Statutes > Illinois Statutes > CHAPTER 210 HEALTH FACILITIES > 210 ILCS 45/ Nursing Home Care Act. > Part 2 - General Provisions

Part 2 - General Provisions


      (210 ILCS 45/Art. III Pt. 2 heading)
PART 2. GENERAL PROVISIONS

    (210 ILCS 45/3‑201) (from Ch. 111 1/2, par. 4153‑201)
    Sec. 3‑201. The Department shall not prescribe the course of medical treatment provided to an individual resident by the resident's physician in a facility.
(Source: P.A. 81‑223.)

    (210 ILCS 45/3‑202)(from Ch. 111 1/2, par. 4153‑202)
    Sec. 3‑202. The Department shall prescribe minimum standards for facilities. These standards shall regulate:
        (1) Location and construction of the facility,
     including plumbing, heating, lighting, ventilation, and other physical conditions which shall ensure the health, safety, and comfort of residents and their protection from fire hazard;
        (2) Number and qualifications of all personnel,
     including management and nursing personnel, having responsibility for any part of the care given to residents; specifically, the Department shall establish staffing ratios for facilities which shall specify the number of staff hours per resident of care that are needed for professional nursing care for various types of facilities or areas within facilities;
        (3) All sanitary conditions within the facility and
     its surroundings, including water supply, sewage disposal, food handling, and general hygiene, which shall ensure the health and comfort of residents;
        (4) Diet related to the needs of each resident based
     on good nutritional practice and on recommendations which may be made by the physicians attending the resident;
        (5) Equipment essential to the health and welfare of
     the residents;
        (6) A program of habilitation and rehabilitation for
     those residents who would benefit from such programs;
        (7) A program for adequate maintenance of physical
     plant and equipment;
        (8) Adequate accommodations, staff and services for
     the number and types of residents for whom the facility is licensed to care, including standards for temperature and relative humidity within comfort zones determined by the Department based upon a combination of air temperature, relative humidity and air movement. Such standards shall also require facility plans that provide for health and comfort of residents at medical risk as determined by the attending physician whenever the temperature and relative humidity are outside such comfort zones established by the Department. The standards must include a requirement that areas of a nursing home used by residents of the nursing home be air conditioned and heated by means of operable air‑conditioning and heating equipment. The areas subject to this air‑conditioning and heating requirement include, without limitation, bedrooms or common areas such as sitting rooms, activity rooms, living rooms, community rooms, and dining rooms. No later than July 1, 2008, the Department shall submit a report to the General Assembly concerning the impact of the changes made by this amendatory Act of the 95th General Assembly;
        (9) Development of evacuation and other appropriate
     safety plans for use during weather, health, fire, physical plant, environmental and national defense emergencies; and
        (10) Maintenance of minimum financial or other
     resources necessary to meet the standards established under this Section, and to operate and conduct the facility in accordance with this Act.
(Source: P.A. 95‑31, eff. 8‑9‑07.)

    (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) and 300.6000 and following (Subpart T) to utilize specialized clinical staff, as defined in rules, to count towards the staffing ratios.
    (b) Beginning July 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 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.
(Source: P.A. 96‑1372, eff. 7‑29‑10.)

    (210 ILCS 45/3‑202.1) (from Ch. 111 1/2, par. 4153‑202.1)
    Sec. 3‑202.1. The Department shall develop and implement a system of alerting and educating facilities and their personnel as to the existence or possibility of weather or other hazardous circumstances which may endanger resident health or safety and designating any precautions to prevent or minimize such danger. The Department may assist any facility experiencing difficulty in dealing with such emergencies. The Department may provide for announcement to the public of the dangers posed to facility residents by such existing or potential weather or hazardous circumstances.
(Source: P.A. 83‑1530.)

    (210 ILCS 45/3‑202.2)
    Sec. 3‑202.2. Rules; residents with mental illness. No later than January 1, 2001, the Department of Public Health shall file with the Joint Committee on Administrative Rules, pursuant to the Illinois Administrative Procedure Act, a proposed rule, or a proposed amendment to an existing rule, regarding the provision of services, including assessment, care planning, discharge planning, and treatment, by nursing facilities to residents who have a serious mental illness.
(Source: P.A. 91‑799, eff. 6‑13‑00.)

