State of Illinois
90th General Assembly

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      New Act
      30 ILCS 105/5.480 new
      210 ILCS 45/2-209.5 new
      210 ILCS 45/3-202         from Ch. 111 1/2, par. 4153-202
      210 ILCS 45/3-202.52 new
      210 ILCS 45/3-202.55 new
      210 ILCS 45/3-202.6 new
      210 ILCS 45/3-202.65 new
      210 ILCS 45/3-202.7 new
          Creates the Nursing Home Reform Act  to  increase  public
      and  nursing  facility  employee  participation in correcting
      substandard care at nursing facilities.  Amends  the  Nursing
      Home  Care  Act  to  set  forth  a  minimum number of nursing
      personnel that must be available to nursing  home  residents.
      Amends  the  State Finance Act to add the Nursing Home Reform
      Fund.  Effective immediately.
 1        AN ACT to create the Nursing Home  Reform  Act,  amending
 2    named Acts.
 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:
 5                   ARTICLE 5.  GENERAL PROVISIONS
 6        Section 5-1.  Short title.  This Act may be cited as  the
 7    Nursing Home Reform Act.
 8        Section 5-5.  Legislative findings.  The General Assembly
 9    finds and declares:
10             (1)  That  the  State  of  Illinois  has a large and
11        growing population of senior  and  disabled  persons  who
12        require  nursing  home care and that the level of patient
13        acuity has risen  dramatically,  requiring  more  complex
14        services.
15             (2)  That  despite  the efforts of federal and State
16        officials to protect the health  and  safety  of  nursing
17        home  residents,  significant  quality problems remain in
18        many nursing homes.
19             (3)  That,  according  to  the  National   Citizens'
20        Coalition  for  Nursing  Home  Reform,  the  nursing home
21        industry in the United States  has  annually  spent  $1.2
22        billion to treat preventable decubitis ulcers (bedsores),
23        caused  by  lack  of nutritional hydration, mobility, and
24        cleanliness, and $4.3 billion on incontinent care because
25        residents are not toileted frequently enough.
26             (4)  That the nursing home industry ranks among  the
27        most  dangerous  for employees in the United States, with
28        nursing home workers injured at a rate that is twice  the
29        national average.
30             (5)  That  long-term  care  nursing  facilities that
                            -2-               LRB9010928LDmbA
 1        receive public money should be required to provide at all
 2        times staffing  resources  to  meet  the  minimum  levels
 3        necessary to provide quality care to each resident.
 4             (6)  That  nursing  facilities  that  receive public
 5        money have a responsibility to report to residents, their
 6        families, and to the taxpayers of this State  information
 7        that  pertains  to  staffing levels, billing charges, and
 8        other matters relating  to  sources  and  uses  of  funds
 9        affecting  the  care  of senior and disabled nursing home
10        residents.
11             (7)  That effective enforcement of  laws  regulating
12        the  nursing  home  industry  is  impossible  without the
13        active support of nursing home workers, who  are  on  the
14        front lines of resident care every day.
15             (8)  That  many  nursing  home  workers  who witness
16        actions and situations that may violate the laws of  this
17        State  may  fail  to  report  these  matters to licensing
18        bodies or other  authorities  because  they  fear  losing
19        their jobs.
20             (9)  That family members and other visitors can also
21        be    observers    and   reporters   providing   valuable
22        supplementary oversight of compliance with the  laws  for
23        protection  of residents' safety and well being, although
24        fear of retaliation may deter them from speaking out.
25        Section 5-10.  Definitions.  As used in this Act:
26        "Department" means the Department of Public Health.
27        "Nursing facility" means all or any  part  of  a  nursing
28    home that is qualified and certified for participation in the
29    Medicaid  program  in  Illinois  or  is licensed as a private
30    nursing home in Illinois.
31        "Plan of correction" means a plan that is prepared by the
32    Department of Public Health to correct deficiencies found  as
33    a  result  of its inspection of a nursing facility or skilled
                            -3-               LRB9010928LDmbA
 1    nursing facility.
