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Notwithstanding
any other law to the contrary, alternative |
health care models
described in this Section may be established |
on a demonstration basis.
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(1) (Blank).
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(2) Alternative health care delivery model; |
postsurgical recovery care
center. A postsurgical recovery |
care center is a designated site which
provides |
postsurgical recovery care for generally healthy patients
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undergoing surgical procedures that potentially require |
overnight nursing care, pain
control, or observation that |
would otherwise be provided in an inpatient
setting. |
Patients may be discharged from the postsurgical recovery |
care center in less than 24 hours if the attending |
physician or the facility's medical director believes the |
patient has recovered enough to be discharged. A |
postsurgical recovery care center is either freestanding |
or a
defined unit of an ambulatory surgical treatment |
center or hospital.
No facility, or portion of a facility, |
may participate in a demonstration
program as a |
postsurgical recovery care center unless the facility has |
been
licensed as an ambulatory surgical treatment center or |
hospital for at least 2
years before August 20, 1993 (the |
effective date of Public Act 88-441). The
maximum length of |
stay for patients in a
postsurgical recovery care center is |
not to exceed 48 hours unless the treating
physician |
requests an extension of time from the recovery center's |
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medical
director on the basis of medical or clinical |
documentation that an additional
care period is required |
for the recovery of a patient and the medical director
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approves the extension of time. In no case, however, shall |
a patient's length
of stay in a postsurgical recovery care |
center be longer than 72 hours. If a
patient requires an |
additional care period after the expiration of the 72-hour
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limit, the patient shall be transferred to an appropriate |
facility. Reports on
variances from the 24-hour or 48-hour |
limit shall be sent to the Department for its
evaluation. |
The reports shall, before submission to the Department, |
have
removed from them all patient and physician |
identifiers. Blood products may be administered in the |
postsurgical recovery care center model. In order to handle
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cases of complications, emergencies, or exigent |
circumstances, every
postsurgical recovery care center as |
defined in this paragraph shall maintain a
contractual |
relationship, including a transfer agreement, with a |
general acute
care hospital. A postsurgical recovery care |
center shall be no larger than 20
beds. A postsurgical |
recovery care center shall be located within 15 minutes
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travel time from the general acute care hospital with which |
the center
maintains a contractual relationship, including |
a transfer agreement, as
required under this paragraph.
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No postsurgical recovery care center shall |
discriminate against any patient
requiring treatment |
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because of the source of payment for services, including
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Medicare and Medicaid recipients.
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The Department shall adopt rules to implement the |
provisions of Public
Act 88-441 concerning postsurgical |
recovery care centers within 9 months after
August 20, |
1993. Notwithstanding any other law to the contrary, a |
postsurgical recovery care center model may provide sleep |
laboratory or similar sleep studies in accordance with |
applicable State and federal laws and regulations.
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(3) Alternative health care delivery model; children's |
community-based
health care center. A children's |
community-based health care center model is a
designated |
site that provides nursing care, clinical support |
services, and
therapies for a period of one to 14 days for |
short-term stays and 120 days to
facilitate transitions to |
home or other appropriate settings for medically
fragile |
children, technology
dependent children, and children with |
special health care needs who are deemed
clinically stable |
by a physician and are younger than 22 years of age. This
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care is to be provided in a home-like environment that |
serves no more than 12
children at a time. Children's |
community-based health care center
services must be |
available through the model to all families, including |
those
whose care is paid for through the Department of |
Healthcare and Family Services, the Department of
Children |
and Family Services, the Department of Human Services, and |
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insurance
companies who cover home health care services or |
private duty nursing care in
the home.
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Each children's community-based health care center |
model location shall be
physically separate and
apart from |
any other facility licensed by the Department of Public |
Health under
this or any other Act and shall provide the |
following services: respite care,
registered nursing or |
licensed practical nursing care, transitional care to
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facilitate home placement or other appropriate settings |
and reunite families,
medical day care, weekend
camps, and |
diagnostic studies typically done in the home setting.
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Coverage for the services provided by the
Department of |
Healthcare and Family Services
under this paragraph (3) is |
contingent upon federal waiver approval and is
provided |
only to Medicaid eligible clients participating in the home |
and
community based services waiver designated in Section |
1915(c) of the Social
Security Act for medically frail and |
technologically dependent children or
children in |
Department of Children and Family Services foster care who |
receive
home health benefits.
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(4) Alternative health care delivery model; community |
based residential
rehabilitation center.
A community-based |
residential rehabilitation center model is a designated
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site that provides rehabilitation or support, or both, for |
persons who have
experienced severe brain injury, who are |
medically stable, and who no longer
require acute |
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rehabilitative care or intense medical or nursing |
services. The
average length of stay in a community-based |
residential rehabilitation center
shall not exceed 4 |
months. As an integral part of the services provided,
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individuals are housed in a supervised living setting while |
having immediate
access to the community. The residential |
rehabilitation center authorized by
the Department may |
have more than one residence included under the license.
