal" means that no other person may
17 be hired before making the position available, through public
18 notice of the availability, for a minimum of 30 days, to
19 qualified displaced employees.
20 "Vacancy" means an available position that the hiring
21 employer does not fill by promoting, transferring, or
22 recalling a permanent employee. A position that is filled by
23 a permanent employee who is on temporary leave status and
24 expected to return to the position shall not be deemed a
25 vacancy. An available position that requires the occupant to
26 be a Board-certified physician shall not be deemed a vacancy.
27 Section 205. Filling of employee vacancies.
28 (a) Qualified applicants displaced by the hiring
29 employer or an affiliated enterprise of the employer have
30 priority to fill a vacancy over qualified applicants
31 displaced by other health care facilities.
32 (b) When considering applications from more than one
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1 qualified displaced employee applicant having equal priority
2 to fill a vacancy, the hiring employer has discretion as to
3 which employee will be offered employment. A position may be
4 filled with an employee entitled to preference under Sections
5 200 through 215 at any time after the required notice of
6 position availability is made.
7 (c) Nothing in Sections 200 through 215 shall preclude a
8 hiring employer from establishing reasonable employment
9 qualifications or prerequisites for a vacancy, provided that
10 employees who performed essentially the same work before
11 their displacement shall be deemed presumptively qualified
12 for any comparable positions.
13 (d) A hiring employer may not discriminate against
14 prospective employees on the basis of any seniority, recall,
15 or employment rights protected under Sections 200 through
16 215.
17 (e) Employees who have been hired by the displacing
18 employer or an affiliated enterprise, contractor, or
19 successor of that employer pursuant to the preference rights
20 under this Section may not be terminated during their first 3
21 months of employment except for just cause. Employees hired
22 by any other health care facility pursuant to the preference
23 rights under Sections 200 through 215 may be required to
24 serve a 30-day probationary period by the new employer.
25 (f) An employer may not permanently fill a vacancy that
26 would otherwise be available to an employee entitled to
27 preference under Sections 200 through 215 by promoting or
28 reassigning a temporary employee unless the temporary
29 employee is also entitled to equal preference under Sections
30 200 through 215. An employer may fill a vacancy on a
31 temporary basis, defined as less than 60 days, with an
32 individual who is not entitled to preference while
33 considering preference applications for the vacancy.
34 (g) Any preference-eligible employee who is displaced,
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1 other than for cause, retains rights of seniority and recall
2 with the employer by whom the employee was displaced,
3 regardless of whether the employee accepts a position with
4 another employer.
5 (h) As used in this Section, public notice of a vacancy
6 requires, at a minimum, that the hiring employer place a
7 notice of the vacancy with the local State employment office.
8 Section 210. Notice of pending employment displacement.
9 (a) Any health care facility that employs at least 10
10 employees must provide those employees, and the designated
11 bargaining representative of those employees, with timely
12 notice of any termination or other employment displacement,
13 other than discharge or termination for cause, affecting more
14 than 20% of the workforce or 2 employees in any one
15 department, or more than 20% of the workforce or 10 employees
16 at the facility, occurring within the period beginning 6
17 months before and ending one year after a conversion covered
18 by this Act.
19 (b) Timely notice of impending employment displacement
20 requires:
21 (1) In the case of an employer that employs 100 or
22 more employees, a minimum notice of 90 days.
23 (2) In the case of an employer that employs fewer
24 than 100 employees, a minimum notice of 60 days.
25 In the case of employees covered by a collective
26 bargaining agreement, timely notice shall be the greater of
27 the notice required under this Act or the notice required
28 under the collective bargaining agreement.
29 (c) During the notice period, affected employees are
30 entitled to attend employment interviews without loss of pay,
31 provided that reasonable notice is given to the employer.
32 (d) A health care facility that fails to timely provide
33 the statutory notice required by this Section is subject to
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1 civil liability in an action filed in the circuit court by or
2 on behalf of an employee or former employee within 3 years
3 after the date of displacement. Upon a finding of a
4 violation, the court may award the relief it deems
5 appropriate, including, at a minimum, liquidated damages in
6 the amount of $100 per day for the period between the time
7 that notice should have been received and the date of actual
8 notice of displacement, and the attorney's fees and costs
9 incurred in filing and maintaining the action.
