Title:77 Part:1100

PART 1100 NARRATIVE AND PLANNING POLICIES : Sections Listing

TITLE 77: PUBLIC HEALTH
CHAPTER II: HEALTH FACILITIES AND SERVICES REVIEW BOARD
SUBCHAPTER a: ILLINOIS HEALTH CARE FACILITIES PLAN
PART 1100 NARRATIVE AND PLANNING POLICIES

SUBPART A: GENERAL NARRATIVE

Section 1100.10 Introduction
Section 1100.20 Authority
Section 1100.30 Purpose
Section 1100.40 Health Maintenance Organizations (Repealed)
Section 1100.50 Subchapter Organization
Section 1100.60 Mandatory Reporting of Data
Section 1100.70 Data Appendices
Section 1100.75 Annual Bed Report
Section 1100.80 Institutional Master Plan - Hospitals (Repealed)
Section 1100.90 Public Hearings (Repealed)

SUBPART B: DEFINITIONS

Section 1100.210 Introduction
Section 1100.220 Definitions

SUBPART C: PLANNING POLICIES

Section 1100.310 Need Assessment
Section 1100.320 Staffing
Section 1100.330 Professional Education
Section 1100.340 Public Testimony (Repealed)
Section 1100.350 Multi-Institutional Systems
Section 1100.360 Modern Facilities
Section 1100.370 Occupancy/Utilization Standards
Section 1100.380 Systems Planning
Section 1100.390 Quality
Section 1100.400 Location
Section 1100.410 Needed Facilities
Section 1100.420 Discontinuation
Section 1100.430 Coordination with Other State Agencies
Section 1100.440 Requirements for Authorized Hospital Beds

SUBPART D: NEED ASSESSMENT

Section 1100.510 Introduction, Formula Components, Planning Area Development Policies, and Distance Determinations
Section 1100.520 Medical-Surgical Care and Pediatric Care
Section 1100.530 Obstetric Care Category of Service
Section 1100.540 Intensive Care Category of Service
Section 1100.550 Comprehensive Physical Rehabilitation Category of Service
Section 1100.560 Acute Mental Illness Treatment Category of Service
Section 1100.570 Substance Abuse/Addiction Treatment Category of Service (Repealed)
Section 1100.580 Neonatal Intensive Care Category of Service
Section 1100.590 Burn Treatment Category of Service (Repealed)
Section 1100.600 Therapeutic Radiology Equipment (Repealed)
Section 1100.610 Open Heart Surgery Category of Service
Section 1100.620 Cardiac Catheterization Services
Section 1100.630 In-Center Hemodialysis Category of Service
Section 1100.640 Non-Hospital Based Ambulatory Surgical Treatment Center Services – Category of Service
Section 1100.650 Computer Systems (Repealed)
Section 1100.660 General Long-Term Nursing Care Category of Service (Repealed)
Section 1100.661 General Long-Term Care-Sheltered Care Category of Service (Repealed)
Section 1100.670 Specialized Long-Term Care Categories of Service (Repealed)
Section 1100.680 Intraoperative Magnetic Resonance Imaging Category of Service (Repealed)
Section 1100.690 High Linear Energy Transfer (L.E.T) (Repealed)
Section 1100.700 Positron Emission Tomographic Scanning (P.E.T.) (Repealed)
Section 1100.710 Extracorporeal Shock Wave Lithotripsy (Repealed)
Section 1100.720 Selected Organ Transplantation
Section 1100.730 Kidney Transplantation
Section 1100.740 Subacute Care Hospital Model
Section 1100.750 Postsurgical Recovery Care Center Alternative Health Care Model
Section 1100.760 Children's Respite Care Center Alternative Health Care Model
Section 1100.770 Community-Based Residential Rehabilitation Center Alternative Health Care Model
Section 1100.800 Freestanding Emergency Center Medical Services Category of Service
Section 1100.810 Long-Term Acute Care Hospital Category of Service
Section 1100.APPENDIX A Applicable Codes and Standards Utilized in 77 Ill. Adm. Code: Chapter II, Subchapter a (Repealed)

AUTHORITY: Authorized by Section 12 of and implementing the Illinois Health Facilities Planning Act [20 ILCS 3960/12].

SOURCE: Fourth Edition adopted at 3 Ill. Reg. 30, p. 194, effective July 28, 1979; amended at 4 Ill. Reg. 4, p. 129, effective January 11, 1980; amended at 5 Ill. Reg. 4895, effective April 22, 1981; amended at 5 Ill. Reg. 10297, effective September 30, 1981; amended at 6 Ill. Reg. 3079, effective March 8, 1982; emergency amendments at 6 Ill. Reg. 6895, effective May 20, 1982, for a maximum of 150 days; amended at 6 Ill. Reg. 11574, effective September 9, 1982; Fifth Edition adopted at 7 Ill. Reg. 5441, effective April 15, 1983; amended at 8 Ill. Reg. 1633, effective January 31, 1984; codified at 8 Ill. Reg. 15476; amended at 9 Ill. Reg. 3344, effective March 6, 1985; amended at 11 Ill. Reg. 7311, effective April 1, 1987; amended at 12 Ill. Reg. 16079, effective September 21, 1988; amended at 13 Ill. Reg. 16055, effective September 29, 1989; amended at 16 Ill. Reg. 16074, effective October 2, 1992; amended at 18 Ill. Reg. 2986, effective February 10, 1994; amended at 18 Ill. Reg. 8448, effective July 1, 1994; emergency amendment at 19 Ill. Reg. 1941, effective January 31, 1995, for a maximum of 150 days; amended at 19 Ill. Reg. 2985, effective March 1, 1995; amended at 19 Ill. Reg. 10143, effective June 30, 1995; recodified from the Department of Public Health to the Health Facilities Planning Board at 20 Ill. Reg. 2594; amended at 20 Ill. Reg. 14778, effective November 15, 1996; amended at 21 Ill. Reg. 6220, effective May 30, 1997; expedited correction at 21 Ill. Reg. 17201, effective May 30, 1997; amended at 23 Ill. Reg. 2960, effective March 15, 1999; amended at 24 Ill. Reg. 6070, effective April 7, 2000; amended at 25 Ill. Reg. 10796, effective August 24, 2001; amended at 27 Ill. Reg. 2904, effective February 21, 2003; amended at 31 Ill. Reg. 15255, effective November 1, 2007; amended at 32 Ill. Reg. 4743, effective March 18, 2008; amended at 32 Ill. Reg. 12321, effective July 18, 2008; expedited correction at 33 Ill. Reg. 4040, effective July 18, 2008; amended at 34 Ill. Reg. 6067, effective April 13, 2010; amended at 35 Ill. Reg. 16978, effective October 7, 2011; amended at 36 Ill. Reg. 2542, effective January 31, 2012; amended at 38 Ill. Reg. 2822, effective February 1, 2014; amended at 42 Ill. Reg. 5410, effective March 7, 2018.

SUBPART A: GENERAL NARRATIVE

Section 1100.10 Introduction

This Subchapter a has been developed to provide the necessary criteria for the review of construction and modification projects submitted for health care facilities under the requirements of P.A. 78-1156, the Illinois Health Facilities Planning Act (the Act) [20 ILCS 3960]. The standards presented herein are designed to promote development of needed facilities and services, avoid duplication of services and prevent unnecessary construction. The statutory citations for all State and federal laws and regulations referenced in this subchapter may be found in the Appendices to 77 Ill. Adm. Code 1110.

(Source: Amended at 21 Ill. Reg. 6220, effective May 30, 1997)

Section 1100.20 Authority

This Part for health care facilities in Illinois is prepared and promulgated by authority granted to the Illinois Health Facilities and Services Review Board (State Board) under The Illinois Health Facilities Planning Act [20 ILCS 3960].

(Source: Amended at 42 Ill. Reg. 5410, effective March 7, 2018)

Section 1100.30 Purpose

This Part is developed in order to implement particular provisions and purposes of the Illinois Health Facilities Planning Act and is specifically designed to develop a procedure that:

a) establishes an orderly and comprehensive health care delivery system that will guarantee the availability of quality health care to the general public;

b) considers the projected impact on health care costs by evaluating financial and economic feasibility of proposed projects;

c) requires a person proposing to establish, construct, or modify a health care facility or acquire major medical equipment subject to this Subchapter to have the qualifications, background, character and financial resources to adequately provide a proper service for the community;

d) promotes through the process of comprehensive health planning the orderly and economic development of health care facilities in the State of Illinois to avoid unnecessary duplication of facilities or services; and

e) provides criteria for reviewing proposed projects and details projects to which this Subchapter applies.

(Source: Amended at 42 Ill. Reg. 5410, effective March 7, 2018)

Section 1100.40 Health Maintenance Organizations (Repealed)

(Source: Repealed at 13 Ill. Reg. 16055, effective September 29, 1989)

Section 1100.50 Subchapter Organization

Subchapter a is organized into two distinct Parts. The first (this Part 1100) details general plan requirements and the policies of the Illinois Health Facilities Planning Board which set the philosophical framework for review standards. The second Part (77 Ill. Adm. Code 1110) details how projects are classified and the specific review criteria utilized to evaluate projects.

Section 1100.60 Mandatory Reporting of Data

Sections 13 and 14.1 of the Act require all health care facilities operating in Illinois to provide data needed for planning. Section 14.1 provides authority for the State Board to impose fines for failure to provide requested information. In addition, Section 13 of the Act provides the following sanctions for failure to supply requested data:

a) Health facilities not complying with this requirement shall be reported to the appropriate licensing, accrediting and certifying agencies, both State and Federal.

b) Health facilities not complying with this requirement shall be reported to the appropriate third-party payors and other payment agencies; State, Federal and private.

(Source: Amended at 23 Ill. Reg. 2960, effective March 15, 1999)

Section 1100.70 Data Appendices

The State Board in conjunction with the Illinois Department of Public Health publishes data appendices at least once every three years that include Inventory of Health Care Facilities and Services and Need Determinations. Inventories contain facility capacity, need estimates, utilization and socio-economic information. Throughout the year, inventories (see 77 Ill. Adm. Code 1110) are updated on the 15^th day of each month (excluding holidays and weekends). Examples of changes included in the monthly update are: permits issued by the State Board; transactions such as a change of facility name or change in bed total; and declaratory rulings made by the State Board.

(Source: Amended at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.75 Annual Bed Report

a) For purposes of this Section, "initial" annual bed reports shall be those that are prepared for the first time after August 31, 2007. Each hospital shall be required to submit its initial report to IDPH within six months after August 31, 2007.

b) Each hospital shall report on its number of beds on an annual basis, in a format that includes:

1) Summary of bed count by operational status (i.e., physically available, reserve, and transitional) and category of service;

2) Identification of the physical location of patient care units (PCUs) and beds; and

3) If the report contains transitional beds, a description of the project and timetable for completion.

c) The annual bed report is to be certified as accurate by the hospital's Chief Executive Officer or his/her equivalent to the best of his/her knowledge. If an approved plan of correction is in place, the applicant shall submit a copy of that plan. In addition, the facility shall provide the Illinois Department of Public Health access to all files and information used in any reports submitted to HFSRB to verify the authenticity of previously submitted annual bed reports.

d) IDPH will review hospital bed reports and summarize reported changes from the existing Inventory of Hospital Beds. Changes to the Inventory of Hospital Beds will be submitted to HFSRB for its approval to be recorded.

e) Any changes in a health care facility's bed capacity, with or without permit, shall be in accordance with 77 Ill. Adm. Code 1130.

f) IDPH and HFSRB have the authority to conduct inspections and request additional documentation to verify the details of the submitted annual bed reports.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.80 Institutional Master Plan - Hospitals (Repealed)

(Source: Repealed at 12 Ill. Reg. 16079, effective September 21, 1988)

Section 1100.90 Public Hearings (Repealed)

(Source: Repealed at 42 Ill. Reg. 5410, effective March 7, 2018)

SUBPART B: DEFINITIONS

Section 1100.210 Introduction

The definitions related to this Subchapter a are listed in this Subpart. Additional definitions pertaining to this Subchapter are contained in the Act, as well as in other State Board rules such as 77 Ill. Adm. Code 1130. If there is disagreement on the applicability of any definition contained in this Subpart, the Administrator shall decide the matter. The decision may be appealed to the State Board pursuant to the declaratory ruling provisions of 77 Ill. Adm. Code 1130.