 2        "Skilled nursing facility" means all or  any  part  of  a
 3    nursing   home   that   is   qualified   and   certified  for
 4    participation in the Medicare program or  is  licensed  as  a
 5    skilled nursing facility in Illinois.
 7        Section 10-5.  Definitions.  As used in this Article:
 8        (a)  "Deficiency" means the failure of a facility subject
 9    to  Section  2-209.5 of the Nursing Home Care Act to meet any
10    of the requirements for participation by the facility in  the
11    Medicaid  program, as specified in Part 483, Subpart B of the
12    Code of Federal Regulations or as otherwise provided by law.
13        (b)  "Substandard quality of  care"  means  one  or  more
14    deficiencies  related to standards for responding to resident
15    behavior and facility practices, quality of life, or  quality
16    of   care,   as   set   forth   in   federal  conditions  for
17    Medicaid/Medicare participation, or related to conditions  of
18    licensure  as a nursing facility in Illinois, that constitute
19    either immediate jeopardy to resident  health  or  safety,  a
20    pattern  of  or  widespread actual harm that is not immediate
21    jeopardy, or a widespread potential for harm  but  less  than
22    immediate jeopardy with no actual harm.
23        Section 10-10.  Mandatory civil penalties.
24        (a)  The Department of Public Health shall impose a civil
25    penalty upon a facility that has been found by the Department
26    to have provided substandard quality of care.
27        (b)  The  amount  of  the  penalty shall be determined as
28    follows:
29             (i)  Upper range - $3,050-$10,000.  Penalties in the
30        range of $3,050 to $10,000 per day shall be  imposed  for
31        deficiencies   that   constitute  immediate  jeopardy  to
                            -4-               LRB9010928LDmbA
 1        resident health or safety.
 2             (ii)  Lower range - $250-$3,000.  Penalties  in  the
 3        range  of  $250  to  $3,000  per day shall be imposed for
 4        deficiencies that constitute substandard quality of  care
 5        and  do  not  constitute  immediate  jeopardy to resident
 6        health and safety.
 7        The Department shall annually adjust the upper and  lower
 8    range  amounts set forth in items (i) and (ii) to reflect the
 9    increase, if any, in the Consumer Price Index For  All  Urban
10    Consumers  for  the  previous calendar year, as determined by
11    the United States  Department  of  Labor.   However,  if  the
12    Consumer  Price Index decreases during a calendar year, there
13    shall be no adjustment for that calendar year.  The  adjusted
14    amounts shall be published in the Department rules.
15        (c)  Civil  penalties  shall  begin to accrue on the date
16    that the facility is first determined by  the  Department  to
17    have  provided substandard quality of care and shall continue
18    to  accrue  until  the   Department   determines   that   the
19    deficiencies  constituting  substandard  quality of care have
20    been corrected.
21        (d)  The penalties described in subsections (a)  and  (b)
22    shall be in addition to other enforcement penalties available
23    to the Department.
25        Section 15-5.  Right to participate.
26        (a)  A  person  who files a complaint with the Department
27    of Public Health with regard to the care of a resident  in  a
28    nursing  facility  subject  to Section 2-209.5 of the Nursing
29    Home  Care  Act  shall,  upon  request,   be   afforded   the
30    opportunity to participate in any inspection arising from the
31    complaint.  An opportunity to participate shall include, at a
32    minimum,  the  right  to  be  present,  either  personally or
                            -5-               LRB9010928LDmbA
 1    through  a  designated  representative,   at   any   initial,
 2    entrance,  and  exit conferences held between the operator of
 3    the facility, or the operator's  designated  agent,  and  the
 4    authorized agent of the Department.
 5        (b)  During any inspection by the Department of a nursing
 6    facility,    including   but   not   limited   to   complaint
 7    investigations, annual inspections, and  post-survey  visits,
 8    State  and Local Long-Term Care Ombudsmen, residents, members
 9    of the families of residents, employees of the facility,  and
10    their   designated   representatives  shall  be  afforded  an
11    opportunity to (1) meet privately  with  the  agents  of  the
12    Department  to  present  concerns  related to compliance with
13    resident care standards and (2) accompany  those  responsible
14    for  the  inspection, in a manner consistent with the privacy
15    of residents, to  the  areas  of  the  facility  where  those
16    concerns are evidenced.