10 Section 215. Preferential hiring rights for employees
11 terminated or displaced by a health care facility.
12 (a) In the case of any action that would result in
13 employee displacement, the health care facility by which the
14 employees are employed must provide for the following fair
15 and equitable arrangements to protect the interests of
16 affected employees:
17 (1) A right of first refusal to fill available
18 vacancies for which they qualify, with continued
19 seniority for benefit eligibility, at current or
20 subsequently opened facilities owned, managed, or
21 operated by the existing health care facility or by the
22 new health care facility; provided, that if a vacancy
23 would require affected employees to travel more than one
24 hour from their current employment site, reasonable
25 moving expenses shall be paid by the health care facility
26 by which they will become employed.
27 (2) If the employment loss results from the
28 contracting-out of the work by the employer health care
29 facility, the employer must ensure that the contractor is
30 contractually obligated to grant affected employees the
31 right of first refusal to jobs for which they are
32 qualified.
33 (3) Not later than the date of displacement, the
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1 employer health care facility must provide each affected
2 employee with notice of employment rights available under
3 Sections 200 through 215. The notice must include
4 identification of the employer's contact representative
5 who can verify the employee's preference status under
6 this Act and a listing of the employer's affiliated
7 enterprises, successors, and contractors with whom the
8 employee has preference eligibility at the time of
9 displacement.
10 (b) A new health care facility that is created as the
11 result of a conversion must, with respect to the employees of
12 the pre-existing health care entity, provide those employees
13 the right to continued employment in the job positions they
14 had before the merger or consolidation, with full recognition
15 of accrued seniority with the prior health care facility
16 employer for benefit purposes, unless the employer can
17 establish that the positions are not presently available
18 because of a bona fide reduction in force, in which case the
19 employer must provide any employees who thereby are unable to
20 continue in a position the notice and rights provided under
21 subsection (a) and a right of first refusal to any vacancies
22 that become available within 12 months thereafter and for
23 which they are qualified.
24 (c) Every health care facility operating within this
25 State must provide notice of available vacancies and a
26 preferential right of first refusal to those vacancies to
27 qualified health care employees displaced by other health
28 care facilities. The obligation and preferential right of
29 first refusal provided under this subsection is subordinate
30 to those rights provided under subsections (a) and (b).
31 (d) Any employee hired pursuant to this Section retains
32 previously established seniority for the purpose of
33 determining benefit entitlement with the new employer.
34 (e) Any employee or former employee who has been
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1 adversely affected by reason of a violation of this Section
2 may bring an action for monetary and injunctive relief,
3 including reinstatement, compensatory damages, attorney's
4 fees, and costs of the action, in the circuit court within 3
5 years after the violation.
6 Section 220. Neutrality concerning union organizing.
7 State funds appropriated to implement this Act may not be
8 used to assist, promote, or deter union organizing.
9 Section 300. Rules. The Department shall adopt rules
10 necessary to implement this Act.
11 Section 400. Severability. The provisions of this Act
12 are severable under Section 1.31 of the Statute on Statutes.
13 Section 900. The Ambulatory Surgical Treatment Center
14 Act is amended by adding Sections 10.5, 10.10, 10.15, 10.20,
15 10.25, and 10.30 as follows:
16 (210 ILCS 5/10.5 new)
17 Sec. 10.5. Facility staffing standards.
18 (a) Every ambulatory surgical treatment center must
19 ensure that it is staffed in a manner to provide sufficient,
20 appropriately qualified staff of each classification and in
21 each department or unit within the facility to meet the
22 individualized care needs of the patients in the facility and
23 must meet the requirements set forth in this Section.
24 (b) Every ambulatory surgical treatment center must have
25 in place and follow an approved staffing plan that ensures
26 adequate and appropriate delivery of health care services to
27 patients. The staffing plan must be expressed in the minimum
28 number, skill mix, and classification of personnel needed in
29 each department or unit, based on the census and the usual or
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1 average cumulative acuity of the patients cared for directly
2 or indirectly in each department or unit. The staffing plan
3 must be developed with the active participation of the direct
4 care nursing staff within each department or unit.
