Section 545.10  Applicability

 

This Part establishes requirements for the treatment of sexual assault survivors in emergency departments of hospitals licensed under the Hospital Licensing Act, or operated under the University of Illinois Hospital Act, that provide general medical and surgical hospital services (Section 2 of the Act), out-of-state hospitals that consent to the jurisdiction of the Department in accordance with Section 2.06 of the Act (Section 5.4(b)(2)(i) of the Act), or approved pediatric health care facilities.

 

(Source:  Amended at 44 Ill. Reg. 6326, effective April 10, 2020)

 

Section 545.20  Definitions

 

Act – the Sexual Assault Survivors Emergency Treatment Act.

 

Advanced practice registered nurse or APRN − has the meaning ascribed in Section 50-10 of the Nurse Practice Act.  (Section 1a of the Act)

 

Alcohol-facilitated sexual assault − the use of any alcoholic beverage in the commission of a sexual assault.

 

Ambulance provider − an individual or entity that owns and operates a business or service using ambulances or emergency medical services vehicles to transport emergency patients. (Section 1a of the Act)

 

Approved pediatric health care facility − a health care facility, other than a hospital, with a sexual assault treatment plan approved by the Department to provide medical forensic services to sexual assault survivors under the age of 18 who present with a complaint of sexual assault within seven days after the assault, who have disclosed past sexual assault by a specific individual and were in the care of that individual within the last seven days, or who have a clinical indication for medical forensic services beyond seven days.  (Section 1a of the Act)

 

Areawide sexual assault treatment plan or areawide plan − a plan, developed by hospitals or by hospitals and approved pediatric health care facilities in a community or area to be served, which provides for medical forensic services to sexual assault survivors that shall be made available by each of the participating hospitals and approved pediatric health care facilities. (Section 1a of the Act)

 

Board-certified child abuse pediatrician – a physician certified by the American Board of Pediatrics in child abuse pediatrics.  (Section 1a of the Act)

 

Board-eligible child abuse pediatrician – a physician who has completed the requirements set forth by the American Board of Pediatrics to take the examination for certification in child abuse pediatrics.  (Section 1a of the Act)

 

Caregiver – any person who is legally responsible for providing care to the patient or who renders support to the patient.

 

Department – the Department of Public Health. (Section 1a of the Act)

 

Drug-facilitated sexual assault − the use of a chemical submissive agent in the commission of a sexual assault, given without consent of the victim, that produces relaxant effects, blackouts, coma, impaired judgment, or loss of coordination.

 

Emergency contraception − medication as approved by the federal Food and Drug Administration (FDA) that can significantly reduce the risk of pregnancy if taken within 72 hours after sexual assault. (Section 1a of the Act)

 

Follow-up health care – health care services related to a sexual assault, including laboratory services and pharmacy services, rendered within 180 days after the initial visit for medical forensic services. (Section 1a of the Act)

 

Health care professional – a physician, a physician assistant, a sexual assault forensic examiner, an APRN, a registered professional nurse, a licensed practical nurse, or a sexual assault nurse examiner. (Section 1a of the Act)

 

Hospital – a hospital licensed under the Hospital Licensing Act or operated under the University of Illinois Hospital Act, any outpatient center or freestanding emergency center licensed under 77 Ill. Adm. Code 518 included in the hospital's sexual assault treatment plan where hospital employees provide medical forensic services, and an out-of-state hospital that has consented to the jurisdiction of the Department under Section 2.06 of the Act. (Section 1a of the Act)  

 

Law enforcement agency having jurisdiction – the law enforcement agency in the jurisdiction where an alleged sexual assault or sexual abuse occurred. (Section 1a of the Act)

 

Licensed practical nurse – has the meaning ascribed in Section 50-10 of the Nurse Practice Act.  (Section 1a of the Act)

 

Medical forensic services – health care delivered to patients within or under the care and supervision of personnel working in a designated emergency department of a hospital or an approved pediatric health care facility. "Medical forensic services" includes, but is not limited to, taking a medical history, performing photo documentation, performing a physical and anogenital examination, assessing the patient for evidence collection, collecting evidence in accordance with a statewide sexual assault evidence collection program administered by the Illinois State Police using the Sexual Assault Evidence Collection Kit, if appropriate, assessing the patient for drug-facilitated or alcohol-facilitated sexual assault, providing an evaluation of and care for sexually transmitted infection and human immunodeficiency virus (HIV), pregnancy risk evaluation and care, and discharge and follow-up healthcare planning.  (Section 1a of the Act)

 

Pediatric health care facility – a clinic or physician's office that provides medical services to patients under the age of 18.  (Section 1a of the Act)

 

Pediatric sexual assault survivor – a person under the age of 13 who presents for medical forensic services in relation to injuries or trauma resulting from a sexual assault.  (Section 1a of the Act)

 

Photo documentation – digital photographs or colposcope videos stored and backed-up securely in the original file format.  (Section 1a of the Act)

 

Physician – a person licensed to practice medicine in all its branches as defined in the Medical Practice Act of 1987. (Section 1a of the Act)

 

Physician assistant – has the meaning ascribed in Section 4 of the Physician Assistant Practice Act of 1987. (Section 1a of the Act)

 

Prepubescent sexual assault survivor – a female who is under the age of 18 years and has not had a first menstrual cycle or a male who is under the age of 18 years and has not started to develop secondary sex characteristics who presents for medical forensic services in relation to injuries or trauma resulting from a sexual assault.  (Section 1a of the Act)

 

Qualified medical provider – a board-certified child abuse pediatrician, board-eligible child abuse pediatrician, sexual assault forensic examiner, or sexual assault nurse examiner who has access to photo documentation tools, and who participates in peer review.  (Section 1a of the Act)

 

Registered Professional Nurse – has the meaning ascribed in Section 50-10 of the Nurse Practice Act.  (Section 1a of the Act)

 

Sexual assault:

 

An act of sexual conduct; as used in this Part, "sexual conduct" has the meaning ascribed under Section 11-0.1 of the Criminal Code of 2012; or

 

Any act of sexual penetration; as used in this Part, "sexual penetration" has the meaning ascribed under Section 11-0.1 of the Criminal Code of 2012 and includes, without limitation, acts prohibited under Sections 11-1.20 through 11-1.60 of the Criminal Code of 2012.  (Section 1a of the Act)

 

Sexual Assault Evidence Collection Kit – the Illinois State Police Sexual Assault Evidence Collection Kit; a prepackaged set of materials and forms to be used for the collection of evidence relating to sexual assault. The standardized evidence collection kit for the State of Illinois shall be the Sexual Assault Evidence Collection Kit. (Section 1a of the Act)

 

Sexual assault forensic examiner − a physician or physician assistant who has completed training that meets or is substantially similar to the Sexual Assault Nurse Examiner Education Guidelines established by the International Association of Forensic Nurses.  (Section 1a of the Act)

 

Sexual assault nurse examiner – an APRN or registered professional nurse who has completed a sexual assault nurse examiner (SANE) training program that meets the Forensic Sexual Assault Nurse Examiner Education Guidelines established by the International Association of Forensic Nurses.  (Section 1a of the Act)

 

Sexual assault services voucher − a document generated by a hospital or approved pediatric health care facility at the time the sexual assault survivor receives outpatient medical forensic services that may be used to seek payment for any ambulance services, medical forensic services, laboratory services, pharmacy services, and follow-up healthcare provided as a result of the sexual assault.  (Section 1a of the Act)

 

Sexual assault survivor or survivor – a person who presents for medical forensic services in relation to injuries or trauma resulting from a sexual assault. (Section 1a of the Act)

 

Sexual assault transfer plan – a written plan developed by a hospital and approved by the Department, which describes the hospital's procedures for transferring sexual assault survivors to another hospital, and an approved pediatric health care facility, if applicable, in order to receive medical forensic services. (Section 1a of the Act)

 

Sexual assault treatment plan − a written plan that describes the procedures and protocols for providing medical forensic services to sexual assault survivors who present themselves for such services, either directly or through transfer from a hospital or approved pediatric health care facility. (Section 1a of the Act)

 

Transfer hospital – a hospital with a sexual assault transfer plan approved by the Department.  (Section 1a of the Act)

 

Transfer services – the appropriate medical screening examination and necessary stabilizing treatment prior to the transfer of a sexual assault survivor to a hospital or an approved pediatric health care facility that provides medical forensic services to sexual assault survivors pursuant to a sexual assault treatment plan or areawide sexual assault treatment plan. (Section 1a of the Act)

 

Treatment hospital – a hospital with a sexual assault treatment plan approved by the Department to provide medical forensic services to all sexual assault survivors who present with a complaint of sexual assault within seven days after the assault, who have disclosed past sexual assault by a specific individual and were in the care of that individual within the last seven days, or who have a clinical indication for medical forensic services beyond seven days.  (Section 1a of the Act)

 

Treatment hospital with approved pediatric transfer – a hospital with a treatment plan approved by the Department to provide medical forensic services to sexual assault survivors 13 years old or older who present with a complaint of sexual assault within seven days after the assault, who have disclosed past sexual assault by a specific individual and were in the care of that individual within the last seven days, or who have a clinical indication for medical forensic services beyond seven days.  (Section 1a of the Act)

 

Unauthorized personnel − all individuals whose presence in the examination room is not desired or required either by the hospital or by the survivor (e.g., representatives of the media).

 

(Source:  Amended at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.25  Incorporated and Referenced Materials

 

a)         The following materials are referenced in this Part:

 

1)         State of Illinois Statutes

 

A)        Sexual Assault Survivors Emergency Treatment Act [410 ILCS 70].

 

B)        Hospital Licensing Act [210 ILCS 85].

 

C)        University of Illinois Hospital Act [110 ILCS 330].

 

D)        Criminal Code of 2012 [720 ILCS 5].

 

E)        Crime Victims Compensation Act [740 ILCS 45].

 

F)         Criminal Identification Act [20 ILCS 2630].

 

G)        Code of Criminal Procedure of 1963 [725 ILCS 5].

 

H)        Illinois Public Aid Code [305 ILCS 5].

 

I)         Illinois Insurance Code [215 ILCS 5].

 

J)         Medical Practice Act of 1987 [225 ILCS 60].

 

K)        Emergency Medical Treatment Act [210 ILCS 70].

 

L)        Nurse Practice Act [225 ILCS 65].

 

M)       Consent by Minors to Health Care Services Act [410 ILCS 210].

 

N)        AIDS Confidentiality Act [410 ILCS 305].

 

O)        Physician Assistant Practice Act of 1987 [225 ILCS 95].

 

P)         Abused and Neglected Child Reporting Act [325 ILCS 5].

 

Q)        Abused and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30].

 

R)        Adult Protective Services Act [320 ILCS 20].

 

S)         Health Care Surrogate Act [755 ILCS 40].

 

T)         Emergency Medical Services (EMS) Systems Act [210 ILCS 50].

 

U)        Juvenile Court Act of 1987 [705 ILCS 405].

 

V)        Sexual Assault Evidence Submission Act [725 ILCS 202].

 

2)         State of Illinois Rules

 

A)        Department of Public Health, Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100).

 

B)        Department of Public Health, Hospital Licensing Requirements (77 Ill. Adm. Code 250).

 

C)        Department of Public Health, Freestanding Emergency Center Code (77 Ill. Adm. Code 518).

 

D)        Department of Healthcare and Family Services, Hospital Services (89 Ill. Adm. Code 148).

 

3)         Federal Statute

 

Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C. 1395dd).

 

4)         "Crime Victims Compensation: Frequently Asked Questions", which may be obtained from the Office of the Illinois Attorney General, 500 S. Second Street, Springfield, IL  62706, or at:  http://tinyurl.com/m7rpnvfx.

 

5)         "Medical Forensic Exam Brochure" (December 27, 2021), which may be obtained from the Office of the Illinois Attorney General at:  https://illinoisattorneygeneral.gov/Page-Attachments/YourRightsAndChoicesForAMedicalForensicExam.pdf.

 

6)         "After Sexual Assault", (April 2024) published by the Illinois Coalition Against Sexual Assault, available at: https://icasa.org/uploads/documents/Publications/ASA-Final.pdf.  A Spanish-language version of this document is available at https://icasa.org/uploads/documents/Publications/ASA-2022.pdf.

