Illinois General Assembly - Full Text of HB2465
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Full Text of HB2465  100th General Assembly




HB2465 EnrolledLRB100 08234 MJP 18334 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 Specialized Mental Health Rehabilitation
5Act of 2013 is amended by changing Sections 1-101.5, 1-102,
62-103, 4-105, and 4-108.5 and by adding Section 4-104.5 as
8    (210 ILCS 49/1-101.5)
9    Sec. 1-101.5. Prior law.
10    (a) This Act provides for licensure of long term care
11facilities that are federally designated as institutions for
12the mentally diseased on the effective date of this Act and
13specialize in providing services to individuals with a serious
14mental illness. On and after the effective date of this Act,
15these facilities shall be governed by this Act instead of the
16Nursing Home Care Act. The existence of a current or pending
17administrative hearing, notice of violation, or other
18enforcement action, except for a pending notice of revocation,
19authorized under the Nursing Home Care Act shall not be a
20barrier to the provisional licensure of a facility under this
21Act. Provisional licensure under this Act shall not relieve a
22facility from the responsibility for the payment of any past,
23current, or future fines or penalties, or for any other



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1enforcement remedy, imposed upon the facility under the Nursing
2Home Care Act.
3    (b) All consent decrees that apply to facilities federally
4designated as institutions for the mentally diseased shall
5continue to apply to facilities licensed under this Act.
6    (c) A facility licensed under this Act may voluntarily
7close, and the facility may reopen in an underserved region of
8the State, if the facility receives a certificate of need from
9the Health Facilities and Services Review Board. At no time
10shall the total number of licensed beds under this Act exceed
11the total number of licensed beds existing on July 22, 2013
12(the effective date of Public Act 98-104).
13(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
14    (210 ILCS 49/1-102)
15    Sec. 1-102. Definitions. For the purposes of this Act,
16unless the context otherwise requires:
17    "Abuse" means any physical or mental injury or sexual
18assault inflicted on a consumer other than by accidental means
19in a facility.
20    "Accreditation" means any of the following:
21        (1) the Joint Commission;
22        (2) the Commission on Accreditation of Rehabilitation
23    Facilities;
24        (3) the Healthcare Facilities Accreditation Program;
25    or



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1        (4) any other national standards of care as approved by
2    the Department.
3    "Applicant" means any person making application for a
4license or a provisional license under this Act.
5    "Consumer" means a person, 18 years of age or older,
6admitted to a mental health rehabilitation facility for
7evaluation, observation, diagnosis, treatment, stabilization,
8recovery, and rehabilitation.
9    "Consumer" does not mean any of the following:
10        (i) an individual requiring a locked setting;
11        (ii) an individual requiring psychiatric
12    hospitalization because of an acute psychiatric crisis;
13        (iii) an individual under 18 years of age;
14        (iv) an individual who is actively suicidal or violent
15    toward others;
16        (v) an individual who has been found unfit to stand
17    trial;
18        (vi) an individual who has been found not guilty by
19    reason of insanity based on committing a violent act, such
20    as sexual assault, assault with a deadly weapon, arson, or
21    murder;
22        (vii) an individual subject to temporary detention and
23    examination under Section 3-607 of the Mental Health and
24    Developmental Disabilities Code;
25        (viii) an individual deemed clinically appropriate for
26    inpatient admission in a State psychiatric hospital; and



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1        (ix) an individual transferred by the Department of
2    Corrections pursuant to Section 3-8-5 of the Unified Code
3    of Corrections.
4    "Consumer record" means a record that organizes all
5information on the care, treatment, and rehabilitation
6services rendered to a consumer in a specialized mental health
7rehabilitation facility.
8    "Controlled drugs" means those drugs covered under the
9federal Comprehensive Drug Abuse Prevention Control Act of
101970, as amended, or the Illinois Controlled Substances Act.
11    "Department" means the Department of Public Health.
12    "Discharge" means the full release of any consumer from a
14    "Drug administration" means the act in which a single dose
15of a prescribed drug or biological is given to a consumer. The
16complete act of administration entails removing an individual
17dose from a container, verifying the dose with the prescriber's
18orders, giving the individual dose to the consumer, and
19promptly recording the time and dose given.
20    "Drug dispensing" means the act entailing the following of
21a prescription order for a drug or biological and proper
22selection, measuring, packaging, labeling, and issuance of the
23drug or biological to a consumer.
24    "Emergency" means a situation, physical condition, or one
25or more practices, methods, or operations which present
26imminent danger of death or serious physical or mental harm to



