Assisted living and shared housing
An assisted living or shared housing establishment may refer its residents only to home services providers licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act.
Illinois · Public Act 104-0666 · Takes effect January 1, 2027
Illinois home care rule changes: the 2027 referral law and Part 245
One new Illinois law affects home services agencies: from January 1, 2027, assisted living, community living and life care facilities may refer residents only to licensed home services providers. The agency rules in Part 245 were last amended in January 2026, and we found no proposal to change them in the 2026 Flinn Reports we could retrieve. Here is what changed, what did not, and how to follow what comes next.
- Rule-verified October 1, 2026
- From Public Act 104-0666 and JCAR’s Flinn Reports
- Every 2026 issue we could retrieve, searched
Quick answer
One new law, no new agency rules. Public Act 104-0666 takes effect on January 1, 2027. From then, "An establishment shall only make referrals to its residents for home services providers that are licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act." 210 ILCS 9/30.5 Community living facilities and life care facilities get a matching limit, and IDPH must publish a flyer on licensed care that these facilities give to residents referred to home care.
The law amends the facilities’ own Acts, not Part 245, so your agency’s duties do not change. What changes is who can receive these referrals: only licensed providers.
Part 245 itself was last amended effective January 30, 2026, in what JCAR’s summary describes as an update to the federal and state materials it incorporates. IDPH removed proposed RN delegation rules from that amendment and says "RN delegation will be addressed in a future rulemaking." Flinn Report, February 13, 2026
Status
- New law
- Public Act 104-0666, takes effect January 1, 2027P.A. 104-0666
- Part 245 last amended
- January 30, 2026 (50 Ill. Reg. 2147)Part 245 source note
- Proposed Part 245 changes
- None found, January 2 to September 25, 2026 (one issue not retrieved)Flinn Reports
- RN delegation
- Left to a future rulemakingFlinn, Feb 13, 2026
Checked against official sources on October 1, 2026.
Adopted · takes effect January 1, 2027
Public Act 104-0666: referrals to licensed providers only
HB 4612 became Public Act 104-0666 when the Governor approved it on July 31, 2026. HB 4612 bill status Its findings explain why: residents of these establishments often rely on their referrals for home services, and "Utilizing untrained or unlicensed home services providers poses a significant risk of harm to vulnerable residents, including improper care, neglect, or financial exploitation." P.A. 104-0666, Section 1
The Act "Amends the Assisted Living and Shared Housing Act, the Community Living Facilities Licensing Act, and the Life Care Facilities Act". HB 4612 synopsis It makes these changes:
Community living facilities
A community living facility may refer its residents only to home services providers licensed under the same Act.
Life care facilities
A life care facility may refer its residents only to providers of at-home continuing care, or other home service providers, licensed under the same Act.
An IDPH flyer on licensed care
IDPH must distribute to each establishment and facility, and publish on its website, a one-page flyer on choosing caregivers, the differences between licensed and unlicensed home care and home health providers, common risks of unlicensed providers, and how to verify that an agency is licensed through the State of Illinois.
The flyer goes to residents
The establishment or facility must give the flyer to any resident who is referred to home care services or who asks for a referral for home care services.
What counts as a referral
Directing a resident, verbally or in writing, to a specific service provider with whom the establishment or facility does not have a contractual arrangement.
How it passed
January 27, 2026
Filed
HB 4612 filed in the House.
April 16, 2026
Passed the House, 107-0
After House Floor Amendment No. 1, which rewrote the bill and removed its penalty provisions.
May 21, 2026
Passed the Senate, 59-0
Passed both houses.
July 31, 2026
Approved by the Governor
Became Public Act 104-0666.
January 1, 2027
Takes effect
The referral limits and the flyer duty apply from this date.
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What it means for your agency
No new duties. The Act changes what facilities may do, not what home services agencies must do. Part 245 is unchanged by it, and no duty in your manual changes.
A license matters for these referrals. From January 1, 2027, an assisted living, shared housing, community living or life care facility can refer residents only to licensed providers. An unlicensed provider cannot receive those referrals; a licensed agency can.
The definition of a referral is narrow. It covers directing a resident to a provider the facility has no contractual arrangement with. 210 ILCS 9/30.5(a) The Act says nothing more about providers a facility does have a contract with.
No penalty section. The bill as introduced had penalties for breaking the referral requirement; House Floor Amendment No. 1 removed them. HB 4612 bill status
Our suggestions, not rule text
- Keep your license current: renew 60 to 90 days before it expires, and tell IDPH about changes within 10 days. 245.90(b)(1) 245.80(h)
- The flyer will tell residents how to check whether an agency is licensed. One public list is IDPH’s Home Services Agency Directory on the Illinois open data portal. IDPH directory Check that your agency’s name, address and license details there are right.