 

b)         The following materials are incorporated in this Part:

 

1)         Federal Guidelines

 

A)        Centers for Disease Control and Prevention, "Sexually Transmitted Infections Treatment Guidelines", 2021, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), July 23, 2021, Vol. 70, No. 4; available at: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf.

 

B)        Centers for Disease Control and Prevention, "Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections", April 13, 2007, Vol. 56, No. 14.  Available from the Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E., Atlanta, GA  30329-4027, or at:  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm.

 

C)        Centers for Disease Control and Prevention, "Sexually Transmitted Disease Surveillance", 2022, available at: https://www.cdc.gov/std/statistics/2022/default.htm.

 

D)        Centers for Disease Control and Prevention, "Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV − United States, 2016", available from the Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA  30329-4027, or at: https://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf.

 

E)        Centers for Disease Control and Prevention, "6 Guiding Principles to a Trauma Informed Approach" (June 2, 2022), available at: https://stacks.cdc.gov/view/cdc/138924.

 

2)         Association Standards

 

A)        "Management of the Patient with the Complaint of Sexual Assault", February, 2020.  Available at: https://tinyurl.com/2aktadne or from the American College of Emergency Physicians, Post Office Box 619911, Dallas, TX  75261-9911.

 

B)        "Sexual Assault Nurse Examiner Education Guidelines, Adult and Pediatric" (2022), which may be obtained from the International Association of Forensic Nurses at:  https://tinyurl.com/3rntt7jx.

 

c)         All incorporations by reference of federal guidelines and association standards refer to the guidelines and standards in effect on the date specified and do not include any later editions or amendments.

 

(Source:  Amended at 48 Ill. Reg. 14759, effective September 25, 2024)

 

Section 545.30  Application of Rules  (Repealed)

 

(Source:  Amended at 27 Ill. Reg. 1567, effective January 15, 2003)

 

Section 545.35  Development and Approval of Plans

 

a)         Every hospital required to be licensed by the Department, pursuant to the Hospital Licensing Act or operated under the University of Illinois Hospital Act that provides general medical and surgical hospital services shall provide either transfer services to all sexual assault survivors, medical forensic services to all sexual assault survivors, or transfer services to pediatric sexual assault survivors and medical forensic services to sexual assault survivors 13 years old or older, in accordance with this Part.  (Section 2(a) of the Act)

 

b)         Every hospital, regardless of whether or not a request is made for reimbursement, shall submit to the Department a plan to provide either transfer services to all sexual assault survivors, medical forensic services to all sexual assault survivors, or transfer services to pediatric sexual assault survivors and medical forensic services to sexual assault survivors 13 years or older within the time frame established by the Department.  (Section 2(a) of the Act)

 

c)         The plan shall be submitted to the Department for approval prior to becoming effective.  The hospital or approved pediatric health care facility shall submit the plan to the Department within 60 days after receiving the Department's request for the plan.

 

d)         A sexual assault treatment plan, transfer plan, pediatric transfer plan, approved pediatric health care facility treatment plan, or out-of-state hospital treatment plan shall be completed using the respective forms provided by the Department.  An emergency contraception protocol consistent with the sample protocols in Appendix C shall be completed.  The Department will approve a plan for either transfer services to all sexual assault survivors, medical forensic services to all sexual assault survivors, or transfer services to pediatric sexual assault survivors and medical forensic services to sexual assault survivors 13 years old or older, if it finds that the implementation of the proposed plan would provide transfer services or medical forensic services for sexual assault survivors in accordance with the Act and this Part, and provide sufficient protections from the risk of pregnancy to sexual assault survivors. (Section 2(a) of the Act)

 

e)         Every hospital and approved pediatric health care facility shall submit an updated treatment plan, transfer plan, pediatric transfer plan, approved pediatric health care facility treatment plan, or out-of-state hospital treatment plan to the Department every three years. A transfer or treatment plan may be part of an areawide plan pursuant to Section 545.50.

 

1)         The Department will not approve a sexual assault transfer plan unless a treatment hospital has agreed, as a part of an areawide treatment plan, to accept sexual assault survivors from the proposed transfer hospital and a transfer to the treatment hospital would not unduly burden the sexual assault survivor.

 

2)         In counties with a population of less than 1,000,000, the Department will not approve a sexual assault transfer plan for a hospital located within a 20-mile radius of a 4-year public university, not including community colleges, unless there is a treatment hospital with a sexual assault treatment plan approved by the Department within a 20-mile radius of the 4-year public university.

 

3)         A transfer shall be in accordance with federal and State laws and local ordinances.

 

4)         A treatment hospital with approved pediatric transfer shall submit an areawide treatment plan under Section 3 of the Act and Section 545.50 of this Part that includes a written agreement with a treatment hospital stating that the treatment hospital will provide medical forensic services to pediatric sexual assault survivors transferred from the treatment hospital with approved pediatric transfer. The areawide treatment plan may also include an approved pediatric health care facility.  The Department may approve a sexual assault transfer plan for the provision of medical forensic services if:

 

A)        A treatment hospital with approved pediatric transfer has agreed, as part of an areawide treatment plan, to accept sexual assault survivors 13 years of age or older from the proposed transfer hospital; and

 

B)        If the treatment hospital with approved pediatric transfer is geographically closer to the transfer hospital than a treatment hospital or another treatment hospital with approved pediatric transfer and the transfer is not unduly burdensome on the sexual assault survivor.

 

5)         A transfer hospital shall submit an areawide treatment plan under Section 3 of the Act and Section 545.50 of this Part that includes a written agreement with a treatment hospital stating that the treatment hospital will provide medical forensic services to all sexual assault survivors transferred from the transfer hospital. The areawide treatment plan may also include an approved pediatric health care facility.  The Department may approve a sexual assault transfer plan for the provision of medical forensic services if:

 

A)        A treatment hospital with approved pediatric transfer has agreed, as part of an areawide treatment plan, to accept sexual assault survivors 13 years of age or older from the proposed transfer hospital, if the treatment hospital with approved pediatric transfer is geographically closer to the transfer hospital than a treatment hospital or another treatment hospital with approved pediatric transfer and the transfer is not unduly burdensome on the sexual assault survivor; and

 

B)        A treatment hospital has agreed, as a part of an areawide treatment plan, to accept sexual assault survivors under 13 years of age from the proposed transfer hospital and transfer to the treatment hospital would not unduly burden the sexual assault survivor.  (Section 2(a) of the Act)

 

f)         A hospital shall submit a plan to provide either transfer services to all sexual assault survivors, medical forensic services to all sexual assault survivors, or transfer services to pediatric sexual assault survivors and medical forensic services to sexual assault survivors 13 years old or older as required in subsection 2(a) of the Act and this Section within 60 days after the Department's request. Failure to submit a plan as described in this subsection will subject a hospital to the imposition of a fine by the Department. The Department will impose a fine of up to $500 per day until the hospital submits a plan as described in this subsection.  (Section (2)(a-5) of the Act)

 

g)         Upon receipt of a plan as described in subsection (f), the Department will review the plan to determine if adequate medical forensic services for the sexual assault survivor is met and will notify the hospital whether or not the plan is acceptable. If the Department determines that the plan is unacceptable, the hospital shall submit a modified plan within 10 days after service of the notification. If the Department determines that the modified plan is unacceptable, or if the hospital fails to submit a modified plan within 10 days, the Department will impose a fine of up to $500 per day until an acceptable plan has been submitted, as determined by the Department.  (Section (2)(a-10) of the Act)

 

h)         No fine shall be taken or assessed until January 1, 2024.  (Sections (2-1)(a-5) and (a-10) of the Act)

 

i)          Each treatment hospital, treatment hospital with approved pediatric transfer, and approved pediatric health care facility shall enter into a memorandum of understanding with a rape crisis center for medical advocacy services, if these services are available to the treatment hospital, treatment hospital with approved pediatric transfer, or approved pediatric health care facility. With the consent of the sexual assault survivor, a rape crisis counselor shall remain in the exam room during the collection for forensic evidence.  (Section 2(c) of the Act)

 

j)          Every treatment hospital, treatment hospital with approved pediatric transfer, and approved pediatric health care facility's sexual assault treatment plan shall include procedures for complying with mandatory reporting requirements pursuant to the:

 

1)         Abused and Neglected Child Reporting Act;

 

2)         Abused and Neglected Long Term Care Facility Residents Reporting Act;

 

3)         Adult Protective Services Act; and

 

4)         Criminal Identification Act.  (Section 2(d) of the Act)

 

k)         Questions regarding a hospital's or approved pediatric health care facility's compliance with its approved plan and this Part should be directed to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson St., 4^th Floor

Springfield, Illinois  62761

(217) 782-7412

 

(Source:  Amended at 47 Ill. Reg. 14538, effective September 26, 2023)

 

Section 545.36  Federally Qualified Health Centers (Repealed)

 

(Source:  Repealed at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.40  Qualified Medical Provider and Emergency Department Clinical Staff

 

a)         Each treatment hospital and treatment hospital with approved pediatric transfer shall ensure that emergency department attending physicians, physician assistants, APRNs, and registered professional nurses providing clinical services, who do not meet the definition of a qualified medical provider in Section 1a of the Act and Section 545.20 of this Part, receive a minimum of two hours of sexual assault training.  Protocols for training shall be included in the hospital's sexual assault treatment plan. (Section 2(a) of the Act)

 

b)         Once a treatment hospital or a treatment hospital with approved pediatric transfer certifies compliance with Section 5(a-7) of the Act, each treatment hospital and treatment hospital with approved pediatric transfer shall ensure that emergency department attending physicians, physician assistants, APRNs, and registered professional nurses providing clinical services, who do not meet the definition of a qualified medical provider in Section 1a of the Act and Section 545.20 of this Part, receive a minimum of two hours of continuing education on responding to sexual assault survivors every two years.  (Section 2(a) of the Act)

 

c)         Sexual assault training provided under this Section may be provided in person or online and shall include, but not be limited to:

 

1)         Information provided on the provision of medical forensic services;

 

2)         Information on the use of the Sexual Assault Evidence Collection Kit;

 

3)         Information on sexual assault epidemiology, neurobiology of trauma, drug-facilitated sexual assault, child sexual abuse, and Illinois sexual assault-related laws; and

 

4)         Information on the hospital's sexual assault-related policies and procedures.  (Section 2(a) of the Act)

 

d)         The online training made available by the Office of the Attorney General under Section 10(b) of the Act may be used to comply with this Section.  (Section 2(a) of the Act)

 

e)         By January 1, 2023, every hospital with a treatment plan approved by the Department shall employ or contract with a qualified medical provider to initiate medical forensic services to a sexual assault survivor within 90 minutes after the patient presenting to the treatment hospital or treatment hospital with approved pediatric transfer. The provision of medical forensic services by a qualified medical provider shall not delay the provision of life-saving medical care.  (Section 5(a-7) of the Act)

 

f)         To qualify as a sexual assault forensic examiner (SAFE) as defined in Section 545.20, a physician or physician assistant shall submit documents to the SANE Coordinator at the Illinois Attorney General's Office, which will review the submission to qualify an individual to practice as an Adult/Adolescent (AA) SAFE or Pediatric/Adolescent (PA) SAFE.  Documentation shall include, but is not limited to, didactic and clinical training, and clinical experience, that meets or is substantially similar to the Sexual Assault Nurse Examiner Education Guidelines, Adult and Pediatric, established by the International Association of Forensic Nurses.  Reviews by the SANE coordinator may include, at the request of the applicant, a peer review by a SANE-A or a SANE-P, or a child abuse pediatrician.

 

(Source:  Amended at 47 Ill. Reg. 5427, effective March 28, 2023)

 

Section 545.50  Areawide Sexual Assault Treatment Plans

 

a)         Hospitals and approved pediatric health care facilities in the area to be served may develop and participate in areawide plans that shall describe the medical forensic services to sexual assault survivors that each participating hospital and approved pediatric health care facility has agreed to make available.  Each hospital and approved pediatric health care facility participating in such a plan shall provide services as it is designated to provide in the plan agreed upon by the participants.  An areawide plan may include treatment hospitals, treatment hospitals with approved pediatric transfer, transfer hospitals, approved pediatric health care facilities, or out-of-state hospitals as provided in Section 5.4 of the Act.  (Section 3 of the Act)

 

b)         All areawide plans shall be submitted to the Department for approval prior to becoming effective. (Section 3 of the Act)

 

c)         The Department will approve a proposed plan if it finds that the minimum requirements set forth in Section 5 of the Act and Section 545.60 of this Part are met and implementation of the plan would provide for appropriate medical forensic services, pursuant to this Part, for the people of the area to be served. (Section 3 of the Act)

 

d)         Each plan shall include a description of the role of each hospital or pediatric health care facility participating in the plan, as well as the individual treatment or transfer plans for each hospital or pediatric health care facility, in accordance with Section 545.60, 545.62, 545.63, 545.64 or 545.65.

