HB4699ham002 95TH GENERAL ASSEMBLY

Rep. Bob Biggins

Filed: 4/14/2008

09500HB4699ham002 LRB095 18756 MJR 49532 a

AMENDMENT TO HOUSE BILL 4699

AMENDMENT NO. ______. Amend House Bill 4699, AS AMENDED, by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Stroke Center Recognition Act.

Section 5. Findings. The General Assembly finds and declares that:

(1) Despite significant advances in diagnosis, treatment, and prevention, stroke remains the third highest killer in the United States. An estimated 700,000 to 750,000 new and recurrent strokes occur each year in this country; and with the aging of the population, the number of persons who have strokes is projected to increase each year. Stroke is the number 3 killer of Illinois residents and leads to the death of more than 7,500 citizens of Illinois each year and disables thousands more. Illinois, Indiana, and Ohio have higher stroke mortality rates than neighboring states Michigan, Minnesota, and Wisconsin.

(2) A level of stroke center and Regional Stroke Center Systems should be established for the treatment of acute stroke. Primary Stroke Centers should be established in acute care hospitals to evaluate, stabilize, and provide emergency care to patients with acute stroke.

(3) It is in the best interest of the residents of this State to have a program to recognize stroke centers throughout the State, to provide specific patient care to ensure that acute stroke patients receive safe and effective care, and to provide financial support to acute care hospitals to maintain and develop stroke centers. Further it is in the best interest of the people of the State of Illinois to improve the State's emergency medical response to assure that stroke patients may be quickly identified and transported to and treated in facilities that provide timely and appropriate treatment for stroke patients.

Section 10. Definitions. For purposes of this Act:

"Department" means the Illinois Department of Public Health.

"Director" means the Director of the Illinois Department of Public Health.

"Emergency Medical Services Provider" or "EMS provider" means a vehicle service provider which coordinates and provides pre-hospital and inter-hospital emergency care and non-emergency medical transports at a Basic Level Support Service, Intermediate Life Support Service, or Advanced Life Support Service level, or any combination thereof, pursuant to an EMS System program plan submitted to and approved by the Department, and pursuant to the EMS Regional Plan adopted for the EMS Region in which the system is located.

"Emergency Medical Services Region" or "EMS Region" means a geographic area designated by the Department that encompasses EMS Systems and trauma centers, in which emergency medical services, trauma centers, and non-emergency medical services are coordinated under an EMS Region Plan.

"Emergency Medical Services System" or "EMS System" means an organization of hospitals, vehicle service providers and personnel approved by the Department 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, or ALS level pursuant to a system program plan submitted to and approved by the Department and pursuant to the EMS Regional Plan adopted for the EMS Region in which the EMS System is located.

"Emergency Medical Services Medical Director" or "EMS Medical Director" means the physician, appointed by the Resource Hospital, who has the responsibility and authority for total management of the EMS System.

"Primary Stroke Center" means a hospital that has been designated by the Joint Commission, or other nationally-recognized accrediting body as approved by the Department of Public Health as qualifying and maintaining conformance with the requirements of this Act.

"Regional EMS Medical Directors Committee" or "Committee" means a group comprised of the Region's EMS Medical Directors, along with the medical advisor to a fire department vehicle service provider. For Regions that include a municipal fire department serving a population of over 2,000,000 people, that fire department's medical advisor shall serve on the Committee. For other EMS Regions, the fire department vehicle service providers shall select which medical advisor to serve on the Committee on an annual basis.

"Regional Stroke Center System" means Primary Stroke Centers recognized by the Department, EMS Systems, and all pre-hospital care providers in an EMS Region.

"Resource Hospital" means the hospital with the authority and the responsibility for an EMS System as outlined in the Department-approved EMS System Program Plan.

Section 15. Recognition of Primary Stroke Centers.

(a) The Department shall recognize any hospital as a designated Primary Stroke Center if the hospital meets any of the following criteria:

(1) is designated a Primary Stroke Center by the Joint Commission;

(2) is designated a Primary Stroke Center by a nationally-recognized accrediting body as approved by the Department, provided that the designation criteria of the accrediting body are in keeping with the most recent evidence-based stroke guidelines as determined by national organizations recognized for leadership and expertise in evidence-based practices related to reducing the occurrence, disabilities and death associated with stroke.

(b) The Department shall re-recognize a hospital as a Primary Stroke Center every 2 years.

(c) Each hospital designated a Primary Stroke Center shall notify the Department of its designation within 30 days after receiving that designation. Each hospital shall notify the Department if it ceases to be a Primary Stroke Center, within 30 days after it ceases having that designation.

(d) The Department may suspend its recognition of a hospital's Primary Stroke Center designation at the request of the hospital seeking a suspended status.

Section 20. Grants.

(a) In order to encourage and ensure the establishment and retention of Primary Stroke Centers throughout the State, the Director may award matching grants to hospitals that have been designated Primary Stroke Centers or that seek designation as Primary Stroke Centers, to be used for necessary infrastructure, including personnel and equipment, or to meet the fee requirements for accreditation surveys in order to satisfy the criteria for designation. A matching grant shall not exceed $250,000 or 50% of the hospital's cost for the necessary infrastructure, whichever is less. Monies shall be given for this purpose as they are intended for this purpose.

(b) The Director may award grant monies to Primary Stroke Centers for the purpose of developing a stroke network.

(c) A Primary Stroke Center or a hospital seeking designation as a Primary Stroke Center may apply to the Director for a matching grant in a manner and form designated by the Director and shall provide information as the Director deems necessary to determine if the hospital is eligible for the grant.