(Source: Amended at 42 Ill. Reg. 5410, effective March 7, 2018)

Section 1100.220 Definitions

"Act" means the Illinois Health Facilities Planning Act [20 ILCS 3960].

"Acute Dialysis" means dialysis given on an intensive care, inpatient basis to patients suffering from (presumably reversible) acute renal failure, or to patients with chronic renal failure with serious complications.

"Acute Mental Illness" means a crisis state or an acute phase of one or more specific psychiatric disorders in which a person displays one or more specific psychiatric symptoms of such severity as to prohibit effective functioning in any community setting. Persons who are acutely mentally ill may be admitted to an acute mental illness facility or unit under the provisions of the Mental Health and Developmental Disabilities Code [405 ILCS 5], which determines the specific requirements for admission by age and type of admission.

"Acute Mental Illness Facility" or "Acute Mental Illness Unit" means a facility or a distinct unit in a facility that provides a program of acute mental illness treatment service (as defined in this Section); that is designed, equipped, organized and operated to deliver inpatient and supportive acute mental illness treatment services; and that is licensed by the Department of Public Health under the Hospital Licensing Act [210 ILCS 85] or is a facility operated or maintained by the State or a State agency.

"Acute Mental Illness Treatment Service" means a category of service that provides a program of care for those persons suffering from acute mental illness. These services are provided in a highly structured setting in a distinct psychiatric unit of a general hospital, in a private psychiatric hospital, or in a State-operated facility to individuals who are severely mentally ill and in a state of acute crisis, in an effort to stabilize the individual and either effect his or her quick placement in a less restrictive setting or reach a determination that extended treatment is needed. Acute mental illness is typified by an average length of stay of 45 days or less for adults and 60 days or less for children and adolescents.

"Administrative Perinatal Center" or "APC" means a referral facility designated under the Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640) and intended to care for the high risk patient before, during or after labor and delivery and characterized by sophistication and availability of personnel, equipment, laboratory, transportation techniques, consultation and other support services. [410 ILCS 250/2(e)] An APC is a university or university-affiliated facility designated by the Department of Public Health that has a Level III hospital and is responsible for providing leadership and oversight of the Department of Public Health's regionalized perinatal health care program, including continuing education for health professions.

"Admissions" means the number of patients accepted for inpatient service during a 12-month period; newborns are not included.

"Adult Catheterization" means the cardiac catheterization of patients 15 years of age and older.

"Adverse Action" means a disciplinary action taken by Illinois Department of Public Health, Centers for Medicare and Medicaid Services, or any other State or federal agency against a person or entity that owns and/or operates a licensed or Medicare or Medicaid certified healthcare facility in the State of Illinois. These actions include, but are not limited to, all Type A violations. A "Type A" violation means a violation of the Nursing Home Care Act or 77 Ill. Adm. Code 300, 330, 340, 350 or 390 that creates a condition or occurrence relating to the operation and maintenance of a facility presenting a substantial probability that death or serious mental or physical harm to a resident will result therefrom. [210 ILCS 45/1-129]

"Agency", "Department" or "IDPH" means the Illinois Department of Public Health. [20 ILCS 3960/3]

"Ambulatory Care" means all types of health care services that are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services that do not require an overnight stay. (Source: Glossary of Terms Commonly Used in Health Care (Illinois Health and Hospital Association, 1151 East Warrenville Road, PO Box 3015, Naperville IL 60566, 630/276-5400; 2004, no later amendments or editions included)).

"Ambulatory Surgical Treatment Center" or "ASTC" means any institution, place or building required to be licensed pursuant to the Ambulatory Surgical Treatment Center Act [210 ILCS 5].

"Authorized Hospital Bed Capacity" means the number of beds recognized for planning purposes at a hospital facility, as determined by HFSRB. The operational status of authorized hospital beds is identified as physically available, reserve, or transitional, as follows:

"Physically Available Beds" means beds that are physically set up, meet hospital licensure requirements, and are available for use. These are beds maintained in the hospital for the use of inpatients and that furnish accommodations with supporting services (such as food, laundry, and housekeeping). These beds may or may not be staffed, but are physically available.

"Reserve Beds" means beds that are not set up for inpatients, but could be made physically available for inpatient use within 72 hours.

"Transitional Beds" means beds for which a Certificate of Need (CON) has been issued, but that are not yet physically available, and beds that are temporarily unavailable due to modernization projects that do not require a CON.

"Authorized Long-Term Care Bed Capacity" means the number of beds by category of service, recognized and licensed by IDPH for long-term care.

"Average Daily Census" or "ADC" means over a 12-month period the average number of inpatients receiving service on any given day.

"Average Length of Stay" or "ALOS" means over a 12-month period the average duration of inpatient stay expressed in days as determined by dividing total inpatient days by total admissions.

"Base Year" means the calendar year, as determined by IDPH, that serves as the starting point or benchmark for the historical utilization and population projections.

"Birth Center" or "Center" means an alternative health care delivery model that is exclusively dedicated to serving the childbirth-related needs of women and their newborns and has no more than 10 beds. A birth center is a designated site that is away from the mother's usual place of residence and in which births are planned to occur following a normal, uncomplicated, and low-risk pregnancy. [210 ILCS 3/35]

"Board Certified or Board Eligible Physician" means a physician who has satisfactorily completed an examination (or is "eligible" to take such examination) in a medical specialty and has taken all of the specific training requirements for certification by a specialty board. For purposes of this definition, "medical specialty" shall mean a specific area of medical practice by health care professionals.

"Cardiac Catheterization Category of Service" means, for the purposes of this Part, the performance of catheterization procedures that, due to safety and quality considerations, are preferably performed within a cardiac catheterization laboratory or special procedure room. Procedures that do not require the use of such specialized settings, such as pericardiocentesis, myocardial biopsy, cardiac pacemaker insertion or replacement, right heart catheterization with a flow-directed catheter (e.g., Swan-Ganz catheter), intra-aortic balloon pump assistance with intra-aortic balloon catheter placement, certain types of electrophysiology, arterial pressure or blood gas monitoring, fluoroscopy, and cardiac ultrasound, are not recognized as procedures that, under this Subchapter, would in and of themselves qualify a facility as having a cardiac catheterization category of service.

"Cardiac Surgeon" means a physician board eligible or board certified by the American Board of Thoracic Surgery.

"Cardiac Surgery Room" means a physically identifiable room adequately staffed and equipped for the performance of open and closed heart surgery and extracorporeal bypass.

"Cardiological Team" means the designated specialists and support personnel who consistently work together in the performance of open heart surgery.

"Cardiovascular Surgical Procedures" means any surgical procedure dealing with the heart, coronary arteries and surgery of the great vessels.

"Cardiovascular Surgical Services" means the programs, equipment and staff dealing with the surgery of the heart, coronary arteries and great vessels.

"Category of Service" means a grouping by generic class of various types or levels of support functions, equipment, care or treatment provided to patient/residents. Examples include but are not limited to medical-surgical, pediatrics, cardiac catheterization, etc. A category of service may include subcategories or levels of care that identify a particular degree or type of care within the category of service.

"Chronic Renal Dialysis" means a category of service in which dialysis is performed on a regular long-term basis in patients with chronic irreversible renal failure. The maintenance and preparation of patients for kidney transplantation (including the immediate post-operative period and in case of organ rejection) or other acute conditions within a hospital does not constitute a chronic renal dialysis category of service.

"Clinical Encounter Time" means an instance of direct provider/practitioner to patient interaction, between a patient and a practitioner vested with primary responsibility for diagnosing, evaluating or treating the patient's condition, or both. The clinical encounter definition excludes practitioner actions in the absence of a patient, such as practitioner to practitioner interaction and practitioner to records interaction.

"Closed Heart Surgery" means any cardiovascular surgical procedures that do not include the use of a heart/lung pump.

"Combined Maternity and Gynecological Unit" means an entire facility or a distinct part of a facility that provides both a program of maternity care (as defined in this Section) and a program of obstetric gynecological care (as defined in this Section), and that is designed, equipped, organized and operated in accordance with the requirements of the Hospital Licensing Act [210 ILCS 85].

"Community-Based Residential Rehabilitation" means services that include, but are not limited to, case management, training and assistance with activities of daily living, nursing consultation, traditional therapies (physical, occupational, speech), functional interventions in the residence and community (job placement, shopping, banking, recreation), counseling, self-management strategies, productive activities, and multiple opportunities for skill acquisition and practice throughout the day. [210 ILCS 3/35]

"Community-Based Residential Rehabilitation Center" means a designated site that provides rehabilitation or support, or both, for persons who have experienced severe brain injury, who are medically stable, and who no longer require acute rehabilitative care or intense medical or nursing services. The average length of stay in a community-based residential rehabilitation center shall not exceed 4 months. [210 ILCS 3/35]

"Comprehensive Physical Rehabilitation" means a category of service provided in a comprehensive physical rehabilitation facility providing the coordinated interdisciplinary team approach to physical disability under a physician licensed to practice medicine in all its branches who directs a plan of management of one or more of the classes of chronic or acute disabling disease or injury. Comprehensive physical rehabilitation services can be provided only by a comprehensive physical rehabilitation facility.

"Comprehensive Physical Rehabilitation Facility" means a distinct bed unit of a hospital or a special referral hospital that provides a program of comprehensive physical rehabilitation; that is designed, equipped, organized and operated to deliver inpatient rehabilitation services; and that is licensed by the Department of Public Health under the Hospital Licensing Act or is a facility operated or maintained by the State or a State agency. Types of comprehensive physical rehabilitation facilities include:

"Freestanding comprehensive physical rehabilitation facility" means a specialty hospital dedicated to the provision of comprehensive rehabilitation; and

"Hospital-based comprehensive physical rehabilitation facility" means a distinct unit, located in a hospital, dedicated to the provision of comprehensive physical rehabilitation.

"Dedicated Cardiac Catheterization Laboratory" means a distinct laboratory that is staffed, equipped and operated solely for the provision of cardiac catheterization.

"Designated Pediatric Beds" means beds within the facility that are primarily used for pediatric patients and are not a component part of a distinct pediatric unit as defined in this Section.

"Dialysis" means a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another across a semi-permeable membrane. [210 ILCS 62/5] The two types of dialysis that are recognized in classical practice are hemodialysis and peritoneal dialysis.

"Dialysis Technician" means an individual who is not a registered nurse or physician and who provides dialysis care under the supervision of a registered nurse or physician. [210 ILCS 62/5]

"Discontinuation" means to cease operation of an entire health care facility or to cease operation of a category of service and is further defined in 77 Ill. Adm. Code 1130.

"Distinct Unit" means a physically distinct area comprising all beds served by a nursing station in which a particular category of service is provided and utilizing a nursing staff assigned exclusively to the distinct area.

"DRG" means diagnostic related groups utilized in the Medicare and Medicaid programs for health care reimbursement.

"Emergency Medical Services System" or "EMS System" means an organization of hospitals, vehicle service providers and personnel approved by IDPH in a specific geographic area, which coordinates and provides pre-hospital and inter-hospital emergency care and non-emergency medical transports at a BLS, ILS, and/or ALS level pursuant to a System program plan submitted to and approved by IDPH, and pursuant to the EMS Region Plan adopted for the EMS Region in which the System is located. [210 ILCS 50/3.20]

"Emergent Care" means medical or surgical procedures and care provided to those patients treated in an emergency department (ED) of a hospital or freestanding emergency center who have traumatic conditions or illnesses with an acuity level that is classified as level one or level two based upon the Emergency Severity Index (ESI) as defined in the "Emergency Severity Index Version 4: Implementation Handbook" published by the Agency for Healthcare Research and Quality, Rockville MD (Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR; AHRQ Publication No. 05-0046-2; May 2005, no later amendments or editions included).

