101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3730

 

Introduced 2/14/2020, by Sen. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/3-202.05
305 ILCS 5/5-5.4l new

    Amends the Nursing Home Care Act. Provides that the definition of "skilled care" includes some specified actions, but does not include others. Defines terms for purposes of imposing specified monetary penalties. Provides that for the purposes of imposing specified monetary penalties, the Department of Public Health must not count each individual day as an occurrence and any unforeseen circumstance that occurs for a continuous period only counts as one time. Amends the Illinois Public Aid Code. Provides that, if all other requirements for coverage under a Medicaid skilled nursing facility benefit are met, skilled nursing services shall be covered under specified circumstances.


LRB101 19922 CPF 69445 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3730LRB101 19922 CPF 69445 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Nursing Home Care Act is amended by changing
5Section 3-202.05 as follows:
 
6    (210 ILCS 45/3-202.05)
7    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
8thereafter.
9    (a) For the purpose of computing staff to resident ratios,
10direct care staff shall include:
11        (1) registered nurses;
12        (2) licensed practical nurses;
13        (3) certified nurse assistants;
14        (4) psychiatric services rehabilitation aides;
15        (5) rehabilitation and therapy aides;
16        (6) psychiatric services rehabilitation coordinators;
17        (7) assistant directors of nursing;
18        (8) 50% of the Director of Nurses' time; and
19        (9) 30% of the Social Services Directors' time.
20    The Department shall, by rule, allow certain facilities
21subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
22S) to utilize specialized clinical staff, as defined in rules,
23to count towards the staffing ratios.

 

 

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1    Within 120 days of the effective date of this amendatory
2Act of the 97th General Assembly, the Department shall
3promulgate rules specific to the staffing requirements for
4facilities federally defined as Institutions for Mental
5Disease. These rules shall recognize the unique nature of
6individuals with chronic mental health conditions, shall
7include minimum requirements for specialized clinical staff,
8including clinical social workers, psychiatrists,
9psychologists, and direct care staff set forth in paragraphs
10(4) through (6) and any other specialized staff which may be
11utilized and deemed necessary to count toward staffing ratios.
12    Within 120 days of the effective date of this amendatory
13Act of the 97th General Assembly, the Department shall
14promulgate rules specific to the staffing requirements for
15facilities licensed under the Specialized Mental Health
16Rehabilitation Act of 2013. These rules shall recognize the
17unique nature of individuals with chronic mental health
18conditions, shall include minimum requirements for specialized
19clinical staff, including clinical social workers,
20psychiatrists, psychologists, and direct care staff set forth
21in paragraphs (4) through (6) and any other specialized staff
22which may be utilized and deemed necessary to count toward
23staffing ratios.
24    (b) (Blank).
25    (b-5) For purposes of the minimum staffing ratios in this
26Section, all residents shall be classified as requiring either

 

 

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1skilled care or intermediate care.
2    As used in this subsection:
3    "Intermediate care" means basic nursing care and other
4restorative services under periodic medical direction.
5"Intermediate care" includes care received by a resident that
6is not skilled care.
7    "Skilled care" means skilled nursing care, continuous
8skilled nursing observations, restorative nursing, and other
9services under professional direction with frequent medical
10supervision. "Skilled care" includes nursing services so
11inherently complex that they can be safely and effectively
12performed only by, or under the supervision of, a registered
13nurse or, when provided by rule or regulation, a licensed
14practical or vocational nurse. A service is not skilled care
15merely because it is performed by or under the direct
16supervision of a nurse. If a service can be safely and
17effectively performed or self-administered by an unskilled
18person, the service shall not be regarded as skilled care even
19if a nurse actually provides the service. The unavailability of
20a competent person to provide a nonskilled service, regardless
21of the importance of the service to the patient, does not
22constitute skilled care when a nurse provides the service.
23    (c) Facilities shall notify the Department within 60 days
24after the effective date of this amendatory Act of the 96th
25General Assembly, in a form and manner prescribed by the
26Department, of the staffing ratios in effect on the effective

 

 

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1date of this amendatory Act of the 96th General Assembly for
2both intermediate and skilled care and the number of residents
3receiving each level of care.
4    (d)(1) (Blank).
5    (2) (Blank).
6    (3) (Blank).
7    (4) (Blank).
8    (5) Effective January 1, 2014, the minimum staffing ratios
9shall be increased to 3.8 hours of nursing and personal care
10each day for a resident needing skilled care and 2.5 hours of
11nursing and personal care each day for a resident needing
12intermediate care.
13    (e) Ninety days after the effective date of this amendatory
14Act of the 97th General Assembly, a minimum of 25% of nursing
15and personal care time shall be provided by licensed nurses,
16with at least 10% of nursing and personal care time provided by
17registered nurses. These minimum requirements shall remain in
18effect until an acuity based registered nurse requirement is
19promulgated by rule concurrent with the adoption of the
20Resource Utilization Group classification-based payment
21methodology, as provided in Section 5-5.2 of the Illinois
22Public Aid Code. Registered nurses and licensed practical
23nurses employed by a facility in excess of these requirements
24may be used to satisfy the remaining 75% of the nursing and
25personal care time requirements. Notwithstanding this
26subsection, no staffing requirement in statute in effect on the

 

 