5 (c) In addition to the basic staffing plan requirements
6 set forth in subsection (b), every ambulatory surgical
7 treatment center must have and follow a staffing system that
8 ensures adequate and appropriate care and that includes the
9 following features:
10 (1) A patient acuity system that meets the
11 following requirements:
12 (A) It identifies, for each department or
13 unit, the range of patient acuity permissible within
14 the department or unit.
15 (B) It documents, on an individual patient
16 basis, the patient diagnosis, the severity of the
17 patient's illness, the need for specialized
18 equipment and technology, patient assessments, the
19 nursing care plan, and the level of staffing, by
20 classification, necessary, in addition to the basic
21 minimum staff set forth in subsection (b), to meet
22 the care plan.
23 (C) It is utilized with the active
24 participation of direct care nursing staff within
25 each department.
26 (D) It references staffing ratios set by
27 professional organizations that set standards of
28 practice for specialty areas.
29 (E) It is validated at least annually or
30 whenever a change in the system is proposed so that
31 it reliably measures individualized patient care
32 needs and staffing requirements.
33 (2) Staffing levels in the plan must be based on
34 the acuity system referenced in paragraph (1) and must
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1 take into account other unit activity (discharges,
2 transfers, and admissions) and administrative and support
3 tasks that must be done by staff within each
4 classification.
5 (3) Every staffing system must include a statement
6 of minimum qualifications for each staff classification
7 referenced in the staffing plan and staffing system.
8 (4) Use of supplemental staff must include a
9 statement of minimum qualifications for each staff
10 classification referenced in the staffing plan and
11 staffing system.
12 (210 ILCS 5/10.10 new)
13 Sec. 10.10. Mandatory overtime and excessive-duty hours
14 prohibited.
15 (a) In this Section:
16 "Declared state of emergency" means an officially
17 designated state of emergency that has been declared by a
18 federal, State, or local government official having authority
19 to declare that the State, county, municipality, or locality
20 is in a state of emergency. The term does not include a
21 state of emergency that results from a labor dispute in the
22 health care industry.
23 "Mandatory" or "mandate" means any request that, if
24 refused or declined by a health care employee, may result in
25 discharge, discipline, loss of promotion, or other adverse
26 employment consequence.
27 "Off-duty" means that an individual has no restrictions
28 placed on his or her whereabouts and is free of all restraint
29 or duty on behalf of an ambulatory surgical treatment center.
30 "On-duty" means that an individual is required to be
31 available and ready to perform services on request within or
32 on behalf of an ambulatory surgical treatment center, and
33 includes any rest periods or breaks during which the
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1 individual's ability to leave the facility is restricted
2 either expressly or by work-related circumstances beyond the
3 individual's control.
4 (b) Notwithstanding any other provision of law to the
5 contrary, and subject only to the exceptions included in this
6 Section, an ambulatory surgical treatment center may not
7 mandate or otherwise require, directly or indirectly, a
8 health care employee to work or be in on-duty status in
9 excess of any of the following:
10 (1) The scheduled work shift or duty period.
11 (2) 12 hours in a 24-hour period.
12 (3) 40 hours in a 7-consecutive-day period.
13 Nothing in this subsection is intended to prohibit a
14 health care employee from voluntarily working overtime.
15 (c) No health care employee may work or be in on-duty
16 status more than 16 hours in any 24-hour period. Any health
17 care employee working 16 hours in any 24-hour period must
18 have at least 8 consecutive hours off duty before being
19 required to return to duty. No health care employee may be
20 required to work or be on duty more than 7 consecutive days
21 without at least one consecutive 24-hour period off duty
22 within that time.
23 (d) Notwithstanding any other provision of this Section,
24 during a declared state of emergency in which an ambulatory
25 surgical treatment center is requested, or otherwise
26 reasonably may be expected, to provide an exceptional level
27 of emergency or other medical services to the community, the
28 mandatory-overtime prohibition under subsection (b) is
29 inoperative to the following extent:
30 (1) Health care employees may be required to work
31 or be on duty up to the maximum hour limitations set
32 forth in subsection (b), provided that the ambulatory
33 surgical treatment center has taken the steps set forth
34 in subsection (e).