"End Stage Renal Disease" or "ESRD" means that stage of renal impairment that appears irreversible and permanent and that requires a regular course of dialysis or kidney transplantation to maintain life. [210 ILCS 62/5]

"End Stage Renal Disease Facility" means a freestanding facility or a unit within an existing health care facility that furnishes in-center hemodialysis treatment and other routine dialysis services to end stage renal disease patients. These types of services may include self-dialysis, training in self-dialysis, dialysis performed by trained professional staff, and chronic maintenance dialysis, including peritoneal dialysis.

"Extracorporeal Circulation" or "Bypass" means, for the purpose of open heart surgery category of service, the circulation of blood outside the body, as through a heart/lung apparatus for carbon dioxide-oxygen exchange.

"Federally Qualified Health Center" means a health center funded under section 330 of the Public Health Service Act (42 USC 254b).

"Fertility Rate" means determinations by IDPH of population fertility that is based upon resident birth data for an area. The fertility rate data sources include:

• birth data from the Division of Vital Records by age of mother and by county; and

• population figures from IDPH estimates for females age 15-44 by county.

"Freestanding Emergency Center" or "FEC" means a facility subject to licensure under Section 32.5 of the Emergency Medical Services (EMS) Systems Act [210 ILCS 50/32.5] that provides emergency medical and related services.

"Freestanding Emergency Center Medical Services" or "FECMS" means a category of service pertaining to the provision of emergency medical and related services provided in a freestanding emergency center.

"General Long-Term Care" means a classification of categories of service that provide inpatient levels of care primarily for convalescent or chronic disease adult patients/residents who do not require specialized long-term care services. The General Long-Term Care Classification includes the nursing category of service, which provides inpatient treatment for convalescent or chronic disease patients/residents and includes the skilled nursing level of care and/or the intermediate nursing level of care (both as defined in IDPH's Skilled Nursing and Intermediate Care Facilities Code (77 Ill. Adm. Code 300)).

"HFSRB" or "State Board" means the Health Facilities and Service Review Board established by the Act.

"Health Professional Shortage Areas" means urban or rural areas, population groups, or medical or other public facilities that may have shortages of primary medical care, dental or mental health providers, as determined by HHS' Shortage Designation Branch in the Health Resources and Services Administration (HRSA) Bureau of Health Professions National Center for Health Workforce; and as determined by the Illinois Designation of Shortage Areas (77 Ill. Adm. Code 590.410).

"Health Service Area" or "HSA" means the following geographic areas:

HSA I – Illinois Counties of Boone, Carroll, DeKalb, Jo Daviess, Lee, Ogle, Stephenson, Whiteside, and Winnebago

HSA II – Illinois Counties of Bureau, Fulton, Henderson, Knox, LaSalle, Marshall, McDonough, Peoria, Putnam, Stark, Tazewell, Warren, and Woodford

HSA III – Illinois Counties of Adams, Brown, Calhoun, Cass, Christian, Greene, Hancock, Jersey, Logan, Macoupin, Mason, Menard, Montgomery, Morgan, Pike, Sangamon, Schuyler, and Scott

HSA IV – Illinois Counties of Champaign, Clark, Coles, Cumberland, DeWitt, Douglas, Edgar, Ford, Iroquois, Livingston, Macon, McLean, Moultrie, Piatt, Shelby, and Vermilion

HSA V – Illinois Counties of Alexander, Bond, Clay, Crawford, Edwards, Effingham, Fayette, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jasper, Jefferson, Johnson, Lawrence, Marion, Massac, Perry, Pope, Pulaski, Randolph, Richland, Saline, Union, Wabash, Washington, Wayne, White, and Williamson

HSA VI – City of Chicago

HSA VII – DuPage County and Suburban Cook County

HSA VIII – Illinois Counties of Kane, Lake, and McHenry

HSA IX – Illinois Counties of Grundy, Kankakee, Kendall, and Will

HSA X – Illinois Counties of Henry, Mercer, and Rock Island

HSA XI – Illinois Counties of Clinton, Madison, Monroe, and St. Clair

"Hematocrit" means a measure of the packed cell volume of red blood cells expressed as a percentage of total blood volume.

"Hemodialysis" means a type of dialysis that involves the use of artificial kidney through which blood is circulated on one side of a semi-permeable membrane while the other side is bathed by a salt dialysis solution. The accumulated toxic products diffuse out of the blood into the dialysate bath solution. The concentration and total amount of water and salt in the body fluid are adjusted by appropriate alterations in composition of the dialysate fluid.

"Home Hemodialysis" means a type of dialysis that is done at home by the patient and a partner. Both are trained in the dialysis facility until the patient and partner become proficient to dialyze at home. The dialysis is usually three times per week.

"Home-Assisted Hemodialysis" means hemodialysis done in a home and/or long term care setting through a staff-assisted program. The patient is not trained to do dialysis himself/herself.

"Hospital" means a facility, institution, place or building licensed pursuant to or operated in accordance with the Hospital Licensing Act [210 ILCS 45] or a State-operated facility that is utilized for the prevention, diagnosis and treatment of physical and mental ills. For purposes of this Subchapter, two basic types of hospitals are recognized:

General Hospital – a facility that offers an integrated variety of categories of service and that offers and performs scheduled surgical procedures on an inpatient basis.

Special or Specialized Hospital – a facility that offers, primarily, a special or particular category of service.

"In-Center Hemodialysis" means a category of service that is provided in an end stage renal disease facility licensed by the State of Illinois and/or certified by the Centers for Medicare and Medicaid Services.

"In-Center Hemodialysis Treatment" means a regimen of hemodialysis received by a patient usually three times a week, averaging four hours.

"Independent Travel Time Studies" means studies developed and submitted to refine or supplement the determination of Normal Travel Time. Independent Travel Time studies will be considered by HFSRB only if conducted utilizing the criteria specified in this Part.

"Index of Medically Underserved" or "IMU" means shortage designation criteria applied to determine Medically Underserved Area or Medically Underserved Population designation. The four variables of the IMU are ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over (Source: Health Resources and Services Administration Bureau of Health Professions website (http://bhpr.hrsa.gov)).

"Intensive Care Service" means a category of service providing the coordinated delivery of treatment to the critically ill patient or to patients requiring continuous care due to special diagnostic considerations requiring extensive monitoring of vital signs through mechanical means and through direct nursing supervision. This service is given at the direction of a physician on behalf of patients by physicians, dentists, nurses, and other professional and technical personnel. The intensive care category of service includes the following subcategories: medical ICU, surgical ICU, coronary care, pediatric ICU, and combinations of such ICUs. This category of service does not include intermediate intensive or coronary care and special care units that are included in the medical-surgical category of service.

"Intensive Care Unit" or "ICU" means a distinct part of a facility that provides a program of intensive care service; that is designed, equipped, organized and operated to deliver optimal medical care for the critically ill or for patients with special diagnostic conditions requiring specialized equipment, procedures and staff; and that is under the direct visual supervision of a nursing staff. Prior to February 15, 2003, the repeal of 77 Ill. Adm. Code 1110.1010, 1110.1020 and 1110.1030, the beds and corresponding utilization for the burn treatment category of service were included in the intensive care category of service.

"Inventory of Health Care Facilities and Services and Need Determinations" means a statewide inventory of beds and other services, and need determinations that HFSRB shall maintain and update on the Board's website, as mandated in the Health Facilities Planning Act. (See Section 12(4) of the Act.)

"Key Room" means a term used in space planning to designate the primary functional component of a department used to develop a space program or estimate of square feet for that department. Examples of key rooms include, but are not limited to, examination rooms for ambulatory care, operating rooms for surgical suites, treatment stations for dialysis, imaging rooms for radiology.

"Kidney Transplantation Center" means a hospital that directly furnishes transplantation and other medical and surgical specialty services required for the care of the kidney transplant patient, including inpatient dialysis furnished directly or under arrangement.

"Kidney Transplantation Service" means a category of service that involves the surgical replacement of a nonfunctioning human kidney with a donor kidney in order to restore renal function to the patient.

"Maternity Care" means a subcategory of obstetric service related to the medical care of the patient prior to and during the act of giving birth either to a living child or to a dead fetus and to the continuing medical care of both patient and newborn infant under the direction of a physician, by physicians, nurses, and other professional and technical personnel.

"Maternity Facility" or "Maternity Unit" means an entire facility or a distinct part of a facility that provides a program of maternity and newborn care and that is designed, equipped, organized, and operated in accordance with the requirements of the Hospital Licensing Act.

"Medically Underserved Areas" means a whole county or a group of contiguous counties, or a group of county or civil divisions, or a group of urban census tracts in which residents have a shortage of personal health services, as determined by HHS' Shortage Designation Branch in the Health Resources and Services Administration (HRSA) Bureau of Health Professions National Center for Health Workforce.

"Medically Underserved Populations" means groups of persons who face economic, cultural or linguistic barriers to health care, as determined by HHS' Shortage Designation Branch in the Health Resources and Services Administration (HRSA) Bureau of Health Professions National Center for Health Workforce.

"Medical-Surgical Service" means a category of service pertaining to the medical-surgical inpatient care performed at the direction of a physician, by physicians, dentists, nurses and other professional and technical personnel. For purposes of 77 Ill. Adm. Code Chapter II, Subchapter a (Illinois Health Care Facilities Plan), this category of service may include medical-surgical and their respective sub-specialties of service. The medical-surgical category of service specifically does not include the following other separate categories of service and their subcategories:

Obstetric Service;

Pediatric Service;

Intensive Care Service;

Comprehensive Physical Rehabilitation Service;

Acute and Chronic Mental Illness Treatment Service;

Neonatal Intensive Care Service;

General Long-Term Care Service;

Specialized Long-Term Care Service;

Long-Term Acute Care Service.

"Medical-Surgical Unit" means an assemblage of inpatient beds and related facilities in which medical-surgical services are provided to a defined and limited class of patients according to their particular medical care needs.

"Modernization" means modification of an existing health care facility by means of building, alteration, reconstruction, remodeling, replacement and/or expansion, the erection of new buildings, or the acquisition, alteration or replacement of equipment. Modification does not include a substantial change in either the bed count or scope of the facility.

"Neonatal Intensive Care" means a level of care providing constant and close medical coordination, multi-disciplinary consultation and supervision to those neonates with serious and life threatening developmental or acquired medical and surgical problems that require highly specialized treatment and highly trained nursing personnel.

"Neonatal Intensive Care Service" means a category of service providing treatment of the infant for problems identified in the neonatal period that warrant intensive care. An intensive neonatal care service must include a related obstetric service for care of the high-risk mother (except when the facility is dedicated to the care of children).

"Neonatal Intensive Care Unit" means a distinct part of a facility that provides a program of intensive neonatal care and that is designed, equipped and operated to deliver medical and surgical care to high-risk infants.

"Neonatologist" means a physician who is certified by the American Board of Pediatrics Subboard of Neonatal-Perinatal Medicine or a licensed osteopathic physician with equivalent training and experience and certified by the American Osteopathic Board of Pediatricians.

"Newborn Nursery Level I", "Newborn Nursery Level II", "Newborn Nursery Level II with Extended Neonatal Capabilities" and "Newborn Nursery Level III" mean designations for hospitals providing newborn health care as defined and listed in the Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640).

"Non-Hospital Based Ambulatory Surgery" means a category of service relating to surgery that is performed at ambulatory surgical treatment centers on patients that arrive and are discharged the same day. Ambulatory surgery as the provision of surgical services may require anesthesia or a period of post-operative observation or both on a patient whose inpatient stay is not anticipated as being medically necessary.

"Non-emergent Care" means medical or surgical procedures and care provided to those patients treated in an emergency department (ED) of a hospital or freestanding emergency center who have conditions or illnesses that are not classified as level one or level two based upon the Emergency Severity Index.

"Observation Days" means the number of days of service provided to outpatients for the purpose of determining whether a patient requires admission as an inpatient or other treatment.