 

e)         Areawide plans shall conform to the federal Emergency Medical Treatment and Active Labor Act.

 

f)         Areawide plans shall incorporate all of the requirements set forth in Section 545.55 for the treatment and transfer of pediatric sexual assault survivors.

 

g)         Until January 1, 2022, the areawide treatment plan may include a written agreement, with a treatment hospital with approved pediatric transfer that is geographically closer than other hospitals providing medical forensic services to sexual assault survivors 13 years of age or older, stating that the treatment hospital with approved pediatric transfer will provide medical services to sexual assault survivors 13 years of age or older who are transferred from the transfer hospital. If the areawide treatment plan includes a written agreement with a treatment hospital with approved pediatric transfer, it must also include a written agreement with a treatment hospital stating that the treatment hospital will provide medical forensic services to sexual assault survivors under 13 years of age who are transferred from the transfer hospital.  (Section 2(a) of the Act)

 

h)         Each plan shall indicate which facility participating in the areawide treatment plan is responsible, upon the completion of medical forensic services, for transporting the sexual assault survivor back to the original location where the individual initially presented seeking medical forensic services, unless transportation is arranged by the survivor or by the survivor’s non-offending parent or legal guardian.

 

(Source:  Amended at 46 Ill. Reg. 6066, effective April 4, 2022)

 

Section 545.55  Treatment and Transfer of Pediatric Sexual Assault Survivors

 

a)         Transfer of Medically Stable Pediatric Sexual Assault Survivors

 

1)         If a medically stable pediatric sexual assault survivor presents at a transfer hospital or treatment hospital with approved pediatric transfer that has a plan approved by the Department requesting medical forensic services, then the hospital emergency department staff shall contact an approved pediatric health care facility, if one is designated in the hospital's plan.

 

2)         If the transferring hospital confirms that medical forensic services can be initiated within 90 minutes after the patient's arrival at the approved pediatric health care facility following an immediate transfer, then the hospital emergency department staff shall notify the patient and non-offending parent or legal guardian that the patient will be transferred for medical forensic services and shall provide the patient and non-offending parent or legal guardian the option of being transferred to the approved pediatric health care facility or the treatment hospital designated in the hospital's transfer plan. The pediatric sexual assault survivor may be transported by ambulance, law enforcement, or personal vehicle.

 

3)         If medical forensic services cannot be initiated within 90 minutes after the patient's arrival at the approved pediatric health care facility, there is no approved pediatric health care facility designated in the hospital's areawide plan, or the patient or non-offending parent or legal guardian chooses to be transferred to a treatment hospital, the hospital emergency department staff shall contact a treatment hospital designated in the hospital's areawide plan to arrange for the transfer of the patient to the treatment hospital for medical forensic services, which are to be initiated within 90 minutes after the patient's arrival at the treatment hospital. The treatment hospital shall provide medical forensic services and shall not transfer the patient to another facility. The pediatric sexual assault survivor may be transported by ambulance, law enforcement, or personal vehicle.  (Section 5.3 of the Act)

 

b)         Treatment of Medically Stable Pediatric Sexual Assault Survivors

 

1)         If a medically stable pediatric sexual assault survivor presents at a treatment hospital that has a plan approved by the Department, and the pediatric sexual assault survivor requests medical forensic services, then the hospital emergency department staff shall contact an approved pediatric health care facility, if one is designated in the treatment hospital's areawide treatment plan.

 

2)         If medical forensic services can be initiated within 90 minutes after the patient's arrival at the approved pediatric health care facility following an immediate transfer, the hospital emergency department staff shall provide the patient and non-offending parent or legal guardian the option of having medical forensic services performed at the treatment hospital or at the approved pediatric health care facility. If the patient or non-offending parent or legal guardian chooses to be transferred, the pediatric sexual assault survivor may be transported by ambulance, law enforcement, or personal vehicle.

 

3)         If medical forensic services cannot be initiated within 90 minutes after the patient's arrival at the approved pediatric health care facility, there is no approved pediatric health care facility designated in the hospital's areawide plan, or the patient or non-offending parent or legal guardian chooses not to be transferred, the hospital shall provide medical forensic services to the patient.

 

4)         If a pediatric sexual assault survivor presents at an approved pediatric health care facility requesting medical forensic services or the facility is contacted by law enforcement or the Department of Children and Family Services requesting medical forensic services for a pediatric sexual assault survivor, the services shall be provided at the facility if the medical forensic services can be initiated within 90 minutes after the patient's arrival at the facility. If medical forensic services cannot be initiated within 90 minutes after the patient's arrival at the facility, then the patient shall be transferred to a treatment hospital designated in the approved pediatric health care facility's areawide plan for medical forensic services. The pediatric sexual assault survivor may be transported by ambulance, law enforcement, or personal vehicle.  (Section 5.3 of the Act)

 

(Source:  Added at 44 Ill. Reg. 6326, effective April 10, 2020)

 

Section 545.60  Treatment of Sexual Assault Survivors

 

a)         Every hospital and approved pediatric health care facility providing medical forensic services to sexual assault survivors shall comply with the federal Emergency Medical Treatment and Active Labor Act and, as minimum requirements for such services, provide, with the consent of the sexual assault survivor, and as ordered by the attending physician, an APRN who possesses clinical privileges recommended by the hospital or approved pediatric health care facility medical staff and granted by the hospital or approved pediatric health care facility, as authorized by the Nurse Practice Act, or a physician assistant, the services set forth in Section 5(a-5) of the Act and this Section.  (Section 5(a) of the Act)

 

b)         A qualified medical provider shall provide the services set forth in Section 5(a-5) of the Act, and this Section.  (Section 5(a) of the Act)

 

c)         Every hospital with a treatment plan approved by the Department shall employ or contract with a qualified medical provider to initiate medical forensic services to a sexual assault survivor within 90 minutes after the patient presenting to the treatment hospital or treatment hospital with approved pediatric transfer. The provision of medical forensic services by a qualified medical provider shall not delay the provision of life-saving medical care.  (Section 5(a-7) of the Act)

 

d)         A treatment hospital, a treatment hospital with approved pediatric transfer or an approved pediatric health care facility shall provide the following services in accordance with Section 5(a) of the Act:

 

1)         Appropriate medical forensic services without delay, in a private, age-appropriate or developmentally appropriate space, required to ensure the health, safety, and welfare of a sexual assault survivor and that may be used as evidence in a criminal proceeding against a person accused of the sexual assault, in a proceeding under the Juvenile Court Act of 1987, or in an investigation under the Abused and Neglected Child Reporting Act.  (Section 5(a-5) of the Act) Medical forensic services shall include, but are not limited to:

 

A)        A general physical examination;

 

B)        Evaluation and treatment for sexually transmitted infections in accordance with the guidelines of the Centers for Disease Control and Prevention titled Sexually Transmitted Diseases Treatment Guidelines, or the standards of the American College of Emergency Physicians titled Management of the Patient with the Complaint of Sexual Assault (see Section 545.25);

 

C)        Evaluation and possible treatment for HIV exposure in accordance with the guidelines of the Centers for Disease Control and Prevention titled Sexually Transmitted Diseases Treatment Guidelines, or the recommendations titled Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV in the United States, or the standards of the American College of Emergency Physicians titled Management of the Patient with the Complaint of Sexual Assault. Testing for HIV shall be conducted in accordance with the AIDS Confidentiality Act; and

 

D)        Pregnancy test for females of childbearing age;

 

2)         An offer to complete the Sexual Assault Evidence Collection Kit for any sexual assault survivor who presents within seven days after the assault, who has disclosed past sexual assault by a specific individual and was in the care of that individual within the last seven days, or who has a clinical indication for medical forensic services beyond seven days.  Nothing in the Act or this Part prevents a treatment hospital or a treatment hospital with approved pediatric transfer from offering to complete the Sexual Assault Evidence Collection Kit for any sexual assault survivor who presents more than seven days after the assault;

 

A)        Appropriate oral and written information concerning evidence-based guidelines for the appropriateness of evidence collection, depending on the sexual development of the sexual assault survivor, the type of sexual assault, and the timing of the sexual assault, shall be provided to the sexual assault survivor. A qualified medical provider shall educate and encourage prepubescent sexual assault survivors who present to a hospital or approved pediatric health care facility with a complaint of sexual assault within 96 hours after the sexual assault to agree to evidence collection (however, the seven-day period in subsection (d)(2) still applies);

 

B)        The information required under this subsection (d) shall be provided in person by the qualified medical provider providing medical forensic services directly to the sexual assault survivor (Section 5(a-5) of the Act);

 

C)        The written information provided shall be the information created in accordance with Section 10 of the Act (Section 5(a-5) of the Act);

 

D)        Following the discussion regarding the evidence-based guidelines for evidence collection in accordance with subsection (d)(2)(A), evidence collection shall be completed at the sexual assault survivor's request. A sexual assault nurse examiner conducting an examination using the Sexual Assault Evidence Collection Kit may do so without the presence or participation of a physician.  (Section 5(a-5) of the Act)

 

3)         Appropriate oral and written information concerning the possibility of infection, sexually transmitted infection, including an evaluation of the sexual assault survivor's risk of contracting human immunodeficiency virus (HIV) from sexual assault, and pregnancy resulting from sexual assault (Section 5(a-5) of the Act);

 

4)         Medically and factually accurate written and oral information about emergency contraception; the indications and contraindications and risks associated with the use of emergency contraception; and a description of how and when sexual assault survivors may be provided emergency contraception at no cost upon the written order of a physician, a licensed APRN, or a licensed physician assistant (Section 2.2(b) of the Act);

 

5)         Appropriate oral and written information concerning accepted medical procedures, laboratory tests, medication, and possible contraindications of that medication available for the prevention or treatment of infection or disease resulting from sexual assault (Section 5(a-5) of the Act);

 

6)         After a medical forensic or physical examination, access to a shower at no cost, unless showering facilities are unavailable (Section 5(a-5) of the Act);

 

7)         An amount of medication, including HIV prophylaxis, for treatment at the hospital or approved pediatric health care facility and after discharge as is deemed appropriate by the attending physician, an APRN, or a physician assistant in accordance with the Centers for Disease Control and Prevention guidelines in Section 545.25(b)(1) and (2), and consistent with the hospital's or approved pediatric health care facility's current approved protocol for sexual assault survivors. (Section 5(a-5) of the Act) When HIV prophylaxis is deemed appropriate, an initial dose or doses of HIV prophylaxis, along with written and oral instructions indicating the importance of timely follow-up health care, shall be given to the survivor;  

 

8)         Photo documentation of the sexual assault survivor's injuries, anatomy involved in the assault, or other visible evidence on the sexual assault survivor's body to supplement the medical forensic history and written documentation of physical findings and evidence. Photo documentation does not replace written documentation of the injury.  (Section 5(a-5) of the Act);

 

9)         Written and oral instructions indicating the need for follow-up examinations and laboratory tests one to two weeks after the sexual assault to determine the presence or absence of sexually transmitted infection (Section 5(a-5) of the Act);

 

10)        Appropriate referral to a physician.  The survivor shall be referred for follow-up health care and monitoring of medication given or prescribed at the time of the initial hospital or approved pediatric health care facility medical forensic services visit as may be deemed appropriate by the attending physician, APRN, or physician assistant;

 

11)        Referral by hospital or approved pediatric health care facility personnel for appropriate counseling. (Section 5(a-5) of the Act) Initial referral should be to a community-based rape crisis center, if a center is available, or referral to other counseling shall be provided;

 

12)        Medical advocacy services provided by a rape crisis counselor whose communications are protected under Section 8-802.1 of the Code of Civil Procedure, if there is a memorandum of understanding between the hospital or approved pediatric health care facility and a rape crisis center. With the consent of the sexual assault survivor, a rape crisis counselor shall remain in the exam room during the medical forensic examination (Section 5(a-5) of the Act);

 

13)        Written information regarding services provided by a children's advocacy center and rape crisis center, if applicable (Section 5(a-5) of the Act);

 

14)        The brochure "After Sexual Assault", published by the Illinois Coalition Against Sexual Assault and the Illinois Department of Public Health, and the pamphlet "Crime Victim Compensation – Frequently Asked Questions by Sexual Assault Victims", published by the Illinois Office of the Attorney General;

 

15)        Information on drug- or alcohol-facilitated sexual assault testing, including an explanation of the comprehensive scope of a drug test or blood alcohol test, and the limited time frame within which evidence can be collected; and

 

16)        Written information regarding the Illinois State Police sexual assault evidence tracking system, as provided in Section 545.61.  (Section 5(a-5) of the Act)

 

e)         Records of medical forensic services, including results of examinations and tests, the Illinois State Police Medical Forensic Documentation Forms, the Illinois State Police Patient Discharge Materials, and the Illinois State Police Patient Consent: Collect and Test Evidence or Collect and Hold Evidence Form, shall be maintained by the hospital or approved pediatric health care facility as part of the patient's electronic medical record.