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1consumers of a facility.
2    "Facility" means a specialized mental health
3rehabilitation facility that provides at least one of the
4following services: (1) triage center; (2) crisis
5stabilization; (3) recovery and rehabilitation supports; or
6(4) transitional living units for 3 or more persons. The
7facility shall provide a 24-hour program that provides
8intensive support and recovery services designed to assist
9persons, 18 years or older, with mental disorders to develop
10the skills to become self-sufficient and capable of increasing
11levels of independent functioning. It includes facilities that
12meet the following criteria:
13        (1) 100% of the consumer population of the facility has
14    a diagnosis of serious mental illness;
15        (2) no more than 15% of the consumer population of the
16    facility is 65 years of age or older;
17        (3) none of the consumers are non-ambulatory;
18        (4) none of the consumers have a primary diagnosis of
19    moderate, severe, or profound intellectual disability; and
20        (5) the facility must have been licensed under the
21    Specialized Mental Health Rehabilitation Act or the
22    Nursing Home Care Act immediately preceding July 22, 2013
23    (the effective date of this Act) and qualifies as an a
24    institute for mental disease under the federal definition
25    of the term.
26    "Facility" does not include the following:



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1        (1) a home, institution, or place operated by the
2    federal government or agency thereof, or by the State of
3    Illinois;
4        (2) a hospital, sanitarium, or other institution whose
5    principal activity or business is the diagnosis, care, and
6    treatment of human illness through the maintenance and
7    operation as organized facilities therefor which is
8    required to be licensed under the Hospital Licensing Act;
9        (3) a facility for child care as defined in the Child
10    Care Act of 1969;
11        (4) a community living facility as defined in the
12    Community Living Facilities Licensing Act;
13        (5) a nursing home or sanatorium operated solely by and
14    for persons who rely exclusively upon treatment by
15    spiritual means through prayer, in accordance with the
16    creed or tenets of any well-recognized church or religious
17    denomination; however, such nursing home or sanatorium
18    shall comply with all local laws and rules relating to
19    sanitation and safety;
20        (6) a facility licensed by the Department of Human
21    Services as a community-integrated living arrangement as
22    defined in the Community-Integrated Living Arrangements
23    Licensure and Certification Act;
24        (7) a supportive residence licensed under the
25    Supportive Residences Licensing Act;
26        (8) a supportive living facility in good standing with



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1    the program established under Section 5-5.01a of the
2    Illinois Public Aid Code, except only for purposes of the
3    employment of persons in accordance with Section 3-206.01
4    of the Nursing Home Care Act;
5        (9) an assisted living or shared housing establishment
6    licensed under the Assisted Living and Shared Housing Act,
7    except only for purposes of the employment of persons in
8    accordance with Section 3-206.01 of the Nursing Home Care
9    Act;
10        (10) an Alzheimer's disease management center
11    alternative health care model licensed under the
12    Alternative Health Care Delivery Act;
13        (11) a home, institution, or other place operated by or
14    under the authority of the Illinois Department of Veterans'
15    Affairs;
16        (12) a facility licensed under the ID/DD Community Care
17    Act;
18        (13) a facility licensed under the Nursing Home Care
19    Act after July 22, 2013 (the effective date of this Act);
20    or
21        (14) a facility licensed under the MC/DD Act.
22    "Executive director" means a person who is charged with the
23general administration and supervision of a facility licensed
24under this Act and who is a licensed nursing home
25administrator, licensed practitioner of the healing arts, or
26qualified mental health professional.