"Obstetric/Gynecological Care" means a subcategory of obstetric service in which medical care is provided to clean (non-infectious) gynecological, surgical or medical cases that are admitted to a postpartum section of an obstetric unit in accordance with the requirements of the Hospital Licensing Act.

"Obstetric Service" means a category of service pertaining to the medical or surgical care of maternity and newborn patients or medical or surgical cases that may be admitted to a postpartum unit

"Occupancy Rate" means a measure of inpatient health facility use, determined by dividing average daily census by the number of authorized beds. It measures the average percentage of a facility's beds occupied and may be institution-wide or specific for one department or service.

"Occupancy Target" means a utilization level established by IDPH for a facility or service reflecting adequate access as well as operational efficiency.

"Open Heart Surgery" means a category of service that utilizes any form of cardiac surgery that requires the use of extracorporeal circulation and oxygenation. The use of a pump during the procedure distinguishes "open heart" from "closed heart" surgery.

"Operating Room (Class B)" or "Surgical Procedure Room (Class B)" means a setting designed and equipped for major or minor surgical procedures performed in conjunction with oral, parenteral or intravenous sedation or under analgesic or dissociative drugs. (Source: Guidelines for Optimal Ambulatory Surgical Care and Office-based Surgery, third edition, American College of Surgeons, 633 N. Saint Clair Street, Chicago IL 60611-3211, 312/202-5000; 2000, no later amendments or editions included)

"Operating Room (Class C)" means a setting designed and equipped for major surgical procedures that require general or regional block anesthesia and support of vital bodily functions. (Source: Guidelines for Optimal Ambulatory Surgical Care and Office-based Surgery, third edition, American College of Surgeons, 633 N. Saint Clair Street, Chicago IL 60611-3211, 312/202-5000; 2000, no later amendments or editions included)

"Out-of-Home Respite Care" means care provided in a facility setting to a clinically stable individual whose medical condition does not require major diagnostic procedures or therapeutic interventions and who normally receives care in a home environment for the purposes of providing a respite to the caregiver from the responsibilities of providing the care.

"Patient Care Unit" means the grouping of beds to provide an inpatient category of service. Units are physically identifiable areas that are staffed to provide all care required for particular service.

"Patient Days" means the total number of days of service provided to inpatients over a 12-month period, usually expressed as annual patient days measured. This figure includes observation days if the observation patient occupies a bed that is included in IDPH's Inventory of Health Care Facilities and Services and Need Determinations.

"Patient Migration" means the total number of patients who reside in a given planning area but receive services at health care facilities located in another planning area for a given year. Patient migration is determined by utilizing the latest available patient origin data concerning admissions to health care facilities by various categories of service for a given year. The term in-migration refers to the number of patients who are not residents of a planning area that enter the area to receive services, while the term out-migration refers to the number of planning area residents who leave the planning area to obtain services elsewhere.

"Pediatric Catheterization" means the cardiac catheterization of patients zero to 14 years in age.

"Pediatric Facility" or "Distinct Pediatric Unit" means an entire facility or a distinct unit of a facility, where the nurses' station services only that unit, that provides a program of pediatric service and is designed, equipped, organized and operated to render medical-surgical care to the zero to 14 age population.

"Pediatric Service" means a category of service for the delivery of treatment pertaining to the non-intensive medical-surgical care of a pediatric patient (zero to 14 years in age) performed at the direction of a physician on behalf of the patient by physicians, dentists, nurses and other professional and technical personnel.

"Perinatal Center" means a referral facility designated under the Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640) and intended to care for the high risk patient before, during or after labor and delivery and characterized by sophistication and availability of personnel, equipment, laboratory, transportation techniques, consultation and other support services. "Perinatal Center" is further defined in the Developmental Disability Prevention Act [410 ILCS 250/2(e)].

"Peritoneal Dialysis" means a type of dialysis in which the dialysate fluid is infused slowly into the peritoneum, causing dialysis of water and waste products to occur through the peritoneal sac, which acts as a semi-permeable membrane. The fluid and waste, after accumulating for a period of time (one hour), is drained from the abdomen and the process is repeated.

"Planning Area" means a defined geographic area within the State established by HFSRB as a basis for the collection, organization, and analysis of information to determine health care resources and needs and to serve as a basis for planning.

"Population Estimates" means the latest available numbers of residents of a geographic area based upon birth and death records and other inputs, as determined by IDPH. These numbers may be further broken down by age and sex cohorts.

"Population Projections" means the numbers of residents of a geographic area projected for one or more future time periods, as determined by IDPH and based upon State of Illinois population projections, as available. These numbers are for defined geographic areas and may be further broken down by age and sex cohorts.

"Post-Anesthesia Recovery Phase I" means the phase in surgical recovery that focuses on providing a transition from a totally anesthetized state to one requiring less acute interventions. Recovery occurs in the post-anesthesia care unit (PACU). The purpose of this phase is for patients to regain physiological homeostasis and receive appropriate nursing intervention as needed.

"Post-Anesthesia Recovery Phase II" means the phase in surgical recovery that focuses on preparing the patient for self care, care by family members, or care in an extended care environment. The patient is discharged to phase II recovery when intensive nursing care no longer is needed. In the phase II area, sometimes referred to as the step-down or discharge area, the patient becomes more alert and functional.

"Postsurgical Recovery Care Center" means a designated site which provides postsurgical recovery care for generally healthy patients undergoing surgical procedures that require overnight nursing care, pain control, or observation that would otherwise be provided in an inpatient setting. Such a center may be either freestanding or a defined unit of an ambulatory surgical treatment center or hospital. The maximum length of stay for patients in a postsurgical recovery care center is not to exceed 72 hours. (Section 35 of the Alternative Health Care Delivery Act [210 ILCS 3/35])

"Postsurgical Recovery Care Center Alternative Health Care Model" means a category of service for the provision of postsurgical recovery care within a postsurgical recovery care center.

"Pre-Dialysis" means that the initiation of hemodialysis therapy is anticipated within 12 months.

"Pump Procedures" means the utilization of a heart/lung pump in surgery to perform the work of the heart and lungs. Included in these procedures are myocardiac revascularization, aortic and mitral valve replacement, ventricular aneurysm repairs, pulmonary valvuloplasty, and all other procedures utilizing a cardiac pump.

"Quality of Care", for purposes of 77 Ill. Adm. Code 1110.110, the degree to which delivered health services meet established professional standards and are judged to be of value to the consumer. Quality may also be seen as the degree to which actions taken or not taken maximize the probability of beneficial health outcomes and minimize risk and other outcomes, given the existing state of medical science and art. (Source: "A Glossary of Terms for Community Health Care and Services for Older Persons", World Health Organization Centre for Health Development, 5-1, 1-chome, Wakinohama-Kaigandori, Chuo-Ku, Kobe 651-0073 Japan, tel. +81 78 230 3100; 2004, no later amendments or editions included)

"Rapid Population Growth Rate" means an average of the three most recent annual growth rates of a defined geographic area's population that has exceeded the average of three to seven immediately preceding annual growth rates by at least 100%.

"Renal Dialysis Facility" means a freestanding facility, or a unit within an existing health care facility, that furnishes routine chronic dialysis services to chronic renal disease patients. Routine services are self-dialysis, training in self-dialysis, dialysis performed by trained professional staff, and chronic maintenance dialysis, including peritoneal dialysis.

"Resource Hospital" means the hospital that is responsible for an Emergency Medical Services (EMS) System in a specific geographic region, as defined in the Emergency Medical Services (EMS) Systems Act [210 ILCS 50].

"Selected Organ Transplantation Center" means a hospital that provides staffing and other adult or pediatric medical and surgical specialty services required for the care of a transplant patient.

"Selected Organ Transplantation Service" means a category of service relating to the surgical transplantation of any of the following human organs: heart, lung, heart-lung, liver, pancreas or intestine. It does not include bone marrow or cornea transplants.

"Self-Care Dialysis" or "Self-Dialysis" means maintenance dialysis performed by a trained patient in a special facility with or without the assistance of a family member or other helper.

"Self-Care Dialysis Training" means a program that trains patients or their helpers, or both, to perform self-care dialysis in the in-center setting.

"Site" means the location of an existing or proposed facility. An existing facility site is determined by street address. In a proposed facility the legal property description or the street address can be used to identify the site.

"Special Procedures Laboratory with a Cardiac Catheterization Service" means a special procedures or angiography laboratory that has the equipment, staff and support services required to provide cardiac catheterization and in which catheterizations are routinely performed. The laboratory is also utilized for other procedures, such as angiography, not directly related to cardiac catheterization.

"Specialized Long-Term Care" means a classification consisting of categories of service that provide inpatient care primarily for children (ages zero through 21) or inpatient care for adults who require specialized treatment and care because of mental or developmental disabilities. The Specialized Long-Term Care Classification includes the following categories of services:

Chronic Mental Illness (MI) − levels of care provided to severely mentally ill clients in a structured setting in a psychiatric unit of a general hospital, in a private psychiatric hospital, or in a State-operated facility primarily in order to facilitate the improvement of their functioning level, to prevent further deterioration of their functioning level, or, in some instances, to maintain their current level of functioning.

Long-Term Care for the Developmentally Disabled (Adult) (DD-Adult) − levels of care for developmentally disabled adults as defined in the Illinois Mental Health and Developmental Disabilities Code [405 ILCS 5] (including those facilities licensed as Intermediate Care Facilities for the Developmentally Disabled (ICF/DD)) that provide an integrated, individually tailored program of services for developmentally disabled adults and that provide an active, aggressive and organized program of services directed toward achieving measurable behavioral and learning objectives.

Long-Term Care for the Developmentally Disabled (Children) (DD‑Children) − levels of care for developmentally disabled children limited to those residents ages zero through 21 years and whose condition meets the definition of developmental disabilities in the Illinois Mental Health and Developmental Disabilities Code.

"Subacute Care" means the provision of medical specialty care for patients who need a greater intensity or complexity of care than generally provided in a skilled nursing facility but who no longer require acute hospital care. Subacute care includes physician supervision, registered nursing and physiological monitoring on a continual basis. (Section 35 of the Alternative Health Care Delivery Act [210 ILCS 3/35])

"Subacute Care Hospital" means a designated site that provides medical specialty care for patients who need a greater intensity or complexity of care than generally provided in a skilled nursing facility but who no longer require acute hospital care. The average length of stay for patients treated in subacute care hospitals shall not be less than 20 days; for individual patients, the expected length of stay at the time of admission shall not be less than 10 days. A subacute care hospital is either a freestanding building or a distinct physical and operational entity within a hospital or nursing home building. A subacute care hospital shall only consist of beds currently existing in licensed hospitals or skilled nursing facilities. (Section 35 of the Alternative Health Care Delivery Act)

"Subacute Care Hospital Model" means a category of service for the provision of subacute care.

"Surgical Referral Site" means an ambulatory surgical treatment center or hospital in which surgery will be performed and the surgical patient then transferred to the recovery care center.

"Teaching Institution" means, for the purpose of selected organ transplantation category of service, a hospital having a major relationship with a medical school as defined and listed in the Directory of Residency Training Programs developed by the American Medical Association and the National Organ Procurement and Transplantation Network (AMA, 535 N. Dearborn, Chicago IL 60610, 312/751-6079; 2009-2010, no later amendments or editions included).

"Urea" means the chief product of urine and the final product of protein metabolism in the body.

"Urea Reduction Ratio" or "URR" means the amount of blood cleared of urea during dialysis. It is reflected by the ratio of the measured level of urea before dialysis and urea remaining after dialysis. The larger the URR, the greater the amount of urea removed during the dialysis treatment.

"Use Rate" means the ratio of inpatient days per 1,000 population over a 12-month period (Inpatient Days/Population in Thousands = Use Rate). For need assessment purposes, HFSRB may establish minimum or maximum use rates in order to promote the development of additional resources or to limit unnecessary duplication of services and beds in a planning area.

"Utilization Standards" means an operational target for facilities or services that may demonstrate operational efficiencies, minimum proficiency or other performance parameters. Utilization standards and their purposes are established by category of service. Utilization may be expressed by various ratios, such as facility or bed service occupancy rates or hours of use for types of equipment, operating rooms, dialysis stations, etc.

