Bill Amendment: IL SB0987 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: GOVERNMENT-TECH

Status: 2019-01-09 - Session Sine Die [SB0987 Detail]

Download: Illinois-2017-SB0987-Senate_Amendment_001.html

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Sen. Wm. Sam McCann

Filed: 3/28/2017

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AMENDMENT TO SENATE BILL 987
AMENDMENT NO. ______. Amend Senate Bill 987 by replacing
everything after the enacting clause with the following:
"Section 5. The Nursing Home Care Act is amended by
changing Section 3-202.05 as follows:
(210 ILCS 45/3-202.05)
Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
thereafter.
(a) For the purpose of computing staff to resident ratios,
direct care staff shall include:
(1) registered nurses;
(2) licensed practical nurses;
(3) certified nurse assistants;
(4) psychiatric services rehabilitation aides;
(5) rehabilitation and therapy aides;
(6) psychiatric services rehabilitation coordinators;

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(7) assistant directors of nursing;
(8) 50% of the Director of Nurses' time; and
(9) 30% of the Social Services Directors' time.
The Department shall, by rule, allow certain facilities
subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
S) to utilize specialized clinical staff, as defined in rules,
to count towards the staffing ratios.
Within 120 days of the effective date of this amendatory
Act of the 97th General Assembly, the Department shall
promulgate rules specific to the staffing requirements for
facilities federally defined as Institutions for Mental
Disease. These rules shall recognize the unique nature of
individuals with chronic mental health conditions, shall
include minimum requirements for specialized clinical staff,
including clinical social workers, psychiatrists,
psychologists, and direct care staff set forth in paragraphs
(4) through (6) and any other specialized staff which may be
utilized and deemed necessary to count toward staffing ratios.
Within 120 days of the effective date of this amendatory
Act of the 97th General Assembly, the Department shall
promulgate rules specific to the staffing requirements for
facilities licensed under the Specialized Mental Health
Rehabilitation Act of 2013. These rules shall recognize the
unique nature of individuals with chronic mental health
conditions, shall include minimum requirements for specialized
clinical staff, including clinical social workers,

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psychiatrists, psychologists, and direct care staff set forth
in paragraphs (4) through (6) and any other specialized staff
which may be utilized and deemed necessary to count toward
staffing ratios.
(b) Beginning January 1, 2011, and thereafter, light
intermediate care shall be staffed at the same staffing ratio
as intermediate care.
(c) Facilities shall notify the Department within 60 days
after the effective date of this amendatory Act of the 96th
General Assembly, in a form and manner prescribed by the
Department, of the staffing ratios in effect on the effective
date of this amendatory Act of the 96th General Assembly for
both intermediate and skilled care and the number of residents
receiving each level of care.
(d)(1) Effective July 1, 2010, for each resident needing
skilled care, a minimum staffing ratio of 2.5 hours of nursing
and personal care each day must be provided; for each resident
needing intermediate care, 1.7 hours of nursing and personal
care each day must be provided.
(2) Effective January 1, 2011, the minimum staffing ratios
shall be increased to 2.7 hours of nursing and personal care
each day for a resident needing skilled care and 1.9 hours of
nursing and personal care each day for a resident needing
intermediate care.
(3) Effective January 1, 2012, the minimum staffing ratios
shall be increased to 3.0 hours of nursing and personal care