17        The  Department  shall not disclose to a nursing facility
18    the identity of a person who  meets  with  an  agent  of  the
19    Department  or  attends  an inspection as provided under this
20    subsection.
21        (c)  As soon as a nursing facility receives  notification
22    from  the  Department  that  an  inspection  is to occur, the
23    facility shall notify its employees  of  the  inspection  and
24    their right to participate.  Nothing in this subsection shall
25    be   construed  to  authorize  facility  notification  of  an
26    inspection prior to the actual occurrence of  the  inspection
27    by the Department.
28        (d)  If   a  deficiency  is  found  as  a  result  of  an
29    inspection, a plan of correction  shall  be  filed  with  the
30    Department  stating  where  and  how  the  deficiency will be
31    corrected  and  the  facility  shall  post  the  plan  in   a
32    conspicuous  place  at  or  near  the  facility  entrance and
33    accessible and visible to the public  concurrently  with  the
34    submission  of  the  plan  to the Department.  The Department
                            -6-               LRB9010928LDmbA
 1    shall afford the opportunity to any interested person to file
 2    comments on a plan of corrections and its implementation  and
 3    shall  review  the  comments prior to renewing the facility's
 4    license or its certification  to  participate  in  a  medical
 5    assistance program.
 6        Section 15-10.  Ban on retaliation.
 7        (a)  No  nursing  facility or officer, agent, or employee
 8    of  the  facility  shall  threaten,  intimidate,  coerce,  or
 9    retaliate in  any  way  against  an  individual  because  the
10    individual  has  notified  the  Department  or another State,
11    local, or federal authority of a deficiency in resident  care
12    or   participated   in  an  investigation  conducted  by  the
13    Department.
14        (b)  An employee whose rights  under  this  Section  have
15    been  violated may bring an action in the appropriate circuit
16    court against the nursing facility and the responsible  agent
17    of the facility for reinstatement, back pay, and compensation
18    for any other damages sustained.
19        Section  15-15.  Restrictions on the use of public health
20    care funds.  The costs of an attorney, consultant,  or  other
21    person  to  advise,  consult,  or  provide  any other service
22    relative to persuading nursing facility employees to  support
23    or  oppose  an  organization  of  the  employees or any other
24    employee self-organization or concerted activity  for  mutual
25    aid  or  protection  shall not be considered to be reasonable
26    costs  under  a  health  care   program   for   purposes   of
27    reimbursement  from  the  State  of  Illinois  or any agency,
28    authority, or political  subdivision  of  this  State.   This
29    Section  shall  not  apply  to  the  costs  of  attorneys  or
30    consultants  to  assist in collective bargaining with a union
31    or other employee organization recognized as  the  employees'
32    bargaining  agent  or  to  administer a collective bargaining
                            -7-               LRB9010928LDmbA
 1    agreement.
 2        Section 15-20.  Employer responsibility for certain costs
 3    of illegal discharges.  A health care employer shall  pay  to
 4    the federal Unemployment Insurance Corporation Fund an amount
 5    equal  to  the  unemployment  benefits  paid  to a person who
 6    receives an award or settlement of back pay resulting from an
 7    action  or  grievance  brought  against  that  employer   for
 8    wrongful  discharge,  if  the amount of any back pay award or
 9    settlement was reduced by the amount of unemployment benefits
10    received.  In addition, the employer shall pay  to  the  Fund
11    any  administrative  or other costs related to the payment of
12    the unemployment benefits.
13        Section 15-25.  Maintenance  of  records.   In  order  to
14    assure   compliance  with  Section  15-15,  all  health  care
15    employers shall maintain for a period  of  10  years  records
16    adequate to demonstrate the source of payment for all covered
17    costs.