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1    "Guardian" means a person appointed as a guardian of the
2person or guardian of the estate, or both, of a consumer under
3the Probate Act of 1975.
4    "Identified offender" means a person who meets any of the
5following criteria:
6        (1) Has been convicted of, found guilty of, adjudicated
7    delinquent for, found not guilty by reason of insanity for,
8    or found unfit to stand trial for, any felony offense
9    listed in Section 25 of the Health Care Worker Background
10    Check Act, except for the following:
11            (i) a felony offense described in Section 10-5 of
12        the Nurse Practice Act;
13            (ii) a felony offense described in Section 4, 5, 6,
14        8, or 17.02 of the Illinois Credit Card and Debit Card
15        Act;
16            (iii) a felony offense described in Section 5, 5.1,
17        5.2, 7, or 9 of the Cannabis Control Act;
18            (iv) a felony offense described in Section 401,
19        401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois
20        Controlled Substances Act; and
21            (v) a felony offense described in the
22        Methamphetamine Control and Community Protection Act.
23        (2) Has been convicted of, adjudicated delinquent for,
24    found not guilty by reason of insanity for, or found unfit
25    to stand trial for, any sex offense as defined in
26    subsection (c) of Section 10 of the Sex Offender Management



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1    Board Act.
2    "Transitional living units" are residential units within a
3facility that have the purpose of assisting the consumer in
4developing and reinforcing the necessary skills to live
5independently outside of the facility. The duration of stay in
6such a setting shall not exceed 120 days for each consumer.
7Nothing in this definition shall be construed to be a
8prerequisite for transitioning out of a facility.
9    "Licensee" means the person, persons, firm, partnership,
10association, organization, company, corporation, or business
11trust to which a license has been issued.
12    "Misappropriation of a consumer's property" means the
13deliberate misplacement, exploitation, or wrongful temporary
14or permanent use of a consumer's belongings or money without
15the consent of a consumer or his or her guardian.
16    "Neglect" means a facility's failure to provide, or willful
17withholding of, adequate medical care, mental health
18treatment, psychiatric rehabilitation, personal care, or
19assistance that is necessary to avoid physical harm and mental
20anguish of a consumer.
21    "Personal care" means assistance with meals, dressing,
22movement, bathing, or other personal needs, maintenance, or
23general supervision and oversight of the physical and mental
24well-being of an individual who is incapable of maintaining a
25private, independent residence or who is incapable of managing
26his or her person, whether or not a guardian has been appointed



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1for such individual. "Personal care" shall not be construed to
2confine or otherwise constrain a facility's pursuit to develop
3the skills and abilities of a consumer to become
4self-sufficient and capable of increasing levels of
5independent functioning.
6    "Recovery and rehabilitation supports" means a program
7that facilitates a consumer's longer-term symptom management
8and stabilization while preparing the consumer for
9transitional living units by improving living skills and
10community socialization. The duration of stay in such a setting
11shall be established by the Department by rule.
12    "Restraint" means:
13        (i) a physical restraint that is any manual method or
14    physical or mechanical device, material, or equipment
15    attached or adjacent to a consumer's body that the consumer
16    cannot remove easily and restricts freedom of movement or
17    normal access to one's body; devices used for positioning,
18    including, but not limited to, bed rails, gait belts, and
19    cushions, shall not be considered to be restraints for
20    purposes of this Section; or
21        (ii) a chemical restraint that is any drug used for
22    discipline or convenience and not required to treat medical
23    symptoms; the Department shall, by rule, designate certain
24    devices as restraints, including at least all those devices
25    that have been determined to be restraints by the United
26    States Department of Health and Human Services in