    (210 ILCS 45/3‑202.2a)
    Sec. 3‑202.2a. Comprehensive resident care plan. A facility, with the participation of the resident and the resident's guardian or representative, as applicable, must develop and implement a comprehensive care plan for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment, which allow the resident to attain or maintain the highest practicable level of independent functioning, and provide for discharge planning to the least restrictive setting based on the resident's care needs. The assessment shall be developed with the active participation of the resident and the resident's guardian or representative, as applicable.
(Source: P.A. 96‑1372, eff. 7‑29‑10.)

    (210 ILCS 45/3‑202.2b)
    Sec. 3‑202.2b. Certification of psychiatric rehabilitation program.
    (a) No later than January 1, 2011, the Department shall file with the Joint Committee on Administrative Rules, pursuant to the Illinois Administrative Procedure Act, proposed rules or proposed amendments to existing rules to establish a special certification program for compliance with 77 Ill. Admin. Code 300.4000 and following (Subpart S), which provides for psychiatric rehabilitation services that are required to be offered by a long term care facility licensed under this Act that serves residents with serious mental illness. Compliance with standards promulgated pursuant to this Section must be demonstrated before a long term care facility licensed under this Act is eligible to become certified under this Section and annually thereafter.
    (b) No long term care facility shall establish, operate,
    maintain, or offer psychiatric rehabilitation services, or admit, retain, or seek referrals of a resident with a serious mental illness diagnosis, unless and until a valid certification, which remains unsuspended, unrevoked, and unexpired, has been issued.
    (c) A facility that currently serves a resident with
    serious mental illness may continue to admit such residents until the Department performs a certification review and determines that the facility does not meet the requirements for certification. The Department, at its discretion, may provide an additional 90‑day period for the facility to meet the requirements for certification if it finds that the facility has made a good faith effort to comply with all certification requirements and will achieve total compliance with the requirements before the end of the 90‑day period. The facility shall be prohibited from admitting residents with serious mental illness until the Department certifies the facility to be in compliance with the requirements of this Section.
    (d) A facility currently serving residents with serious
    mental illness that elects to terminate provision of services to this population must immediately notify the Department of its intent, cease to admit new residents with serious mental illness, and give notice to all existing residents with serious mental illness of their impending discharge. These residents shall be accorded all rights and assistance provided to a resident being involuntarily discharged and those provided under Section 2‑201.5. The facility shall continue to adhere to all requirements of 77 Ill. Admin. Code 300.4000 until all residents with serious mental illness have been discharged.
    (e) A long term care facility found to be out of
    compliance with the certification requirements under this Section may be subject to denial, revocation, or suspension of the psychiatric rehabilitation services certification or the imposition of sanctions and penalties, including the immediate suspension of new admissions. Hearings shall be conducted pursuant to Article III, Part 7 of this Act.
    (f) The Department shall indicate, on its list of
    licensed long term care facilities, which facilities are certified under this Section and shall distribute this list to the appropriate State agencies charged with administering and implementing the State's program of pre‑admission screening and resident review, hospital discharge planners, Area Agencies on Aging, Case Coordination Units, and others upon request.
    (g) No public official, agent, or employee of the State,
    or any subcontractor of the State, may refer or arrange for the placement of a person with serious mental illness in a long term care facility that is not certified under this Section. No public official, agent, or employee of the State, or any subcontractor of the State, may place the name of a long term care facility on a list of facilities serving the seriously mentally ill for distribution to the general public or to professionals arranging for placements or making referrals unless the facility is certified under this Section.
    (h) Certification requirements. The Department shall
    establish requirements for certification that augment current quality of care standards for long term care facilities serving residents with serious mental illness, which shall include admission, discharge planning, psychiatric rehabilitation services, development of age‑group appropriate treatment plan goals and services, behavior management services, coordination with community mental health services, staff qualifications and training, clinical consultation, resident access to the outside community, and appropriate environment and space for resident programs, recreation, privacy, and any other issue deemed appropriate by the Department. The augmented standards shall at a minimum include, but need not be limited to, the following:
        (1) Staff sufficient in number and qualifications
    necessary to meet the scheduled and unscheduled needs of the residents on a 24‑hour basis. The Department shall establish by rule the minimum number of psychiatric services rehabilitation coordinators in relation to the number of residents with serious mental illness residing in the facility.
        (2) The number and qualifications of consultants
    required to be contracted with to provide continuing education and training, and to assist with program development.
        (3) Training for all new employees specific to the
    care needs of residents with a serious mental illness diagnosis during their orientation period and annually thereafter. Training shall be independent of the Department and overseen by an agency designated by the Governor to determine the content of all facility employee training and to provide training for all trainers of facility employees. Training of employees shall at minimum include, but need not be limited to, (i) the impact of a serious mental illness diagnosis, (ii) the recovery paradigm and the role of psychiatric rehabilitation, (iii) preventive strategies for managing aggression and crisis prevention, (iv) basic psychiatric rehabilitation techniques and service delivery, (v) resident rights, (vi) abuse prevention, (vii) appropriate interaction between staff and residents, and (viii) any other topic deemed by the Department to be important to ensuring quality of care.
        (4) Quality assessment and improvement requirements,
    in addition to those contained in this Act on the effective date of this amendatory Act of the 96th General Assembly, specific to a facility's residential psychiatric rehabilitation services, which shall be made available to the Department upon request. A facility shall be required at a minimum to develop and maintain policies and procedures that include, but need not be limited to, evaluation of the appropriateness of resident admissions based on the facility's capacity to meet specific needs, resident assessments, development and implementation of care plans, and discharge planning.
        (5) Room selection and appropriateness of roommate
    assignment.
        (6) Comprehensive quarterly review of all treatment
    plans for residents with serious mental illness by the resident's interdisciplinary team, which takes into account, at a minimum, the resident's progress, prior assessments, and treatment plan.
        (7) Substance abuse screening and management and
    documented referral relationships with certified substance abuse treatment providers.
        (8) Administration of psychotropic medications to a
    resident with serious mental illness who is incapable of giving informed consent, in compliance with the applicable provisions of the Mental Health and Developmental Disabilities Code.
    (i) The Department shall establish a certification fee schedule by rule, in consultation with advocates, nursing homes, and representatives of associations representing long term care facilities.
    (j) The Director or her or his designee shall seek input
    from the Long Term Care Facility Advisory Board before filing rules to implement this Section.
    Rules proposed no later than January 1, 2011 under this
    Section shall take effect 180 days after being approved by the Joint Committee on Administrative Rules.
(Source: P.A. 96‑1372, eff. 7‑29‑10.)