19        Section 20-5.  Right to itemized bills.
20        (a)  Upon receipt of a written request from a resident or
21    his  or  her responsible guardian or family member, a nursing
22    facility  operating  within  this  State  shall   provide   a
23    statement  itemizing  all  charges  incurred  for care of the
24    resident since his or her initial entry into the facility.
25        (b)  A nursing facility shall notify every  resident  and
26    his or her responsible guardian or family member of the right
27    to receive an itemized statement, upon the resident's initial
28    entry into the facility.
29        Section 20-10.  Disclosure of full information.
                            -8-               LRB9010928LDmbA
 1        (a)  The  statement  of  charges provided in Section 20-5
 2    shall include a  list  of  each  type  of  service  provided,
 3    including pharmaceuticals, equipment use, and other ancillary
 4    services  and  the amount charged the resident directly or to
 5    any public or private health care program, plan, or insurance
 6    on his or her behalf for each type of service received.   For
 7    any  per  diem  rate listed, the nursing facility shall state
 8    the services provided at that rate.
 9        (b)  The statement shall also include the agency to which
10    the  service  was  billed   and   the   resident's   case-mix
11    designation as to the level of care to be provided.
12        Section 20-15.  Non-discrimination.  The right to receive
13    the  information  described  in Sections 20-5 and 20-10 shall
14    extend  to  all  residents  irrespective   of   whether   the
15    resident's care is reimbursed by public programs.
16        Section 20-20.  Process for questioning charges.
17        (a)  The  Governor  shall  establish an office within the
18    Department of Public Health to  respond  to  and  investigate
19    inquiries  relating  to  statements  under  Sections 20-5 and
20    20-10.  The office shall  also  act  as  an  advocate  for  a
21    taxpayer  in  cases  where  public  dollars are being used to
22    reimburse the nursing facility.
23        (b)  If a person receiving an  itemized  statement  under
24    Section   20-5   believes   charges   or   services   to   be
25    inappropriate,  he  or  she  must  first  notify  the nursing
26    facility administrator in writing  of  his  or  her  concerns
27    before  seeking  an  investigation by the office described in
28    subsection (a).
29        Section 20-25.  Enforcement.
30        (a)  If, after conducting an  investigation,  the  office
31    described  in  subsection (a) of Section 20-20 finds improper
                            -9-               LRB9010928LDmbA
 1    charges associated with  the  resident's  care,  the  nursing
 2    facility  shall  reimburse  the person or entity who has paid
 3    the  charges  no  later  than   60   days   after   receiving
 4    notification from the office.
 5        (b)  No  facility shall take any adverse action against a
 6    person who exercises the rights provided under this  law.   A
 7    person  against  whom  such  adverse action is taken shall be
 8    entitled to recover in a civil  suit  treble  the  amount  of
 9    damages incurred.
11        Section   25-5.  Maintenance   of   records.   A  nursing
12    facility operating  within  this  State  shall  maintain  the
13    following records for a 10-year period:
14        (1)  reports  of  all  safety  and health inspections and
15    surveys;
16        (2)  Occupational Safety and Health Act complaints  under
17    the federal Occupational Safety and Health Act of 1970;
18        (3)  payroll  records  and  wage  and  hour complaints to
19    public agencies on behalf of employees of the facility;
20        (4)  complaints relating to the  facility  filed  by  the
21    National Labor Relations Board;
22        (5)  reports of deficiencies prepared by the Department;
23        (6)  reports  of  incidents involving injury or harm to a
24    resident,  employee,  or  visitor   or   breach   of   safety
25    precautions; and
26        (7)  daily  records of both scheduled and actual staffing
27    of each department for each shift.
28        Section 25-10.  Public right to information.   A  nursing
29    facility  shall  notify  the  public  of  the  right  to  the
30    information  set forth in Section 25-5.  This notice shall be
31    posted in a conspicuous manner accessible and visible to  the
                            -10-              LRB9010928LDmbA
 1    public  at  or  near  the  entrance  to  the  facility.   The
 2    information  shall be made available for the current year and
 3    the 2 years immediately prior to the current year.