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each day for a resident needing skilled care and 2.1 hours of
nursing and personal care each day for a resident needing
intermediate care.
(4) Effective January 1, 2013, the minimum staffing ratios
shall be increased to 3.4 hours of nursing and personal care
each day for a resident needing skilled care and 2.3 hours of
nursing and personal care each day for a resident needing
intermediate care.
(5) Effective January 1, 2014, the minimum staffing ratios
shall be increased to 3.8 hours of nursing and personal care
each day for a resident needing skilled care and 2.5 hours of
nursing and personal care each day for a resident needing
intermediate care.
(e) Ninety days after the effective date of this amendatory
Act of the 97th General Assembly, a minimum of 25% of nursing
and personal care time shall be provided by licensed nurses,
with at least 10% of nursing and personal care time provided by
registered nurses. These minimum requirements shall remain in
effect until an acuity based registered nurse requirement is
promulgated by rule concurrent with the adoption of the
Resource Utilization Group classification-based payment
methodology, as provided in Section 5-5.2 of the Illinois
Public Aid Code. Registered nurses and licensed practical
nurses employed by a facility in excess of these requirements
may be used to satisfy the remaining 75% of the nursing and
personal care time requirements. Notwithstanding this

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subsection, no staffing requirement in statute in effect on the
effective date of this amendatory Act of the 97th General
Assembly shall be reduced on account of this subsection.
(f) On and after the effective date of this amendatory Act
of the 100th General Assembly, in addition to any other
staffing requirements under this Section, a facility licensed
under this Act shall comply with the following:
(1) The facility must have and implement a written plan
that:
(A) ensures staffing sufficient to meet the
minimum staffing requirements described in paragraphs
(3) through (8) of this subsection;
(B) ensures staffing sufficient to meet the needs
of each resident; and
(C) identifies procedures to obtain required staff
when absences occur.
The facility must maintain a written, weekly staffing
schedule showing the number and category of staff assigned
to each shift and the person to be called in the event of
an absence.
(2) The facility must have the number of on-duty
nursing staff publicly posted 24 hours each day. The posted
staffing forms must (A) be prominently displayed in a
public area and readily accessible to residents and
visitors; (B) be at least 8.5 x 14 inches and printed in a
minimum font size of 16; and (C) include the facility's

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name, current date, current resident census per shift, the
total number and actual hours worked by registered nurses,
licensed practical nurses, and nursing assistants directly
responsible for resident services per shift, and the
minimum staffing standard, nursing assistant to resident
ratio, under paragraph (6) of this subsection.
The posted staffing information must be an accurate
reflection of the actual staff working each shift.
Upon oral or written request, the facility must make
direct care staffing data available to the public for
review at a cost not to exceed the community standard. The
facility must maintain the posted nurse staffing data for a
minimum of 18 months.
(3) Resident service needs must be the primary
consideration in determining the number and categories of
nursing personnel needed. Nursing staff must be sufficient
in quantity and quality to provide nursing services for
each resident as needed, including restorative services
that enable each resident to achieve and maintain the
highest practicable degree of function, self-care, and
independence, as determined by the resident's care plan.
Sufficient staffing under this paragraph must be provided
even though it exceeds other requirements specified by this
subsection or specified in a waiver.
(4) Licensed nurse hours must include no less than one
registered nurse hour per resident per week. When a

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registered nurse serves as the administrator in the
temporary absence of an administrator, the registered
nurse's hours must not be used to meet minimum nursing
hours. In facilities with 41 or more beds, the hours of a
licensed nurse who serves as facility administrator must
not be included in any licensed nurse coverage required by
this subsection. The licensed nurse serving as a charge
nurse must not be counted toward the minimum staffing
requirements under paragraph (6) of this subsection.
(5) The facility must have a licensed charge nurse on
each shift 24 hours per day.
A registered nurse must serve as the licensed charge
nurse for no less than 8 consecutive hours between the
start of day shift and the end of evening shift, 7 days a
week.
The director of nursing services may serve as the
charge nurse only when the facility has 60 or fewer
residents.
The requirements of this paragraph (5) may be waived by
the Department. The request for waiver must comply with the
provisions of this Act and must be reviewed annually. The
waiver shall be considered by the Department if the
facility certifies that (i) the facility has been unable to
recruit appropriate personnel despite diligent efforts,
including offering wages at the community prevailing rate
for nursing facilities; (ii) the waiver does not endanger