- Put your IDPH license number on your website and in what you give facilities, so their staff can confirm it quickly.
We could not check whether IDPH has published the flyer yet: IDPH’s website does not respond to our checks, which is why the IDPH pages we cite are Internet Archive copies.
The January 30, 2026 amendment to Part 245
JCAR’s summary of the adopted rule says it updated "incorporated federal and State regulations and other documents", and that "Home health and home nursing agencies are affected." Flinn Report, February 13, 2026 It does not list home services agencies.
Part 245’s source notes show which sections it touched: 245.20 (definitions), 245.25 (incorporated and referenced materials) and 245.40 (staffing and staff responsibilities). Part 245, source notes Section 245.40 includes the home services worker task rules, so we cannot say the amendment left home services wording untouched: we could not read the Illinois Register text that shows each edit, because the Secretary of State’s site does not respond to our checks.
What we can say: the Part 245 text CareRulebook works from is current through this amendment (50 Ill. Reg. 2147), so the manual’s rule quotes already reflect it. 77 Ill. Adm. Code 245
RN delegation: left to a future rulemaking
The June 2025 proposal would have added rules "that allow registered nurses to delegate skilled nursing activities, tasks, or interventions to other RNs, licensed practical nurses, and home health aides in specific situations" Flinn Report, June 6, 2025 Before adopting the amendment, IDPH removed those provisions: "RN delegation will be addressed in a future rulemaking." Flinn Report, February 13, 2026 In the 2026 issues we searched, no Part 245 proposal has appeared since, on delegation or anything else.
For a home services agency this does not change anything today. IDPH’s application says "As a non-medical service license, this license does not allow for any skilled services to be provided regardless of whether an individual is licensed or certified in their respective discipline." Form 445104, page 7 and the rule bars a home services agency from medical services that a home health or home nursing agency would perform. 245.210(d)(1) If a new delegation proposal is published, we will read it for any effect on home services agencies.
Part 245 since 2025
Every Part 245 rulemaking step in the Flinn Reports we hold, oldest first.
March 25, 2025
Flinn, Apr 11, 2025Training certificates (adopted)
Agencies must give a home services worker a copy of their training certificate on request (245.71(i)). JCAR listed home services providers as affected.
May 30, 2025
Flinn, May 30, 2025Local health department fees (proposed)
A proposal (49 Ill. Reg. 7485) implementing Public Act 103-734 on license fees for certified local health departments.
June 6, 2025
Flinn, Jun 6, 2025RN delegation and incorporated materials (proposed)
A proposal (49 Ill. Reg. 7878) to let RNs delegate skilled nursing tasks to other RNs, LPNs and home health aides in specific situations, and to update the materials Part 245 incorporates.
September 2, 2025
Flinn, Sep 12, 2025Local health department fees (adopted)
IDPH may not charge certified local health departments license fees for home health agencies, and Part 245 now applies the same bar to home nursing and placement agencies. 245.95(b) separately exempts them from the home services fee.
November 14, 2025
Flinn, Nov 14, 2025Second Notice
IDPH moved the June 2025 proposal to Second Notice, starting JCAR’s review.
December 17, 2025
Flinn, Dec 19, 2025Second Notice extended
JCAR did not clear the June 2025 proposal at its December 17 meeting. By our reading of its report, JCAR extended the Second Notice period by 45 days, with IDPH’s agreement, to take it up again on January 9, 2026.
January 9, 2026
Flinn, Jan 16, 2026No objection from JCAR
JCAR’s report of its January 9 meeting does not list the proposal, and says rulemakings on the agenda that it does not list received No Objection and may be adopted. So, by our reading, IDPH could then adopt it.
January 30, 2026
Flinn, Feb 13, 2026Adopted, without RN delegation
Effective at 50 Ill. Reg. 2147, updating incorporated federal and state materials. The RN delegation provisions were removed before adoption.
For 2025 we saved the Flinn Reports that cover these Part 245 rulemakings; we did not search every 2025 issue.
What we checked, and what we could not
The Illinois Register, where proposals are published, is on the Secretary of State’s website, which does not respond to our checks. So we searched JCAR’s Flinn Report, its weekly summary of the Register: "The Flinn Report is a weekly summary of regulatory actions of State agencies published in the Illinois Register and action taken by the Illinois General Assembly’s Joint Committee on Administrative Rules (JCAR)." JCAR, The Flinn Report
- Searched: Volume 50, Issues 1 to 9 and 11 to 39, published January 2 to September 25, 2026, for Part 245, the background check code (Part 955), the dementia services code (Part 973), and the words home services, home health and home nursing.