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1 (2) Before requiring any health care employee to
2 work mandatory overtime, the ambulatory surgical
3 treatment center must make reasonable efforts to fill its
4 immediate staffing needs through alternative efforts,
5 including requesting off-duty staff to voluntarily report
6 to work, requesting on-duty staff to volunteer for
7 overtime hours, and recruiting per diem and registry
8 staff to report to work.
9 (3) The exemption provided by this subsection may
10 not exceed the duration of the declared state of
11 emergency or the ambulatory surgical treatment center's
12 direct role in responding to medical needs resulting from
13 the declared state of emergency, whichever is less.
14 (e) During a declared state of emergency in which an
15 ambulatory surgical treatment center is requested, or
16 otherwise reasonably may be expected, to provide an
17 exceptional level of emergency or other medical services to
18 the community, the maximum hours limitation under subsection
19 (c) is inoperative to the following extent:
20 (1) A health care employee may work or remain on
21 duty for more than the maximum hour limitations set forth
22 in subsection (c) under the following circumstances:
23 (A) The decision to work the additional time
24 is voluntarily made by the individual health care
25 employee affected.
26 (B) The health care employee is given at least
27 one uninterrupted 4-hour rest period before the
28 completion of the first 16 hours of duty and an
29 uninterrupted 8-hour rest period at the completion
30 of 24 hours of duty.
31 (C) No health care employee may work or remain
32 on duty for more than 28 consecutive hours in a
33 72-hour period.
34 (D) A health care employee who has been on
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1 duty for more than 16 hours in a 24-hour period who
2 informs the health care facility that he or she
3 needs immediate rest must be relieved from duty as
4 soon thereafter as possible, consistent with patient
5 safety needs, and must be given at least 8
6 uninterrupted hours off duty before being required
7 to return for duty.
8 As used in this paragraph (1), "rest period" means a
9 period in which an individual may be required to remain
10 on the premises of the ambulatory surgical treatment
11 center but is free of all restraint or duty or
12 responsibility for work or duty should the occasion
13 arise.
14 (2) The exemption provided by this subsection may
15 not exceed the duration of the declared state of
16 emergency or the ambulatory surgical treatment center's
17 direct role in responding to medical needs resulting from
18 the declared state of emergency, whichever is less.
19 (f) A work shift schedule or overtime program
20 established pursuant to a collective bargaining agreement
21 negotiated on behalf of the health care employees by a bona
22 fide labor organization may provide for mandatory on-duty
23 hours in excess of that permitted under subsection (b),
24 provided that adequate measures are included in the agreement
25 to ensure against excessive fatigue on the part of the
26 affected employees.
27 (210 ILCS 5/10.15 new)
28 Sec. 10.15. Public disclosure.
29 (a) Every ambulatory surgical treatment center must
30 maintain the following information:
31 (1) The staffing plan required under Section 10.5.
32 (2) Records that reflect daily staffing levels for
33 each department and unit covered by the staffing plan.
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1 (3) Nurse-sensitive patient outcome information
2 (for example, infection and readmission rates).
3 (4) Mandated and actual staffing levels.
4 (b) Information required to be maintained under
5 paragraphs (1), (2), and (4) of subsection (a) must be posted
6 on each unit and in each department. All other information
7 that must be maintained under this Section must be made
8 available to the public upon request. The information must
9 be provided within 14 days after the request.
10 (c) The ambulatory surgical treatment center must also
11 post, and provide to the public upon request, a notice of
12 violations of the staffing requirements set forth in Sections
13 10.5 through 10.15.
14 (210 ILCS 5/10.20 new)
15 Sec. 10.20. Employee's right to refuse assignment.
16 (a) An employee of an ambulatory surgical treatment
17 center has a right to refuse assignment under conditions that
18 would be in violation of the standards imposed by Sections
19 10.5 through 10.15 under the following circumstances:
20 (1) Education and experience have not prepared the
21 employee to safely fulfill the assignment.
22 (2) The employee is required to work overtime, and
23 the employee determines that the resulting level of
24 fatigue or decreased alertness, or both, would compromise
25 or jeopardize patient safety or the employee's ability to
26 meet patient needs.
27 (3) The assignment does not meet staffing
28 requirements, and the employee has the good-faith belief
29 that patient care will be threatened by the proposed
30 staffing.
