Bill Text: IL HB5050 | 2011-2012 | 97th General Assembly | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Alternative Health Care Delivery Act. Sets forth definitions for "ambulatory surgical treatment center" and "postsurgical recovery care center model". Requires the Department of Public Health to enforce by rule certain provisions concerning the approval of protocols for the admission of postsurgical patients with respect to each postsurgical recovery care center model. Sets forth criteria for admission to a postsurgical recovery care center model, including the administration of blood in relation to an intraoperative or postoperative complication. Requires the Department of Public Health to enforce by rule certain provisions concerning laboratory, pharmacy, and radiological services with respect to each postsurgical recovery care center model.

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Passed) 2012-08-17 - Public Act . . . . . . . . . 97-0987 [HB5050 Detail]

Download: Illinois-2011-HB5050-Engrossed.html

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AN ACT concerning public health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Alternative Health Care Delivery Act is
amended by changing Sections 10 and 35 as follows:
(210 ILCS 3/10)
Sec. 10. Definitions. In this Act, unless the context
otherwise requires:
"Ambulatory surgical treatment center" or "ASTC" means any
institution, place, or building licensed under the Ambulatory
Surgical Treatment Center Act.
"Alternative health care model" means a facility or program
authorized under Section 35 of this Act.
"Board" means the State Board of Health.
"Department" means the Illinois Department of Public
Health.
"Demonstration program" means a program to license and
study alternative health care models authorized under this Act.
"Director" means the Director of Public Health.
(Source: P.A. 87-1188.)
(210 ILCS 3/35)
Sec. 35. Alternative health care models authorized.

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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.
(1) (Blank).
(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
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
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
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
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
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.
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
Medicare and Medicaid recipients.
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.
(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
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.
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
facilitate home placement or other appropriate settings
and reunite families, medical day care, weekend camps, and
diagnostic studies typically done in the home setting.
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.
(4) Alternative health care delivery model; community
based residential rehabilitation center. A community-based
residential rehabilitation center model is a designated
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,
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.
(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
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
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
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.
(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.
(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
distinct from a hospital but is operated under a
license issued to a hospital under the Hospital
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
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
the birth center maintains a contractual relationship,
including a transfer agreement, as required under this
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
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
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
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

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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.)