Bill Text: IL SB3730 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Nursing Home Care Act. Provides that the definition of "skilled care" includes some specified actions, but does not include others. Defines terms for purposes of imposing specified monetary penalties. Provides that for the purposes of imposing specified monetary penalties, the Department of Public Health must not count each individual day as an occurrence and any unforeseen circumstance that occurs for a continuous period only counts as one time. Amends the Illinois Public Aid Code. Provides that, if all other requirements for coverage under a Medicaid skilled nursing facility benefit are met, skilled nursing services shall be covered under specified circumstances.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB3730 Detail]

Download: Illinois-2019-SB3730-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB3730 Introduced 2/14/2020, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
210 ILCS 45/3-202.05
305 ILCS 5/5-5.4l new
Amends the Nursing Home Care Act. Provides that the definition of "skilled care" includes some specified actions, but does not include others. Defines terms for purposes of imposing specified monetary penalties. Provides that for the purposes of imposing specified monetary penalties, the Department of Public Health must not count each individual day as an occurrence and any unforeseen circumstance that occurs for a continuous period only counts as one time. Amends the Illinois Public Aid Code. Provides that, if all other requirements for coverage under a Medicaid skilled nursing facility benefit are met, skilled nursing services shall be covered under specified circumstances.
LRB101 19922 CPF 69445 b
FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
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;
(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.

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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,
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) (Blank).
(b-5) For purposes of the minimum staffing ratios in this
Section, all residents shall be classified as requiring either

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skilled care or intermediate care.
As used in this subsection:
"Intermediate care" means basic nursing care and other
restorative services under periodic medical direction.
"Intermediate care" includes care received by a resident that
is not skilled care.
"Skilled care" means skilled nursing care, continuous
skilled nursing observations, restorative nursing, and other
services under professional direction with frequent medical
supervision. "Skilled care" includes nursing services so
inherently complex that they can be safely and effectively
performed only by, or under the supervision of, a registered
nurse or, when provided by rule or regulation, a licensed
practical or vocational nurse. A service is not skilled care
merely because it is performed by or under the direct
supervision of a nurse. If a service can be safely and
effectively performed or self-administered by an unskilled
person, the service shall not be regarded as skilled care even
if a nurse actually provides the service. The unavailability of
a competent person to provide a nonskilled service, regardless
of the importance of the service to the patient, does not
constitute skilled care when a nurse provides the service.
(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

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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) (Blank).
(2) (Blank).
(3) (Blank).
(4) (Blank).
(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
subsection, no staffing requirement in statute in effect on the

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effective date of this amendatory Act of the 97th General
Assembly shall be reduced on account of this subsection.
(f) The Department shall submit proposed rules for adoption
by January 1, 2020 establishing a system for determining
compliance with minimum staffing set forth in this Section and
the requirements of 77 Ill. Adm. Code 300.1230 adjusted for any
waivers granted under Section 3-303.1. Compliance shall be
determined quarterly by comparing the number of hours provided
per resident per day using the Centers for Medicare and
Medicaid Services' payroll-based journal and the facility's
daily census, broken down by intermediate and skilled care as
self-reported by the facility to the Department on a quarterly
basis. The Department shall use the quarterly payroll-based
journal and the self-reported census to calculate the number of
hours provided per resident per day and compare this ratio to
the minimum staffing standards required under this Section, as
impacted by any waivers granted under Section 3-303.1.
Discrepancies between job titles contained in this Section and
the payroll-based journal shall be addressed by rule.
(g) The Department shall submit proposed rules for adoption
by January 1, 2020 establishing monetary penalties for
facilities not in compliance with minimum staffing standards
under this Section. No monetary penalty may be issued for
noncompliance during the implementation period, which shall be
July 1, 2020 through September 30, 2020. If a facility is found
to be noncompliant during the implementation period, the