 4        Section  25-15.  Notification  of  hazard.    A   nursing
 5    facility shall immediately notify the family of each resident
 6    of  each  occasion  on  which  the  resident  and workers are
 7    evacuated from the facility and  of  each  occasion  when  an
 8    imminent hazard to residents or workers arises.
 9        Section  25-20.  Notification  of  incidents  involving a
10    resident.  A nursing facility  or  skilled  nursing  facility
11    shall   promptly   notify  the  physician  and  a  resident's
12    designated family member or representative of any incident in
13    which there is harm or potential harm to the resident and  of
14    any significant change in the resident's status.
16        Section 30-5.  Prohibition of adverse action.
17        (a)  A nursing facility operating within this State shall
18    not  take any of the following actions against an employee on
19    the basis of a protected communication:
20             (1)  permanently  or   temporarily   terminate   the
21        employee's employment;
22             (2)  demote or involuntarily transfer the employee;
23             (3)  reduce the employee's pay or benefits;
24             (4)  impose a fine or other penalty; or
25             (5)  take  other  adverse  actions as defined by the
26        Department in rules implementing this Section.
27        Section 30-10.  Definition of protected communication.
28        (a)  For   purposes   of   this    Article,    "protected
29    communication"  means  a  communication, other than a knowing
                            -11-              LRB9010928LDmbA
 1    and willful misrepresentation,  made  by  an  employee  of  a
 2    nursing  facility  to an employee, officer, or representative
 3    of an agency of this State or  the  United  States  that  has
 4    responsibility    for    the    licensing,   regulation,   or
 5    reimbursement of nursing  facilities  operating  within  this
 6    State.
 7        A  "protected communication" includes, but is not limited
 8    to, a communication concerning:
 9             (A)  violations  of  laws  regulating  the   health,
10        safety, and well-being of nursing facility residents;
11             (B)  violations of workplace safety and health laws;
12             (C)  violations of labor and employment law;
13             (D)  alleged  fraud  or misrepresentation, including
14        misrepresentation of billing information  to  federal  or
15        State  agencies  or  to private health insurers or health
16        plans; and
17             (E)  other  communications   as   defined   by   the
18        Department in rules implementing this Section.
19        Section 30-15.  Civil penalties.
20        (a)  An entity that violates Section 30-5 of this Article
21    shall  be subject to a civil penalty of (1) up to $25,000 for
22    each violation or (2) up to $100,000 for  each  violation  if
23    the Department determines that the entity has engaged, within
24    5  years immediately preceding the violation, in a pattern of
25    such violations. For purposes of this subsection,  a  pattern
26    of violations means 3 or more violations in a 2-year period.
27        (b)  Enforcement under this Section shall not foreclose a
28    civil   action  under  Section  30-20  or  any  other  remedy
29    available at law.
30        Section 30-20.  Employee's private right of  action.   An
31    employee  who suffers harm or monetary loss as a result of an
32    employer's violation of Section 30-5  may,  in  civil  action
                            -12-              LRB9010928LDmbA
 1    against  the  employer,  recover  back pay and damages in the
 2    same manner as  provided  under  subsection  (b)  of  Section
 3    15-10.
 5        Section  40-5.  Wage and benefit pass-through.  It is the
 6    intent of the General Assembly that at least 50% of inflation
 7    increases in rates shall be  used  for  a  wage  and  benefit
 8    pass-through to nursing home workers.  The rate increases for
 9    enhanced  wages  and  benefits  shall  be  provided  to those
10    facilities that apply re-assessment of rate  increases  under
11    the  Medicaid program share of wage and benefits increases up
12    to 50 cents per employee hour.  The pass-through  shall  only
13    be  used  to increase wages and benefits.  Nursing facilities
14    shall be required to document that  these  wage  and  benefit
15    increases were actually provided.
16        In  the event that a federal budget reconciliation act is
17    adopted that increases Medicaid appropriations for  Illinois,
18    it  is the intent of the General Assembly that funds shall be
19    appropriated to increase the Medicaid program  share  of  the
20    nursing  facility  wage pass-through up to $1.00 per employee
21    hour.