31 (b) An employee may exercise his or her right to refuse
32 an assignment under subsection (a) through the following
33 procedure:
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1 (1) The employee must first report his or her
2 concern to his or her supervisor and ask to be relieved
3 of the assignment.
4 (2) The supervisor must review the conditions, and
5 either remedy situation causing the violation of
6 standards, relieve the employee of the assignment, or
7 advise the employee that he or she finds that the
8 conditions do not justify relieving the employee.
9 (3) If the supervisor does not agree to relieve the
10 employee of the assignment or remedy the alleged
11 violation, the employee may exercise his or her right to
12 refuse the assignment if:
13 (A) the supervisor rejects the request without
14 proposing a remedy, or the proposed remedy is
15 inadequate or untimely;
16 (B) the alleged violation cannot be timely
17 addressed through the other enforcement provisions
18 of Sections 10.5 through 10.15; and
19 (C) the employee in good faith believes that
20 the assignment violates Sections 10.5 through 10.15
21 and would create an unsafe condition for either the
22 employee or for patients who would be receiving care
23 or services from the employee.
24 (4) An employee has a private cause of action for
25 any violation of the rights set forth in this Section.
26 (210 ILCS 5/10.25 new)
27 Sec. 10.25. Enforcement.
28 (a) The Department must conduct unannounced, random site
29 visits of ambulatory surgical treatment centers to determine
30 compliance with the requirements of Sections 10.5 through
31 10.20. The ambulatory surgical treatment centers visited
32 must be randomly selected, and every ambulatory surgical
33 treatment center must be visited at least once within 6
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1 months.
2 (b) The Department must also inspect an ambulatory
3 surgical treatment center in response to a reported violation
4 of Sections 10.5 through 10.20. These inspections must take
5 place within 14 days after the Department receives a report
6 of a violation. Every report of a violation must be
7 investigated, whether it was written or oral.
8 (c) A violation may be reported by any person, including
9 any employee. The identity of the person reporting the
10 violation must remain confidential, and may not be disclosed
11 to the ambulatory surgical treatment center.
12 (d) If the Department finds a violation of Sections 10.5
13 through 10.20 during either a random visit or an inspection
14 resulting from a report of a violation, the Department must
15 detail its finding in a written report and must prepare a
16 correction plan. The Department shall conduct further
17 investigations as necessary to determine compliance with the
18 correction plan. Copies of both the finding of a violation
19 and the correction plan must be made available to the public
20 upon request.
21 (210 ILCS 5/10.30 new)
22 Sec. 10.30. Penalties for violations.
23 (a) An ambulatory surgical treatment center that is
24 found to be in violation of any provision in Sections 10.5
25 through 10.20 is subject to any one or more of the following
26 penalties:
27 (1) Loss of licensure under this Act.
28 (2) A civil penalty of not more than $5,000 per day
29 for each day of a violation.
30 (3) Issuance of an order by a court of competent
31 jurisdiction to correct the violation.
32 (b) If the health of patients is threatened by the
33 violation, the Department may issue an order: to immediately
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1 close the affected department or unit; to close the affected
2 unit or department, or the entire facility, to further
3 admissions; or imposing a regulatory overseer for the
4 facility, department, or unit, with the overseer having the
5 authority to assign additional staff at the cost of the
6 facility.
7 (c) If the Department finds that a violation was willful
8 or that there have been repeated violations by an ambulatory
9 surgical treatment center, the Department may impose a civil
10 penalty, as provided in subsection (a), against the chief
11 executive officer of the facility or the chief nursing
12 officer of the facility, or both.
13 (d) The Department may impose a civil penalty under this
14 Section only after notice and a hearing at which the
15 ambulatory surgical treatment center is given an opportunity
16 to present evidence concerning the alleged violation.
17 (e) The Attorney General may bring a civil action to
18 enforce the collection of a civil penalty imposed under this
19 Section.
20 Section 905. The Hospital Licensing Act is amended by
21 adding Sections 6.50, 6.55, 6.60, 6.65, 6.70, and 6.75 as
22 follows:
23 (210 ILCS 85/6.50 new)
24 Sec. 6.50. Facility staffing standards.
25 (a) Every hospital must ensure that it is staffed in a
26 manner to provide sufficient, appropriately qualified staff
27 of each classification and in each department or unit within
28 the facility to meet the individualized care needs of the
29 patients in the facility and must meet the requirements set
30 forth in this Section.