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1    interpretive guidelines issued for the purposes of
2    administering Titles XVIII and XIX of the federal Social
3    Security Act. For the purposes of this Act, restraint shall
4    be administered only after utilizing a coercive free
5    environment and culture.
6    "Self-administration of medication" means consumers shall
7be responsible for the control, management, and use of their
8own medication.
9    "Crisis stabilization" means a secure and separate unit
10that provides short-term behavioral, emotional, or psychiatric
11crisis stabilization as an alternative to hospitalization or
12re-hospitalization for consumers from residential or community
13placement. The duration of stay in such a setting shall not
14exceed 21 days for each consumer.
15    "Therapeutic separation" means the removal of a consumer
16from the milieu to a room or area which is designed to aid in
17the emotional or psychiatric stabilization of that consumer.
18    "Triage center" means a non-residential 23-hour center
19that serves as an alternative to emergency room care,
20hospitalization, or re-hospitalization for consumers in need
21of short-term crisis stabilization. Consumers may access a
22triage center from a number of referral sources, including
23family, emergency rooms, hospitals, community behavioral
24health providers, federally qualified health providers, or
25schools, including colleges or universities. A triage center
26may be located in a building separate from the licensed



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1location of a facility, but shall not be more than 1,000 feet
2from the licensed location of the facility and must meet all of
3the facility standards applicable to the licensed location. If
4the triage center does operate in a separate building, safety
5personnel shall be provided, on site, 24 hours per day and the
6triage center shall meet all other staffing requirements
7without counting any staff employed in the main facility
9(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
1099-180, eff. 7-29-15; revised 9-8-16.)
11    (210 ILCS 49/2-103)
12    Sec. 2-103. Staff training. Training for all new employees
13specific to the various levels of care offered by a facility
14shall be provided to employees during their orientation period
15and annually thereafter. Training shall be independent of the
16Department and overseen by the Division of Mental Health to
17determine the content of all facility employee training and to
18provide training for all trainers of facility employees.
19Training of employees shall be consistent with nationally
20recognized national accreditation standards as defined later
21in this Act. Training of existing staff of a recovery and
22rehabilitation support center shall be conducted in accordance
23with, and on the schedule provided in, the staff training plan
24approved by the Division of Mental Health. Training of existing
25staff for any other level of care licensed under this Act,



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1including triage, crisis stabilization, and transitional
2living shall be completed at a facility prior to the
3implementation of that level of care. Training shall be
4required for all existing staff at a facility prior to the
5implementation of any new services authorized under this Act.
6(Source: P.A. 98-104, eff. 7-22-13.)
7    (210 ILCS 49/4-104.5 new)
8    Sec. 4-104.5. Waiver of compliance. Upon application by a
9facility, the Director may grant or renew the waiver of the
10facility's compliance with a rule or standard for a period not
11to exceed the duration of the current license or, in the case
12of an application for license renewal, the duration of the
13renewal period. The waiver may be conditioned upon the facility
14taking action prescribed by the Director as a measure
15equivalent to compliance. In determining whether to grant or
16renew a waiver, the Director shall consider the duration and
17basis for any current waiver with respect to the same rule or
18standard and the validity and effect upon patient health and
19safety of extending it on the same basis, the effect upon the
20health and safety of consumers, the quality of consumer care,
21the facility's history of compliance with the rules and
22standards of this Act and the facility's attempts to comply
23with the particular rule or standard in question. Upon request
24by a facility, the Department must evaluate or allow for an
25evaluation of compliance with the Life Safety Code using the



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1Fire Safety Evaluation System. In determining whether to grant
2or renew a waiver of a standard pertaining to Chapter 33 of the
3National Fire Protection Association (NFPA) 101 Life Safety
4Code, the Director shall use Fire Safety Evaluation Systems in
5determining whether to grant or renew the waiver. The
6Department may provide, by rule, for the automatic renewal of
7waivers concerning physical plant requirements upon the
8renewal of a license. The Department shall renew waivers
9relating to physical plant standards issued in accordance with
10this Section at the time of the indicated reviews, unless it
11can show why such waivers should not be extended for either of
12the following reasons:
13        (1) the condition of the physical plant has
14    deteriorated or its use substantially changed so that the
15    basis upon which the waiver was issued is materially
16    different; or
17        (2) the facility is renovated or substantially
18    remodeled in such a way as to permit compliance with the
19    applicable rules and standards without a substantial
20    increase in cost.
21    A copy of each waiver application and each waiver granted
22or renewed shall be on file with the Department and available
23for public inspection.
24    No penalty or fine may be assessed for a condition for
25which the facility has received a variance or waiver of a