A |
residence may be no larger than 12 beds and shall be |
located as an integral
part of the community. Day treatment |
or
individualized outpatient services shall be provided |
for persons who reside in
their own home. Functional |
outcome goals shall be established for each
individual. |
Services shall include, but are not limited to, case |
management,
training and assistance with activities of |
daily living, nursing
consultation, traditional therapies |
(physical, occupational, speech),
functional interventions |
in the residence and community (job placement,
shopping, |
banking, recreation), counseling, self-management |
strategies,
productive activities, and multiple |
opportunities for skill acquisition and
practice |
throughout the day. The design of individualized program |
plans shall
be consistent with the outcome goals that are |
established for each resident.
The programs provided in |
this setting shall be accredited by the
Commission
on |
Accreditation of Rehabilitation Facilities (CARF). The |
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program shall have
been accredited by CARF as a Brain |
Injury Community-Integrative Program for at
least 3 years.
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(5) Alternative health care delivery model; |
Alzheimer's disease
management center. An Alzheimer's |
disease management center model is a
designated site that |
provides a safe and secure setting for care of persons
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diagnosed with Alzheimer's disease. An Alzheimer's disease |
management center
model shall be a facility separate from |
any other facility licensed by the
Department of Public |
Health under this or any other Act. An Alzheimer's
disease |
management center shall conduct and document an assessment |
of each
resident every 6 months. The assessment shall |
include an evaluation of daily
functioning, cognitive |
status, other medical conditions, and behavioral
problems. |
An Alzheimer's disease management center shall develop and |
implement
an ongoing treatment plan for each resident. The |
treatment
plan shall have defined goals.
The
Alzheimer's |
disease management center shall treat behavioral problems |
and mood
disorders using nonpharmacologic approaches such |
as environmental modification,
task simplification, and |
other appropriate activities.
All staff must have |
necessary
training to care for all stages of Alzheimer's |
Disease. An
Alzheimer's disease
management center shall |
provide education and support for residents and
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caregivers. The
education and support shall include |
referrals to support organizations for
educational |
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materials on community resources, support groups, legal |
and
financial issues, respite care, and future care needs |
and options. The
education and support shall also include a |
discussion of the resident's need to
make advance |
directives and to identify surrogates for medical and legal
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decision-making. The provisions of this paragraph |
establish the minimum level
of services that must be |
provided by an Alzheimer's disease management
center. An |
Alzheimer's disease management center model shall have no |
more
than 100 residents. Nothing in this paragraph (5) |
shall be construed as
prohibiting a person or facility from |
providing services and care to persons
with Alzheimer's |
disease as otherwise authorized under State law.
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(6) Alternative health care delivery model; birth |
center. A birth
center shall be exclusively dedicated to |
serving the childbirth-related needs of women and their |
newborns and shall have no more than 10 beds. A birth |
center is a designated site
that is away from the mother's |
usual place of residence and in which births are
planned to |
occur following a normal, uncomplicated, and low-risk |
pregnancy. A
birth center shall offer prenatal care and |
community education services and
shall coordinate these |
services with other health care services available in
the |
community.
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(A) A birth center shall not be separately licensed |
if it
is one of the following: |
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(1) A part of a hospital; or |
(2) A freestanding facility that is physically
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distinct from a hospital but is operated under a
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license issued to a hospital under the Hospital
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Licensing Act. |
(B) A separate birth center license shall be |
required if the birth center is operated as: |
(1) A part of the operation of a federally
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qualified health center as designated by the |
United
States Department of Health and Human |
Services; or |
(2) A facility other than one described in |
subparagraph (A)(1), (A)(2), or (B)(1) of this |
paragraph (6) whose costs are
reimbursable under |
Title XIX of the federal Social
Security Act. |
In adopting rules for birth centers, the Department |
shall consider:
the American Association
of Birth Centers' |
Standards for Freestanding Birth Centers; the American |
Academy of Pediatrics/American College of Obstetricians |
and Gynecologists Guidelines for Perinatal Care; and the |
Regionalized Perinatal Health Care Code. The Department's |
rules shall stipulate the eligibility criteria for birth |
center admission. The Department's rules shall
stipulate |
the necessary equipment for emergency care
according to the |
American Association of Birth Centers'
standards and any |
additional equipment deemed necessary by the Department. |
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The Department's rules shall provide for a time
period |
within which each birth center not part of a
hospital must |
become accredited by either the Commission for the
|
Accreditation of Freestanding Birth Centers or The Joint |
Commission. |
A birth center shall be certified to participate in the |
Medicare and Medicaid
programs under Titles XVIII and XIX, |
respectively, of the federal Social
Security Act.