31 (b) Every hospital must have in place and follow an
32 approved staffing plan that ensures adequate and appropriate
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1 delivery of health care services to patients. The staffing
2 plan must be expressed in the minimum number, skill mix, and
3 classification of personnel needed in each department or
4 unit, based on the census and the usual or average cumulative
5 acuity of the patients cared for directly or indirectly in
6 each department or unit. The staffing plan must be developed
7 with the active participation of the direct care nursing
8 staff within each department or unit.
9 (c) In addition to the basic staffing plan requirements
10 set forth in subsection (b), every hospital must have and
11 follow a staffing system that ensures adequate and
12 appropriate care and that includes the following features:
13 (1) A patient acuity system that meets the
14 following requirements:
15 (A) It identifies, for each department or
16 unit, the range of patient acuity permissible within
17 the department or unit.
18 (B) It documents, on an individual patient
19 basis, the patient diagnosis, the severity of the
20 patient's illness, the need for specialized
21 equipment and technology, patient assessments, the
22 nursing care plan, and the level of staffing, by
23 classification, necessary, in addition to the basic
24 minimum staff set forth in subsection (b), to meet
25 the care plan.
26 (C) It is utilized with the active
27 participation of direct care nursing staff within
28 each department.
29 (D) It references staffing ratios set by
30 professional organizations that set standards of
31 practice for specialty areas.
32 (E) It is validated at least annually or
33 whenever a change in the system is proposed so that
34 it reliably measures individualized patient care
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1 needs and staffing requirements.
2 (2) Staffing levels in the plan must be based on
3 the acuity system referenced in paragraph (1) and must
4 take into account other unit activity (discharges,
5 transfers, and admissions) and administrative and support
6 tasks that must be done by staff within each
7 classification.
8 (3) Every staffing system must include a statement
9 of minimum qualifications for each staff classification
10 referenced in the staffing plan and staffing system.
11 (4) Use of supplemental staff must include a
12 statement of minimum qualifications for each staff
13 classification referenced in the staffing plan and
14 staffing system.
15 (210 ILCS 85/6.55 new)
16 Sec. 6.55. Mandatory overtime and excessive-duty hours
17 prohibited.
18 (a) In this Section:
19 "Declared state of emergency" means an officially
20 designated state of emergency that has been declared by a
21 federal, State, or local government official having authority
22 to declare that the State, county, municipality, or locality
23 is in a state of emergency. The term does not include a
24 state of emergency that results from a labor dispute in the
25 health care industry.
26 "Mandatory" or "mandate" means any request that, if
27 refused or declined by a health care employee, may result in
28 discharge, discipline, loss of promotion, or other adverse
29 employment consequence.
30 "Off-duty" means that an individual has no restrictions
31 placed on his or her whereabouts and is free of all restraint
32 or duty on behalf of a hospital.
33 "On-duty" means that an individual is required to be
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1 available and ready to perform services on request within or
2 on behalf of a hospital, and includes any rest periods or
3 breaks during which the individual's ability to leave the
4 facility is restricted either expressly or by work-related
5 circumstances beyond the individual's control.
6 (b) Notwithstanding any other provision of law to the
7 contrary, and subject only to the exceptions included in this
8 Section, a hospital may not mandate or otherwise require,
9 directly or indirectly, a health care employee to work or be
10 in on-duty status in excess of any of the following:
11 (1) The scheduled work shift or duty period.
12 (2) 12 hours in a 24-hour period.
13 (3) 40 hours in a 7-consecutive-day period.
14 Nothing in this subsection is intended to prohibit a
15 health care employee from voluntarily working overtime.
16 (c) No health care employee may work or be in on-duty
17 status more than 16 hours in any 24-hour period. Any health
18 care employee working 16 hours in any 24-hour period must
19 have at least 8 consecutive hours off duty before being
20 required to return to duty. No health care employee may be
21 required to work or be on duty more than 7 consecutive days
22 without at least one consecutive 24-hour period off duty
23 within that time.
