Health Law Healthcare, of course, is a heavily regulated industry. This section discusses some of the key components of that regulation, which is mostly governed by Illinois law, although some federal laws come into play.
Long-term care facilities. Long-term care facilities, more commonly called nursing homes, are used by those who can no longer care for themselves. Under federal and state law, nursing home residents are guaranteed certain rights.
Residents are allowed to manage their own financial affairs, unless the resident authorizes the nursing home administrator in writing to manage his or her affairs. Residents are entitled to use and wear their own personal property in their own living quarters, unless deemed medically inappropriate by a physician. If the home provides clothing, it must fit properly. The home must supply adequate storage space for the resident's personal belongings, and it must provide safeguards for the resident who keeps belongings in his or her room. The home must also have adequate procedures for investigating theft.
Residents are entitled to continue seeing their own physician, at their own expense. Residents are entitled to participate in their own care and caregiving decisions, and they are entitled to refuse treatment. Homes are forbidden from conducting experimental research on residents without residents' consent.
Residents are entitled to privacy in their medical treatment, with visitors, and in their phone calls. Home employees cannot open residents' mail and cannot enter residents' rooms without knocking. Residents are entitled to freedom of religious expression.
Visitors have the right to meet with residents if the purpose of the visit is social; educational, in the sense that they are there to inform the residents of their rights; or legal, in the sense that they are there to help the resident assert legal rights or provide legal advice.
Residents have the right to be discharged against medical advice, after written notice has been provided to the proper parties. Residents cannot be discharged against their will unless their condition meets certain conditions, such as that their behavior endangers other residents or that their health has improved to such an extent that they no longer need the home's services.
Homes must establish grievance procedures to address resident complaints. Homes cannot discharge or other retaliate against residents who follow the complaint procedures.
HMOs. The Illinois HMO Act governs conduct by health maintenance organizations and is similar to the laws passed in about 40 other states. It sets the rule for establishing HMOs in Illinois, how HMOs may invest their funds, and the types of services and coverages HMOs can and must provide.
The Managed Care Reform and Patient Rights Act, effective January 1, 2000, forced HMOs to share certain types of information with patients. The law requires that HMOs supply a description of their service area, an explanation of exclusions and limitations, an explanation of pre-certification and utilization review requirements, a description of limitations to access specialty care, an explanation of out-of-pocket expenses, an explanation of the appeals process, and other similar information.
HIPAA. A federal law, the Health Insurance Portability and Accountability Act, protects people with pre-existing medical conditions by limiting exclusion periods, prohibiting discrimination, granting certain enrollment rights, and guaranteeing renewal rights. It also protects those who change jobs from losing their coverage.
COBRA. A federal law, the Consolidated Omnibus Budget Reconciliation Act, which applies to employers with at least 20 employees, gives employees who lose their jobs the right to continued coverage in the group plan for a certain period of time, usually for 18 months but longer in some cases.
Illinois also has a coverage continuation law, which applies to employers of any size and contains some minor difference with its federal counterpart, such as that the coverage is for nine months and it requires that premiums not exceed the group rate (COBRA allows 102% of the group rate).
Vaccinations. In Illinois, parents are required to vaccinate children against certain communicable diseases, such as measles, polio, and tetanus, "as soon after birth as medically indicated." Parents with religious objections are exempt from the requirement.
Infertility. Illinois requires group plans and HMOs to provide infertility benefits to employee groups with more than 25 employees. The law mandates coverage for advanced procedures, such as invitro fertilization, but only after less expensive approaches have failed. Vasectomies are not covered.
State medical regulation. Illinois law has established standards that medical providers and facilities must meet. The Office of Health Care Regulation licenses and reviews the following medical providers: ambulances and other emergency services vehicles, ambulatory surgical treatment centers, breath test labs and operators, certified nurse aides, emergency medical service providers, HMOs, home health agencies, hospices, hospitals, medical labs, nursing homes, physical therapists, poison control resource centers, pregnancy termination centers, rural health clinics, sperm and tissue banks, and trauma centers. The Department of Professional Regulation regulates doctors, nurses, nursing home administrators, therapists, and others.
Nurses. The types of nursing licenses available are registered professional nurse (RN), licensed practical nurse (LPN), and advanced practice nurse (APN).
RNs have graduated from an accredited nursing education program and have passed the Registered Professional Nurse examination. LPNs have graduated from an accredited nursing education program and have passed the Licensed Practical Nurse examination. APNs are licensed RNs who are certified in their practice area, a master's degree in their practice area, and sufficient work experience in their practice area. The APN designation was only recently made available in Illinois.
Midwives. The status of midwifery in Illinois is somewhat murky. In a highly publicized case, the Illinois Department of Professional Regulation filed suit to stop a midwife, who was a Certified Professional Midwife, from practicing midwifery on the theory that midwifery is a type of nursing, and she wasn't licensed as a nurse in Illinois. There were no state laws regulating midwifery, and state regulators made statements to the effect that the practice should be limited to licensed nurses.
Effective July 1, 2001, the state legislature amended the APN nursing designation to add Certified Nurse Midwife as a category. Thus, midwives in Illinois would appear to be regulated by the nursing laws, which means that those interested in midwifery need to meet the nursing requirements set out in the statutes. Traditional midwifery is presumably illegal in Illinois.
A variety of educational programs, professional organizations, support networks, and certification programs are available to those who want to become midwives.
Hospitals. State licensing of hospitals involves rules governing hospital administration and planning, medical staff, personnel, laboratory, radiological services, emergency services, nursing services, surgery, recovery and anesthesia services, food service, housekeeping, laundry and physical plant. Cities may also issue licenses.
Viatical settlements. A viatical settlement is an arrangement between an insurance company, typically, and the beneficiary of a life insurance policy on a seriously ill person in which the insurance company pays the beneficiary a sum of money less than he or she will receive under the policy. The beneficiary gets the money up front, while the insurer ultimately gets more than it paid out. The Illinois Viatical Settlements Act regulates viatical settlements and requires that those involved in viatical settlements obtain a state license.