22        Section 40-15.  Services for the  elderly  and  disabled.
23    Medical  services  shall  be provided to elderly and disabled
24    persons with incomes less  than  or  equal  to  100%  of  the
25    official  poverty  line,  pursuant  to  the State's option to
26    elect such coverage under section 1902(a)(10)(A)(ii) and  (m)
27    of  title  XIX  of  the  Social Security Act, chapter 531, 49
28    Stat. 620, 42 U.S.C. 1396a.
29        Section  40-20.  Department  enforcement  actions.    The
30    Department  shall  implement enforcement actions as specified
                            -13-              LRB9010928LDmbA
 1    in the nursing facility enforcement provisions of  42  U.S.C.
 2    1396c.
 3        Section  40-25.  The  Department is authorized to receive
 4    and  spend  penalty  money  received   as   the   result   of
 5    noncompliance with this Act.  Penalty money, characterized as
 6    private  funds, received by the Department shall be deposited
 7    into the Nursing Home Reform Fund, a special fund created  in
 8    the   State   Treasury,   and   shall  be  used  to  increase
 9    authorizations and allotments in the long-term care accounts.
10    Any unexpended penalty money in the Fund at the  end  of  the
11    fiscal year shall carry forward to the following year.
13        Section  45-5.  Rulemaking.  The  Department  shall adopt
14    rules in accordance with  Illinois  Administrative  Procedure
15    Act to implement this Act.
17        Section 50-5.  The State Finance Act is amended by adding
18    Section 5.480 as follows:
19        (30 ILCS 105/5.480 new)
20        Sec. 5.480.  The Nursing Home Reform Fund.
21        Section   50-10.  The Nursing Home Care Act is amended by
22    changing Section 3-202 and adding Sections 2-209.5, 3-202.52,
23    3-202.55, 3-202.6, 3-202.65, and 3-202.7  as follows:
24        (210 ILCS 45/2-209.5 new)
25        Sec. 2-209.5.  Minimum standards for nurse staffing.
26        (a)  At a  minimum,  a  Medicare  or  Medicaid  certified
                            -14-              LRB9010928LDmbA
 1    facility  that  is  a  skilled  nursing facility or a nursing
 2    facility licensed in Illinois and  any  part  of  a  licensed
 3    nursing  home  that  has  public  and  private pay beds shall
 4    provide:
 5        (1)  the following administrative nursing personnel:
 6                  (A)  one full-time Registered Nurse  acting  as
 7             Director of Nursing;
 8                  (B)  in  a  facility with 100 or more beds, one
 9             full-time  Registered  Nurse  acting  as   Assistant
10             Director of Nursing;
11                  (C)  in  a  facility  with fewer than 100 beds,
12             one   half-time   Registered   Nurse   Director   of
13             In-service Education;
14                  (D)  in a facility with 100 or more  beds,  one
15             full-time  Registered  Nurse  Director of In-service
16             Education; and
17        (2)  the following direct care nursing personnel:
18                  (A)  one Registered Nurse on duty at all  times
19             at the facility acting as Nursing Supervisor who may
20             not be the Director of Nursing, except in facilities
21             with 60 or fewer residents;
22                  (B)  one   direct   caregiver,   including  and
23             limited to a Registered  Nurse,  Licensed  Practical
24             Nurse  licensed  in  the State of Illinois, or Nurse
25             Aide certified in this State, for every 5  residents
26             during a day shift, for every 10 residents during an
27             evening  shift,  and for every 15 residents during a
28             night shift; and
29                  (C)  one  licensed  caregiver,  including   and
30             limited  to a Registered Nurse or Licensed Practical
31             Nurse licensed in the State of Illinois,  for  every
32             15  residents  during  a  day  shift,  for  every 25
33             residents during an evening shift, and for every  35
34             residents during a night shift.
                            -15-              LRB9010928LDmbA
 1        (b)  In  addition,  staff  must  be increased above these
 2    minimum requirements  to meet the care needs of any  resident
 3    population,  based  on each resident's assessed care needs to
 4    attain or maintain the highest  practical  mental,  physical,
 5    and psychosocial well-being.