    (210 ILCS 45/3‑202.3)
    Sec. 3‑202.3. (Repealed).
(Source: P.A. 94‑163, eff. 7‑11‑05. Repealed by P.A. 94‑752, eff. 5‑10‑06.)

    (210 ILCS 45/3‑202.4)
    Sec. 3‑202.4. (Repealed).
(Source: P.A. 94‑163, eff. 7‑11‑05. Repealed by P.A. 94‑752, eff. 5‑10‑06.)

    (210 ILCS 45/3‑202.5)
    (Text of Section before amendment by P.A. 96‑339)
    Sec. 3‑202.5. Facility plan review; fees.
    (a) Before commencing construction of a new facility or specified types of alteration or additions to an existing long term care facility involving major construction, as defined by rule by the Department, with an estimated cost greater than $100,000, architectural drawings and specifications for the facility shall be submitted to the Department for review and approval. A facility may submit architectural drawings and specifications for other construction projects for Department review according to subsection (b) that shall not be subject to fees under subsection (d). Review of drawings and specifications shall be conducted by an employee of the Department meeting the qualifications established by the Department of Central Management Services class specifications for such an individual's position or by a person contracting with the Department who meets those class specifications. Final approval of the drawings and specifications for compliance with design and construction standards shall be obtained from the Department before the alteration, addition, or new construction is begun.
    (b) The Department shall inform an applicant in writing within 10 working days after receiving drawings and specifications and the required fee, if any, from the applicant whether the applicant's submission is complete or incomplete. Failure to provide the applicant with this notice within 10 working days shall result in the submission being deemed complete for purposes of initiating the 60‑day review period under this Section. If the submission is incomplete, the Department shall inform the applicant of the deficiencies with the submission in writing. If the submission is complete the required fee, if any, has been paid, the Department shall approve or disapprove drawings and specifications submitted to the Department no later than 60 days following receipt by the Department. The drawings and specifications shall be of sufficient detail, as provided by Department rule, to enable the Department to render a determination of compliance with design and construction standards under this Act. If the Department finds that the drawings are not of sufficient detail for it to render a determination of compliance, the plans shall be determined to be incomplete and shall not be considered for purposes of initiating the 60 day review period. If a submission of drawings and specifications is incomplete, the applicant may submit additional information. The 60‑day review period shall not commence until the Department determines that a submission of drawings and specifications is complete or the submission is deemed complete. If the Department has not approved or disapproved the drawings and specifications within 60 days, the construction, major alteration, or addition shall be deemed approved. If the drawings and specifications are disapproved, the Department shall state in writing, with specificity, the reasons for the disapproval. The entity submitting the drawings and specifications may submit additional information in response to the written comments from the Department or request a reconsideration of the disapproval. A final decision of approval or disapproval shall be made within 45 days of the receipt of the additional information or reconsideration request. If denied, the Department shall state the specific reasons for the denial.
    (c) The Department shall provide written approval for occupancy pursuant to subsection (g) and shall not issue a violation to a facility as a result of a licensure or complaint survey based upon the facility's physical structure if:
        (1) the Department reviewed and approved or deemed
     approved the drawings and specifications for compliance with design and construction standards;
        (2) the construction, major alteration, or addition
     was built as submitted;
        (3) the law or rules have not been amended since the
     original approval; and
        (4) the conditions at the facility indicate that
     there is a reasonable degree of safety provided for the residents.