To the |
extent necessary, the Illinois Department of Healthcare |
and Family Services shall apply for
a waiver from the |
United States Health Care Financing Administration to |
allow
birth centers to be reimbursed under Title XIX of the |
federal Social Security
Act. |
A birth center that is not operated under a hospital |
license shall be located within a ground travel time |
distance from the general acute care hospital with which
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the birth center maintains a contractual relationship,
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including a transfer agreement, as required under this
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paragraph, that allows for an emergency caesarian delivery |
to be started within 30 minutes of the decision a caesarian |
delivery is necessary. A birth center operating under a |
hospital license shall be located within a ground travel |
time distance from the licensed hospital that allows for an |
emergency caesarian delivery to be started within 30 |
minutes of the decision a caesarian delivery is necessary. |
The services of a
medical director physician, licensed |
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to practice medicine in all its branches, who is certified |
or eligible for certification by the
American College of |
Obstetricians and Gynecologists or the
American Board of |
Osteopathic Obstetricians and Gynecologists or has |
hospital
obstetrical privileges are required in birth |
centers. The medical director in consultation with the |
Director of Nursing and Midwifery Services shall |
coordinate the clinical staff and overall provision of |
patient care.
The medical director or his or her physician |
designee shall be available on the premises or within a |
close proximity as defined by rule. The medical director |
and the Director of Nursing and Midwifery Services shall |
jointly develop and approve policies defining the criteria |
to determine which pregnancies are accepted as normal, |
uncomplicated, and low-risk, and the anesthesia services |
available at the center. No general anesthesia may be |
administered at the center. |
If a birth center employs
certified nurse midwives, a |
certified nurse midwife shall be the Director of
Nursing |
and Midwifery
Services who is responsible for the |
development of policies and procedures for
services as |
provided by Department rules. |
An obstetrician, family
practitioner, or certified |
nurse midwife shall attend each woman in labor from
the |
time of admission through birth and throughout the |
immediate postpartum
period. Attendance may be delegated |
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only to another physician or certified
nurse
midwife. |
Additionally, a second staff person shall also be present |
at each
birth who is licensed or certified in Illinois in a |
health-related field and under the supervision of the |
physician or certified nurse midwife
in attendance, has |
specialized training in labor and delivery techniques and
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care of newborns, and receives planned and ongoing training |
as needed to
perform assigned duties effectively. |
The maximum length of stay in a birth center shall be
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consistent with existing State laws allowing a 48-hour stay |
or appropriate
post-delivery care, if discharged earlier |
than 48 hours. |
A birth center shall
participate in the Illinois |
Perinatal
System under the Developmental Disability |
Prevention Act. At a minimum, this
participation shall |
require a birth center to establish a letter of agreement
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with a hospital designated under the Perinatal System. A |
hospital that
operates or has a letter of agreement with a |
birth center shall include the
birth center under its |
maternity service plan under the Hospital Licensing Act
and |
shall include the birth center in the hospital's letter of |
agreement with
its regional perinatal center. |
A birth center may not discriminate against any patient |
requiring treatment
because of the source of payment for |
services, including Medicare and Medicaid
recipients. |
No general anesthesia and no surgery may be performed |
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at a birth center.
The Department may by rule add birth |
center patient eligibility criteria or standards as it |
deems necessary.
The Department shall by rule require each |
birth center to report the information which the Department |
shall make publicly available, which shall include, but is |
not limited to, the following: |
(i) Birth center ownership. |
(ii) Sources of payment for services. |
(iii) Utilization data involving patient length of |
stay. |
(iv) Admissions and discharges. |
(v) Complications. |
(vi) Transfers. |
(vii) Unusual incidents. |
(viii) Deaths. |
(ix) Any other publicly reported data required |
under the Illinois Consumer Guide. |
(x) Post-discharge patient status data where |
patients are followed for 14 days after discharge from |
the birth center to determine whether the mother or |
baby developed a complication or infection. |
Within 9 months after the effective date of this |
amendatory Act of the 95th
General Assembly, the Department |
shall adopt rules that are developed with consideration of: |
the American Association of Birth Centers' Standards for |
Freestanding Birth Centers; the American Academy of |
|
Pediatrics/American College of Obstetricians and |
Gynecologists Guidelines for Perinatal Care; and the |
Regionalized Perinatal Health Care Code. |
The Department shall adopt other rules as necessary to |
implement the provisions of this
amendatory Act of the 95th |
General Assembly within 9 months after the
effective date |
of this amendatory Act of the 95th General Assembly. |
(Source: P.A. 97-135, eff. 7-14-11.)
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