 

1)         Records of medical forensic services for sexual assault survivors under the age of 18 shall be retained by the hospital or approved pediatric health care facility for a period of 60 years after the sexual assault survivor reaches the age of 18. Records of medical forensic services of sexual assault survivors 18 years of age or older shall be retained by the hospital for a period of 20 years after the date the record was created.

 

2)         Records of medical forensic services may only be disseminated in accordance with Section 6.5 of the Act, Section 545.61 of this Part, and other State and federal law.  (Section 5(a-5) of the Act)

 

f)         Any person who is a sexual assault survivor who seeks medical forensic services or follow-up healthcare under the Act shall be provided those services without the consent of any parent, guardian, custodian, surrogate, or agent. If a sexual assault survivor is unable to consent to medical forensic services, the services may be provided under the Consent by Minors to Health Care Services Act, the Health Care Surrogate Act, or other applicable State and federal laws.  (Section 5(b) of the Act)

 

g)         The hospital or approved pediatric health care facility shall develop a uniform system for recording results of medical examinations and all diagnostic tests performed in connection with the examination to determine the condition and necessary treatment of sexual assault survivors. The results shall be preserved in a confidential manner as part of the hospital's or approved pediatric health care facility's record of the sexual assault survivor.  (Section 6.1 of the Act) The medical record shall include the information required in this subsection (g):

 

1)         The medical record shall indicate if the sexual assault survivor changed clothes, bathed or douched, defecated, urinated, ate, smoked, or performed oral hygiene between the time of the sexual assault and the time of the examination.

 

2)         The medical record shall indicate presence of all indications of trauma, major or minor, that may be used in a criminal proceeding (e.g., cuts, scratches, bruises, red marks, any minor signs of trauma).  Photographs of indications of trauma may be taken for evidentiary purposes with the written consent of the sexual assault survivor or the survivor's parent or guardian if the survivor is under 13 years of age.  If the survivor is under 13 years of age and the parent or guardian is not immediately available, photographs may be taken and shall be released to law enforcement personnel and state's attorney staff with written consent of a parent, guardian, or law enforcement officer, or the Department of Children and Family Services.

 

3)         The medical record shall not reflect any conclusions regarding whether a crime (e.g., criminal sexual assault, criminal sexual abuse) occurred.

 

4)         Medical history shall include brief, general information concerning possible injury; drug allergies; and, for female patients, a detailed gynecological history, including whether the patient knows or believes that she is pregnant, history of prior gynecological surgery such as hysterectomy or tubal ligation, history of contraceptive use, history of cancer, and any prior genital injury or trauma.

 

5)         The medical record shall indicate the presence of any and all persons during the examination process.  If a medical advocate from a rape crisis center is present, the medical advocate may be listed by first name only, so long as the full name of the rape crisis center is listed in the record.

 

6)         The medical record shall document the compliance with each procedure required by subsection (i).

 

7)         The medical record shall indicate whether a report was filed with the Department of Children and Family Services, or whether the Department on Aging or the Department of Public Health was contacted.

 

8)         The medical record shall include a completed emergency department record.

 

9)         The medical record shall indicate whether the Sexual Assault Evidence Collection Kit was completed.

 

h)         All medical records for sexual assault survivors shall be maintained through a filing system that allows for immediate accessibility during Department surveys. This filing system may be maintained electronically.

 

i)          Procedures to ensure the welfare and privacy of the survivor shall be followed and shall include, but not be limited to, the following:

 

1)         A member of the health care team shall respond within minutes to move the survivor to a closed environment to ensure privacy.  Health care personnel shall refer to survivors by code to avoid embarrassment.

 

2)         If, for any reason, the survivor is incapable of receiving oral and written information required in subsection (a), the information shall be given to the caregiver/guardian.

 

3)         When a survivor is in custody, or has been arrested for or convicted of a violent crime or forcible felony and continues to be in custody when the survivor presents for the medical forensic exam, then if the qualified medical provider and the representative of the custodial agency, after consultation with the rape crisis advocate, agree that it is a necessary safety precaution, the representative of the custodial agency may remain in the room. In these situations, hospital staff shall facilitate privacy for the survivor using curtains and positioning.

 

4)         The hospital or approved pediatric health care facility shall call a sexual assault crisis advocate, where available, and shall offer to call a friend or family member to accompany the survivor.

 

j)          When a minor is the victim of a predatory criminal sexual assault of a child, aggravated criminal sexual assault, criminal sexual assault, aggravated criminal sexual abuse or criminal sexual abuse, as provided in Sections 11-1.20 through 11-1.60 of the Criminal Code of 2012, the consent of the minor's parent or legal guardian need not be obtained to authorize a hospital, approved pediatric health care facility, physician, chiropractic physician, optometrist, APRN, physician assistant, or other medical personnel to furnish medical care or counseling related to the diagnosis or treatment of any disease or injury arising from the offense.  The minor may consent to counseling, diagnosis or treatment as if the minor had reached his or her age of majority.  This consent shall not be voidable, nor subject to later disaffirmance, because of minority. (Section 3(b) of the Consent by Minors to Health Care Services Act)

 

k)         All hospitals or approved pediatric health care facilities that provide emergency medical services to sexual assault survivors shall comply with the Crime Victims Compensation Act, the Consent by Minors to Health Care Services Act and any local ordinances, municipal codes, rules, or regulations that may apply to the treatment of sexual assault survivors.

 

l)          All hospitals or approved pediatric health care facilities shall comply with the reporting procedures for sexual assault survivors required by Section 3.2 of the Criminal Identification Act.

 

m)        Nothing in this Section creates a physician-patient relationship that extends beyond discharge from the hospital or approved pediatric health care facility.  (Section 5(c) of the Act)

 

n)         The hospital or approved pediatric health care facility shall take all reasonable steps to secure the patient's informed written decision to consent to or decline examination and treatment.  

 

o)         Nothing in the Act or this Part prohibits a treatment hospital, a treatment hospital with approved pediatric transfer, or an approved pediatric health care facility from treating a sexual assault survivor who presents more than seven days following the assault.

 

(Source:  Amended at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.61  Submitting Sexual Assault Evidence to Law Enforcement

 

a)         The Sexual Assault Evidence Collection Kit shall be used in the manner prescribed by the information contained in that kit.

 

1)         With the survivor's consent, as prescribed by subsection (c), the kit shall be completed if the survivor presents themself for medical forensic services within seven days after the sexual assault, has disclosed past sexual assault by a specific individual and was in the care of that individual within the last seven days, or has a clinical indication for medical forensic services beyond seven days.  (Section 1a of the Act)

 

2)         If the Evidence Collection Kit is not collected by law enforcement upon completion, the hospital or approved pediatric health care facility shall comply with subsection (d).

 

b)         A treatment hospital, a treatment hospital with approved pediatric transfer, an out-of-state hospital as defined in Section 5.4 of the Act and Section 545.64, or an approved pediatric health care facility shall comply with Section 50 of the Sexual Assault Evidence Submission Act and register with the Illinois State Police to utilize the CheckPoint sexual assault evidence tracking system.  (Section 5(a-5)(10) of the Act)

 

c)         Written Consent to the Release of Sexual Assault Evidence for Testing

 

1)         Upon the completion of medical forensic services, the health care professional providing the medical forensic services shall provide the patient the opportunity to sign a written consent to allow law enforcement to submit the sexual assault evidence for testing, if collected. The written consent shall be on a form included in the sexual assault evidence collection kit and posted on the Illinois State Police website. The consent form shall include whether the survivor consents to the release of information about the sexual assault to law enforcement.

 

A)        A survivor 13 years of age or older may sign the written consent to release the evidence for testing.

 

B)        If the survivor is a minor who is under 13 years of age, the written consent to release the sexual assault evidence for testing may be signed by the parent, guardian, investigating law enforcement officer, or Department of Children and Family Services.

 

C)        If the survivor is an adult who has a guardian of the person, a health care surrogate, or an agent acting under a health care power of attorney, the consent of the guardian, surrogate, or agent is not required to release evidence and information concerning the sexual assault or sexual abuse. If the adult is unable to provide consent for the release of evidence and information and a guardian, surrogate, or agent under a health care power of attorney is unavailable or unwilling to release the information, then an investigating law enforcement officer may authorize the release.

 

D)        Any health care professional or health care institution, including any hospital or approved pediatric health care facility, who provides evidence or information to a law enforcement officer under a written consent, as specified in this subsection (c), is immune from any civil or professional liability that might arise from those actions, with the exception of willful or wanton misconduct. The immunity provision applies only if all of the requirements of the Act and this Section are met.

 

2)         The hospital or approved pediatric health care facility shall keep a copy of a signed or unsigned written consent form in the patient's medical record pursuant to 77 Ill. Adm. Code 250.1510 (Hospital Licensing Requirements).

 

3)         If a written consent to allow law enforcement to hold the sexual assault evidence is signed at the completion of medical forensic services, the hospital or approved pediatric health care facility shall include the following information in its discharge instructions:

 

A)        The sexual assault evidence will be stored for 10 years from the completion of a Sexual Assault Evidence Collection Kit, or 10 years from the age of 18 years, whichever is longer;

 

B)        A person authorized to consent to the testing of the sexual assault evidence may sign a written consent to allow law enforcement to test the sexual assault evidence at any time during that 10-year period for an adult victim, or until a minor victim turns 28 years of age by:

 

i)          Contacting the law enforcement agency having jurisdiction, or, if unknown, the law enforcement agency contacted by the hospital or approved pediatric health care facility under Section 3.2 of the Criminal Identification Act; or

 

ii)         By working with an advocate at a rape crisis center;

 

C)        The name, address, and phone number of the law enforcement agency having jurisdiction, or, if unknown, the name, address, and phone number of the law enforcement agency contacted by the hospital under Section 3.2 of the Criminal Identification Act; and

 

D)        The name and phone number of a local rape crisis center. (Section 6.5 of the Act)

 

d)         Submission of Sexual Assault Evidence

 

1)         As soon as practicable, but in no event more than four hours after the completion of medical forensic services, the hospital or approved pediatric health care facility shall make reasonable efforts to determine the law enforcement agency having jurisdiction where the sexual assault occurred, if sexual assault evidence was collected. The hospital or approved pediatric health care facility may obtain the name of the law enforcement agency with jurisdiction from the local law enforcement agency.

 

2)         Within four hours after the completion of medical forensic services, the hospital or approved pediatric health care facility shall notify the law enforcement agency having jurisdiction that the hospital or approved pediatric health care facility is in possession of sexual assault evidence and the date and time the collection of evidence was completed. The hospital or approved pediatric health care facility shall document the notification in the patient's medical records and shall include the agency notified, the date and time of the notification, and the name of the person who received the notification. This notification to the law enforcement agency having jurisdiction satisfies the hospital's or approved pediatric health care facility's requirement to contact its local law enforcement agency under Section 3.2 of the Criminal Identification Act.