    (d) The Department shall charge the following fees in connection with its reviews conducted before June 30, 2004 under this Section:
        (1) (Blank).
        (2) (Blank).
        (3) If the estimated dollar value of the alteration,
     addition, or new construction is $100,000 or more but less than $500,000, the fee shall be the greater of $2,400 or 1.2% of that value.
        (4) If the estimated dollar value of the alteration,
     addition, or new construction is $500,000 or more but less than $1,000,000, the fee shall be the greater of $6,000 or 0.96% of that value.
        (5) If the estimated dollar value of the alteration,
     addition, or new construction is $1,000,000 or more but less than $5,000,000, the fee shall be the greater of $9,600 or 0.22% of that value.
        (6) If the estimated dollar value of the alteration,
     addition, or new construction is $5,000,000 or more, the fee shall be the greater of $11,000 or 0.11% of that value, but shall not exceed $40,000.
    The fees provided in this subsection (d) shall not apply to major construction projects involving facility changes that are required by Department rule amendments.
    The fees provided in this subsection (d) shall also not apply to major construction projects if 51% or more of the estimated cost of the project is attributed to capital equipment. For major construction projects where 51% or more of the estimated cost of the project is attributed to capital equipment, the Department shall by rule establish a fee that is reasonably related to the cost of reviewing the project.
    The Department shall not commence the facility plan review process under this Section until the applicable fee has been paid.
    (e) All fees received by the Department under this Section shall be deposited into the Health Facility Plan Review Fund, a special fund created in the State Treasury. All fees paid by long‑term care facilities under subsection (d) shall be used only to cover the costs relating to the Department's review of long‑term care facility projects under this Section. Moneys shall be appropriated from that Fund to the Department only to pay the costs of conducting reviews under this Section. None of the moneys in the Health Facility Plan Review Fund shall be used to reduce the amount of General Revenue Fund moneys appropriated to the Department for facility plan reviews conducted pursuant to this Section.
    (f) (1) The provisions of this amendatory Act of 1997
     concerning drawings and specifications shall apply only to drawings and specifications submitted to the Department on or after October 1, 1997.
        (2) On and after the effective date of this
     amendatory Act of 1997 and before October 1, 1997, an applicant may submit or resubmit drawings and specifications to the Department and pay the fees provided in subsection (d). If an applicant pays the fees provided in subsection (d) under this paragraph (2), the provisions of subsection (b) shall apply with regard to those drawings and specifications.
    (g) The Department shall conduct an on‑site inspection of the completed project no later than 30 days after notification from the applicant that the project has been completed and all certifications required by the Department have been received and accepted by the Department. The Department shall provide written approval for occupancy to the applicant within 5 working days of the Department's final inspection, provided the applicant has demonstrated substantial compliance as defined by Department rule. Occupancy of new major construction is prohibited until Department approval is received, unless the Department has not acted within the time frames provided in this subsection (g), in which case the construction shall be deemed approved. Occupancy shall be authorized after any required health inspection by the Department has been conducted.
    (h) The Department shall establish, by rule, a procedure to conduct interim on‑site review of large or complex construction projects.
    (i) The Department shall establish, by rule, an expedited process for emergency repairs or replacement of like equipment.
    (j) Nothing in this Section shall be construed to apply to maintenance, upkeep, or renovation that does not affect the structural integrity of the building, does not add beds or services over the number for which the long‑term care facility is licensed, and provides a reasonable degree of safety for the residents.
(Source: P.A. 90‑327, eff. 8‑8‑97; 90‑600, eff. 6‑25‑98; 91‑712, eff. 7‑1‑00.)
 