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1    Waivers granted to a facility by the Department under any
2other law shall not be considered by the Department in its
3determination of a facility's compliance with the requirements
4of this Act, including, but not limited to, compliance with the
5Life Safety Code.
6    (210 ILCS 49/4-105)
7    Sec. 4-105. Provisional licensure duration. A provisional
8license shall be valid upon fulfilling the requirements
9established by the Department by emergency rule. The license
10shall remain valid as long as a facility remains in compliance
11with the licensure provisions established in rule. Provisional
12licenses issued upon initial licensure as a specialized mental
13health rehabilitation facility shall expire at the end of a
143-year period, which commences on the date the provisional
15license is issued. Issuance of a provisional license for any
16reason other than initial licensure (including, but not limited
17to, change of ownership, location, number of beds, or services)
18shall not extend the maximum 3-year period, at the end of which
19a facility must be licensed pursuant to Section 4-201.
20Notwithstanding any other provision of this Act or the
21Specialized Mental Health Rehabilitation Facilities Code, 77
22Ill. Admin. Code 380, to the contrary, if a facility has
23received notice from the Department that its application for
24provisional licensure to provide recovery and rehabilitation
25services has been accepted as complete and the facility has



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1attested in writing to the Department that it will comply with
2the staff training plan approved by the Division of Mental
3Health, then a provisional license for recovery and
4rehabilitation services shall be issued to the facility within
560 days after the Department determines that the facility is in
6compliance with the requirements of the Life Safety Code in
7accordance with Section 4-104.5 of this Act.
8(Source: P.A. 98-104, eff. 7-22-13; 99-712, eff. 8-5-16.)
9    (210 ILCS 49/4-108.5)
10    Sec. 4-108.5. Provisional licensure period; surveys.
11During the provisional licensure period, the Department shall
12conduct surveys to determine compliance with timetables and
13benchmarks with a facility's provisional licensure application
14plan of operation. Timetables and benchmarks shall be
15established in rule and shall include, but not be limited to,
16the following: (1) training of new and existing staff; (2)
17establishment of a data collection and reporting program for
18the facility's Quality Assessment and Performance Improvement
19Program; and (3) compliance with building environment
20standards beyond compliance with Chapter 33 of the National
21Fire Protection Association (NFPA) 101 Life Safety Code.
22Waivers granted by the Department in accordance with Section
234-104.5 of this Act shall be considered by the Department in
24its determination of the facility's compliance with the Life
25Safety Code.



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1    During the provisional licensure period, the Department
2shall conduct State licensure surveys as well as a conformance
3standard review to determine compliance with timetables and
4benchmarks associated with the accreditation process.
5Timetables and benchmarks shall be met in accordance with the
6preferred accrediting organization conformance standards and
7recommendations and shall include, but not be limited to,
8conducting a comprehensive facility self-evaluation in
9accordance with an established national accreditation program.
10The facility shall submit all data reporting and outcomes
11required by accrediting organization to the Department of
12Public Health for review to determine progress towards
13accreditation. Accreditation status shall supplement but not
14replace the State's licensure surveys of facilities licensed
15under this Act and their certified programs and services to
16determine the extent to which these facilities provide high
17quality interventions, especially evidence-based practices,
18appropriate to the assessed clinical needs of individuals in
19the 4 certified levels of care.
20    Except for incidents involving the potential for harm,
21serious harm, death, or substantial facility failure to address
22a serious systemic issue within 60 days, findings of the
23facility's root cause analysis of problems and the facility's
24Quality Assessment and Performance Improvement program in
25accordance with item (22) of Section 4-104 shall not be used as
26a basis for non-compliance.



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1    The Department shall have the authority to hire licensed
2practitioners of the healing arts and qualified mental health
3professionals to consult with and participate in survey and
4inspection activities.
5(Source: P.A. 98-651, eff. 6-16-14.)
6    Section 99. Effective date. This Act takes effect July 1,