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1 AN ACT concerning State government.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Act on the Aging is amended by
5 changing Section 4.04 as follows:
6 (20 ILCS 105/4.04) (from Ch. 23, par. 6104.04)
7 Sec. 4.04. Long Term Care Ombudsman Program. The purpose
8 of the Long Term Care Ombudsman Program is to ensure that older
9 persons and persons with disabilities receive quality
10 services. This is accomplished by providing advocacy services
11 for residents of long term care facilities and participants
12 receiving home care and community-based care. Managed care is
13 increasingly becoming the vehicle for delivering health and
14 long-term services and supports to seniors and persons with
15 disabilities, including dual eligible participants. The
16 additional ombudsman authority will allow advocacy services to
17 be provided to Illinois participants for the first time and
18 will produce a cost savings for the State of Illinois by
19 supporting the rebalancing efforts of the Patient Protection
20 and Affordable Care Act.
21 (a) Long Term Care Ombudsman Program. The Department shall
22 establish a Long Term Care Ombudsman Program, through the
23 Office of State Long Term Care Ombudsman ("the Office"), in
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1 accordance with the provisions of the Older Americans Act of
2 1965, as now or hereafter amended. The Long Term Care
3 Ombudsman Program is authorized, subject to sufficient
4 appropriations, to advocate on behalf of older persons and
5 persons with disabilities residing in their own homes or
6 community-based settings, relating to matters which may
7 adversely affect the health, safety, welfare, or rights of
8 such individuals.
9 (b) Definitions. As used in this Section, unless the
10 context requires otherwise:
11 (1) "Access" means the right to:
12 (i) Enter any long term care facility or assisted
13 living or shared housing establishment or supportive
14 living facility;
15 (ii) Communicate privately and without restriction
16 with any resident, regardless of age, who consents to
17 the communication;
18 (iii) Seek consent to communicate privately and
19 without restriction with any participant or resident,
20 regardless of age;
21 (iv) Inspect and copy the clinical and other
22 records of a participant or resident, regardless of
23 age, with the express written consent of the
24 participant or resident;
25 (v) Observe all areas of the long term care
26 facility or supportive living facilities, assisted
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1 living or shared housing establishment except the
2 living area of any resident who protests the
3 observation; and
4 (vi) Subject to permission of the participant or
5 resident requesting services or his or her
6 representative, enter a home or community-based
7 setting.
8 (2) "Long Term Care Facility" means (i) any facility
9 as defined by Section 1-113 of the Nursing Home Care Act,
10 as now or hereafter amended; (ii) any skilled nursing
11 facility or a nursing facility which meets the
12 requirements of Section 1819(a), (b), (c), and (d) or
13 Section 1919(a), (b), (c), and (d) of the Social Security
14 Act, as now or hereafter amended (42 U.S.C. 1395i-3(a),
15 (b), (c), and (d) and 42 U.S.C. 1396r(a), (b), (c), and
16 (d)); (iii) any facility as defined by Section 1-113 of
17 the ID/DD Community Care Act, as now or hereafter amended;
18 (iv) any facility as defined by Section 1-113 of MC/DD
19 Act, as now or hereafter amended; and (v) any facility
20 licensed under Section 4-105 or 4-201 of the Specialized
21 Mental Health Rehabilitation Act of 2013, as now or
22 hereafter amended.
23 (2.5) "Assisted living establishment" and "shared
24 housing establishment" have the meanings given those terms
25 in Section 10 of the Assisted Living and Shared Housing
26 Act.
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1 (2.7) "Supportive living facility" means a facility
2 established under Section 5-5.01a of the Illinois Public
3 Aid Code.
4 (2.8) "Community-based setting" means any place of
5 abode other than an individual's private home.
6 (3) "State Long Term Care Ombudsman" means any person
7 employed by the Department to fulfill the requirements of
8 the Office of State Long Term Care Ombudsman as required
9 under the Older Americans Act of 1965, as now or hereafter
10 amended, and Departmental policy.
11 (3.1) "Ombudsman" means any designated representative
12 of the State Long Term Care Ombudsman Program; provided
13 that the representative, whether he is paid for or
14 volunteers his ombudsman services, shall be qualified and
15 designated by the Office to perform the duties of an
16 ombudsman as specified by the Department in rules and in
17 accordance with the provisions of the Older Americans Act
18 of 1965, as now or hereafter amended.
19 (4) "Participant" means an older person aged 60 or
20 over or an adult with a disability aged 18 through 59 who
21 is eligible for services under any of the following:
22 (i) A medical assistance waiver administered by
23 the State.
24 (ii) A managed care organization providing care
25 coordination and other services to seniors and persons
26 with disabilities.
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1 (5) "Resident" means an older person aged 60 or over
2 or an adult with a disability aged 18 through 59 who
3 resides in a long-term care facility.