24 (d) Notwithstanding any other provision of this Section,
25 during a declared state of emergency in which a hospital is
26 requested, or otherwise reasonably may be expected, to
27 provide an exceptional level of emergency or other medical
28 services to the community, the mandatory-overtime prohibition
29 under subsection (b) is inoperative to the following extent:
30 (1) Health care employees may be required to work
31 or be on duty up to the maximum hour limitations set
32 forth in subsection (b), provided that the hospital has
33 taken the steps set forth in subsection (e).
34 (2) Before requiring any health care employee to
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1 work mandatory overtime, the hospital must make
2 reasonable efforts to fill its immediate staffing needs
3 through alternative efforts, including requesting
4 off-duty staff to voluntarily report to work, requesting
5 on-duty staff to volunteer for overtime hours, and
6 recruiting per diem and registry staff to report to work.
7 (3) The exemption provided by this subsection may
8 not exceed the duration of the declared state of
9 emergency or the hospital's direct role in responding to
10 medical needs resulting from the declared state of
11 emergency, whichever is less.
12 (e) During a declared state of emergency in which
13 hospital is requested, or otherwise reasonably may be
14 expected, to provide an exceptional level of emergency or
15 other medical services to the community, the maximum hours
16 limitation under subsection (c) is inoperative to the
17 following extent:
18 (1) A health care employee may work or remain on
19 duty for more than the maximum hour limitations set forth
20 in subsection (c) under the following circumstances:
21 (A) The decision to work the additional time
22 is voluntarily made by the individual health care
23 employee affected.
24 (B) The health care employee is given at least
25 one uninterrupted 4-hour rest period before the
26 completion of the first 16 hours of duty and an
27 uninterrupted 8-hour rest period at the completion
28 of 24 hours of duty.
29 (C) No health care employee may work or remain
30 on duty for more than 28 consecutive hours in a
31 72-hour period.
32 (D) A health care employee who has been on
33 duty for more than 16 hours in a 24-hour period who
34 informs the health care facility that he or she
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1 needs immediate rest must be relieved from duty as
2 soon thereafter as possible, consistent with patient
3 safety needs, and must be given at least 8
4 uninterrupted hours off duty before being required
5 to return for duty.
6 As used in this paragraph (1), "rest period" means a
7 period in which an individual may be required to remain
8 on the premises of the hospital but is free of all
9 restraint or duty or responsibility for work or duty
10 should the occasion arise.
11 (2) The exemption provided by this subsection may
12 not exceed the duration of the declared state of
13 emergency or the hospital's direct role in responding to
14 medical needs resulting from the declared state of
15 emergency, whichever is less.
16 (f) A work shift schedule or overtime program
17 established pursuant to a collective bargaining agreement
18 negotiated on behalf of the health care employees by a bona
19 fide labor organization may provide for mandatory on-duty
20 hours in excess of that permitted under subsection (b),
21 provided that adequate measures are included in the agreement
22 to ensure against excessive fatigue on the part of the
23 affected employees.
24 (210 ILCS 85/6.60 new)
25 Sec. 6.60. Public disclosure.
26 (a) Every hospital must maintain the following
27 information:
28 (1) The staffing plan required under Section 6.50.
29 (2) Records that reflect daily staffing levels for
30 each department and unit covered by the staffing plan.
31 (3) Nurse-sensitive patient outcome information
32 (for example, infection and readmission rates).
33 (4) Mandated and actual staffing levels.
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1 (b) Information required to be maintained under
2 paragraphs (1), (2), and (4) of subsection (a) must be posted
3 on each unit and in each department. All other information
4 that must be maintained under this Section must be made
5 available to the public upon request. The information must
6 be provided within 14 days after the request.
7 (c) The hospital must also post, and provide to the
8 public upon request, a notice of violations of the staffing
9 requirements set forth in Sections 6.50 through 6.60.
10 (210 ILCS 85/6.65 new)
11 Sec. 6.65. Employee's right to refuse assignment.
12 (a) An employee of hospital has a right to refuse
13 assignment under conditions that would be in violation of the
14 standards imposed by Sections 6.50 through 6.60 under the
15 following circumstances:
16 (1) Education and experience have not prepared the
17 employee to safely fulfill the assignment.