    (Text of Section after amendment by P.A. 96‑339)
    Sec. 3‑202.5. Facility plan review; fees.
    (a) Before commencing construction of a new facility or specified types of alteration or additions to an existing long term care facility involving major construction, as defined by rule by the Department, with an estimated cost greater than $100,000, architectural drawings and specifications for the facility shall be submitted to the Department for review and approval. A facility may submit architectural drawings and specifications for other construction projects for Department review according to subsection (b) that shall not be subject to fees under subsection (d). Review of drawings and specifications shall be conducted by an employee of the Department meeting the qualifications established by the Department of Central Management Services class specifications for such an individual's position or by a person contracting with the Department who meets those class specifications. Final approval of the drawings and specifications for compliance with design and construction standards shall be obtained from the Department before the alteration, addition, or new construction is begun.
    (b) The Department shall inform an applicant in writing within 10 working days after receiving drawings and specifications and the required fee, if any, from the applicant whether the applicant's submission is complete or incomplete. Failure to provide the applicant with this notice within 10 working days shall result in the submission being deemed complete for purposes of initiating the 60‑day review period under this Section. If the submission is incomplete, the Department shall inform the applicant of the deficiencies with the submission in writing. If the submission is complete the required fee, if any, has been paid, the Department shall approve or disapprove drawings and specifications submitted to the Department no later than 60 days following receipt by the Department. The drawings and specifications shall be of sufficient detail, as provided by Department rule, to enable the Department to render a determination of compliance with design and construction standards under this Act. If the Department finds that the drawings are not of sufficient detail for it to render a determination of compliance, the plans shall be determined to be incomplete and shall not be considered for purposes of initiating the 60 day review period. If a submission of drawings and specifications is incomplete, the applicant may submit additional information. The 60‑day review period shall not commence until the Department determines that a submission of drawings and specifications is complete or the submission is deemed complete. If the Department has not approved or disapproved the drawings and specifications within 60 days, the construction, major alteration, or addition shall be deemed approved. If the drawings and specifications are disapproved, the Department shall state in writing, with specificity, the reasons for the disapproval. The entity submitting the drawings and specifications may submit additional information in response to the written comments from the Department or request a reconsideration of the disapproval. A final decision of approval or disapproval shall be made within 45 days of the receipt of the additional information or reconsideration request. If denied, the Department shall state the specific reasons for the denial.
    (c) The Department shall provide written approval for occupancy pursuant to subsection (g) and shall not issue a violation to a facility as a result of a licensure or complaint survey based upon the facility's physical structure if:
        (1) the Department reviewed and approved or deemed
     approved the drawings and specifications for compliance with design and construction standards;
        (2) the construction, major alteration, or addition
     was built as submitted;
        (3) the law or rules have not been amended since the
     original approval; and
        (4) the conditions at the facility indicate that