(Source: Amended at 42 Ill. Reg. 5410, effective March 7, 2018)

SUBPART C: PLANNING POLICIES

Section 1100.310 Need Assessment

a) The State Board in its evaluation of proposed projects must consider if a proposed project best meets the needs of an area population. Need equations which are presented in this subchapter consider such factors as demand, population growth, incidence and state and federal facility utilization.

b) Need estimates thus derived reflect the conceptual baseline for determining if proposed projects are needed. Specific need equations are presented in Subpart D of this Part.

c) Provision is made in this Subchapter for the recognition by the State Board of variances to computed need. Variances are developed to account for unique needs and resources of a particular area or population.

Section 1100.320 Staffing

The State Board recognizes that adequate and appropriate staffing is essential for facilities to carry out a successful program of services.

Section 1100.330 Professional Education

Applicants involved with professional education should seek to utilize existing facilities, beds and services through the development of affiliation agreements rather than undertaking construction or modification projects relating to professional education.

(Source: Amended at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.340 Public Testimony (Repealed)

(Source: Repealed at 42 Ill. Reg. 5410, effective March 7, 2018)

Section 1100.350 Multi-Institutional Systems

The State Board encourages the development of interrelationships between and among health care providers when such relationships increase efficiency, effectiveness, and quality of care.

(Source: Amended at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.360 Modern Facilities

The people of Illinois should have facilities which are modern in accord with all recognized standards of design, construction, operation and which represent the most cost efficient alternative for the provision of quality care.

Section 1100.370 Occupancy/Utilization Standards

a) As a measure of service capability and efficient operation, occupancy or utilization targets are established by category of service within this Plan (77 Ill. Adm. Code 1100 and 1110).

b) Facilities and services should operate at or above the prescribed utilization targets.

Section 1100.380 Systems Planning

The State Board encourages each institution to develop an internal planning process which gives attention to assuring the operation of a modern facility consistent with the assurance of high-quality patient care, the responsible use of manpower and money, and which represents the most cost efficient alternative for the provision of quality care.

Section 1100.390 Quality

The responsibility of each facility is to provide quality services. All facilities should be in compliance with all required licensure requirements for operation, provide support services which are necessary for quality operation and provide for internal mechanisms such as peer review for the ongoing evaluation of services provided.

Section 1100.400 Location

Health care services should be appropriately located to best meet the needs of the population. Illinois residents needing services should not be forced to travel excessive distances. Where feasible, underutilized services should be consolidated to promote efficiency of operation and quality when such consolidation does not create access problems.

Section 1100.410 Needed Facilities

The State Board encourages the maintenance and support of needed health care facilities in order to prevent the loss of essential health care services to Illinois residents.

(Source: Amended at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.420 Discontinuation

The discontinuation of a category of service or of a health care facility should occur only when such discontinuation does not adversely affect the public interest and should be carried out in such fashion to protect the continuity and quality of care provided to affected patients.

(Source: Amended at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.430 Coordination with Other State Agencies

In its determination of needed services and facilities as well as in individual project review, the State Board shall coordinate its planning efforts with other agencies of the State.

(Source: Added at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.440 Requirements for Authorized Hospital Beds

a) Authorized hospital beds are to be classified as one of the following:

1) Physically Available Beds

A) Patient rooms and patient care units (PCUs) shall be compliant with applicable licensure codes and standards for hospital facilities, pursuant to the Hospital Licensing Requirements (77 Ill. Adm. Code 250) as determined by IDPH.

B) The approved number of beds is to be recorded in the Inventory of Health Care Facilities.

2) Reserve Beds

A) Patient rooms and PCUs must be compliant with applicable licensure codes and standards for hospital facilities, as determined by IDPH.

B) Patient rooms and PCUs shall be able to be set up and physically available for inpatient care within 72 hours, including equipment, furnishings and non-time-sensitive supplies.

C) Patient room and PCU equipment, furnishings and supplies designated for reserve beds shall be maintained either on the hospital's campus or in a storage facility that is owned or operated by the hospital.

D) The number of reserve beds shall not exceed 10% of the sum of physically available beds and transitional beds within each category of service. Hospitals with a total bed count of less than 50 beds may report up to a total of five reserve beds.

E) The approved number of beds is to be recorded in the Inventory of Health Care Facilities.

3) Transitional Beds

A) For transitional beds that are part of an approved CON project, the CON project is to be compliant with CON requirements.

B) For transitional beds that are not part of a CON project, the individually identified beds can be designated transitional for no more than one reporting period.

C) The approved number of beds is to be recorded in the Inventory of Health Care Facilities.

b) The sum of physically available, reserve, and transitional beds for each category of service shall not exceed the authorized bed capacity for that service.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

SUBPART D: NEED ASSESSMENT

Section 1100.510 Introduction, Formula Components, Planning Area Development Policies, and Distance Determinations

a) Introduction

This Subpart details the policies and methodologies utilized to assess the need for beds and services. The calculations and numeric results, as well as the related data elements that pertain to the methodologies detailed in this Subpart, are contained in the Inventory of Health Care Facilities.

b) Formula Components

Formulas utilized by HFSRB in projecting the need for beds and services can be categorized as demand based or incidence based need formulas. Each of these formula types represents a different conceptual outlook and incorporates different data elements as formula variables.

1) Demand Based Formula. Demand equations utilize the concept that what has occurred in the past will occur in the future. The formulas utilize inpatient days of care and population projections as the key data variables. The first formula step is to establish a utilization to population ratio (use rate). This ratio basically says that within a population an average number of inpatient days of care will be generated. This rate is then applied to the population projection for the same area. This states that if the rate of use is constant, a future population can be expected to generate an identifiable number of inpatient days. These projected days are then converted to a daily census (total projected patient days divided by days in year) and multiplied by an occupancy target. The projected day figure can be equated to 100% occupancy of service for which need is projected. An occupancy factor adjustment is applied to insure that sufficient beds exist to handle days when inpatient admissions are exceptionally high. This type of formula may also be adjusted by the application of minimum and maximum use rates in planning areas that lack facilities or certain types of beds or where a high concentration of beds and services has caused unnecessary duplication. These rates are controls and serve to inflate (minimum use rate) or deflate (maximum use rate) the projected bed need. These rates are established when historical patterns of use are influenced by a maldistribution of services. By adding to or subtracting from the number of needed beds, development of new beds and facilities can be influenced to add beds to underserved areas and to restrict bed growth in areas of high bed to population ratios.

2) Incidence Based Formula. This type of formula utilizes the incidence level of a disease or a condition within a population to predict need. Utilizing national or State rates, the formula predicts the number of planning area residents who will need hospitalization based on the number of people who live in the planning area. Utilizing a standard estimate of how long a patient will be hospitalized, admissions are converted into patient days. As in the demand formulas, days are then converted to an average daily census and an occupancy factor adjustment is applied to obtain area bed need.

c) Planning Area Development Policies

HFSRB recognizes the need to establish planning areas for the purpose of assessing and determining the need for health care facilities, beds, and services. In establishing planning areas the following principles and factors apply:

1) For purposes of delineating planning area boundaries and for purposes of calculating population estimates, the smallest geographical areas to be utilized shall be community areas for the city of Chicago and townships for all other areas in the State outside of Chicago.

2) Source of patient information shall be the primary basis for the allocation of geographic areas (e.g., townships, community areas, counties) into planning areas. As a general principle, 50% or more of residents receiving care from facilities or resources located within the planning area should reside within the planning area.

HFSRB NOTE: Source of patient information may only be available on a zip code basis. In such cases, the relationship between zip code boundaries and community area or township boundaries will be approximated for use in establishing planning area boundaries.

3) Planning area boundaries should be established taking into consideration the number and type of existing health care facilities and services located within the area, shared and overlapping market areas between or among facilities, and patterns of patient referral to area health care facilities. Planning areas may vary in size in order to ensure access within a reasonable travel time.

4) The primary market area for health care facilities located within a planning area should serve a substantial number of residents of the planning area. A primary market area means the geographic location in which 50% or more of a facility's patients/residents reside. HFSRB recognizes that certain health care facilities (e.g., tertiary and specialty facilities) may have primary market areas that are not entirely contained within the planning area in which the facility is located.

5) Planning area boundaries can also be influenced by the following factors:

A) natural geographic boundaries;

B) political boundaries that affect the patterns of services;

C) transportation patterns and systems;

D) time and distance required to access service by area residents;

E) affiliations between health care facilities and other health care entities that affect patterns of service;

F) trade and economic market patterns that influence the financing of health care services;

G) the lack of existing health resources or services in an area;

H) referral patterns to obtain tertiary services;

I) the impact of reimbursement or managed care programs;

J) socio-economic factors such as but not limited to population density, income level, or age characteristics.

6) Planning area boundaries may vary by category of service. HFSRB recognizes that certain services (e.g., neonatal ICU, comprehensive physical rehabilitation, selected organ transplantation, cardiac surgery, etc.) may require a large population base in order to assure the provision of quality care and to be cost effective.

7) Planning areas for the acute care categories of services of medical-surgical/pediatrics, obstetrics and intensive care must contain a minimum population of 40,000. This population base would be sufficient to support a 100 bed hospital based upon a facility target occupancy of 80% and an inpatient day use rate of 725 days per 1,000 population.

8) Planning areas for general long-term service must contain a minimum population of 10,000. This population base would be sufficient to support 100 nursing care beds based upon a rate of 9 beds per 1,000 population (projected 1997 statewide need divided by projected 1997 State population) with a target occupancy of 90%.

9) HFSRB recognizes that some long-term care facilities may have a primary market area that is not contained within the planning area in which the facility is located. Placement in long-term care facilities may be influenced by such factors as, but not limited to: location of next of kin or relatives; seeking services of a specialized nature such as treatment for various diseases or disabilities; or seeking services related to religious, ethnic, or fraternal needs. Because of the significant degree of mobility that is exercised in seeking long term care services, HFSRB shall not allocate portions of a facility's beds and services to more than one planning area.

d) Distance Determinations

Normal travel radius for proposed projects shall be based upon the location of the applicant facility.

1) For applicant facilities located in the Chicago Metropolitan counties of Cook, DuPage, Lake, Will and Kane, the radius shall be 10 miles.

2) For applicant facilities located in the counties of Kankakee, Grundy, Kendall, DeKalb, McHenry, Winnebago, Champaign, Sangamon, Peoria, Tazewell, Rock Island, Madison, Monroe and St. Clair , the radius shall be 17 miles.

3) For applicant facilities located in any other area of the State, the radius shall be 21 miles.

e) Independent Travel Time Studies may be prepared and submitted in addition to the information found in subsection (d) to refine or supplement the determination of the applicable radius, provided that they are conducted as follows:

1) The study is conducted by an engineering firm pre-qualified in traffic studies by the Illinois Department of Transportation or prepared by a professional engineer also certified by the Institute of Transportation Engineers as a Professional Traffic Operations Engineer.

2) A 30-minute travel time radius from the applicant facility shall consist of a minimum of three round trips for each defined survey route.

3) No more than one third of the round trips shall start or conclude during a rush hour period, i.e.:

Morning Peak Period: 6:30 AM-9:30 AM

Evening Peak Period: 3:30 PM-6:30 PM

4) The routes used for determining the travel time shall be reasonably direct.

5) Average travel time for a one-way trip will be considered.

6) All travel routes and calculations of the travel time are to be documented and sealed by the responsible professional engineer.

(Source: Amended at 42 Ill. Reg. 5410, effective March 7, 2018)

Section 1100.520 Medical-Surgical Care and Pediatric Care

a) Planning Areas

There are 40 medical-surgical and pediatric care planning areas that have been delineated by HFSRB contained within six regions established for the State of Illinois.