18 (2) The employee is required to work overtime, and
19 the employee determines that the resulting level of
20 fatigue or decreased alertness, or both, would compromise
21 or jeopardize patient safety or the employee's ability to
22 meet patient needs.
23 (3) The assignment does not meet staffing
24 requirements, and the employee has the good-faith belief
25 that patient care will be threatened by the proposed
26 staffing.
27 (b) An employee may exercise his or her right to refuse
28 an assignment under subsection (a) through the following
29 procedure:
30 (1) The employee must first report his or her
31 concern to his or her supervisor and ask to be relieved
32 of the assignment.
33 (2) The supervisor must review the conditions, and
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1 either remedy situation causing the violation of
2 standards, relieve the employee of the assignment, or
3 advise the employee that he or she finds that the
4 conditions do not justify relieving the employee.
5 (3) If the supervisor does not agree to relieve the
6 employee of the assignment or remedy the alleged
7 violation, the employee may exercise his or her right to
8 refuse the assignment if:
9 (A) the supervisor rejects the request without
10 proposing a remedy, or the proposed remedy is
11 inadequate or untimely;
12 (B) the alleged violation cannot be timely
13 addressed through the other enforcement provisions
14 of Sections 6.50 through 6.60; and
15 (C) the employee in good faith believes that
16 the assignment violates Sections 6.50 through 6.60
17 and would create an unsafe condition for either the
18 employee or for patients who would be receiving care
19 or services from the employee.
20 (4) An employee has a private cause of action for
21 any violation of the rights set forth in this Section.
22 (210 ILCS 85/6.70 new)
23 Sec. 6.70. Enforcement.
24 (a) The Department must conduct unannounced, random site
25 visits of hospitals to determine compliance with the
26 requirements of Sections 6.50 through 6.65. The hospitals
27 visited must be randomly selected, and every hospital must be
28 visited at least once within 6 months.
29 (b) The Department must also inspect a hospital in
30 response to a reported violation of Sections 6.50 through
31 6.65. These inspections must take place within 14 days after
32 the Department receives a report of a violation. Every
33 report of a violation must be investigated, whether it was
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1 written or oral.
2 (c) A violation may be reported by any person, including
3 any employee. The identity of the person reporting the
4 violation must remain confidential, and may not be disclosed
5 to the hospital.
6 (d) If the Department finds a violation of Sections 6.50
7 through 6.65 during either a random visit or an inspection
8 resulting from a report of a violation, the Department must
9 detail its finding in a written report and must prepare a
10 correction plan. The Department shall conduct further
11 investigations as necessary to determine compliance with the
12 correction plan. Copies of both the finding of a violation
13 and the correction plan must be made available to the public
14 upon request.
15 (210 ILCS 85/6.75 new)
16 Sec. 6.75. Penalties for violations.
17 (a) A hospital that is found to be in violation of any
18 provision in Sections 6.50 through 6.65 is subject to any one
19 or more of the following penalties:
20 (1) Loss of licensure under this Act.
21 (2) A civil penalty of not more than $5,000 per day
22 for each day of a violation.
23 (3) Issuance of an order by a court of competent
24 jurisdiction to correct the violation.
25 (b) If the health of patients is threatened by the
26 violation, the Department may issue an order: to immediately
27 close the affected department or unit; to close the affected
28 unit or department, or the entire facility, to further
29 admissions or, in the case of an emergency room, to further
30 patients; or imposing a regulatory overseer for the facility,
31 department, or unit, with the overseer having the authority
32 to assign additional staff at the cost of the facility.
33 (c) If the Department finds that a violation was willful
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1 or that there have been repeated violations by a hospital,
2 the Department may impose a civil penalty, as provided in
3 subsection (a), against the chief executive officer of the
4 facility or the chief nursing officer of the facility, or
5 both.
6 (d) The Department may impose a civil penalty under this
7 Section only after notice and a hearing at which the hospital
8 is given an opportunity to present evidence concerning the
9 alleged violation.
10 (e) The Attorney General may bring a civil action to
11 enforce the collection of a civil penalty imposed under this
12 Section.
13 Section 999. Effective date. This Act takes effect upon
14 becoming law.