(d) Matching grant awards shall be made to Primary Stroke Centers or to hospitals seeking designation as a Primary Stroke Center, placing greatest priority on facilities in areas with high stroke morbidity rates and achieving geographic diversity where possible.

Section 25. Reporting.

(a) The Director shall, not later than July 1, 2010, prepare and submit to the Governor, the President of the Senate, and the Speaker of the House of Representatives a report indicating the total number of hospitals that have applied for grants under Section 20 of this Act, the project for which the application was submitted, the number of those applicants that have been found eligible for the grants, the total number of grants awarded, the name and address of each grantee, and the amount of the award issued to each grantee.

(b) The Director shall, not later than September 1, 2009, prepare and submit to the Governor, the President of the Senate, and the Speaker of the House of Representatives a report indicating, as of August 1, 2009, the total number of hospitals that have attained Primary Stroke Center designation and the accrediting body through which Primary Stroke Center designations were attained.

(c) By September 1, 2009, the Director shall send the list of recognized Primary Stroke Centers to all Resource Hospital EMS Medical Directors in this State and shall post a list of recognized Primary Stroke Centers on the Department's website.

(d) The Department shall add Primary Stroke Centers immediately to the website listing upon notice to the Department; any Primary Stroke Center whose designation is revoked shall be removed from the website listing immediately upon notice to the Department.

(e) The Department shall administer a data collection system to collect data reported by Primary Stroke Centers to the Joint Commission or other accrediting body as required to fulfill Primary Stroke Center designation requirements. The Department shall work with each Primary Stroke Center to capture information using existing electronic reporting tools used for accreditation purposes. Nothing in this Section shall be construed to empower the Department to specify the form of internal recordkeeping. The data collection system and data collected shall comply with the following requirements:

(1) The confidentiality of patient records shall be maintained in accordance with State and federal regulations on the confidentiality of records.

(2) Hospitals shall not be required to submit financial information that is proprietary in nature and unrelated to the scope or purposes of this Act.

(3) Information submitted to the Department shall be privileged, strictly confidential, and shall be used only for medical research and the evaluation and improvement of quality care. The identity, or any group of facts that tends to lead to the identity, of any person or facility is confidential and shall not be open to public inspection or dissemination. Data submitted to the Department pursuant to this Act shall not be a public record within the meaning contained in the Illinois Freedom of Information Act. The Director shall submit standards or guidelines for ensuring the protection of data collected by the Department to the General Assembly for approval pursuant to Section 45 of this Act.

(4) Primary Stroke Centers may provide complete copies of the same reports they submit to the Joint Commission or other accrediting body. The Department shall access this information directly from an accrediting body provided that the Primary Stroke Center has granted the Department permission to do so. The Department shall provide the Primary Stroke Center with a copy of the data received from the accreditation body so the Primary Stroke Center can verify its accuracy.

(5) The aggregate data shall be made available to any and all government agencies or contractors of government agencies that have responsibility for the management and administration of emergency medical services throughout the State.

(6) The Department shall compile the data and report it in aggregate form to be posted annually on its website. The results of this report may be used by the EMS Regions and the Department to conduct training regarding best practices in the treatment of stroke.

(7) The data specific to a Primary Stroke Center shall be made available only if that Primary Stroke Center provides the Department written authorization for the release of the data.

Section 30. Emergency medical services providers; triage and transportation of a possible acute stroke patient to a Primary Stroke Center.

(a) The Director shall submit a proposed stroke assessment tool to the General Assembly for approval pursuant to Section 45 of this Act. Upon approval by the General Assembly, the Director shall distribute the standardized stroke assessment tool. The Director must post this stroke assessment tool on the Department's website and provide a copy of the assessment tool to each licensed emergency medical services provider no later than January 15, 2010. Each EMS System must use a stroke-triage assessment tool that conforms with and is substantially similar to the sample stroke-triage assessment tool provided by the Department.

(b) The Director shall work with EMS System Medical Directors and Regional Stroke Center Systems to establish protocols related to the assessment, treatment, and transport of possible acute stroke patients by licensed emergency medical services providers. Such protocols shall include regional transport plans for the triage and transport of possible acute stroke patients to the most appropriate facility, which may include the bypass of health care facilities not designated as Primary Stroke Centers when it is appropriate to do so. Hospitals that are part of a stroke network shall not be bypassed unless it is appropriate to do so.

(c) Each EMS System in the State shall comply with the protocols established by the EMS Region related to the assessment, treatment, and transport of possible acute stroke patients by licensed emergency medical services providers in the State and with all of the Sections of this Act by March 1, 2010.

(d) Each EMS System must address the items described in subsections (a) through (c) of this Section through the established quality improvement and patient outcome reviews as provided in the EMS Regional Plan.

Section 35. Restricted practices. This Act is not a medical practice guideline and may not be used to restrict the authority of a hospital to provide services for which it has received a license under State law. The General Assembly intends that all patients be treated individually based on each patient's needs and circumstances.

Section 40. Authorization to advertise. A person may not claim or advertise to the public, by way of any medium whatsoever, that a hospital is a Primary Stroke Center unless the hospital is designated a Primary Stroke Center in accordance with this Act.

Section 45. No authority to make or promulgate rules. Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this Act. If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this Act, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly's discretion. Nothing contained in this Act shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given. For the purposes of this Act, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.

Section 99. Effective date. This Act takes effect upon becoming law.".