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the health or safety of residents; and (iii) a registered
nurse or physician is available and obligated to
immediately respond to telephone calls from the facility.
(6) The facility must determine the specific time frame
for beginning and ending each consecutive 8-hour shift
using one of the following options:
(A) Option one shall include (i) a day shift from
5:30 a.m. to 1:30 p.m., (ii) an evening shift from 1:30
p.m. to 9:30 p.m., and (iii) a night shift from 9:30
p.m. to 5:30 a.m.
(B) Option 2 shall include (i) a day shift from 6
a.m. to 2 p.m., (ii) an evening shift from 2 p.m. to 10
p.m., and (iii) a night shift from 10 p.m. to 6 a.m.
(C) Option 3 shall include (i) a day shift from
6:30 a.m. to 2:30 p.m., (ii) an evening shift from 2:30
p.m. to 10:30 p.m., and (iii) a night shift from 10:30
p.m. to 6:30 a.m.
(D) Option 4 shall include (i) a day shift from 7
a.m. to 3 p.m., (ii) an evening shift from 3 p.m. to 11
p.m., and (iii) a night shift from 11 p.m. to 7 a.m.
Each resident must have assigned and be informed of the
nursing assistant responsible for his or her care and
services on each shift. The numbers listed in this
subsection represent the minimum staffing requirement. The
numbers do not represent sufficient nursing staff. The
number of staff necessary to meet the needs of each

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resident determines sufficient nursing staff. The number
of residents per nursing assistant must not exceed the
ratios under this paragraph.
On and after January 1, 2018, the number of residents
per nursing assistant must not exceed the following ratios:
for day shifts, there shall be at least one nursing
assistant per 7 residents; for evening shifts, there shall
be at least one nursing assistant per 9.5 residents; for
night shifts, there shall be at least one nursing assistant
per 17 residents.
Each facility must submit a quarterly staffing report
to the Department using the Department's approved method
and format. The report must provide an accurate daily
account of resident census and nursing assistant staffing
levels for each shift. The facility must submit the report
to the Department no later than the end of the month
immediately following the end of each calendar quarter. The
report must specify the shifts in which the minimum
staffing standards as set forth in this paragraph were not
met. Upon the Department's request, the facility must
provide documents to support the quarterly staffing
report, including payroll records.
(7) This subsection does not prohibit nursing
assistants from providing services to a resident to whom
they are not assigned. The facility must ensure that
nursing assistants only perform those tasks for which they

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are competent and qualified to perform and that are
permitted by the laws of this State. Nursing assistants
with a restricted duty status may be counted toward meeting
the minimum staffing ratio as set forth in paragraph (6) of
this subsection if the nursing assistant is able to perform
90% of the authorized duties and responsibilities, with or
without accommodation, required of a certified nursing
assistant.
The facility must ensure that a nursing assistant is
not assigned more residents than the number for which the
nursing assistant is able to meet the individual service
needs. The facility must have a minimum of 2 nursing staff
on duty within the facility at all times. Nursing staff
must be present at all times in each detached building,
distinct and segregated area including those separated by
closed doors, and on each level or floor where residents
are housed.
Nursing assistants do not include dining assistants.
Nursing assistants serving as restorative aides must not be
counted toward the minimum staffing requirement under
paragraph (6) of this subsection.
(8) A facility must not employ any person as a nursing
assistant for longer than 4 months from the date of hire
without the person being certified as a certified nursing
assistant. The facility must ensure no more than 25% of the
nursing assistants assigned to residents per shift

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pursuant to paragraph (6) of this subsection are
uncertified nursing assistants.
(9) The facility must ensure that all nursing
assistants administering non-injectable medications are
certified as nursing assistants and licensed as medication
aides. Documentation of this certification and license
must be maintained in the facility. The licensed medication
aide assigned to administer medications must not be counted
toward meeting the minimum staffing requirements for
direct service of residents under paragraph (6) of this
subsection.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
Section 99. Effective date. This Act takes effect July 1,
2017.".