 

3)         If the law enforcement agency having jurisdiction has not taken physical custody of sexual assault evidence within five days after the first contact by the hospital or approved pediatric health care facility, the hospital or approved pediatric health care facility shall renotify the law enforcement agency having jurisdiction that the hospital or approved pediatric health care facility is in possession of sexual assault evidence and the date the sexual assault evidence was collected. The hospital or approved pediatric health care facility shall document the renotification in the patient's medical records and shall include the agency notified, the date and time of the notification, and the name of the person who received the notification.

 

4)         If the law enforcement agency having jurisdiction has not taken physical custody of the sexual assault evidence within 10 days after the first contact by the hospital or approved pediatric health care facility and the hospital or approved pediatric health care facility has provided renotification under subsection (d)(3), the hospital or approved pediatric health care facility shall contact the State's Attorney of the county where the law enforcement agency having jurisdiction is located. The hospital or approved pediatric health care facility shall inform the State's Attorney that the hospital or approved pediatric health care facility is in possession of sexual assault evidence, the date the sexual assault evidence was collected, the law enforcement agency having jurisdiction, and the dates, times and names of persons notified under subsections (d)(2) and (d)(3). The notification shall be made within 14 days after the collection of the sexual assault evidence. (Section 6.6 of the Act)

 

(Source:  Amended at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.62  Pediatric Health Care Facilities

 

a)         A pediatric health care facility that submits a plan to the Department for approval under Section 2 of the Act and Section 85 of this Part consents to the jurisdiction and oversight of the Department, including, but not limited to, inspections, investigations, and evaluations arising out of complaints relevant to the Act made to the Department.  (Section 2.06 of the Act)

 

b)         A pediatric health care facility that submits a plan to the Department for approval under Section 2 of the Act and Section 85 of this Part shall be deemed to have given consent to annual inspections, surveys, or evaluations relevant to the Act by properly identified personnel of the Department or by such other properly identified persons, including local health department staff, as the Department may designate.  (Section 2.06 of the Act)

 

c)         Representatives of the Department shall have access to and may reproduce or photocopy any books, records, and other documents maintained by the pediatric health care facility or the facility's representatives, to the extent necessary to carry out the Act and this Part.  (Section 2.06 of the Act)

 

d)         No representative, agent, or person acting on behalf of the pediatric health care facility in any manner shall intentionally prevent, interfere with, or attempt to impede in any way any duly authorized investigation and enforcement of the Act and this Part.  (Section 2.06 of the Act)

 

e)         An approved pediatric health care facility may provide medical forensic services, in accordance with this Part, to all sexual assault survivors under the age of 18 who present for medical forensic services in relation to injuries or trauma resulting from a sexual assault. These services shall be provided by a qualified medical provider.  (Section 2(b) of the Act)

 

f)         A pediatric health care facility shall participate in or submit an areawide treatment plan under Section 3 of the Act and Section 545.50 of this Part that includes a treatment hospital. If a pediatric health care facility does not provide certain medical or surgical services that are provided by hospitals, the areawide sexual assault treatment plan shall include a procedure for ensuring a sexual assault survivor in need of these medical or surgical services receives the services at the treatment hospital. The areawide treatment plan may also include a treatment hospital with approved pediatric transfer.  (Section 2(b) of the Act)

 

g)         The Department will review a proposed sexual assault treatment plan submitted by a pediatric health care facility within 60 days after receipt of the plan. If the Department finds that the proposed plan meets the minimum requirements set forth in Section 5 of the Act and Section 545.60 of this Part, and that implementation of the proposed plan would provide medical forensic services for sexual assault survivors under the age of 18, then the Department will approve the plan.

 

1)         If the Department does not approve a plan, then the Department will, via certified mail, notify the pediatric health care facility that the proposed plan has not been approved. The pediatric health care facility shall have 30 days after receipt of the Department's notice of disapproval to submit a revised plan.

 

2)         The Department will review the revised plan within 30 days after receipt of the plan and notify the pediatric health care facility whether the revised plan is approved or rejected.  (Section 2(b) of the Act)

 

h)         A pediatric health care facility may not provide medical forensic services to sexual assault survivors under the age of 18 until the Department has approved a treatment plan.  (Section 2(b) of the Act)

 

i)          If an approved pediatric health care facility is not open 24 hours a day, seven days a week, it shall post signage at each public entrance to its facility that:

 

1)         Is at least 14 inches by 14 inches in size;

 

2)         Directs those seeking services as follows: "If closed, call 911 for services or go to the closest hospital emergency department, (insert name) located at (insert address).";

 

3)         Lists the approved pediatric health care facility's hours of operation;

 

4)         Lists the street address of the building;

 

5)         Has a black background with white bold capital lettering in a clear and easy to read font that is at least 72-point type, and with "call 911" in at least 125-point type;

 

6)         Is posted clearly and conspicuously on or adjacent to the door at each entrance and, if building materials allow, is posted internally for viewing through glass; if posted externally, the sign shall be made of weather-resistant and theft-resistant materials, non-removable, and adhered permanently to the building; and

 

7)         Has lighting that is part of the sign itself or is lit with a dedicated light that fully illuminates the sign.  (Section 2(b) of the Act)

 

j)          A copy of the proposed sign shall be submitted to the Department and approved as part of the approved pediatric health care facility's sexual assault treatment plan.  (Section 2(b) of the Act)

 

k)         Each approved pediatric health care facility shall enter into a memorandum of understanding with a rape crisis center for medical advocacy services, if these services are available to the approved pediatric health care facility. With the consent of the sexual assault survivor, a rape crisis counselor shall remain in the exam room during the collection for forensic evidence.  (Section 2(c) of the Act)

 

l)          Every approved pediatric health care facility's sexual assault treatment plan shall include procedures for complying with mandatory reporting requirements pursuant to the:

 

1)         Abused and Neglected Child Reporting Act;

 

2)         Abused and Neglected Long Term Care Facility Residents Reporting Act;

 

3)         Adult Protective Services Act; and

 

4)         Criminal Identification Act.  (Section 2(d) of the Act)

 

m)        Pursuant to Section 5.2(b) of the Act, each employee of an approved pediatric health care facility with access to the Medical Electronic Data Interchange or successor system shall sign a statement affirming that system will only be used for the purpose of issuing sexual assault services vouchers.  (Section 5.2(b) of the Act)

 

n)         Within 60 days after the Department's approval of a treatment plan, an approved pediatric health care facility and any health care professional employed by an approved pediatric health care facility shall develop a billing protocol that ensures that no survivor of sexual assault is sent a bill for any medical forensic services and submit the billing protocol to the Crime Victim Services Division of the Office of the Attorney General for approval.  (Section 7.5(d) of the Act)

 

o)         In carrying out oversight of a pediatric health care facility, the Department will respect the confidentiality of all patient records, including by complying with the patient record confidentiality requirements set out in Section 6.14b of the Hospital Licensing Act.  (Section 2.06 of the Act)

 

(Source:  Amended at 47 Ill. Reg. 14538, effective September 26, 2023)

 

Section 545.63  Treatment Hospitals with Pediatric Transfer

 

a)         A treatment hospital with approved pediatric transfer shall submit to the Department an areawide plan with a treatment hospital.  This areawide plan may also include an approved pediatric health care facility.  The treatment hospital with approved pediatric transfer shall comply with Sections 545.55, 545.60 and 545.65 for the treatment of sexual assault survivors and the transfer of pediatric patients.

 

b)         Each treatment hospital with approved pediatric transfer shall enter into a memorandum of understanding with a rape crisis center for medical advocacy services, if these services are available to the treatment hospital with approved pediatric transfer. With the consent of the sexual assault survivor, a rape crisis counselor shall remain in the exam room during the collection for forensic evidence.  (Section 2(c) of the Act)

 

c)         Every treatment hospital with approved pediatric transfer's sexual assault treatment plan shall include procedures for complying with mandatory reporting requirements pursuant to the:

 

1)         Abused and Neglected Child Reporting Act;

 

2)         Abused and Neglected Long Term Care Facility Residents Reporting Act;

 

3)         Adult Protective Services Act; and

 

4)         Criminal Identification Act.  (Section 2(d) of the Act)

 

(Source:  Added at 44 Ill. Reg. 6326, effective April 10, 2020)

 

Section 545.64  Out-of-State Hospitals

 

a)         An out-of-state hospital that submits an areawide treatment plan to the Department in accordance with Section 5.4(b) of the Act and Section 545.90 of this Part consents to the jurisdiction and oversight of the Department, including, but not limited to, inspections, investigations, and evaluations arising out of complaints, relevant to the Act, made to the Department.  (Section 2.06 of the Act)

 

b)         An out-of-state hospital that submits an areawide treatment plan to the Department in accordance with Section 5.4(b) of the Act and Section 545.90 of this Part shall be deemed to have given consent to annual inspections, surveys, or evaluations relevant to the Act by properly identified personnel of the Department or by such other properly identified persons, including local health department staff, as the Department may designate.  (Section 2.06 of the Act)

 

c)         Representatives of the Department shall have access to and may reproduce or photocopy any books, records, and other documents maintained by the out-of-state hospital or the out-of-state hospital's representative to the extent necessary to carry out the Act and this Part.  (Section 2.06 of the Act)

 

d)         No representative, agent, or person acting on behalf of the out-of-state hospital in any manner shall intentionally prevent, interfere with, or attempt to impede in any way any duly authorized investigation and enforcement of the Act and this Part.  (Section 2.06 of the Act)

 

e)         Each out-of-state treatment hospital shall enter into a memorandum of understanding with an Illinois rape crisis center for medical advocacy services, if these services are available to the out-of-state treatment hospital. With the consent of the sexual assault survivor, a rape crisis counselor shall remain in the exam room during the collection for forensic evidence.  (Section 2(c) of the Act)

 

f)         Every out-of-state treatment hospital's sexual assault treatment plan shall include procedures for complying with mandatory reporting requirements pursuant to the:

 

1)         Abused and Neglected Child Reporting Act;

 

2)         Abused and Neglected Long Term Care Facility Residents Reporting Act;

 

3)         Adult Protective Services Act; and

 

4)         Criminal Identification Act.  (Section 2(d) of the Act)

 

g)         An out-of-state hospital shall comply with Section 545.60.

 

h)         Out-of-state Hospitals Designated as Trauma Centers

 

1)         Nothing in the Act or this Part shall prohibit the transfer of a patient in need of medical services to a hospital that has been designated as a trauma center by the Department in accordance with Section 3.90 of the Emergency Medical Services (EMS) Systems Act.

 

2)         A transfer hospital, treatment hospital with approved pediatric transfer, or approved pediatric health care facility may transfer a sexual assault survivor to an out-of-state hospital that is located in a county that borders Illinois if the out-of-state hospital:

 

A)        Submits an areawide treatment plan approved by the Department; and

 

B)        Has certified to the Department, in a form and manner prescribed by the Department, that the out-of-state hospital will:

 

i)          Consent to the jurisdiction of the Department in accordance with Section 2.06 of the Act and this Section;

 

ii)         Comply with Section 545.60 and all requirements of the Act applicable to treatment hospitals, including, but not limited to, offering evidence collection to any Illinois sexual assault survivor who presents with a complaint of sexual assault within seven days after the assault, who has disclosed past sexual assault by a specific individual and was in the care of that individual within the last seven days, or who has a clinical indication for medical forensic services beyond seven days, and not billing the sexual assault survivor for medical forensic services or 180 days of follow-up healthcare;

 

iii)        Use a Sexual Assault Evidence Collection Kit to collect forensic evidence from an Illinois sexual assault survivor;

 

iv)        Ensure its staff cooperates with Illinois law enforcement agencies and is responsive to subpoenas issued by Illinois courts; and

 

v)         Provide appropriate transportation, upon the completion of medical forensic services, back to the transfer hospital, treatment hospital with pediatric transfer, or approved pediatric health care facility where the sexual assault survivor initially presented seeking medical forensic services, unless the sexual assault survivor chooses to arrange his or her own transportation.  (Section 5.4 of the Act)

 

i)          In carrying out oversight of an out-of-state hospital, the Department will respect the confidentiality of all patient records, including by complying with the patient record confidentiality requirements set out in Section 6.14b of the Hospital Licensing Act.  (Section 2.06 of the Act)

 

(Source:  Amended at 47 Ill. Reg. 14538, effective September 26, 2023)

 

Section 545.65  Transfer of Sexual Assault Survivors

 

a)         The transfer hospital shall comply with the federal Emergency Medical Treatment and Active Labor Act and with Sections 545.50 and 545.55 of this Part.  

