‘Omnibus’ health care bill passed amid criticisms
Wide-ranging law put popular, controversial measures into a single package
A law recently signed by Gov. JB Pritzker will extend the deadline for the state to transfer criminal defendants deemed mentally incompetent to stand trial from jail to a mental hospital.
That same bill,House Bill 240, also gives nursing homes in Illinois two more years to comply with minimum staffing levels implemented in 2022 before getting fined by the Department of Public Health.
Those are just two parts of a 67-page “omnibus” health care bill that passed the General Assembly on the final day of its recent lame duck session.
And even though parts of the bill received criticism, many lawmakers who opposed those elements said they felt compelled to vote for it anyway because other parts of the bill were too important. Those necessary provisions included enabling certain rural hospitals to draw upon more federal funds, distributing federal disaster aid to ambulance services impacted by the COVID-19 pandemic, and extending the deadline for a shuttered hospital in Chicago’s west suburbs to reopen under new ownership.
“I think that there are some important changes in this bill, and I certainly disagree with the process of putting things together where some I really support and some I don't,” said then-Rep. Avery Bourne, R-Morrisonville, during a committee hearing on the bill.
Bourne ran unsuccessfully for lieutenant governor in 2022, giving up the opportunity for a fifth term in the House.
Extended jail stays
Previous standards set in Illinois law set a 20-day deadline for the Department of Human Services to assume custody of a criminal defendant deemed incompetent to stand trial or found not guilty by reason of insanity. DHS would then be required to place them in a psychiatric institution.
The new law extends the period a defendant can sit in jail to 60 days. And, if DHS cannot place the defendant in a facility in that amount of time, it can ask the court for 30-day extensions until such time as a space becomes available.
Officials in the Pritzker administration testified that DHS often isn’t able to do that, either because the agency doesn’t get notice from the court that a defendant needs to be transferred or because there simply aren’t enough staffed beds available in Illinois’ seven state-run mental institutions.
“I think it really was just an attempt to try to be realistic,” said Ann Spillane, Pritzker’s general counsel, in committee testimony earlier this month. “We're not meeting 20 days. We haven't for a long time.”
State officials estimate there are currently more than 200 individuals in county jails who have been awaiting transfer to a state mental hospital for 60 days or more.
Spillane said DHS is working to expand the number of mental hospital beds in the state, but there has been a “tremendous increase” in the past year in the number of people found unfit to stand trial or not guilty by reason of insanity.
But county sheriffs, who oversee county jails, argued they have staffing shortages too, and that they are not equipped to house and treat people with severe mental illnesses.
Jim Kaitschuk, executive director of the Illinois Sheriffs’ Association, said the problem is especially severe in southern Illinois where there is a shortage of community-based mental health services to begin with. He pointed to ongoing litigation filed by a number of state’s attorneys over DHS’ failure to promptly take people into its custody out of county jails.
“We certainly understand the dilemma that the Department of Human Service has in terms of getting those staff,” he said. “The problem is, at the local level, we have that same problem. So, we're not able to maintain the level of staffing and the number of people and the beds that we need within our county jails.”
He also said many counties lack community services to provide treatment to the individuals.
During House debate earlier this month, now-retired House Republican Leader Jim Durkin, of Western Springs, said he understood the concerns of county sheriffs, but said the rest of the bill was too important to be held up by that issue.
“Don't let this provision kill or change your position or change your vote on this,” he said. “It's a really good bill.”
Durkin suggested lawmakers should continue to negotiate that specific issue in the new General Assembly which began January 11.
Other lawmakers had similar issues with a provision giving nursing homes two more years – until 2025 – to come into compliance with minimum staffing requirements before facing fines from the Department of Public Health.
Illinois has some of the most understaffed nursing homes in the country, and last year lawmakers passed asweeping overhaul of the way they are reimbursed through Medicaid that included as much as $700 million per year in incentive payments to increase their staff and raise wages for nursing home workers.
But nursing home industry lobbyists said many facilities are still reeling from the financial impact of the COVID-19 pandemic and that statewide, employment in nursing homes is still below pre-pandemic levels.
“Pandemic exhaustion has led to the resignation of thousands of nursing home employees and strained the long-term care labor market,” Ron Nunziato, director of policy and regulatory affairs at the Health Care Council of Illinois, said in a statement.
He said nursing homes are facing the same hiring obstacles as the rest of the health care industry.
“The pipeline for workforce development is slow in many areas of the state and it will take years for nursing homes to recover from staffing challenges,” Nunziato said.
Rep. Lakesia Collins, D-Chicago, a former nursing home worker, spoke against that provision on the floor of the House, but at the same time said her objections to it weren’t enough to reject the whole bill.
“I am not going to sink the ship on this because these other measures are very important,” she said. “But as a former nursing home worker, I would be remiss to not speak about the importance of short staffing and the provision in the bill about holding off for another two years around the penalties.”
The bill passed the Senate on Jan. 6 by a 32-15 margin. It passed the House Jan. 10, 85-24.
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