- Not retrieved: Issue 10 (March 6, 2026). ilga.gov returned "not found" for it, and the Internet Archive has no copy.
- Found: only Issue 7 (February 13, 2026) mentions Part 245, reporting the adopted amendment above. No issue reports a proposed amendment to Part 245, 955 or 973.
- Also found: in Issue 35 (August 28, 2026), IDPH’s proposed Certified Medication Aide Training Program Code (77 IAC 394). The medication aides are for assisted living establishments and nursing facilities; a home services agency is named only as one possible sponsor of a training program. It does not amend Part 245. Flinn Report, August 28, 2026
We last checked on October 1, 2026. A proposal published after that date, or in the issue we could not retrieve, would not be on this page yet.
How to follow Illinois rulemaking
IDPH changes Part 245 through the Illinois Register, with review by the General Assembly’s Joint Committee on Administrative Rules (JCAR). Each step is summarized in JCAR’s weekly Flinn Report.
- 01
First Notice: the proposal and the comment period
"Rules proposed by agencies this week, commencing a First Notice public comment period of at least 45 days." The proposed text is published in the Illinois Register, which you can read on the Secretary of State’s website or under "Illinois Register" on ilga.gov.
- 02
Commenting
Questions and comments go to the agency contact named under each summary in JCAR’s Flinn Report, by mail, email or phone. For IDPH’s May 2025 Part 245 proposal that was IDPH’s rules contact at dph.rules@illinois.gov.
- 03
Second Notice: JCAR’s review
When the agency moves a proposal to Second Notice, JCAR’s review period starts and JCAR considers it at a scheduled meeting. Further comments then go to JCAR at jcar@ilga.gov, and the Second Notice text is on the JCAR website.
- 04
Adoption
Proposals JCAR does not object to "may now be adopted by their agencies". JCAR can also extend a Second Notice period, as it did for IDPH’s 2025 proposal. The adopted rule appears in the Illinois Register with its effective date, and the Flinn Report summarizes it under Adopted Rules.
- 05
Emergency rules
Emergency rules are temporary rules adopted for no more than 150 days. The Flinn Report lists them separately from proposals, so watch both.
New laws, like Public Act 104-0666, go through the General Assembly instead; ilga.gov shows each bill’s status and the Public Act once it is signed. For licensing questions, IDPH’s number for application questions is 217-782-7412. Form 445104, page 1
Which CareRulebook policies are affected
The CareRulebook Illinois manual has 37 policies written to the rules in force. Public Act 104-0666 touches one of them, and only to explain it:
Policy 1.5
License application, renewal and notices to IDPH
Its Proposed changes section sets out the referral limits for all three kinds of facility and the flyer, and says no duty in the policy changes when the law takes effect. Keeping the license current, which this policy covers, is what keeps your agency eligible for these referrals.
The January 2026 amendment is already in the rule text the manual quotes, and RN delegation does not affect it: Policy 5.2, home services tasks: what workers may and may not do, keeps skilled tasks out of a home services worker’s scope.
CareRulebook
A manual written to the rules in force
CareRulebook writes every policy Part 245 asks for, with your agency’s details and the rule quoted under each, from Part 245 as amended in January 2026. Policy 1.5 already explains the 2027 referral law.
- 37 policies, 113 rule requirements mapped
- Policy 1.5: License application, renewal and notices to IDPH
- Policy 1.6: Inspections, surveys and plans of correction
- For 12 months, each download uses our current policy library
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Common questions, answered from the source
Does Illinois's 2027 referral law add new duties for home services agencies?
No. Public Act 104-0666 amends the Assisted Living and Shared Housing Act, the Community Living Facilities Licensing Act and the Life Care Facilities Act, not Part 245. From January 1, 2027, those establishments and facilities may refer residents only to home services providers licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act, so an agency needs a current IDPH license to receive their referrals.
"Amends the Assisted Living and Shared Housing Act, the Community Living Facilities Licensing Act, and the Life Care Facilities Act"
Can Illinois home services workers do nursing tasks an RN delegates to them?
No. A home services license allows no skilled services, even when the worker is licensed or certified. The 2025 proposal on RN delegation was about home health and home nursing agencies, and IDPH removed it before adopting the January 2026 amendment, saying delegation will be addressed in a future rulemaking.
"As a non-medical service license, this license does not allow for any skilled services to be provided regardless of whether an individual is licensed or certified in their respective discipline."
Can an Illinois home services worker give or set up medications?