1) Region A (comprised of HSAs 6, 7, 8 and 9)

A) Planning Area A-1: City of Chicago Community Areas of Uptown, Lincoln Square, North Center, Lakeview, Lincoln Park, Near North Side, Edison Park, Norwood Park, Jefferson Park, Forest Glen, North Park, Albany Park, Portage Park, Irving Park, Dunning, Montclare, Belmont Cragin, Hermosa, Avondale, Logan Square, O'Hare and Edgewater.

B) Planning Area A-2: City of Chicago Community Areas of Humboldt Park, West Town, Austin, West Garfield Park, East Garfield Park, Near West Side, North Lawndale, South Lawndale, Lower West Side, Loop, Armour Square, McKinley Park and Bridgeport.

C) Planning Area A-3: City of Chicago Community Areas of Douglas, Oakland, Fuller Park, Grand Boulevard, Kenwood, Near South Side, Washington Park, Hyde Park, Woodlawn, South Shore, Chatham, Avalon Park, South Chicago, Burnside, Calumet Heights, Roseland, Pullman, South Deering, East Side, Garfield Ridge, Archer Heights, Brighton Park, New City, West Elsdon, Gage Park, Clearing, West Lawn, West Englewood, Englewood, Chicago Lawn and Greater Grand Crossing.

D) Planning Area A-4: City of Chicago Community Areas of West Pullman, Riverdale, Hegewisch, Ashburn, Auburn Gresham, Beverly, Washington Heights, Mount Greenwood, and Morgan Park; Cook County Townships of Lemont, Stickney, Worth, Lyons, Palos, Calumet, Thornton, Bremen, Orland, Rich and Bloom.

E) Planning Area A-5: DuPage County.

F) Planning Area A-6: Cook County Townships of River Forest, Oak Park, Cicero, Berwyn, Riverside, Proviso, Leyden and Norwood Park.

G) Planning Area A-7: Cook County Townships of Maine, Elk Grove, Schaumburg, Palatine and Wheeling.

H) Planning Area A-8: City of Chicago Community Areas of Rogers Park and West Ridge; Cook County Townships of Northfield, New Trier, Niles and Evanston.

I) Planning Area A-9: Lake County.

J) Planning Area A-10: McHenry County.

K) Planning Area A-11: Cook County Townships of Barrington and Hanover; Kane County Townships of Hampshire, Rutland, Dundee, Burlington, Plato, Elgin, Virgil, Campton and St. Charles.

L) Planning Area A-12: Kendall County; Kane County Townships of Kaneville, Black Berry, Aurora, Big Rock, Sugar Grove, Batavia and Geneva.

M) Planning Area A-13: Grundy and Will Counties.

N) Planning Area A-14: Kankakee County.

2) Region B (comprised of HSA 1)

A) Planning Area B-1: Boone and Winnebago Counties; DeKalb County Townships of Franklin, Kingston, and Genoa; Ogle County Townships of Monroe, White Rock, Lynnville, Scott, Marion, Byron, Rockvale, Leaf River and Mount Morris.

B) Planning Area B-2: Jo Daviess and Stephenson Counties; Ogle County Townships of Forreston, Maryland, Lincoln, and Brookville; Carroll County Townships of Washington, Savanna, Woodland, Mount Carroll, Freedom, Salem, Cherry Grove-Shannon and Rock Creek-Lima.

C) Planning Area B-3: Whiteside County; Lee County Townships of Palmyra, Nelson, Harmon, Hamilton, Dixon, South Dixon, Marion, East Grove, Nachusa, China, Amboy, May, Ashton, Bradford, Lee Center, and Sublette; Carroll County Townships of York, Fairhaven, Wysox, and Elkhorn Grove; Ogle County Townships of Eagle Point, Buffalo, Pine Creek, Woosung, Grand Detour, Oregon, Nashua, Taylor, Pine Rock and Lafayette.

D) Planning Area B-4: Lee County Townships of Reynolds, Alto, Viola, Willow Creek, Brooklyn, and Wyoming; DeKalb County

Townships of Paw Paw, Victor, Somonauk, Sandwich, Shabbona, Clinton, Squaw Grove, Milan, Afton, Pierce, Malta, DeKalb, Cortland, Mayfield, South Grove and Sycamore; Ogle County Townships of Flagg and Dement.

3) Region C (comprised of HSAs 2 and 10)

A) Planning Area C-1: Woodford, Peoria, Tazwell, and Marshall Counties; Stark County Townships of Goshen, Toulon, Penn, West Jersey, Valley and Essex.

B) Planning Area C-2: LaSalle, Bureau, and Putnam Counties; Stark County Townships of Elmira and Osceola.

C) Planning Area C-3: Henderson, Warren and Knox Counties.

D) Planning Area C-4: McDonough and Fulton Counties.

E) Planning Area C-5: Rock Island, Henry and Mercer Counties.

4) Region D (comprised of HSA 4)

A) Planning Area D-1: Champaign, Douglas, and Piatt Counties; Ford County Townships of Lyman, Sullivant, Peach Orchard, Wall, Drummer, Dix, Patton, and Button; Iroquois County Townships of Loda, Pigeon Grove and Artesia.

B) Planning Area D-2: Livingston and McLean Counties; Ford County Townships of Rogers, Mona, Pella and Brenton.

C) Planning Area D-3: Vermilion County; Iroquois County Townships of Milks Grove, Chebanse, Papineau, Beaverville, Ashkum, Martinton, Beaver, Danforth, Douglas, Iroquois, Cresent, Middleport, Belmont, Concord, Sheldon, Ash Grove, Milford, Stockland, Fountain Creek, Lovejoy, Prairie Green, Onarga and Ridgeland.

D) Planning Area D-4: DeWitt, Macon, Moultrie and Shelby Counties.

E) Planning Area D-5: Coles, Cumberland, Clark and Edgar Counties.

5) Region E (comprised of HSA 3)

A) Planning Area E-1: Logan, Menard, Mason, Sangamon, Christian and Cass Counties; Brown County Townships of Ripley, Cooperstown, and Versailles; Schuyler County Townships of Littleton, Oakland, Buena Vista, Rushville, Browning, Hickory, Woodstock, Bainbridge and Frederick.

B) Planning Area E-2: Macoupin and Montgomery Counties.

C) Planning Area E-3: Greene, Jersey and Calhoun Counties.

D) Planning Area E-4: Pike, Scott and Morgan Counties.

E) Planning Area E-5: Adams and Hancock Counties; Schuyler County Townships of Birmingham, Brooklyn, Camden, and Huntsville; Brown County Townships of Pea Ridge, Missouri, Lee, Mount Sterling, Buckhorn and Elkhorn.

6) Region F (comprised of HSAs 5 and 11)

A) Planning Area F-1: Madison and St. Clair Counties; Monroe County Precincts 2, 3, 4, 5, 7, 10, 11, 14, 16, 17, 18, 19, 21, and 22; Clinton County Townships of Sugar Creek, Looking Glass, Germantown, Breese, St. Rose, Wheatfield, Wade, Sante Fe, Lake, Irishtown, Carlyle and Clement.

B) Planning Area F-2: Bond, Fayette, and Effingham Counties; Clay County Townships of Blair, Bible Grove, and Larkinsburg; Jasper County Townships of Grove, North Muddy, South Muddy, Smallwood, Wade and Crooked Creek.

C) Planning Area F-3: Crawford, Lawrence, Richland, Wabash, and Edwards Counties; Jasper County Townships of Hunt City, Willow Hill, Ste. Marie, Fox, and Grandville; Clay County Townships of Louisville, Songer, Xenia, Oskaloosa, Hoosier, Harter, Stanford, Pixley, and Clay City; Wayne County Townships of Orchard,

Keith, Garden Hill, Berry, Bedford, Lamard, Indian Prairie, Zif, Elm River, Jasper, Mount Erie, Massilion, Leech, Barnhill and Grover.

D) Planning Area F-4: Marion, Jefferson, and Washington Counties; Wayne County Townships of Big Mound, Orel, Hickory Hill, Arrington and Four Mile; Clinton County Townships of East Fork, Meridian and Brookside.

E) Planning Area F-5: Hamilton, White, Gallatin, Hardin, and Saline Counties; Pope County Townships of Eddyville #6 and Golconda #2.

F) Planning Area F-6: Franklin, Williamson, Johnson, and Massac Counties; Pope County Townships of Jefferson #4, Webster #5, Golconda #1 and Golconda #3.

G) Planning Area F-7: Randolph, Perry, Jackson, Union, Alexander, and Pulaski Counties; Monroe County Precincts 1, 6, 8, 9, 12, 13, 15, 20 and 23.

b) Age Groups

1) For medical-surgical care, ages 15 and over.

2) For pediatric care, ages 0-14.

c) Occupancy Targets:

1) Occupancy Targets for "Modernization".

A) Medical-Surgical	1-25 beds	60%
	26-99 beds	75%
	100-199 beds	85%
	200+ beds	88%
B) Pediatrics	1-30 beds	65%
	31+ beds	75%

2) Occupancy Targets for "Addition of Beds".

A) Medical-Surgical	1-99 beds	80%
	100-199 beds	85%
	200+ beds	90%

B) Pediatrics	1-99 MS beds	80%
	100-199 MS beds	85%
	200+ MS beds	90%

d) Bed Capacity

1) Medical-surgical bed capacity is the total number of medical-surgical beds for a facility as determined by HFSRB pursuant to this Part.

2) Pediatric bed capacity is the total number of pediatric beds for a facility as determined by HFSRB pursuant to this Part.

e) Need Determination

In assessing the number of beds required to serve the residents of a planning area, HFSRB shall establish a base year and utilize the following methodology to determine the projected number of medical-surgical and pediatric beds needed in a planning area:

1) Divide the three year average of experienced medical-surgical and pediatric patient days (i.e., the average of the base year's and the two prior years' patient days) for each of five age groups (0-14, 15-44, 45-64, 65-74, and 75+) by the base year population estimate for each age group, resulting in age specific base use rates;

2) Multiply each age specific base use rate by the population projection, five years from the base year, to obtain each age group's projected patient days;

3) Add the projected days of the age groups to obtain total projected patient days;

4) Increase or decrease the projected patient days by a migration patient days factor to obtain total projected patient days. The migration patient days factor is determined as follows:

A) Subtract the number of medical-surgical and pediatric in-migration admissions (i.e., non-planning area residents who were admitted to planning area facilities) from the number of out-migration admissions (i.e., planning area residents who were admitted to facilities located outside of the planning area) to obtain either a positive or negative net patient migration number;

B) Multiply the net patient migration number by the State's base year average length of stay for the combined medical-surgical and pediatric admissions to obtain net migration patient days for the planning area;

C) Multiply the net migration patient days number by .50 (50% statutory adjustment factor) to obtain the migration patient days factor;

5) Divide the total projected patient days by the number of days in the projected year to obtain the planning area's projected average daily census (ADC);

6) Divide the ADC by .80 (80% occupancy factor) if the ADC is below 100; by .85 (85% occupancy factor) if the ADC is 100 through 199; and by .90 (90% occupancy factor) if the ADC is 200 or over, to obtain the projected planning area bed need;

7) Subtract the number of existing beds in the planning area from the projected planning area bed need to determine the projected number of surplus (excess) beds or the projected bed deficit or additional beds needed in the area.

(Source: Amended at 38 Ill. Reg. _____, effective 2822_______)

Section 1100.530 Obstetric Care Category of Service

a) Planning Areas

Planning areas are the same as those for medical-surgical and pediatric care.

b) Age Groups

1) For maternity care, female ages 15-44.