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1effective date of this amendatory Act of the 97th General
2Assembly shall be reduced on account of this subsection.
3    (f) The Department shall submit proposed rules for adoption
4by January 1, 2020 establishing a system for determining
5compliance with minimum staffing set forth in this Section and
6the requirements of 77 Ill. Adm. Code 300.1230 adjusted for any
7waivers granted under Section 3-303.1. Compliance shall be
8determined quarterly by comparing the number of hours provided
9per resident per day using the Centers for Medicare and
10Medicaid Services' payroll-based journal and the facility's
11daily census, broken down by intermediate and skilled care as
12self-reported by the facility to the Department on a quarterly
13basis. The Department shall use the quarterly payroll-based
14journal and the self-reported census to calculate the number of
15hours provided per resident per day and compare this ratio to
16the minimum staffing standards required under this Section, as
17impacted by any waivers granted under Section 3-303.1.
18Discrepancies between job titles contained in this Section and
19the payroll-based journal shall be addressed by rule.
20    (g) The Department shall submit proposed rules for adoption
21by January 1, 2020 establishing monetary penalties for
22facilities not in compliance with minimum staffing standards
23under this Section. No monetary penalty may be issued for
24noncompliance during the implementation period, which shall be
25July 1, 2020 through September 30, 2020. If a facility is found
26to be noncompliant during the implementation period, the

 

 

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1Department shall provide a written notice identifying the
2staffing deficiencies and require the facility to provide a
3sufficiently detailed correction plan to meet the statutory
4minimum staffing levels. Monetary penalties shall be imposed
5beginning no later than January 1, 2021 and quarterly
6thereafter and shall be based on the latest quarter for which
7the Department has data. Monetary penalties shall be
8established based on a formula that calculates on a daily basis
9the cost of wages and benefits for the missing staffing hours.
10All notices of noncompliance shall include the computations
11used to determine noncompliance and establishing the variance
12between minimum staffing ratios and the Department's
13computations. The penalty for the first offense shall be 125%
14of the cost of wages and benefits for the missing staffing
15hours. The penalty shall increase to 150% of the cost of wages
16and benefits for the missing staffing hours for the second
17offense and 200% the cost of wages and benefits for the missing
18staffing hours for the third and all subsequent offenses. The
19penalty shall be imposed regardless of whether the facility has
20committed other violations of this Act during the same period
21that the staffing offense occurred. The penalty may not be
22waived, but the Department shall have the discretion to
23determine the gravity of the violation in situations where
24there is no more than a 10% deviation from the staffing
25requirements and make appropriate adjustments to the penalty.
26The Department is granted discretion to waive the penalty when

 

 

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1unforeseen circumstances have occurred that resulted in
2call-offs of scheduled staff. This provision shall be applied
3no more than 6 times per quarter. The Department must not count
4each individual day as an occurrence and any unforeseen
5circumstance that occurs for a continuous period only counts as
6one time. Nothing in this Section diminishes a facility's right
7to appeal.
8    For purposes of imposing the monetary penalties
9established under this subsection, the following definitions
10apply:
11        "Benefits" means the average cost of legally required
12    benefits per hour worked that is reported by the Bureau of
13    Labor Statistics of the United States Department of Labor
14    through the quarterly updated Employer Costs for Employee
15    Compensation for the Regions report. The Department must
16    use the legally required benefits for the report's Midwest
17    region.
18        "Legally required benefits" includes Social Security,
19    Medicare, federal and State unemployment insurance, and
20    workers' compensation.
21        "Wages" means the most current median hourly wage data
22    reported by the Bureau of Labor Statistics of the United
23    States Department of Labor in the Occupational Employment
24    Statistics' Metropolitan and Nonmetropolitan Area
25    Occupational Employment and Wage Estimates for the State of
26    Illinois. The Department must use Bureau of Labor

 

 

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1    Statistics of the United States Department of Labor's
2    occupational code 29-1141 for registered nurses,
3    occupational code 29-2061 for licensed practical and
4    licensed vocational nurses, and occupational code 31-1014
5    for certified nurse assistants and all other direct care
6    staff job categories listed under subsection (a).
7(Source: P.A. 101-10, eff. 6-5-19.)
 
8    Section 10. The Illinois Public Aid Code is amended by
9adding Section 5-5.4l as follows:
 
10    (305 ILCS 5/5-5.4l new)
11    Sec. 5-5.4l. Skilled care.
12    (a) In this Section, "skilled care" has the same meaning as
13defined in Section 3-202.5 of the Nursing Home Care Act.
14    (b) If all other requirements for coverage under a Medicaid
15skilled nursing facility benefit are met, skilled nursing
16services shall be covered when an individualized assessment of
17a patient's clinical condition demonstrates that the
18specialized judgment, knowledge, and skills of a registered
19nurse or, when provided by rule or regulation, a licensed
20practical or vocational nurse are necessary. Skilled care shall
21be covered if (1) such skilled care is necessary to maintain
22the patient's current condition or prevent or slow further
23deterioration so long as the beneficiary requires skilled care
24for the services to be safely and effectively provided and (2)

 

 

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1all other requirements for coverage under the Medicare skilled
2nursing facility benefit are met. Coverage shall not turn on
3the presence or absence of an individual's potential for
4improvement from nursing care, but rather on the beneficiary's
5need for skilled care.
6    (c) A condition that would not ordinarily require skilled
7care may nevertheless require skilled care under certain
8circumstances. In such instances, skilled care is necessary
9only when: (1) the particular patient's special medical
10complications require the skills of a registered nurse or, when
11provided by regulation, a licensed practical nurse to perform a
12type of service that would otherwise be considered nonskilled;
13or (2) the needed services are of such complexity that the
14skills of a registered nurse or, when provided by rule or
15regulation, a licensed practical nurse are required to furnish
16the services.