No. A home services worker may only remind: ask whether medications were taken, prompt, hand over or open a medication minder that the client, family, a nurse or a pharmacist has already filled and marked by day and time. Setting up medications is prohibited, and irregularities must be reported to the supervisor at once.
"A home services worker may assist a client with medication reminding only when medications have been pre-selected by the client, a family member, a nurse, or a pharmacist and are stored in containers other than the prescription bottles, such as medication minders."
Frequently asked questions
Are there new home care rules in Illinois?
Not in Part 245. In the 2026 Flinn Reports we could retrieve (January 2 to September 25; the March 6 issue could not be retrieved) we found no proposed change to Part 245, the background check code (Part 955) or the dementia services code (Part 973). One new law affects home care from January 1, 2027: Public Act 104-0666, which limits who assisted living, community living and life care facilities may refer residents to. Part 245 was last amended effective January 30, 2026.
What does Public Act 104-0666 do?
From January 1, 2027, assisted living and shared housing establishments, community living facilities and life care facilities may refer residents only to home services providers licensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act (for life care facilities, providers of at-home continuing care or other home service providers). IDPH must publish a one-page flyer on choosing caregivers, licensed versus unlicensed providers and how to check a license, and those facilities must give it to residents referred to home care.
Does the referral law add duties for my home services agency?
Not directly. It amends the Assisted Living and Shared Housing Act, the Community Living Facilities Licensing Act and the Life Care Facilities Act, not Part 245. Its effect on an agency is that these facilities may refer residents only to licensed providers, so a current IDPH license is what keeps you eligible for their referrals.
Is there a penalty for a facility that refers to an unlicensed provider?
The bill as introduced had penalty provisions, and House Floor Amendment No. 1 removed them. The enacted text has no penalty section of its own. How the facilities’ licensing agencies will enforce the referral limit is not something the Act spells out.
Can my home services workers now do tasks an RN delegates?
No. A home services license allows no skilled services, even when the worker is licensed or certified. The 2025 RN delegation proposal was about home health and home nursing agencies, and IDPH removed it before adopting the January 2026 amendment, saying RN delegation will be addressed in a future rulemaking. No Part 245 proposal has appeared since, in the issues we searched.
Did the January 2026 amendment change the home services rules?
Part 245’s source notes show it changed Sections 245.20 (definitions), 245.25 (incorporated materials) and 245.40 (staffing). JCAR’s summary says it updated incorporated federal and state materials and lists home health and home nursing agencies as affected, not home services agencies. We could not read the Illinois Register text that shows each edit. The CareRulebook manual quotes Part 245 as amended by it.
How do I comment on a proposed Illinois rule?
A proposal opens a First Notice comment period of at least 45 days. Send comments to the agency contact named under the proposal’s summary in JCAR’s Flinn Report; for IDPH’s May 2025 Part 245 proposal that was dph.rules@illinois.gov. After the agency moves the proposal to Second Notice, comments go to JCAR at jcar@ilga.gov.
Does the CareRulebook Illinois manual cover these changes?
The manual follows the rules in force. Policy 1.5 explains Public Act 104-0666 in a Proposed changes section; no duty in the manual changes when the law takes effect. For 12 months after you buy, every download is built from our current policy library, so a policy we update after an Illinois rule change reaches you when you download again within that time.
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Sources
- 77 Ill. Adm. Code 245, Home Health, Home Services, and Home Nursing Agency Code (current through 50 Ill. Reg. 2147, effective January 30, 2026) · Illinois Department of Public Health (Illinois Administrative Code, Joint Committee on Administrative Rules, ilga.gov) · retrieved October 1, 2026
- Public Act 104-0666 (HB 4612), referral of licensed home services providers, and its bill status page · Illinois General Assembly (ilga.gov) · retrieved October 1, 2026
- Home Services Application, Form 445104 (Initial, Renewal and Change of Ownership; archived copy of March 21, 2026) · Illinois Department of Public Health · retrieved October 1, 2026
- IDPH Home Services Agency Directory (data.illinois.gov dataset 9miz-pbzm; archived copy of August 25, 2026, rows last updated April 28, 2026) · Illinois Department of Public Health (Illinois open data portal) · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 15 (April 11, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 23 (June 6, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 37 (September 12, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 51 (December 19, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 50, Issue 7 (February 13, 2026) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 46 (November 14, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 49, Issue 22 (May 30, 2025) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 50, Issues 1 to 39 (January 2 to September 25, 2026; Issue 10 of March 6, 2026 could not be retrieved) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026
- The Flinn Report, Volume 50, Issue 35 (August 28, 2026) · Illinois General Assembly, Joint Committee on Administrative Rules · retrieved October 1, 2026