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HB4672 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4672

Introduced 2/3/2026, by Rep. Yolonda Morris

SYNOPSIS AS INTRODUCED:

30 ILCS 772/15
210 ILCS 45/3-202.05

Amends the Equity in Long-term Care Quality Act and the Nursing Home
Care Act. Provides that funds generated from penalties imposed for
non-compliance with minimum staffing standards shall be deposited into the
Equity in Long-term Care Quality Fund. Sets forth requirements concerning
the distribution of those moneys. Effective immediately.
LRB104 16322 HLH 29708 b

A BILL FOR

HB4672
LRB104 16322 HLH 29708 b
1

AN ACT concerning finance.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Equity in Long-term Care Quality Act is
5
amended by changing Section 15 as follows:

6

(30 ILCS 772/15)
7

Sec. 15.
Equity in Long-term Care Quality Fund.
8

(a) There is created in the State treasury a special fund
9
to be known as the Equity in Long-term Care Quality Fund.
10
Grants shall be funded using federal civil monetary penalties
11
collected and deposited into the Long Term Care
12
Monitor/Receiver Fund established under the Nursing Home Care
13
Act. Subject to appropriation, moneys in the Fund shall be
14
used to improve the quality of nursing home care in areas
15
without access to high-quality long-term care. Interest earned
16
on moneys in the Fund shall be deposited into the Fund.
17

(b)
Except as otherwise provided in subsection (c), the

18
The
Department may use no more than 10% of the moneys deposited
19
into the Fund in any year to administer the program
20
established by the Fund and to implement the requirements of
21
the Nursing Home Care Act with respect to distressed
22
facilities.
23

(c) Any moneys generated from penalties imposed for

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LRB104 16322 HLH 29708 b
1
non-compliance with minimum staffing standards under Section
2
3-202.05 of the Nursing Home Care Act shall be deposited into
3
the Fund and, beginning in Fiscal Year 2027, shall be
4
distributed as follows:

5

(1) $1,000,000 shall be used in each State fiscal year
6

by the Department of Public Health to administer the
7

staffing fines established under Section 3-202.05 of the
8

Nursing Home Care Act;

9

(2) $2,000,000 shall, in each State fiscal year, be
10

ordered transferred by the State Comptroller and
11

transferred by the State Treasurer from the Equity in
12

Long-term Care Quality Fund to the Public Aid Recoveries
13

Trust Fund to be used by the Department of Healthcare and
14

Family Services to conduct minimum data set and other
15

audits of facilities licensed under the Nursing Home Care
16

Act;

17

(3) $2,000,000 shall be used in each State fiscal year
18

by the Department of Public Health to administer the
19

identified offenders and other safety activities; and

20

(4) 50% of the remainder of the moneys deposited under
21

this subsection (c) after the allocations under items (1)
22

through (3) have been completed shall, in each fiscal
23

year, be ordered transferred by the State Comptroller and
24

transferred by the State Treasurer from the Equity in
25

Long-term Care Quality Fund to the Common School Fund to
26

be used by the State Board of Education for vocational

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1

training of certified nurse assistants at the secondary
2

level of education; and

3

(5) 50% of the remainder of the moneys deposited under
4

this subsection (c) after the allocations under items (1)
5

through (3) have been completed shall, in each fiscal
6

year, be ordered transferred by the State Comptroller and
7

transferred by the State Treasurer from the Equity in
8

Long-term Care Quality Fund to the Education Assistance
9

Fund to be used by the Board of Higher Education for
10

nursing scholarships at the post-secondary level of
11

education.

12
(Source: P.A. 96-1372, eff. 7-29-10.)

13

Section 10.
The Nursing Home Care Act is amended by
14
changing Section 3-202.05 as follows:

15

(210 ILCS 45/3-202.05)
16

Sec. 3-202.05.
Staffing ratios effective July 1, 2010 and
17
thereafter.
18

(a) For the purpose of computing staff to resident ratios,
19
direct care staff shall include:
20

(1) registered nurses;
21

(2) licensed practical nurses;
22

(3) certified nurse assistants;
23

(4) psychiatric services rehabilitation aides;
24

(5) rehabilitation and therapy aides;

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(6) psychiatric services rehabilitation coordinators;
2

(7) assistant directors of nursing;
3

(8) 50% of the Director of Nurses' time; and
4

(9) 30% of the Social Services Directors' time.
5

The Department shall, by rule, allow certain facilities
6
subject to 77 Ill. Adm. Code 300.4000 and following (Subpart
7
S) to utilize specialized clinical staff, as defined in rules,
8
to count towards the staffing ratios.
9