4 (c) Ombudsman; rules. The Office of State Long Term Care
5 Ombudsman shall be composed of at least one full-time
6 ombudsman and shall include a system of designated regional
7 long term care ombudsman programs. Each regional program shall
8 be designated by the State Long Term Care Ombudsman as a
9 subdivision of the Office and any representative of a regional
10 program shall be treated as a representative of the Office.
11 The Department, in consultation with the Office, shall
12 promulgate administrative rules in accordance with the
13 provisions of the Older Americans Act of 1965, as now or
14 hereafter amended, to establish the responsibilities of the
15 Department and the Office of State Long Term Care Ombudsman
16 and the designated regional Ombudsman programs. The
17 administrative rules shall include the responsibility of the
18 Office and designated regional programs to investigate and
19 resolve complaints made by or on behalf of residents of long
20 term care facilities, supportive living facilities, and
21 assisted living and shared housing establishments, and
22 participants residing in their own homes or community-based
23 settings, including the option to serve residents and
24 participants under the age of 60, relating to actions,
25 inaction, or decisions of providers, or their representatives,
26 of such facilities and establishments, of public agencies, or
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1 of social services agencies, which may adversely affect the
2 health, safety, welfare, or rights of such residents and
3 participants. The Office and designated regional programs may
4 represent all residents and participants, but are not required
5 by this Act to represent persons under 60 years of age, except
6 to the extent required by federal law. When necessary and
7 appropriate, representatives of the Office shall refer
8 complaints to the appropriate regulatory State agency. The
9 Department, in consultation with the Office, shall cooperate
10 with the Department of Human Services and other State agencies
11 in providing information and training to designated regional
12 long term care ombudsman programs about the appropriate
13 assessment and treatment (including information about
14 appropriate supportive services, treatment options, and
15 assessment of rehabilitation potential) of the participants
16 they serve.
17 The State Long Term Care Ombudsman and all other
18 ombudsmen, as defined in paragraph (3.1) of subsection (b)
19 must submit to background checks under the Health Care Worker
20 Background Check Act and receive training, as prescribed by
21 the Illinois Department on Aging, before visiting facilities,
22 private homes, or community-based settings. The training must
23 include information specific to assisted living
24 establishments, supportive living facilities, shared housing
25 establishments, private homes, and community-based settings
26 and to the rights of residents and participants guaranteed
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1 under the corresponding Acts and administrative rules.
2 (c-5) Consumer Choice Information Reports. The Office
3 shall:
4 (1) In collaboration with the Attorney General, create
5 a Consumer Choice Information Report form to be completed
6 by all licensed long term care facilities to aid
7 Illinoisans and their families in making informed choices
8 about long term care. The Office shall create a Consumer
9 Choice Information Report for each type of licensed long
10 term care facility. The Office shall collaborate with the
11 Attorney General and the Department of Human Services to
12 create a Consumer Choice Information Report form for
13 facilities licensed under the ID/DD Community Care Act or
14 the MC/DD Act.
15 (2) Develop a database of Consumer Choice Information
16 Reports completed by licensed long term care facilities
17 that includes information in the following consumer
18 categories:
19 (A) Medical Care, Services, and Treatment.
20 (B) Special Services and Amenities.
21 (C) Staffing.
22 (D) Facility Statistics and Resident Demographics.
23 (E) Ownership and Administration.
24 (F) Safety and Security.
25 (G) Meals and Nutrition.
26 (H) Rooms, Furnishings, and Equipment.
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1 (I) Family, Volunteer, and Visitation Provisions.
2 (3) Make this information accessible to the public,
3 including on the Internet by means of a hyperlink on the
4 Office's World Wide Web home page. Information about
5 facilities licensed under the ID/DD Community Care Act or
6 the MC/DD Act shall be made accessible to the public by the
7 Department of Human Services, including on the Internet by
8 means of a hyperlink on the Department of Human Services'
9 "For Customers" website.
10 (4) Have the authority, with the Attorney General, to
11 verify that information provided by a facility is
12 accurate.
13 (5) Request a new report from any licensed facility
14 whenever it deems necessary.
15 (6) Include in the Office's Consumer Choice
16 Information Report for each type of licensed long term
17 care facility additional information on each licensed long
18 term care facility in the State of Illinois, including
19 information regarding each facility's compliance with the
20 relevant State and federal statutes, rules, and standards;
21 customer satisfaction surveys; and information generated
22 from quality measures developed by the Centers for
23 Medicare and Medicaid Services.
24 (d) Access and visitation rights.
