Public Act 101-0616

SB0391 Enrolled LRB101 04152 KTG 49160 b

AN ACT concerning children.

Be it enacted by the People of the State of Illinois,

represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by

changing Section 5-5.23 as follows:

(305 ILCS 5/5-5.23)

(Text of Section after amendment by P.A. 101-461)

Sec. 5-5.23. Children's mental health services.

(a) The Department of Healthcare and Family Services, by

rule, shall require the screening and assessment of a child

prior to any Medicaid-funded admission to an inpatient hospital

for psychiatric services to be funded by Medicaid. The

screening and assessment shall include a determination of the

appropriateness and availability of out-patient support

services for necessary treatment. The Department, by rule,

shall establish methods and standards of payment for the

screening, assessment, and necessary alternative support

services.

(b) The Department of Healthcare and Family Services, to

the extent allowable under federal law, shall secure federal

financial participation for Individual Care Grant expenditures

made by the Department of Healthcare and Family Services for

the Medicaid optional service authorized under Section 1905(h)

of the federal Social Security Act, pursuant to the provisions

of Section 7.1 of the Mental Health and Developmental

Disabilities Administrative Act. The Department of Healthcare

and Family Services may exercise the authority under this

Section as is necessary to administer Individual Care Grants as

authorized under Section 7.1 of the Mental Health and

Developmental Disabilities Administrative Act.

(c) The Department of Healthcare and Family Services shall

work collaboratively with the Department of Children and Family

Services and the Division of Mental Health of the Department of

Human Services to implement subsections (a) and (b).

(d) On and after July 1, 2012, the Department shall reduce

any rate of reimbursement for services or other payments or

alter any methodologies authorized by this Code to reduce any

rate of reimbursement for services or other payments in

accordance with Section 5-5e.

(e) All rights, powers, duties, and responsibilities

currently exercised by the Department of Human Services related

to the Individual Care Grant program are transferred to the

Department of Healthcare and Family Services with the transfer

and transition of the Individual Care Grant program to the

Department of Healthcare and Family Services to be completed

and implemented within 6 months after the effective date of

this amendatory Act of the 99th General Assembly. For the

purposes of the Successor Agency Act, the Department of

Healthcare and Family Services is declared to be the successor

agency of the Department of Human Services, but only with

respect to the functions of the Department of Human Services

that are transferred to the Department of Healthcare and Family

Services under this amendatory Act of the 99th General

Assembly.

(1) Each act done by the Department of Healthcare and

Family Services in exercise of the transferred powers,

duties, rights, and responsibilities shall have the same

legal effect as if done by the Department of Human Services

or its offices.

(2) Any rules of the Department of Human Services that

relate to the functions and programs transferred by this

amendatory Act of the 99th General Assembly that are in

full force on the effective date of this amendatory Act of

the 99th General Assembly shall become the rules of the

Department of Healthcare and Family Services. All rules

transferred under this amendatory Act of the 99th General

Assembly are hereby amended such that the term "Department"

shall be defined as the Department of Healthcare and Family

Services and all references to the "Secretary" shall be

changed to the "Director of Healthcare and Family Services

or his or her designee". As soon as practicable hereafter,

the Department of Healthcare and Family Services shall

revise and clarify the rules to reflect the transfer of

rights, powers, duties, and responsibilities affected by

this amendatory Act of the 99th General Assembly, using the

procedures for recodification of rules available under the

Illinois Administrative Procedure Act, except that

existing title, part, and section numbering for the

affected rules may be retained. The Department of

Healthcare and Family Services, consistent with its

authority to do so as granted by this amendatory Act of the

99th General Assembly, shall propose and adopt any other

rules under the Illinois Administrative Procedure Act as

necessary to administer the Individual Care Grant program.

These rules may include, but are not limited to, the

application process and eligibility requirements for

recipients.

(3) All unexpended appropriations and balances and

other funds available for use in connection with any

functions of the Individual Care Grant program shall be

transferred for the use of the Department of Healthcare and

Family Services to operate the Individual Care Grant

program. Unexpended balances shall be expended only for the

purpose for which the appropriation was originally made.

The Department of Healthcare and Family Services shall

exercise all rights, powers, duties, and responsibilities

for operation of the Individual Care Grant program.

(4) Existing personnel and positions of the Department

of Human Services pertaining to the administration of the

Individual Care Grant program shall be transferred to the

Department of Healthcare and Family Services with the

transfer and transition of the Individual Care Grant

program to the Department of Healthcare and Family

Services. The status and rights of Department of Human

Services employees engaged in the performance of the

functions of the Individual Care Grant program shall not be

affected by this amendatory Act of the 99th General

Assembly. The rights of the employees, the State of

Illinois, and its agencies under the Personnel Code and

applicable collective bargaining agreements or under any

pension, retirement, or annuity plan shall not be affected

by this amendatory Act of the 99th General Assembly. All

transferred employees who are members of collective

bargaining units shall retain their seniority, continuous

service, salary, and accrued benefits.

(5) All books, records, papers, documents, property

(real and personal), contracts, and pending business

pertaining to the powers, duties, rights, and

responsibilities related to the functions of the

Individual Care Grant program, including, but not limited

to, material in electronic or magnetic format and necessary

computer hardware and software, shall be delivered to the

Department of Healthcare and Family Services; provided,

however, that the delivery of this information shall not

violate any applicable confidentiality constraints.

(6) Whenever reports or notices are now required to be

made or given or papers or documents furnished or served by

any person to or upon the Department of Human Services in

connection with any of the functions transferred by this

amendatory Act of the 99th General Assembly, the same shall

be made, given, furnished, or served in the same manner to

or upon the Department of Healthcare and Family Services.