Within 120 days of June 14, 2012 (the effective date of
10
Public Act 97-689), the Department shall promulgate rules
11
specific to the staffing requirements for facilities federally
12
defined as Institutions for Mental Disease. These rules shall
13
recognize the unique nature of individuals with chronic mental
14
health conditions, shall include minimum requirements for
15
specialized clinical staff, including clinical social workers,
16
psychiatrists, psychologists, and direct care staff set forth
17
in paragraphs (4) through (6) and any other specialized staff
18
which may be utilized and deemed necessary to count toward
19
staffing ratios.
20

Within 120 days of June 14, 2012 (the effective date of
21
Public Act 97-689), the Department shall promulgate rules
22
specific to the staffing requirements for facilities licensed
23
under the Specialized Mental Health Rehabilitation Act of
24
2013. These rules shall recognize the unique nature of
25
individuals with chronic mental health conditions, shall
26
include minimum requirements for specialized clinical staff,

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including clinical social workers, psychiatrists,
2
psychologists, and direct care staff set forth in paragraphs
3
(4) through (6) and any other specialized staff which may be
4
utilized and deemed necessary to count toward staffing ratios.
5

(a-5) The Centers for Medicare and Medicaid Services'
6
payroll-based journal job title codes, which correspond to the
7
staff used for the staffing ratios in subsection (a), are as
8
follows:
9

(1) Registered Nurse Director of Nursing, job title
10

code 5.
11

(2) Registered Nurse with Administrative Duties, job
12

title code 6.
13

(3) Registered Nurse, job title code 7.
14

(4) Licensed Practical/Vocational Nurse with
15

Administrative Duties, job title code 8.
16

(5) Licensed Practical/Vocational Nurse, job title
17

code 9.
18

(6) Certified Nurse Aide, job title code 10.
19

(7) Nurse Aide in Training, job title code 11.
20

(8) Medication Aide/Technician, job title code 12.
21

(9) Nurse Practitioner, job title code 13.
22

(10) Clinical Nurse Specialist, job title code 14.
23

(11) Occupational Therapist, job title code 18.
24

(12) Occupational Therapy Assistant, job title code
25

19.
26

(13) Occupational Therapy Aide, job title code 20.

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1

(14) Physical Therapist, job title code 21.
2

(15) Physical Therapy Assistant, job title code 22.
3

(16) Physical Therapy Assistant, job title code 23.
4

(17) Respiratory Therapist, job title code 24.
5

(18) Respiratory Therapy Technician, job title code
6

25.
7

(19) Speech/Language Pathologist, job title code 26.
8

(20) Qualified Activities Professional, job title code
9

28.
10

(21) Other Activities Staff, job title code 29.
11

(22) Qualified Social Worker, job title code 30.
12

(23) Other Social Worker, job title code 31.
13

(24) Mental Health Service Worker, job title code 34.
14

For all job title codes in this subsection, 100% of the
15
hours worked by the staff must be counted toward the
16
staff-to-resident ratio, except job code title 5, which is
17
limited to 50%, and job title codes 28, 30, and 31, which are
18
limited to 30%.
19

(b) (Blank).
20

(b-5) For purposes of the minimum staffing ratios in this
21
Section, all residents shall be classified as requiring either
22
skilled care or intermediate care.
23

As used in this subsection:
24

"Intermediate care" means basic nursing care and other
25
restorative services under periodic medical direction.
26

"Skilled care" means skilled nursing care, continuous

HB4672
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LRB104 16322 HLH 29708 b
1
skilled nursing observations, restorative nursing, and other
2
services under professional direction with frequent medical
3
supervision.
4

(c) Facilities shall notify the Department within 60 days
5
after July 29, 2010 (the effective date of Public Act
6
96-1372), in a form and manner prescribed by the Department,
7
of the staffing ratios in effect on July 29, 2010 (the
8
effective date of Public Act 96-1372) for both intermediate
9
and skilled care and the number of residents receiving each
10
level of care.
11

(d)(1) (Blank).
12

(2) (Blank).
13

(3) (Blank).
14

(4) (Blank).
15

(5) Effective January 1, 2014, the minimum staffing ratios
16
shall be increased to 3.8 hours of nursing and personal care
17
each day for a resident needing skilled care and 2.5 hours of
18
nursing and personal care each day for a resident needing
19
intermediate care.
20

(e) Ninety days after June 14, 2012 (the effective date of
21
Public Act 97-689), a minimum of 25% of nursing and personal
22
care time shall be provided by licensed nurses, with at least
23
10% of nursing and personal care time provided by registered
24
nurses. These minimum requirements shall remain in effect
25
until an acuity based registered nurse requirement is
26
promulgated by rule concurrent with the adoption of the