 6        (c)  The   Department  shall  prescribe  methodology  for
 7    adjusting nursing service staffing above the required minimum
 8    to meet the care needs of residents.
 9        (210 ILCS 45/3-202) (from Ch. 111 1/2, par. 4153-202)
10        Sec.  3-202.  The  Department  shall  prescribe   minimum
11    standards for facilities. These standards shall regulate:
12        (1)  Location and construction of the facility, including
13    plumbing,  heating, lighting, ventilation, and other physical
14    conditions which shall ensure the health, safety, and comfort
15    of residents and their protection from fire hazard;
16        (2)  Number  and   qualifications   of   all   personnel,
17    including    management   and   nursing   personnel,   having
18    responsibility for any part of  the  services  provided  care
19    given  to residents, with the exception of a nursing facility
20    that is subject to Section  2-209.5  of  this  Act  and  that
21    establishes   the  required  nursing  staff  ratios  for  the
22    facility.;specifically,  The   Department   shall   establish
23    staffing ratios for facilities which shall specify the number
24    of  staff  hours  per  resident  of  care that are needed for
25    professional nursing care for various types of facilities  or
26    areas within facilities other than nursing facilities subject
27    to Section 2-209.5 of this Act;
28        (3)  All  sanitary conditions within the facility and its
29    surroundings, including water supply, sewage  disposal,  food
30    handling,  and general hygiene, which shall ensure the health
31    and comfort of residents;
32        (4)  Diet related to the needs of each resident based  on
33    good nutritional practice and on recommendations which may be
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 1    made by the physicians attending the resident;
 2        (5)  Equipment  essential  to  the  health,  safety,  and
 3    welfare of the residents;
 4        (6)  A  program  of  habilitation  and rehabilitation for
 5    those residents who would benefit from such programs;
 6        (7)  A program for adequate maintenance of physical plant
 7    and equipment;
 8        (8)  Adequate accommodations, staff and services for  the
 9    number  and  types  of  residents  for  whom  the facility is
10    licensed to care, including  standards  for  temperature  and
11    relative  humidity  within  comfort  zones  determined by the
12    Department based  upon  a  combination  of  air  temperature,
13    relative  humidity  and  air  movement.  Such standards shall
14    also require facility  plans  that  provide  for  health  and
15    comfort  of  residents  at  medical risk as determined by the
16    attending physician whenever  the  temperature  and  relative
17    humidity  are  outside  such comfort zones established by the
18    Department.
19        (9)  Development  of  evacuation  and  other  appropriate
20    safety plans for use during weather, health,  fire,  physical
21    plant, environmental and national defense emergencies; and
22        (10)  Maintenance of minimum financial or other resources
23    necessary  to  meet  the  standards  established  under  this
24    Section,   and   to  operate  and  conduct  the  facility  in
25    accordance with this Act.
26    (Source: P.A. 83-1530.)
27        (210 ILCS 45/3-202.52 new)
28        Sec. 3-202.52.  Sanctions for noncompliance with  minimum
29    nurse staffing standards.
30        (a)  The  Department  of Public Health shall not issue or
31    renew a license of a Medicare or Medicaid  licensed  facility
32    that  is  a  skilled  nursing  facility or a nursing facility
33    subject to Section 2-209.5 of this Act unless  that  facility
                            -17-              LRB9010928LDmbA
 1    employs  nursing  personnel  sufficient to meet the standards
 2    set forth in Section 2-209.5.
 3        (b)  An employee designated as a member  of  the  nursing
 4    staff  shall not be required to provide services such as food
 5    preparation, housekeeping, laundry, or maintenance  services.
 6    A  person employed to provide such services shall not provide
 7    nursing care  to  residents  and  shall  not  be  counted  in
 8    determining the ratios set forth in Section 2-209.5.