2) For gynecological care within obstetrics units, female ages 15 and over.

c) Facility Utilization Rates

Facilities that provide an obstetrics service should operate those beds at or above an annual minimum occupancy rate of:

1) 60% for facilities with a bed capacity of 1-10 beds;

2) 75% for facilities with a bed capacity of 11-25 beds;

3) 78% for facilities with a bed capacity of 26 or more beds.

d) Bed Capacity

Obstetrics bed capacity is the total number of obstetrics beds for a facility as determined by HFSRB pursuant to this Part.

e) Need Determination

The following methodology is utilized to determine the projected number of obstetrics beds needed in a planning area:

1) Multiply the projected year's female 15-44 population (the projected year is five years from the base year) by the current fertility rate of the health planning area to obtain projected births;

2) Multiply the projected number of births by a hospitalization factor of .99 (99%) to determine number of projected births occurring in hospitals;

3) Multiply projected births occurring in hospitals by length of stay factor of 2.5 days to obtain projected maternity patient days;

4) Divide the gynecology utilization (of the base year) within obstetrics units by the current female 15+ population to obtain a gynecology patients use rate;

5) Multiply the use rate of gynecology patients by the projected female 15+ population to obtain projected gynecology patient days;

6) Divide the projected maternity patient days by 365 to obtain a maternity average daily census;

7) Divide the projected gynecology patient days by 365 to obtain a gynecology average daily census;

8) Divide the gynecology patient days by .9 (90%) to determine obstetric beds needed for gynecology patients;

9) Divide the maternity average daily census by .60 (60% occupancy factor) if the ADC is below 10; by .75 (75% occupancy factor) if the ADC is 10 through 25; and by .78 (78% occupancy factor) if the ADC is 26 and over, to obtain obstetrics beds needed for maternity patients;

10) Add the maternity bed need (step 9) with the gynecology need (step 8) to determine total unadjusted obstetrics bed need.

11) Determine the number of patients entering the planning area from outside and the number of area residents leaving the planning area for obstetrics service;

12) Multiply the total number of patients entering the area and those leaving the area by 2.5 to determine a patient day estimate for in-migration and out-migration;

13) Multiply the patient totals for area in-migration and out-migration by a .85 (85%) adjustment factor;

14) Subtract the resulting in-migration adjusted patient day total from the out-migration adjusted patient day total to determine the net in or out patient day migration estimate;

STATE BOARD NOTE: Patient migration adjustment is for a one year period and the base year shall be the date of the latest available patient origin data.

15) Divide the net in or out patient day estimate by 365 to determine the average daily census for migration;

16) Add to net in-migration areas the average daily census for migration to the unadjusted bed need to determine the migration adjusted obstetrics bed need; in net out-migration areas subtract the average daily census for migration to determine adjusted obstetrics bed need;

17) Subtract the number of existing beds in the planning area from the projected planning area bed need to determine the projected number of surplus (excess) beds or the projected bed deficit or additional beds needed in the area.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.540 Intensive Care Category of Service

a) Planning Areas

Planning areas are the same as those for medical-surgical and pediatrics care.

b) Age Groups

For intensive care, all ages.

c) Facility Utilization Rates

Facilities that provide intensive care services should operate those beds at or above an annual minimum occupancy rate of 60%.

d) Bed Capacity

Intensive care bed capacity is the total number of intensive care beds for a facility as determined by HFSRB pursuant to this Part.

e) Need Determination

1) Divide the three year average of experienced intensive care patient days by the total base year population to obtain a use rate;

2) Multiply the use rate by the projected year's total population projection, five years from the base year, to obtain projected patient days;

3) Divide the projected patient days by days in the projected year to obtain a projected average daily census;

4) Divide the projected average daily census by .60 (60% occupancy factor) to obtain the projected planning area bed need;

5) Subtract the number of existing beds in the planning area from the projected planning area bed need to determine the projected number of surplus (excess) beds or the projected bed deficit or additional beds needed in the area.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.550 Comprehensive Physical Rehabilitation Category of Service

a) Planning Areas

Planning areas for comprehensive physical rehabilitation are Health Service Areas.

b) Age Groups

For comprehensive physical rehabilitation, all ages.

c) Utilization Target

Facilities that provide a comprehensive physical rehabilitation service should operate those beds at or above an annual minimum occupancy rate of 85%.

d) Bed Capacity

Comprehensive Physical Rehabilitation bed capacity is the total number of comprehensive physical rehabilitation beds for a facility as determined by HFSRB pursuant to this Part.

e) Need Determination

The following methodology is utilized to determine the projected number of comprehensive physical rehabilitation beds needed in a planning area:

1) Divide the base year's experienced rehabilitation patient days by the base year population estimate to determine the planning area's experienced use rate. If the experienced use rate is less than 60% of the State's base year experienced use rate, adjust the planning area's use rate to 60% of the State's base year use rate to establish a minimum use rate;

2) Multiply the planning area's experienced or minimum use rate, if applicable, by the population projection for five years from the base year to determine projected patient days for the planning area;

3) Divide the projected patient days by the number of days in the projected year to obtain the projected average daily census;

4) Divide the projected average daily census by .85 (85% occupancy rate) to obtain the projected planning area bed need;

5) Subtract the number of existing beds in the planning area from the projected planning area bed need to determine the projected number of excess beds (surplus) or the projected need (deficit) for additional beds in the area.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.560 Acute Mental Illness Treatment Category of Service

a) Planning Areas

1) For HSAs I, II, III, IV, V, X and XI, the HSA is the planning area;

2) For HSAs VI, VII, VIII and IX, medical-surgical and pediatric care planning areas A-1 through A-14 are the planning areas.

b) Age Groups

For acute mental illness, all ages.

c) Utilization Target

Facilities that provide an acute mental illness service should operate those beds at or above an annual minimum occupancy rate of 85%.

d) Bed Capacity

Acute Mental Illness bed capacity for facilities not operated by the Department of Human Services is the total number of acute mental illness beds for a facility as determined by HFSRB pursuant to this Part. For facilities operated by the Department of Human Services, all mental illness beds are counted as chronic beds. State facilities can provide acute mental illness care, but for purposes of review, only the service, not the beds, is recognized as acute.

e) Need Determination for Bed Not Operated by the Department of Human Services

The following methodology is utilized to determine the projected number of acute mental illness beds needed in a planning area:

1) A bed need of .11 beds per 1,000 projected population is established in each planning area as the minimum bed need.

2) Calculate the planning area's experienced use rate by dividing the number of patient days in the base year by the base year population in thousands. Multiply the experienced use rate by the population estimate in thousands to obtain estimated patient days. Divide the estimated patient days by the number of days in the population projection (which is five years from the base year) to determine the projected average daily census (ADC). Divide the estimated ADC by .85 (85% occupancy factor) to obtain a projected bed need in the planning area.

3) When the projected bed need is less than the minimum bed need, the minimum bed need is the projected bed need. When the estimated bed need is greater than the minimum bed need, the estimated bed need is the projected bed need.

4) Calculate the number of additional beds needed in each area by subtracting the number of existing beds from the projected bed need.

5) Subtract the number of existing beds in the planning area from the projected planning area bed need to determine the projected number of excess (surplus) beds or the projected need for additional beds (deficit) in the area.

f) No bed need formula for facilities operated by the Department of Human Services has been developed. It is the responsibility of the applicant to document the need for a project by complying with the Review Criteria contained in 77 Ill. Adm. Code 1110.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.570 Substance Abuse/Addiction Treatment Category of Service (Repealed)

(Source: Repealed at 24 Ill. Reg. 6070, effective April 7, 2000)

Section 1100.580 Neonatal Intensive Care Category of Service

a) Planning Areas:

HSA	1	HSAs	5 and 11
HSAs	2 and 10	HSAs	6, 7, 8, and 9
HSAs	3 and 4

b) Occupancy Targets: 75%

c) Bed Capacity: Neonatal Intensive Care bed capacity is the reported functional capacity per patient room.

d) Bed Need Determination-Neonatal Intensive Care:

No formula bed need for neonatal intensive care beds has been developed. It is the responsibility of the applicant to document the need for the number of neonatal intensive beds proposed by complying with the Review Criteria contained in 77 Ill. Adm. Code 1110.

(Source: Amended at 26 Ill. Reg. ______, effective ____________)

Section 1100.590 Burn Treatment Category of Service (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.600 Therapeutic Radiology Equipment (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.610 Open Heart Surgery Category of Service

a) Planning Areas: Health Service Areas

b) Utilization Standards:

1) Adult: There should be a minimum of 200 open heart procedures performed annually by each facility within three years after initiation, in any institution in which open heart surgery is performed for adults. Higher case loads, over 200 per annum, are encouraged.

2) Pediatric: There should be a minimum of 75 pediatric open heart operations performed annually by each facility within three years after initiation of the service.

3) Adult/Pediatric: The defined minimum utilization standards for both adult and pediatric shall apply for programs doing both adult and pediatric open heart surgery.

c) Open Heart Surgery Programs:

The need for an open heart surgery category of service shall be institution specific and determined by the volume of at least 200 patients referred to other institutions for surgery following a cardiac catheterization procedure at the applicant facility or a minimum of 750 cardiac catheterizations were performed annually at the applicant facility.

(Source: Amended at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.620 Cardiac Catheterization Services

a) Planning Areas: Health Service Areas as defined by the Department of Health and Human Services pursuant to P.L. 93-641.

b) Utilization Standards:

There should be a minimum of 200 cardiac catheterization procedures performed annually within two years after initiation.

c) Need Determination – Cardiac Catheterization Programs:

No additional cardiac catheterization service shall be started unless each facility in the planning area offering cardiac catheterization services operates at a level of 400 procedures annually.

(Source: Amended at 11 Ill. Reg. 7311, effective April 1, 1987)

Section 1100.630 In-Center Hemodialysis Category of Service

a) Planning Areas

Planning areas for the in-center hemodialysis category of service are Health Service Areas.

b) Age Groups

For in-center hemodialysis, all ages.

c) Utilization Target

Facilities providing in-center hemodialysis should operate their dialysis stations at or above an average annual utilization rate of 80%, assuming three patient shifts per day per renal dialysis station operating six days a week.

d) Need Determination

The five-year need determination is a short-term assessment that applies to the planning area need requirements in the 77 Ill. Adm. Code 1110 category of service review criteria. The in-center hemodialysis or end stage renal disease (ESRD) station need is a five year projection from the base year. The need for additional treatment stations can be projected utilizing the following methodology:

1) Establish a minimum institutional dialysis rate by dividing the total number of institutional dialysis patients in the base year by the State base year population estimate in thousands and multiply the result by .6 (60%).

2) Determine each planning area's experienced institutional dialysis rate by dividing the number of patients receiving dialysis in the base year by the planning area population projection in thousands for the base year.

3) Multiply each planning area's population projection in thousands by the greater of the minimum institutional dialysis rate or the experienced institutional dialysis rate for the planning area to determine the estimated number of institutional dialysis patients.

4) Multiply the planning area's projected number of institutional dialysis patients by a factor of 1.33 (5 year increase in prevalence) to determine the projected number of institutional dialysis patients in the planning area for the projected year.

5) Multiply the projected number of annual institutional dialysis patients by 156 (3 treatments/week x 52 weeks) to determine the projected number of institutional procedures.

6) Divide the projected number of annual institutional procedures by 749 (3 shifts/day x 6 days/week x 52 weeks/year x .80 utilization target) to determine the projected number of stations needed for the projected year.

7) Subtract the number of existing stations from the projected number of needed stations to determine the excess (surplus) or additional (deficit) number of stations needed.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.640 Non-Hospital Based Ambulatory Surgical Treatment Center Services – Category of Service

a) Planning Areas

No planning areas are established for need determination purposes. Ambulatory surgical treatment facilities (ASTCs) shall be inventoried by health service area.

b) Age Groups

For non-hospital based ambulatory surgery, all ages.

c) Utilization Target

ASTCs surgical or treatment rooms should be utilized at a minimum of 80% occupancy. The 80% occupancy equates to 1,500 hours of use per room per year (including setup and cleanup time) and is based upon treatment room availability of 7.5 hours per day times 250 days per year.

d) Need Determination

No formula need determination for the number of ASTCs and the number of surgical or treatment rooms in an area has been established. Need must be

established pursuant to the applicable review criteria of 77 Ill. Adm. Code 1110.