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LRB104 16322 HLH 29708 b
1
Resource Utilization Group classification-based payment
2
methodology, as provided in Section 5-5.2 of the Illinois
3
Public Aid Code. Registered nurses and licensed practical
4
nurses employed by a facility in excess of these requirements
5
may be used to satisfy the remaining 75% of the nursing and
6
personal care time requirements. Notwithstanding this
7
subsection, no staffing requirement in statute in effect on
8
June 14, 2012 (the effective date of Public Act 97-689) shall
9
be reduced on account of this subsection.
10

(f) The Department shall submit proposed rules for
11
adoption by January 1, 2020 establishing a system for
12
determining compliance with minimum staffing set forth in this
13
Section and the requirements of 77 Ill. Adm. Code 300.1230
14
adjusted for any waivers granted under Section 3-303.1.
15
Compliance shall be determined quarterly by comparing the
16
number of hours provided per resident per day using the
17
Centers for Medicare and Medicaid Services' payroll-based
18
journal and the facility's daily census, broken down by
19
intermediate and skilled care as self-reported by the facility
20
to the Department on a quarterly basis. The Department shall
21
use the quarterly payroll-based journal and the self-reported
22
census to calculate the number of hours provided per resident
23
per day and compare this ratio to the minimum staffing
24
standards required under this Section, as impacted by any
25
waivers granted under Section 3-303.1. Discrepancies between
26
job titles contained in this Section and the payroll-based

HB4672
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LRB104 16322 HLH 29708 b
1
journal shall be addressed by rule. The manner in which the
2
Department requests payroll-based journal information to be
3
submitted shall align with the federal Centers for Medicare
4
and Medicaid Services' requirements that allow providers to
5
submit the quarterly data in an aggregate manner.
6

(g) Monetary penalties for non-compliance. The Department
7
shall submit proposed rules for adoption by January 1, 2020
8
establishing monetary penalties for facilities not in
9
compliance with minimum staffing standards under this Section.
10
Facilities shall be required to comply with the provisions of
11
this subsection beginning January 1, 2025. No monetary penalty
12
may be issued for noncompliance prior to the revised
13
implementation date, which shall be January 1, 2025. If a
14
facility is found to be noncompliant prior to the revised
15
implementation date, the Department shall provide a written
16
notice identifying the staffing deficiencies and require the
17
facility to provide a sufficiently detailed correction plan
18
that describes proposed and completed actions the facility
19
will take or has taken, including hiring actions, to address
20
the facility's failure to meet the statutory minimum staffing
21
levels. Monetary penalties shall be imposed beginning no later
22
than July 1, 2025, based on data for the quarter beginning
23
January 1, 2025 through March 31, 2025 and quarterly
24
thereafter. Monetary penalties shall be established based on a
25
formula that calculates on a daily basis the cost of wages and
26
benefits for the missing staffing hours. All notices of

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1
noncompliance shall include the computations used to determine
2
noncompliance and establishing the variance between minimum
3
staffing ratios and the Department's computations. The penalty
4
for the first offense shall be 125% of the cost of wages and
5
benefits for the missing staffing hours. The penalty shall
6
increase to 150% of the cost of wages and benefits for the
7
missing staffing hours for the second offense and 200% the
8
cost of wages and benefits for the missing staffing hours for
9
the third and all subsequent offenses. The penalty shall be
10
imposed regardless of whether the facility has committed other
11
violations of this Act during the same period that the
12
staffing offense occurred. The penalty may not be waived,
13
except where there is no more than a 10% deviation from the
14
staffing requirements, in which case the facility shall not
15
receive a violation or penalty. The Department is granted
16
discretion to waive the violation and penalty when unforeseen
17
circumstances have occurred that resulted in call-offs of
18
scheduled staff. This provision shall be applied no more than
19
6 times per quarter. Nothing in this Section diminishes a
20
facility's right to appeal the imposition of a monetary
21
penalty. No facility may appeal a notice of noncompliance
22
issued during the revised implementation period. The changes
23
made to this subsection by this amendatory Act of the 104th
24
General Assembly in regard to nursing home staffing fines
25
shall apply to the July 1, 2025 fines based on data for the
26
quarter beginning January 1, 2025 through March 31, 2025 and

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LRB104 16322 HLH 29708 b
1
quarterly thereafter.
2

Moneys generated from the monetary penalties imposed on
3
facilities that are not in compliance with minimum staffing
4
standards under this subsection and rules adopted under this
5
subsection shall be deposited into the Equity in Long-term
6
Care Quality Fund and shall be used as provided in subsection
7
(c) of Section 15 of the Equity in Long-term Care Quality Act.

8
(Source: P.A. 104-9, eff. 6-16-25.)

9

Section 99.
Effective date.
This Act takes effect upon
10
becoming law.

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