 

b)         Sexual assault survivors may be transferred to a treatment hospital or approved pediatric health care facility, in accordance with the requirements of this Section, as part of an areawide plan.

 

c)         The hospital shall provide an appropriate medical screening examination and necessary stabilizing treatment prior to transfer of the sexual assault survivor.  If a sexual assault survivor has an emergency medical condition that has not stabilized, the hospital shall comply with the requirements of the federal Emergency Medical Treatment and Active Labor Act.

 

d)         When a sexual assault survivor is in custody, or has been arrested for or convicted of a violent crime or forcible felony and continues to be in custody when the sexual assault survivor presents for medical forensic services, then during the medical screening examination and necessary stabilization treatment prior to transfer, or if transfer is declined, during any medical care and treatment provided, if the medical provider and the representative of the custodial agency agree that it is a necessary safety precaution, the representative of the custodial agency may remain in the room. In these situations, hospital staff shall facilitate privacy for the sexual assault survivor using curtains and positioning.

 

e)         The emergency department record shall not reflect any conclusions regarding whether a crime (e.g., criminal sexual assault, criminal sexual abuse) occurred.

 

f)         The sexual assault survivor shall be given an appropriate explanation concerning the medical reason for the transfer to another hospital or approved pediatric health care facility, the importance of collecting evidence in a timely manner, and the financial benefits, including an explanation of the voucher system and Crime Victims Compensation.  The explanation shall include the use of the "Medical Forensic Exam Brochure," and "Crime Victims Compensation:  Frequently Asked Questions", both created by the Office of the Illinois Attorney General.

 

g)         The hospital shall require each member of its emergency department who provides direct clinical services to receive training annually regarding its areawide treatment plan and the requirements of this Section, including but not limited to, the care of the sexual assault survivor, the transfer process, including when a patient declines transfer; chain of custody; treatment if the sexual assault survivor declines transfer; and trauma-informed approaches consistent with the Centers for Disease Control and Prevention guideline, "6 Guiding Principles to a Trauma Informed Approach."  The hospital may include the local rape crisis center or treatment hospitals in its areawide treatment plan in presenting the training.

 

h)         All hospitals shall comply with the notification procedures for sexual assault survivors required by Section 3.2 of the Criminal Identification Act, the Abused and Neglected Child Reporting Act, the Abused and Neglected Long Term Care Facility Residents Reporting Act, and the Adult Protective Services Act.  The hospital shall not require the survivor to speak to law enforcement regarding the sexual assault.

 

i)          The following requirements shall apply to sexual assault survivors who consent to be transferred.

 

1)         The emergency department personnel of the transfer hospital shall notify the receiving hospital or approved pediatric health care facility of the transfer of the sexual assault survivor.  The Department recommends that the hospital consult with a Qualified Medical Provider (QMP), when available, prior to transferring the survivor to ensure the transfer meets the clinical requirements defined in Section 1a of the Act.

 

2)         The receiving hospital or approved pediatric health care facility shall comply with Sections 545.60, 545.62, and 545.63, as applicable.  A receiving hospital, approved pediatric health care facility, or health care professional furnishing medical forensic services shall furnish services or medications to that person without charge and shall seek payment in accordance with Section 7 of the Act. (Section 7(a) of the Act)

 

3)         An emergency department record shall be completed and a copy transported with the sexual assault survivor to the receiving hospital or approved pediatric health care facility.  This record shall include:

 

A)        A completed emergency department admission form;

 

B)        Clinical findings, if any;

 

C)        Clinicians' notes;

 

D)        The name and relationship to the sexual assault survivor, if known, of any person present during an examination conducted pursuant to this Section;

 

E)        Observations of signs and symptoms and the presence of any trauma or injury (e.g., cuts, scratches, bruises, red marks, and broken bones), if any examination was conducted or treatment rendered pursuant to subsection (c); and

 

F)         The results of any tests.

 

4)         The hospital shall maintain a chain of custody in the handling of the sexual assault survivor as outlined in subsections (i)(4)(A) through (C), including the sexual assault survivor's clothing.

 

A)        The hospital shall not attempt to obtain any specimens for evidentiary purposes (e.g., blood, saliva, hair samples, etc.) unless if necessary as described in subsection (i)(4)(C).

 

B)        The hospital shall handle the sexual assault survivor and the sexual assault survivor's clothing as minimally as possible and keep the sexual assault survivor in their own clothing if possible.

 

i)          If removal of any clothing is necessary to render emergency services as described in subsection (c), removal should be attempted without cutting, tearing or shaking the garments.

 

ii)         All loose or removed articles of clothing or other possessions of the sexual assault survivor shall be left to dry if possible, placed in separate paper bags, and then placed in one larger paper bag.  The bag shall be sealed and labeled with the sexual assault survivor's name, the names of the health care personnel in attendance, the contents, the date, and the time collected.

 

iii)        Except as otherwise provided in subsection (i)(4)(B)(v), the sealed bag shall not be transported with the sexual assault survivor to the receiving hospital or approved pediatric health care facility.

 

iv)        If the sexual assault survivor is not transferred by ambulance or other hospital-provided transportation, but by a friend or family member, the hospital shall notify the law enforcement agency having jurisdiction that a sexual assault survivor sought medical forensic services related to a sexual assault. The hospital shall maintain and secure the sealed bag with the law enforcement report number until, after obtaining the sexual assault survivor's written consent, the sealed bag is released to the law enforcement agency having jurisdiction (see Section 545.61).

 

v)         If the sexual assault survivor is transported by ambulance, the sealed bag, after obtaining the sexual assault survivor's written consent, shall be released to the law enforcement agency having jurisdiction or transported with EMS personnel only upon completion of a chain of custody form. The chain of custody form shall be signed by the transfer hospital relinquishing custody of the sealed bag, the EMS personnel with custody of the sealed bag during transport, and the receiving hospital or approved pediatric health care facility taking custody of the sealed bag. Each signature shall include the times and dates the sealed bag was handled.

 

C)        If the transfer hospital collects a urine sample from the sexual assault survivor for testing for a drug-facilitated or alcohol-facilitated sexual assault, the hospital shall comply with Section 11-1.10(g) of the Criminal Code of 2012 for collection. Pursuant to obtaining the sexual assault survivor's written consent, the urine sample and any pre-void wipes utilized during collection for adolescent and adult survivors shall be submitted to the local law enforcement agency having jurisdiction (see Section 545.61).

 

5)         If the sexual assault survivor has no life-threatening conditions and consents to the transfer, the sexual assault survivor may transport themself or be transported by the police or by a friend or family member to a treatment hospital or approved pediatric health care facility.  The hospital shall offer transfers by ambulance or other hospital-arranged transportation. If the sexual assault survivor chooses to be transferred by ambulance or other hospital-arranged transportation, the hospital or ambulance provider shall provide the transportation at no cost to the sexual assault survivor.  An ambulance provider furnishing transportation to a sexual assault survivor shall furnish services to that person without charge and shall seek payment in accordance with Section 7 of the Act. (Section 7(a) of the Act).

 

6)         If an adult plans to transport a sexual assault survivor under 18 years of age, the hospital shall conduct an assessment to ensure that the sexual assault survivor is not transported by or with the alleged perpetrator and to determine the need for action based on an immediate threat of harm (e.g., present or impending danger).  If the hospital finds an immediate threat of harm exists, the hospital must notify the Department of Children and Family Services prior to the transfer.

 

7)         If the sexual assault survivor is an adult who has a guardian of the person, a health care surrogate, or an agent acting under a health care power of attorney, the hospital shall conduct an assessment to ensure that the sexual assault survivor is not transported by or with the alleged perpetrator and to determine the need for action based on an immediate threat of harm (e.g., present or impending danger).  If the hospital finds an immediate threat of harm exists, the hospital must notify the Department on Aging prior to the transfer.

 

8)         The hospital may offer a gas card or transportation voucher as an option when it would be effective to facilitate the transfer.  

 

9)         Regardless of the transportation arrangement, all transferred patients shall be treated as transfers according to the hospital's areawide treatment plan.

 

10)       A transfer hospital shall transfer a sexual assault survivor to a treatment hospital or approved pediatric health care facility designated in its approved transfer plan.

 

11)       The hospital shall offer to call a friend or family member to accompany the sexual assault survivor and to call a rape crisis advocate for telephone crisis counseling before or during transfer.

 

12)       The hospital shall take all reasonable steps to secure the sexual assault survivor's written informed consent to a transfer to another hospital.

 

j)          The sexual assault survivor may decline to be transferred.  The hospital shall offer a consultation for the sexual assault survivor considering declining transfer with a qualified medical provider identified in the hospital's areawide treatment plan.  The consultation may be virtual or by telephone.

 

k)         If a sexual assault survivor under 13 years of age declines transfer, the transfer hospital shall contact a qualified medical provider for consultation for sexual assault survivors prior to any evaluation or treatment related to the alleged sexual assault.

 

l)          If a sexual assault survivor under age 18 declines transfer, the transfer hospital shall ensure that a sexual assault survivor under the age of 18 is referred to an outpatient pediatric facility with a qualified medical provider for specialized follow-up care if a facility is available.

 

m)        For all sexual assault survivors who decline transfer, the hospital shall offer medical care and treatment when appropriate based on the consultation with the qualified medical provider, if applicable, which may include but is not limited to the following:

 

1)         A general physical examination;

 

2)         Evaluation and treatment for sexually transmitted infections in accordance with the Centers for Disease Control and Prevention guidelines titled Sexually Transmitted Infections Treatment Guidelines;

 

3)         Evaluation and possible treatment for HIV exposure in accordance with the Centers for Disease Control and Prevention guidelines titled Sexually Transmitted Infections Treatment Guidelines, or the recommendations titled Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV – United States, 2016. Testing for HIV shall be conducted in accordance with the AIDS Confidentiality Act;

 

4)         An amount of medication, including HIV prophylaxis, for treatment at the hospital and after discharge as deemed appropriate by the attending physician, APRN, or physician assistant in accordance with the Centers for Disease Control and Prevention guidelines named in subsection (m). When HIV prophylaxis is deemed appropriate, an initial dose or doses of HIV prophylaxis, along with oral and written instructions indicating the importance of timely follow-up health care, shall be given to the sexual assault survivor;

 

5)         Appropriate oral and written information concerning:

 

A)        Accepted medical procedures, laboratory tests, medication, and possible contraindications of that medication available for the prevention or treatment of infection or disease resulting from sexual assault, and

 

B)        The possibility of infection, sexually transmitted infection, including an evaluation of the sexual assault survivor's risk of contracting HIV from sexual assault, and pregnancy resulting from sexual assault.

 

6)         Evaluation and treatment for possible pregnancy for females of childbearing age, including but not limited to a pregnancy test, emergency contraception, and medically and factually accurate oral and written information about emergency contraception, the indications and contraindications and risks associated with the use of emergency contraception, and a description of how and when sexual assault survivors may be provided emergency contraception at no cost upon the written order of a physician, a APRN, or a physician assistant.  For further guidance, see Section 545.APPENDIX C;

 

7)         Evaluation for a drug-facilitated sexual assault when there is reasonable cause to believe that a sexual assault survivor has been administered or has taken any intoxicating, anesthetic, or controlled substance, regardless of who provided the substance (see Section 11-1.10(g) of the Criminal Code of 2012), including:

 

A)        An explanation to the sexual assault survivor about the nature and effects of commonly used substances and how these substances are administered;

 

B)        An offer to the sexual assault survivor of testing for the presence of these substances;

 

C)        A disclosure to the sexual assault survivor that all substances or alcohol ingested by the survivor will be disclosed by the test;

 

D)        A statement that the test is voluntary, and

 

E)        A form for written authorization for sample analysis of all substances and alcohol ingested by the sexual assault survivor, which may be found at https://isp.illinois.gov/StaticFiles/docs/ForensicServices/6-713.pdf;

 

8)         A safety assessment prior to discharge, which may include but is not limited to:  suicide screening; assessing the relationship, if any, between the sexual assault survivor and the alleged assailant; assessing whether the sexual assault survivor has any concerns about their safety; and referral to a community-based rape crisis center for safety planning;

 

9)         Oral and written instructions indicating the need for follow-up examinations and laboratory tests one to two weeks after the sexual assault to determine the presence or absence of a sexually transmitted infection;

 

10)       Appropriate referral to a health care provider.  The sexual assault survivor shall be referred for follow-up health care and monitoring of medication given or prescribed at the time of the initial hospital visit as may be deemed appropriate by the attending physician, APRN, or physician assistant; and

 

11)       Referral for appropriate counseling. Initial referral should be to a community-based rape crisis center, if a center is available, or referral to other counseling shall be provided.