(Source: Amended at 38 Ill. Reg. 2822, effective February 1, 2014)

Section 1100.650 Computer Systems (Repealed)

(Source: Repealed at 11 Ill. Reg. 7311, effective April 1, 1987)

Section 1100.660 General Long-Term Nursing Care Category of Service (Repealed)

(Source: Repealed at 35 Ill. Reg. 16978, effective October 7, 2011)

Section 1100.661 General Long-Term Care-Sheltered Care Category of Service (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.670 Specialized Long-Term Care Categories of Service (Repealed)

(Source: Repealed at 35 Ill. Reg. 16978, effective October 7, 2011)

Section 1100.680 Intraoperative Magnetic Resonance Imaging Category of Service (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.690 High Linear Energy Transfer (L.E.T) (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.700 Positron Emission Tomographic Scanning (P.E.T.) (Repealed)

(Source: Repealed at 27 Ill. Reg. 2904, effective February 21, 2003)

Section 1100.710 Extracorporeal Shock Wave Lithotripsy (Repealed)

(Source: Repealed at 23 Ill. Reg. 2960, effective March 15, 1999)

Section 1100.720 Selected Organ Transplantation

a) Planning Area – The State of Illinois

b) Need Determination:

No formula need has been developed for this category of service. It is the responsibility of the applicant to document the need for the service by complying with all applicable Review Criteria contained in 77 Ill. Adm. Code 1110.

(Source: Amended at 23 Ill. Reg. 2960, effective March 15, 1999)

Section 1100.730 Kidney Transplantation

a) Planning Area – The State of Illinois

b) Need Determination – One program is needed for a population base of two million unserved people within a three-hour travel time.

c) Utilization Standards – Minimum utilization of 25 transplants annually.

(Source: Added at 16 Ill. Reg. 16074, effective October 2, 1992)

Section 1100.740 Subacute Care Hospital Model

a) Planning Area:

1) the City of Chicago;

2) Cook County outside the City of Chicago;

3) DuPage, Kane, Lake, McHenry, and Will Counties;

4) Municipalities with a population greater than 50,000 not located in the areas described in subsections (a)(1), (2), and (3) of this Section. Municipalities means geographic areas designated as a Metropolitan Statistical Area (MSA) by the Bureau of the Census pursuant to the 1990 census but shall not include any counties within an MSA having a 1990 population of less than 35,000. Counties with a 1990 population less than 35,000 and which are located in an MSA are: Boone, Clinton, Grundy, Jersey, Menard, Monroe, and Woodford counties. These counties shall be classified as rural areas pursuant to subsection (a)(5) of this Section; and

5) Rural areas, i.e., all areas exclusive of subsections (a)(1), (2), (3), and (4) of this Section.

b) Age groups: All ages

c) Occupancy Targets: Modernization/Establishment 75%

d) Bed capacity:

1) the lesser of measured bed capacity or functional bed capacity per individual room utilized for subacute care for facilities licensed or operated pursuant to the Hospital Licensing Act [210 ILCS 85]; or

2) the licensed bed capacity per individual room utilized for subacute care for facilities licensed pursuant to the Nursing Home Care Act [210 ILCS 45].

e) Need Determination: There shall be no more than:

1) Three subacute alternative health care models in the City of Chicago; one in an existing licensed hospital, one in an existing licensed long-term care facility and one located on a designated site which shall have been licensed as a hospital under the Illinois Hospital Licensing Act within the ten years immediately before the application for a license (Section 30 of the Alternative Health Care Delivery Act [210 ILCS 3/30]) but which is not now currently operating as such.

2) Two subacute alternative health care models in Cook County outside the city of Chicago; one of which must located in an existing licensed hospital and the other in an existing licensed long-term care facility.

3) Two subacute alternative health care models in DuPage, Kane, Lake, McHenry and Will Counties; one of which must be located in an existing licensed hospital and the other in an existing licensed long-term care facility.

4) Two subacute alternative health care models in municipalities with a population greater than 50,000 not located in areas included in subsections (e)(1), (2), or (3) of this Section; one of which must be located in an existing licensed hospital and the other in an existing licensed long-term care facility.

5) Four subacute alternative health care models in rural areas; two of which must be located in existing licensed hospitals and the other two in existing long-term care facilities.

f) Beds approved for a subacute care hospital model shall be inventoried for the category of service utilized prior to permit issuance during the demonstration period.

g) If after a period of one year from the effective date of this regulation, the need in a planning area for a subacute care hospital model to be located in either an existing licensed hospital or long-term care facility has not been met, the need may be met by either an existing hospital or an existing long-term care facility.

(Source: Amended at 19 Ill. Reg. 10143, effective June 30, 1995)

Section 1100.750 Postsurgical Recovery Care Center Alternative Health Care Model

a) Planning Areas:

1) The City of Chicago;

2) Cook County outside the City of Chicago;

3) Kane, Lake, and McHenry Counties;

5) Rural areas, i.e., all areas exclusive of subsections (a)(1), (2), (3), and (4) of this Section.

b) Age Groups:

All ages

c) Development Restrictions:

1) No proposed postsurgical recovery care center alternative health care model shall be located in counties with populations greater than 600,000 but less than 1,000,000. (Section 30(a) of the Alternative Health Care Delivery Act [210 ILCS 3/30(a)])

2) A proposed postsurgical recovery care center alternative health care model must be owned or operated by a hospital if it is to be located within, or will primarily serve the residents of, a health service area (see Section 1100.220 for definition of Health Service Area) in which more than 60% of the gross patient revenue of the hospitals within that health service area are derived from Medicare and Medicaid, according to the most recently available calendar year data from the Illinois Health Care Cost Containment Council. (Section 30(a) of the Alternative Health Care Delivery Act [210 ILCS 3/30(a)]) Health Service Areas which exceed this standard are Health Service Areas 5 and 11.

3) Restrictions delineated above shall not preclude a hospital and an ambulatory surgical treatment center from forming a joint venture or developing a collaborative agreement to own or operate a postsurgical recovery care center. (Section 30(a) of the Alternative Health Care Delivery Act [210 ILCS 3/30a])

4) No facility, or portion of a facility, may participate in a demonstration program as a postsurgical recovery care center unless the facility has been licensed as an ambulatory surgical treatment center or hospital for at least two years before August 20, 1993. (Section 35 of the Alternative Health Care Delivery Act [210 ILCS 3/35])

d) Bed Capacity:

A postsurgical recovery care center shall be no larger than 20 beds. (Section 35 of the Alternative Health Care Delivery Act [210 ILCS 3/35]) Bed capacity within a postsurgical recovery care center shall be inventoried as a separate category of service.

e) Occupancy Targets:

Beds should have an occupancy of 80% or higher.

f) Need Determination:

There shall be no more than a total of twelve postsurgical recovery care center alternative health care models in the demonstration program, located as follows:

1) Two in the City of Chicago.

2) Two in Cook County outside the City of Chicago. At least one of these shall be owned or operated by a hospital devoted exclusively to caring for children.

3) Two in Kane, Lake and McHenry Counties.

4) Four in municipalities (as defined in subsection (a)(4)), three of which shall be owned or operated by hospitals, at least two of which shall be located in counties with a population of less than 175,000, according to the most recent decennial census for which data are available, and one of which shall be owned or operated by an ambulatory surgical treatment center.

5) Two in rural areas (as defined in subsection (a)(5)), both of which shall be owned or operated by hospitals. (Section 30(a-5) of the Alternative Health Care Delivery Act [210 ILCS 3/30(a-5)])

(Source: Amended at 20 Ill. Reg. 14778, effective November 15, 1996)

Section 1100.760 Children's Respite Care Center Alternative Health Care Model

a) Planning Areas:

1) The City of Chicago;

2) Cook County outside the City of Chicago;

3) DuPage, Kane, Lake, Will and McHenry Counties;

5) Rural areas, i.e., all areas exclusive of subsections (a) (1), (2), (3), and (4) of this Section.

b) Age Groups:

Children up to age 18.

c) Development Restrictions:

No more than one children's respite care model owned and operated by a licensed skilled pediatric facility shall be located in each of the areas designated in subsection (a) of this Section. (Section 30(a)(10) of the Alternative Health Care Delivery Act [210 ILCS 3/30(a)(10)])

d) Bed Capacity:

A Children's Respite Care Alternative Health Care Model shall provide care in a home-like environment that serves no more than 10 children at a time. (Section 35(3) of the Alternative Health Care Delivery Act [210 ILCS 3/35(3)]) Bed capacity within a children's respite care alternative health care model shall not exceed 10 beds and shall be inventoried as a separate category of service.

e) Occupancy Targets:

Beds should have an occupancy of 40% or higher.

f) Need Determination:

There shall be no more than a total of eight Children's Respite Care Alternative Health Care Models in the demonstration program, located as follows:

1) One in the City of Chicago.

2) One in Cook County outside the City of Chicago.

3) Two in DuPage, Kane, Lake, McHenry and Will counties.

4) Two in municipalities (as defined in subsection (a)(4)) not located in areas specified in subsection (f)(1), (2) or (3) above.

5) Two in rural areas (as defined in subsection (a)(5)) not located in areas specified in subsection (f)(1), (2), (3) or (4) above. (Section 30(a)(10) of the Alternative Health Care Delivery Act [210 ILCS 3/30(a)(10)])

(Source: Added at 20 Ill. Reg. 14778, effective November 15, 1996)

Section 1100.770 Community-Based Residential Rehabilitation Center Alternative Health Care Model

a) Planning Area: The area of Illinois south of Interstate Highway 70

b) Age Groups: All ages

c) Occupancy Targets: Modernization/Establishment 70% or higher

d) Bed Capacity: No more than 12 beds per residence

e) Need Determination: One model for the State of Illinois

f) Beds approved for this model shall be inventoried as Community-Based Residential Rehabilitation Center beds.

(Source: Added at 24 Ill. Reg. 6070, effective April 7, 2000)

Section 1100.800 Freestanding Emergency Center Medical Services Category of Service

a) Planning Areas

Planning areas are the same as those for medical-surgical and pediatric care.

b) Age Groups

For freestanding emergency center medical services, all ages.

c) Utilization

The minimum operational capacity for each treatment station in an FEC is 5.5 patients per day (2000 patient visits per year) based upon 24-hour availability.

d) Need Determination

No formula need determination for the establishment of a freestanding emergency center medical service category of service or the number of treatment stations has been established. Need shall be established pursuant to the applicable review criteria of 77 Ill. Adm. Code 1110.

(Source: Added at 32 Ill. Reg. 12321, effective July 18, 2008)

Section 1100.810 Long-Term Acute Care Hospital Category of Service

a) Planning Areas

HSA 1 HSAs 5 and 11

HSAs 2 and 10 HSAs 6, 7, 8 and 9

HSAs 3 and 4

b) Age Groups

For Long-Term Acute Care Hospital (LTACH) services, all ages.

c) Occupancy Target

Facilities that provide LTACH beds should operate those beds at or above an annual minimum occupancy rate of 85%.

d) Authorized Hospital Bed Capacity

1) Any beds in existence prior to April 15, 2010 that were used as LTACH beds have been reclassified from medical-surgical or ICU beds to LTACH beds.

2) Beds in LTACHs certified by CMMS shall be reclassified by HFSRB in its Inventory of Health Care Facilities and Services and Need Determinations.

e) Need Determination

The following methodology is utilized to determine the projected number of LTACH beds needed in a planning area:

1) Divide the patient days for LTACH category of service for the base year by the population for the base year to determine the planning area's experienced use rate.

2) If the experienced use rate is less than 60% of the State's base year use rate, adjust the planning area's use rate to 60% of the State's base year use rate to establish a minimum use rate.

3) Multiply the experienced or minimum use rate by the projected population to obtain projected patient days.

4) Divide total projected patient days by days in year to obtain projected average daily census.

5) Divide the projected average daily census by the occupancy target for the service to obtain the bed need.

6) Calculate the number of beds that should be added in each area by subtracting the number of beds in existing facilities from the number of beds needed.

(Source: Added at 34 Ill. Reg. 6067, effective April 13, 2010)

Section 1100.APPENDIX A Applicable Codes and Standards Utilized in 77 Ill. Adm. Code: Chapter II, Subchapter a (Repealed)

(Source: Repealed at 34 Ill. Reg. 6067, effective April 13, 2010)