 9        (210 ILCS 45/3-202.55 new)
10        Sec.  3-202.55.  Public  right to staffing information. A
11    nursing facility subject to Section 2-209.5  shall  post  for
12    each  wing  and  floor of the facility and for each shift the
13    current number  of  licensed  and  unlicensed  nursing  staff
14    directly responsible for resident care and the current ratios
15    of  residents  to  staff, which show separately the number of
16    residents  to  licensed  nursing  staff  and  the  number  of
17    residents to unlicensed nursing staff.    In  addition,  that
18    information  shall  be posted for the most recently concluded
19    cost reporting period in the form  of  average  daily  direct
20    care  nursing  personnel  staffing  ratios per shift for that
21    period.  The information shall be posted in a manner that  is
22    visible  and  accessible  to  all  residents, their families,
23    caregivers, and potential consumers in each facility.
24        (210 ILCS 45/3-202.6 new)
25        Sec. 3-202.6.  Enforcement.
26        (a)  The Department of Public Health shall impose a civil
27    penalty upon a facility  that  fails  to  meet  the  staffing
28    requirements set forth in Section 2-209.5.  The penalty shall
29    be imposed for each day on which the failure occurs.
30        (b)  The amount of the penalty in subsection (a) shall be
31    determined as follows:
32             (i)  Upper range - $3,050-$10,000.  Penalties in the
                            -18-              LRB9010928LDmbA
 1        range  of  $3,050 to $10,000 per day shall be imposed for
 2        deficiencies  in  staffing  that   constitute   immediate
 3        jeopardy  to  resident  health  or  safety and for repeat
 4        deficiencies when a penalty has been previously imposed.
 5             (ii)  Lower range - $250-$3,000.  Penalties  in  the
 6        range  of  $250  to  $3,000  per day shall be imposed for
 7        deficiencies in staffing that do not constitute immediate
 8        jeopardy to resident health or safety. In each case,  the
 9        penalty  shall  not  be  less  than the cost of providing
10        required staff members.
11        The Department shall annually adjust the upper and  lower
12    range  amounts set forth in items (i) and (ii) to reflect the
13    increase, if any, in the Consumer Price Index For  All  Urban
14    Consumers  for  the  previous calendar year, as determined by
15    the United States  Department  of  Labor.   However,  if  the
16    Consumer  Price Index decreases during a calendar year, there
17    shall be no adjustment for that calendar year.  The  adjusted
18    amounts shall be published in the Department rules.
19        (c)  In  addition to the penalty described in subsections
20    (a) and (b), in any action brought forth by or on behalf of a
21    resident of the facility or his or her heirs or  assigns  for
22    intentional  or  negligent  infliction  of  harm  or  lack of
23    adequate care, it shall be established that a failure to meet
24    the  staffing  requirements  of   Section   2-209.5   was   a
25    contributory cause of an injury sustained by a resident.
26        (d)  The Department of Public Health shall impose a civil
27    penalty  upon  a  facility  that  fails  to  meet the posting
28    requirements set forth  in  Section  3-202.55.   The  penalty
29    shall  be in the amount of $100 and shall be imposed for each
30    day on which the facility fails to  meet  fully  the  posting
31    requirements.
32        (210 ILCS 45/3-202.65 new)
33        Sec.  3-202.65.  Resident  private  right  of  action.  A
                            -19-              LRB9010928LDmbA
 1    resident who suffers harm or monetary loss as a result  of  a
 2    nursing  facility's violation of this Act or the Department's
 3    knowing or willful failure to enforce the provisions of  this
 4    Act  may,  in  a civil action against the nursing facility or
 5    the Department, recover compensation for damages sustained.
 6        (210 ILCS 45/3-202.7 new)
 7        Sec. 3-202.7.  Independent Ombudsman Program.  To  ensure
 8    the independent operation of the Illinois Department on Aging
 9    Ombudsman  Program  established  to  protect the interests of
10    nursing facility residents, the Illinois Department on  Aging
11    shall    contract    with    an    appropriate   independent,
12    not-for-profit  advocacy  organization  to   administer   the
13    Ombudsmen Program.
14                     ARTICLE 90.  EFFECTIVE DATE
15        Section  90-5.  Effective  date.   This  Act takes effect
16    upon becoming law.

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