 

12)       The transfer hospital shall offer to call a friend or family member to support the sexual assault survivor while they are at the hospital.  The hospital shall also call the local rape crisis center, if available, to request medical advocacy, which may be provided in person or over the phone.

 

n)         The transfer hospital shall not bill the sexual assault survivor for these outpatient services.  The hospital shall seek payment as directed in Section 7 of the Act and Section 545.100 of this Part.  The hospital may bill a sexual assault survivor's private insurance, but the hospital shall provide any sexual assault survivor who is not the subscriber or primary policyholder of the sexual assault survivor's insurance policy an opportunity to opt out of billing their private insurance provider.

 

o)         The transfer hospital shall conduct an annual quality performance review of its transfers of sexual assault survivors to ensure that the plan and procedures are being followed, including a review of the number of sexual assault survivors who complete transfer and receive treatment at the treatment hospital, and the number of sexual assault survivors who decline transfer and consideration.  The review shall consider any necessary changes to reduce barriers and increase support for sexual assault survivors, including, but not limited to, transportation, consultation opportunities, and referrals for follow-up care and support from the rape crisis center. The hospital may include the treatment hospital with which it has a memorandum of understanding in the review of the transfers. Documentation of the annual quality performance review shall be provided to the Department upon request.

 

(Source:  Amended at 48 Ill. Reg. 14759, effective September 25, 2024; expedited correction at 49 Ill. Reg. 2224, effective September 25, 2024)

 

Section 545.66  Photo Documentation

 

a)         Photo documentation taken during a medical forensic examination shall be maintained by the hospital or approved pediatric health care facility as part of the patient's medical record.

 

b)         Photo documentation shall be stored and backed up securely in its original file format in accordance with written facility protocol. The written facility protocol shall require limited access to the images and shall be included in the sexual assault treatment plan submitted to the Department. 

 

c)         Photo documentation of a sexual assault survivor under the age of 18 shall be retained for a period of 60 years after the sexual assault survivor reaches the age of 18. Photo documentation of a sexual assault survivor 18 years of age or older shall be retained for a period of 20 years after the record was created.

 

d)         Photo documentation of the sexual assault survivor's injuries, anatomy involved in the assault, or other visible evidence on the sexual assault survivor's body may be used in connection with peer review; expert second opinion; or in a criminal proceeding against a person accused of sexual assault, a proceeding under the Juvenile Court Act of 1987, or an investigation under the Abused and Neglected Child Reporting Act. Any dissemination under this subsection (d) shall be in accordance with State and federal law.  (Section 5.1 of the Act)

 

(Source:  Added at 44 Ill. Reg. 6326, effective April 10, 2020)

 

Section 545.67  Compliance Review

 

a)         The Department will conduct on-site reviews of approved sexual assault treatment plans with hospital and approved pediatric health care facility personnel at least once during each 3-year approval period to ensure that the established procedures are being followed.  (Section 2.05(a) of the Act)

 

b)         If the Department determines that the hospital or approved pediatric health care facility is not in compliance with its approved plan, the Department will provide the hospital or approved pediatric health care facility with a written list of the specific items of noncompliance within 10 working days after the conclusion of the on-site review. The hospital or approved pediatric health care facility shall have 10 working days to submit to the Department a plan of correction that contains the hospital's or approved pediatric health care facility's specific proposals for correcting the items of noncompliance.  The Department will review the plan of correction and notify the hospital or approved pediatric health care facility in writing within 10 working days as to whether the plan is acceptable or unacceptable.  (Section 2.1(a) of the Act)

 

c)         The plan of correction shall include the following specific proposals for correcting items of noncompliance:

 

1)         A time frame for implementing corrections;

 

2)         A description of the activity that will be undertaken to correct the items of noncompliance;

 

3)         Identification of the person or persons responsible for implementing the corrections; and

 

4)         A description of how the requirements of the Act and this Part will be met.

 

d)         If the Department finds the plan of correction unacceptable, the hospital or approved pediatric health care facility shall have 10 working days to resubmit an acceptable plan of correction.  Upon notification that its plan of correction is acceptable, a hospital or approved pediatric health care facility shall implement the plan of correction within 60 days.  (Section 2.1(a) of the Act)

 

e)         The failure of a hospital to submit an acceptable plan of correction or to implement the plan of correction, within the time frames required in this Section, will subject a hospital to the imposition of a fine by the Department.  The Department will impose a fine of up to $500 per day until the Department has determined that the hospital is in compliance with the requirements of the Act and this Section.  (Section 2.1-1(b) of the Act)

 

f)         If an approved pediatric health care facility fails to submit an acceptable plan of correction or to implement the plan of correction within the time frames required in the Act and this Section, then the Department will notify the approved pediatric health care facility that the approved pediatric health care facility shall not provide medical forensic services under the Act and this Part.  If an approved pediatric health care facility submits two plans of correction that are found to not be acceptable by the Department, the facility shall become subject to the imposition of a fine by the Department and the termination of its approved sexual assault treatment plan.  The Department, subject to subsection (g), will impose a fine of up to $500 per patient provided services in violation of the Act and this Part.  (Section 2.1(b) of the Act)

 

g)         Before imposing a fine pursuant to the Act and this Section, the Department will provide the hospital or approved pediatric health care facility via certified mail with written notice and an opportunity for an administrative hearing.  A hospital or approved pediatric health care facility shall submit a written hearing request to the Department within 10 working days after receipt of the Department's notice.  All hearings shall be conducted in accordance with the Department's rules, Practice and Procedure in Administrative Hearings.  (Section 2.1(c) of the Act)

 

h)         The Department will maintain the confidentiality of all patient identities and medical information provided during a site survey or otherwise received by the Department pursuant to this Part. 

 

i)          The Department will comply with the patient record confidentiality requirements set out in Section 6.14b of the Hospital Licensing Act.  (Section 2.06 of the Act)

 

(Source:  Amended at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.70  Approval of a Sexual Assault Transfer Plan

 

a)         The transfer hospital shall submit its sexual assault transfer plan on a form provided by the Department. The transfer plan shall include, at a minimum:

 

1)         The name and address of the transfer hospital;

 

2)         The contact information, including the name, telephone number, fax number, and email address, for the individual responsible for implementation and enforcement of the transfer plan and the billing submission to the Illinois Department of Healthcare and Family Services; and

 

3)         Documentation of the transfer hospital's ability to comply with Sections 2, 2.2, 5, 5.2, 5.3, and 7 of the Act.

 

b)         The completed transfer plan shall be sent to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson Street, 4^th Floor

Springfield IL  62761-0001

 

c)         A completed copy of the transfer plan shall be retained by the transfer hospital.

 

(Source:  Former Section 545.70 repealed at 12 Ill. Reg. 20790, effective December 1, 1988; new Section 545.70 added at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.75  Approval of a Sexual Assault Treatment Hospital with a Pediatric Transfer Plan

 

a)         The treatment hospital shall submit its treatment/pediatric transfer plan on a form provided by the Department. The pediatric transfer plan shall include, at a minimum:

 

1)         The name and address of the treatment hospital;

 

2)         The contact information, including name, telephone number, fax number, and email address, for the individual responsible for implementation and enforcement of the adult treatment and pediatric transfer plan and billing submission to the Illinois Department of Healthcare and Family Services; and

 

3)         Documentation of the treatment hospital's ability to comply with Sections 2, 2.2, 5, 5.1, 5.2, 5.3, 6.5, 6.6, and 7 of the Act.

 

b)         The completed adult treatment and pediatric transfer plan shall be sent to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson Street, 4^th Floor

Springfield IL  62761-0001

 

c)         A completed copy of the treatment/pediatric transfer plan shall be retained by the treatment hospital.

 

(Source:  Added at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.80  Approval of a Sexual Assault Treatment Plan

 

a)         The treatment hospital shall submit its sexual assault treatment plan on a form provided by the Department. The sexual assault treatment plan shall include, at a minimum:

 

1)         The name and address of the treatment hospital;

 

2)         The contact information, including name, telephone number, fax number, and email address, for the individual responsible for implementation and enforcement of the plan and billing submission to the Illinois Department of Healthcare and Family Services; and

 

3)         Documentation of the treatment hospital's ability to comply with Sections 2, 2.2, 5, 5.1, 5.2, 5.3, 6.5, 6.6, and 7 of the Act.

 

b)         The completed sexual assault treatment plan shall be sent to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson Street, 4^th Floor

Springfield IL  62761-0001

 

c)         A completed copy of the sexual assault treatment plan shall be retained by the treatment hospital.

 

(Source:  Former Section 545.80 repealed at 27 Ill. Reg. 1567, effective January 15, 2003; new Section 545.80 added at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.81  Approval of a Federally Qualified Health Center Sexual Assault Treatment Plan (Repealed)

 

(Source:  Repealed at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.85  Approval of a Pediatric Health Care Facility Sexual Assault Treatment Plan

 

a)         The pediatric health care facility shall submit its pediatric sexual assault treatment plan on a form provided by the Department. The pediatric sexual assault treatment plan shall include, at a minimum:

 

1)         The name and address of the pediatric health care facility;

 

2)         The contact information, including name, telephone number, fax number, and email address, for the individual responsible for implementation and enforcement of the sexual assault treatment plan and billing submission to the Illinois Department of Healthcare and Family Services; and

 

3)         Documentation of the pediatric health care facility's ability to comply with Sections 2, 2.06, 2.2, 5, 5.1, 5.2, 5.3, 6.5, 6.6, and 7 of the Act.

 

b)         The completed pediatric sexual assault treatment plan shall be sent to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson Street, 4^th Floor

Springfield IL  62761-0001

 

c)         A completed copy of the pediatric sexual assault treatment plan shall be retained by the pediatric health care facility.

 

(Source:  Added at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.90  Approval of an Out-of-State Hospital Sexual Assault Treatment Plan

 

a)         The out-of-state hospital that consents to the jurisdiction of the Department in accordance with Section 2.06 of the Act (Section 5.4(b)(i) of the Act) shall submit its sexual assault treatment plan on a form provided by the Department. The out-of-state hospital sexual assault treatment plan shall include, at a minimum:

 

1)         The name and address of the out-of-state hospital;

 

2)         The contact information, including name, telephone number, fax number, and email address, for the individual responsible for implementation and enforcement of the sexual assault treatment plan and billing submission to the Illinois Department of Healthcare and Family Services; and

 

3)         Documentation of the out-of-state hospital's ability to comply with Sections 2, 2.06, 2.2, 5, 5.1, 5.2, 5.3, 5.4, 6.5, 6.6, and 7 of the Act.

 

b)         The completed sexual assault treatment plan shall be sent to:

 

Illinois Department of Public Health

Division of Health Care Facilities and Programs

525 West Jefferson Street, 4^th Floor

Springfield IL  62761-0001

 

c)         A completed copy of the sexual assault treatment plan shall be retained by the out-of-state hospital.

 

(Source:  Former Section 545.90 repealed at 27 Ill. Reg. 1567, effective January 15, 2003; new Section 545.90 added at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.95  Emergency Contraception

 

a)         Every hospital or approved pediatric health care facility providing services to sexual assault survivors in accordance with a plan approved under Section 545.35 shall develop a protocol for providing emergency contraception information and treatment to sexual assault survivors.  (Section 2.2(b) of the Act)  

 

b)         The Department will approve the protocol if it finds that the implementation of the protocol would provide sufficient protection for survivors of sexual assault and if the protocol provides for the following as soon as possible and, in any event, no later than 12 hours after the sexual assault survivor presents himself or herself at the hospital or approved pediatric health care facility for emergency care:

 

1)       Medically and factually accurate written and oral information about emergency contraception;

 

2)       The indications and contraindications and risks associated with the use of emergency contraception;

 

3)       A description of how and when victims may be provided emergency contraception at no cost upon the written order of a physician, a licensed APRN who possesses clinical privileges recommended by the hospital or approved pediatric health care facility medical staff and granted by the hospital or approved pediatric health care facility as authorized by the Nurse Practice Act, or a licensed physician assistant (Section 2.2(b) of the Act); and

 

4)       Appropriate referral to a physician.