25 (1) In accordance with subparagraphs (A) and (E) of
26 paragraph (3) of subsection (c) of Section 1819 and
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1 subparagraphs (A) and (E) of paragraph (3) of subsection
2 (c) of Section 1919 of the Social Security Act, as now or
3 hereafter amended (42 U.S.C. 1395i-3 (c)(3)(A) and (E) and
4 42 U.S.C. 1396r (c)(3)(A) and (E)), and Section 712 of the
5 Older Americans Act of 1965, as now or hereafter amended
6 (42 U.S.C. 3058f), a long term care facility, supportive
7 living facility, assisted living establishment, and shared
8 housing establishment must:
9 (i) permit immediate access to any resident,
10 regardless of age, by a designated ombudsman;
11 (ii) permit representatives of the Office, with
12 the permission of the resident, the resident's legal
13 representative, or the resident's legal guardian, to
14 examine and copy a resident's clinical and other
15 records, regardless of the age of the resident, and if
16 a resident is unable to consent to such review, and has
17 no legal guardian, permit representatives of the
18 Office appropriate access, as defined by the
19 Department, in consultation with the Office, in
20 administrative rules, to the resident's records; and
21 (iii) permit a representative of the Program to
22 communicate privately and without restriction with any
23 participant who consents to the communication
24 regardless of the consent of, or withholding of
25 consent by, a legal guardian or an agent named in a
26 power of attorney executed by the participant.
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1 (2) Each long term care facility, supportive living
2 facility, assisted living establishment, and shared
3 housing establishment shall display, in multiple,
4 conspicuous public places within the facility accessible
5 to both visitors and residents and in an easily readable
6 format, the address and phone number of the Office of the
7 Long Term Care Ombudsman, in a manner prescribed by the
8 Office.
9 (e) Immunity. An ombudsman or any representative of the
10 Office participating in the good faith performance of his or
11 her official duties shall have immunity from any liability
12 (civil, criminal or otherwise) in any proceedings (civil,
13 criminal or otherwise) brought as a consequence of the
14 performance of his official duties.
15 (f) Business offenses.
16 (1) No person shall:
17 (i) Intentionally prevent, interfere with, or
18 attempt to impede in any way any representative of the
19 Office in the performance of his official duties under
20 this Act and the Older Americans Act of 1965; or
21 (ii) Intentionally retaliate, discriminate
22 against, or effect reprisals against any long term
23 care facility resident or employee for contacting or
24 providing information to any representative of the
25 Office.
26 (2) A violation of this Section is a business offense,
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1 punishable by a fine not to exceed $501.
2 (3) The State Long Term Care Ombudsman shall notify
3 the State's Attorney of the county in which the long term
4 care facility, supportive living facility, or assisted
5 living or shared housing establishment is located, or the
6 Attorney General, of any violations of this Section.
7 (g) Confidentiality of records and identities. All records
8 containing resident, participant, and complainant information
9 collected by the Long Term Care Ombudsman Program are
10 confidential and shall not be disclosed outside of the program
11 without a lawful subpoena or the permission of the State
12 Ombudsman. The State Ombudsman, at his or her discretion, may
13 disclose resident or participant information if it is in the
14 best interest of the resident or participant. The Department
15 shall establish procedures for the disclosure of program
16 records by the State Ombudsman. The or the regional ombudsmen
17 entities of files maintained by the program. The procedures
18 shall provide that the files and records may be disclosed only
19 at the discretion of the State Long Term Care Ombudsman or the
20 person designated by the State Ombudsman to disclose the files
21 and records, and the procedures shall prohibit the disclosure
22 of the identity of any complainant, resident, participant,
23 witness, or employee of a long term care provider in case
24 records unless:
25 (1) the complainant, resident, participant, witness,
26 or employee of a long term care provider or his or her
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1 legal representative consents to the disclosure and the
2 consent is in writing;
3 (2) the complainant, resident, participant, witness,
4 or employee of a long term care provider or the resident or
5 participant's legal representative gives consent orally;
6 and the consent is documented contemporaneously in writing
7 in accordance with such requirements as the Department
8 shall establish; or
9 (3) the disclosure is required by court order.
10 (h) Legal representation. The Attorney General shall
11 provide legal representation to any representative of the
12 Office against whom suit or other legal action is brought in
13 connection with the performance of the representative's
14 official duties, in accordance with the State Employee
15 Indemnification Act.
16 (i) Treatment by prayer and spiritual means. Nothing in
17 this Act shall be construed to authorize or require the
18 medical supervision, regulation or control of remedial care or
19 treatment of any resident in a long term care facility
20 operated exclusively by and for members or adherents of any
21 church or religious denomination the tenets and practices of
22 which include reliance solely upon spiritual means through
23 prayer for healing.
24 (j) The Long Term Care Ombudsman Fund is created as a
25 special fund in the State treasury to receive moneys for the
26 express purposes of this Section. All interest earned on
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