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Department shall provide a written notice identifying the
staffing deficiencies and require the facility to provide a
sufficiently detailed correction plan to meet the statutory
minimum staffing levels. Monetary penalties shall be imposed
beginning no later than January 1, 2021 and quarterly
thereafter and shall be based on the latest quarter for which
the Department has data. Monetary penalties shall be
established based on a formula that calculates on a daily basis
the cost of wages and benefits for the missing staffing hours.
All notices of noncompliance shall include the computations
used to determine noncompliance and establishing the variance
between minimum staffing ratios and the Department's
computations. The penalty for the first offense shall be 125%
of the cost of wages and benefits for the missing staffing
hours. The penalty shall increase to 150% of the cost of wages
and benefits for the missing staffing hours for the second
offense and 200% the cost of wages and benefits for the missing
staffing hours for the third and all subsequent offenses. The
penalty shall be imposed regardless of whether the facility has
committed other violations of this Act during the same period
that the staffing offense occurred. The penalty may not be
waived, but the Department shall have the discretion to
determine the gravity of the violation in situations where
there is no more than a 10% deviation from the staffing
requirements and make appropriate adjustments to the penalty.
The Department is granted discretion to waive the penalty when

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unforeseen circumstances have occurred that resulted in
call-offs of scheduled staff. This provision shall be applied
no more than 6 times per quarter. The Department must not count
each individual day as an occurrence and any unforeseen
circumstance that occurs for a continuous period only counts as
one time. Nothing in this Section diminishes a facility's right
to appeal.
For purposes of imposing the monetary penalties
established under this subsection, the following definitions
apply:
"Benefits" means the average cost of legally required
benefits per hour worked that is reported by the Bureau of
Labor Statistics of the United States Department of Labor
through the quarterly updated Employer Costs for Employee
Compensation for the Regions report. The Department must
use the legally required benefits for the report's Midwest
region.
"Legally required benefits" includes Social Security,
Medicare, federal and State unemployment insurance, and
workers' compensation.
"Wages" means the most current median hourly wage data
reported by the Bureau of Labor Statistics of the United
States Department of Labor in the Occupational Employment
Statistics' Metropolitan and Nonmetropolitan Area
Occupational Employment and Wage Estimates for the State of
Illinois. The Department must use Bureau of Labor

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Statistics of the United States Department of Labor's
occupational code 29-1141 for registered nurses,
occupational code 29-2061 for licensed practical and
licensed vocational nurses, and occupational code 31-1014
for certified nurse assistants and all other direct care
staff job categories listed under subsection (a).
(Source: P.A. 101-10, eff. 6-5-19.)
Section 10. The Illinois Public Aid Code is amended by
adding Section 5-5.4l as follows:
(305 ILCS 5/5-5.4l new)
Sec. 5-5.4l. Skilled care.
(a) In this Section, "skilled care" has the same meaning as
defined in Section 3-202.5 of the Nursing Home Care Act.
(b) If all other requirements for coverage under a Medicaid
skilled nursing facility benefit are met, skilled nursing
services shall be covered when an individualized assessment of
a patient's clinical condition demonstrates that the
specialized judgment, knowledge, and skills of a registered
nurse or, when provided by rule or regulation, a licensed
practical or vocational nurse are necessary. Skilled care shall
be covered if (1) such skilled care is necessary to maintain
the patient's current condition or prevent or slow further
deterioration so long as the beneficiary requires skilled care
for the services to be safely and effectively provided and (2)

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all other requirements for coverage under the Medicare skilled
nursing facility benefit are met. Coverage shall not turn on
the presence or absence of an individual's potential for
improvement from nursing care, but rather on the beneficiary's
need for skilled care.
(c) A condition that would not ordinarily require skilled
care may nevertheless require skilled care under certain
circumstances. In such instances, skilled care is necessary
only when: (1) the particular patient's special medical
complications require the skills of a registered nurse or, when
provided by regulation, a licensed practical nurse to perform a
type of service that would otherwise be considered nonskilled;
or (2) the needed services are of such complexity that the
skills of a registered nurse or, when provided by rule or
regulation, a licensed practical nurse are required to furnish
the services.