 

c)         The hospital or approved pediatric health care facility shall implement the protocol upon approval by the Department.  (Section 2.2(b) of the Act)

 

d)         The Department will produce medically and factually accurate written materials that all treatment hospitals and approved pediatric health care facilities shall provide to each female sexual assault survivor of childbearing age.  

 

(Source:  Amended at 44 Ill. Reg. 6326, effective April 10, 2020)

 

Section 545.100  Sexual Assault Services Vouchers and Written Notice to Sexual Assault Survivors

 

a)         Every hospital or approved pediatric health care facility providing medical forensic services to sexual assault survivors shall issue a voucher to any sexual assault survivor who is eligible to receive one in accordance with Section 5.2 of the Act. The hospital or approved pediatric health care facility shall make a copy of the voucher and place it in the medical record of the sexual assault survivor. The hospital or approved pediatric health care facility shall provide a copy of the voucher to the sexual assault survivor after discharge upon request.  (Section 5(b-5) of the Act)

 

b)         Every hospital and approved pediatric health care facility providing treatment services to sexual assault survivors in accordance with a plan approved under Section 2 of the Act and this Part shall provide a written notice to a sexual assault survivor. The written notice shall include, but is not limited to, the following:

 

1)         A statement that the sexual assault survivor should not be directly billed by any ambulance provider providing transportation services, or by any hospital, approved pediatric health care facility, health care professional, laboratory, or pharmacy for the services the sexual assault survivor received as an outpatient at the hospital or approved pediatric health care facility;

 

2)         A statement that a sexual assault survivor who is admitted to a hospital may be billed for inpatient services provided by a hospital, health care professional, laboratory, or pharmacy;

 

3)         A statement that, prior to the sexual assault survivor leaving the hospital or approved pediatric health care facility, the hospital or approved pediatric health care facility will give the sexual assault survivor a sexual assault services voucher for follow-up healthcare if the sexual assault survivor is eligible to receive a sexual assault services voucher;

 

4)         The definition of "follow-up healthcare" as set forth in Section 1a of the Act and Section 545.20 of this Part;

 

5)         A phone number the sexual assault survivor may call should the sexual assault survivor receive a bill from the hospital or pediatric health care facility for medical forensic services; and

 

6)         The toll-free phone number of the Office of the Illinois Attorney General, Crime Victim Services Division, that the sexual assault survivor may call should the sexual assault survivor receive a bill from an ambulance provider, approved pediatric health care facility, a health care professional, a laboratory, or a pharmacy.

 

c)         Subsection (b) shall not apply to hospitals that provide transfer services as defined under Section 1a of the Act and Section 545.20 of this Part. (Section 7.5(c) of the Act)

 

d)         A sexual assault services voucher shall be issued by a treatment hospital, treatment hospital with approved pediatric transfer or approved pediatric health care facility at the time a sexual assault survivor receives medical forensic services.

 

e)         Each treatment hospital, treatment hospital with approved pediatric transfer, and approved pediatric health care facility shall include in its sexual assault treatment plan submitted to the Department in accordance with Section 2 of the Act and Section 545.35 of this Part a protocol for issuing sexual assault services vouchers. The protocol shall, at a minimum, include the following:

 

1)         Identification of employee positions responsible for issuing sexual assault services vouchers;

 

2)         Identification of employee positions with access to the Medical Electronic Data Interchange or successor system; and

 

3)         For pediatric health care facilities, a statement to be signed by each employee of that facility with access to the Medical Electronic Data Interchange or successor system affirming that system will only be used for the purpose of issuing sexual assault services vouchers.

 

f)         A sexual assault services voucher may be used to seek payment for any ambulance services, medical forensic services, laboratory services, pharmacy services, and follow-up healthcare provided as a result of the sexual assault.

 

g)         Any treatment hospital, treatment hospital with approved pediatric transfer, approved pediatric health care facility, health care professional, ambulance provider, laboratory, or pharmacy may submit a bill for services provided to a sexual assault survivor as a result of a sexual assault to the Department of Healthcare and Family Services Sexual Assault Emergency Treatment Program. The bill shall include the:

 

1)         Name and date of birth of the sexual assault survivor;

 

2)         Service provided;

 

3)         Charge of service;

 

4)         Date the service was provided; and

 

5)         Recipient identification number, if known.  (Section 5.2 of the Act)

 

h)         A hospital, approved pediatric health care facility, health care professional, ambulance provider, laboratory, or pharmacy furnishing medical forensic services, transportation, follow-up healthcare, or medication to a sexual assault survivor shall not:

 

1)         Charge or submit a bill for any portion of the costs of the services, transportation, or medications to the sexual assault survivor, including any insurance deductible, co-pay, co-insurance, denial of claim by an insurer, spenddown, or any other out-of-pocket expense;

 

2)         Communicate with, harass, or intimidate the sexual assault survivor for payment of services, including, but not limited to, repeatedly calling or writing to the sexual assault survivor and threatening to refer the matter to a debt collection agency or to an attorney for collection, enforcement, or filing of other process;

 

3)         Refer a bill to a collection agency or attorney for collection action against the sexual assault survivor;

 

4)         Contact or distribute information to affect the sexual assault survivor's credit rating; or

 

5)         Take any other action adverse to the sexual assault survivor or his or her family on account of providing services to the sexual assault survivor.  (Section 7.5(a) of the Act)

 

i)          Nothing in subsection (h) precludes a hospital, health care provider, ambulance provider, laboratory, or pharmacy from billing the sexual assault survivor or any applicable health insurance or coverage for inpatient services.  (Section 7.5(b) of the Act)

 

j)          Notwithstanding any other provision of law, including, but not limited to, Section 7.5(a) of the Act and subsection (h), a sexual assault survivor who is not the subscriber or primary policyholder of the sexual assault survivor's insurance policy may opt out of billing the sexual assault survivor's private insurance provider. If the sexual assault survivor opts out of billing the sexual assault survivor's private insurance provider, then the bill for medical forensic services shall be sent to the Department of Healthcare and Family Services' Sexual Assault Emergency Treatment Program for reimbursement for the services provided to the sexual assault survivor.  (Section 7.5(a-5) of the Act)

 

(Source:  Amended at 47 Ill. Reg. 18705, effective January 1, 2024)

 

Section 545.105  Treatment Data Required by the Department

 

a)         Each treatment hospital, treatment hospital with approved pediatric transfer, and approved pediatric health care facility shall submit to the Department every six months, in a manner prescribed by the Department, the following information:

 

1)         The total number of patients who presented with a complaint of sexual assault; and

 

2)         The total number of Sexual Assault Evidence Collection Kits:

 

A)        Offered to all sexual assault survivors and pediatric sexual assault survivors pursuant to of Section 5(a-5)(1.5) of the Act;

 

B)        Completed for all sexual assault survivors and pediatric sexual assault survivors; and

 

C)        Declined by all sexual assault survivors and pediatric sexual assault survivors.

 

b)         This information will be made available on the Department's website.  (Section 2(e) of the Act)

 

(Source:  Added at 44 Ill. Reg. 6326, effective April 10, 2020)

Section 545.APPENDIX A   Sexual Assault Treatment Plan Form (Repealed)

 

(Source:  Repealed at 43 Ill. Reg. 4992, effective April 17, 2019)

Section 545.APPENDIX B   Sexual Assault Transfer Plan Form (Repealed)

 

(Source:  Repealed at 43 Ill. Reg. 4992, effective April 17, 2019)

 

Section 545.APPENDIX C   Emergency Contraception Protocols

 

CONTRACEPTIVE INTERVENTION

 

SAMPLE PROTOCOL I

 

A.        GENERAL

 

Each survivor of sexual assault will receive medically and factually accurate written and oral information about emergency contraception as soon as possible and, in any event, no later than 12 hours after the sexual assault survivor presents herself/himself at the hospital for emergency treatment services; the indications and counter-indications and risks associated with the use of emergency contraception; and a description of how and when survivors will be provided emergency contraception upon the written order of a physician licensed to practice medicine in all its branches, an advanced practice nurse who has a written collaborative agreement with a collaborating physician that authorizes prescriptions of emergency contraception, or a physician assistant who has been delegated authority to prescribe emergency contraception.  If the alleged sexual assault survivor accepts this treatment, the physician will administer emergency contraception as approved by the federal Food and Drug Administration (FDA), unless contraindicated for medical reasons, while the survivor is in emergency care.  Each survivor of sexual assault will be provided with an appropriate referral to a physician licensed to practice medicine in all its branches as provided in the Medical Practice Act of 1987.

 

CONTRACEPTIVE INTERVENTION

 

SAMPLE PROTOCOL II

(CATHOLIC HOSPITAL ASSOCIATION)

 

A.        GENERAL

 

Each survivor of sexual assault will receive medically and factually accurate written and oral information about emergency contraception as soon as possible and, in any event, no later than 12 hours after the sexual assault survivor presents herself/himself at the hospital for emergency treatment services; the indications and counter-indications and risks associated with the use of emergency contraception; and a description of how and when survivors will be provided emergency contraception upon the written order of a physician licensed to practice medicine in all its branches, an advanced practice nurse who has a written collaborative agreement with a collaborating physician that authorizes prescriptions of emergency contraception, or a physician assistant who has been delegated authority to prescribe emergency contraception.  A female survivor of sexual assault who shows a negative result for pregnancy on the blood test and a negative result with respect to the urine dip-stick test, and whose history corresponds to this, will be offered a contraceptive intervention of high dose Ovral (or equivalent).  If the sexual assault survivor accepts this treatment, the first dose will be provided in the emergency department to achieve the contraceptive effect.

 

If the survivor presents a positive result on the tests, the survivor will be counseled that the emergency department will not offer the formulation.  If the blood test is positive for pregnancy, the sexual assault survivor will be counseled that this pregnancy is not of immediate or recent origin.  If the urine test is positive and relates to the individual's history, it indicates that the LH surge is under way or that the woman is ovulating, and that a contraceptive formulation would not be effective in preventing ovulation, and contraceptive intervention will not be provided by the hospital.

 

Sexual assault survivors will be referred to a physician for appropriate follow-up health care.

 

B.        CLINICAL APPLICATION

 

I.          If a woman is determined to be in the preovulatory phase of her cycle, then Ovral (or equivalent) will be immediately available for the most effective contraceptive intervention in the dosage of 2 pills at the present time, and 2 in 12 hours.

 

1)         History: Compatible with preovulatory phase

 

2)         Physical examination: Compatible with preovulatory phase

 

3)         LH urine: Negative

Progesterone level less than 1.5 ng/mL

 

II.        If the woman is determined to be past the early postovulatory phase (LH urine: negative; progesterone: greater than or equal to 6 ng/mL), because the timing of the sexual assault could not have coincided with the presence of an ovum, Ovral (or equivalent) may be prescribed for the psychological benefit of the woman who requests it.

 

III.       If the woman is determined to be in the late postovulatory phase, because the timing of the sexual assault could not have coincided with the presence of an ovum, Ovral (or equivalent) may be prescribed for the benefit of the woman who requests it:

 

1)         Progesterone level: Less than 6 ng/mL

 

2)         LH urine: Negative

 

3)         Menstrual history: Anticipation of menses in less than 7 days (usually 3-5 days)

 

IV.       If a woman is determined to be in (1) her midcycle LH surge phase or (2) early postovulatory phase, Ovral (or equivalent) will not be given by the emergency department physician:

 

1)         LH urine: Positive

Progesterone level: Unnecessary to perform

 

2)         LH urine: Negative

Progesterone level: Greater than or equal to 1.5 or less than or equal to 5.9 ng/mL

Menstrual history: Compatible with midcycle and early postovulatory phase (menses expected in greater than 7 days).

 

(Source:  Amended at 33 Ill. Reg. 14588, effective October 9, 2009)