(7) This amendatory Act of the 99th General Assembly

shall not affect any act done, ratified, or canceled or any

right occurring or established or any action or proceeding

had or commenced in an administrative, civil, or criminal

cause regarding the Department of Human Services before the

effective date of this amendatory Act of the 99th General

Assembly; and those actions or proceedings may be defended,

prosecuted, and continued by the Department of Human

Services.

(f) (Blank).

(g) Family Support Program. The Department of Healthcare

and Family Services shall restructure the Family Support

Program, formerly known as the Individual Care Grant program,

to enable early treatment of youth, emerging adults, and

transition-age adults with a serious mental illness or serious

emotional disturbance.

(1) As used in this subsection and in subsections (h)

through (s):

(A) "Youth" means a person under the age of 18.

(B) "Emerging adult" means a person who is 18

through 20 years of age.

(C) "Transition-age adult" means a person who is 21

through 25 years of age.

(2) The Department shall amend 89 Ill. Adm. Code 139 in

accordance with this Section and consistent with the

timelines outlined in this Section.

(3) Implementation of any amended requirements shall

be completed within 8 months of the adoption of any

amendment to 89 Ill. Adm. Code 139 that is consistent with

the provisions of this Section.

(4) To align the Family Support Program with the

Medicaid system of care, the services available to a youth,

emerging adult, or transition-age adult through the Family

Support Program shall include all Medicaid community-based

mental health treatment services and all Family Support

Program services included under 89 Ill. Adm. Code 139. No

person receiving services through the Family Support

Program or the Specialized Family Support Program shall

become a Medicaid enrollee unless Medicaid eligibility

criteria are met and the person is enrolled in Medicaid. No

part of this Section creates an entitlement to services

through the Family Support Program, the Specialized Family

Support Program, or the Medicaid program.

(5) The Family Support Program shall align with the

following system of care principles:

(A) Treatment and support services shall be based

on the results of an integrated behavioral health

assessment and treatment plan using an instrument

approved by the Department of Healthcare and Family

Services.

(B) Strong interagency collaboration between all

State agencies the parent or legal guardian is involved

with for services, including the Department of

Healthcare and Family Services, the Department of

Human Services, the Department of Children and Family

Services, the Department of Juvenile Justice, and the

Illinois State Board of Education.

(C) Individualized, strengths-based practices and

trauma-informed treatment approaches.

(D) For a youth, full participation of the parent

or legal guardian at all levels of treatment through a

process that is family-centered and youth-focused. The

process shall include consideration of the services

and supports the parent, legal guardian, or caregiver

requires for family stabilization, and shall connect

such person or persons to services based on available

insurance coverage.

(h) Eligibility for the Family Support Program.

Eligibility criteria established under 89 Ill. Adm. Code 139

for the Family Support Program shall include the following:

(1) Individuals applying to the program must be under

the age of 26.

(2) Requirements for parental or legal guardian

involvement are applicable to youth and to emerging adults

or transition-age adults who have a guardian appointed

under Article XIa of the Probate Act.

(3) Youth, emerging adults, and transition-age adults

are eligible for services under the Family Support Program

upon their third inpatient admission to a hospital or

similar treatment facility for the primary purpose of

psychiatric treatment within the most recent 12 months and

are hospitalized for the purpose of psychiatric treatment.

(4) School participation for emerging adults applying

for services under the Family Support Program may be waived

by request of the individual at the sole discretion of the

Department of Healthcare and Family Services.

(5) School participation is not applicable to

transition-age adults.

(i) Notification of Family Support Program and Specialized

Family Support Program services.

(1) Within 12 months after the effective date of this

amendatory Act of the 101st General Assembly, the

Department of Healthcare and Family Services, with

meaningful stakeholder input through a working group of

psychiatric hospitals, Family Support Program providers,

family support organizations, the Community and

Residential Services Authority, a statewide association

representing a majority of hospitals, a statewide

association representing physicians, and foster care

alumni advocates, shall establish a clear process by which

a youth's or emerging adult's parents, guardian, or

caregiver, or the emerging adult or transition-age adult,

is identified, notified, and educated about the Family

Support Program and the Specialized Family Support Program

upon a first psychiatric inpatient hospital admission, and

any following psychiatric inpatient admissions.

Notification and education may take place through a Family

Support Program coordinator, a mobile crisis response

provider, a Comprehensive Community Based Youth Services

provider, the Community and Residential Services

Authority, or any other designated provider or coordinator

identified by the Department of Healthcare and Family

Services. In developing this process, the Department of

Healthcare and Family Services and the working group shall

take into account the unique needs of emerging adults and

transition-age adults without parental involvement who are

eligible for services under the Family Support Program. The

Department of Healthcare and Family Services and the

working group shall ensure the appropriate provider or

coordinator is required to assist individuals and their

parents, guardians, or caregivers, as applicable, in the

completion of the application or referral process for the

Family Support Program or the Specialized Family Support

Program.

(2) Upon a youth's, emerging adult's or transition-age

adult's second psychiatric inpatient hospital admission,

prior to hospital discharge, the hospital must, if it is

aware of the patient's prior psychiatric inpatient

hospital admission, ensure that the youth's parents,

guardian, or caregiver, or the emerging adult or

transition-age adult, has have been notified of the Family

Support Program and the Specialized Family Support Program

prior to hospital discharge.

(3) Psychiatric lockout as last resort.

(A) Prior to referring any youth to the Department

of Children and Family Services for the filing of a

petition in accordance with subparagraph (c) of

paragraph (1) of Section 2-4 of the Juvenile Court Act

of 1987 alleging that the youth is dependent because

the youth was left in a psychiatric hospital beyond

medical necessity, the hospital shall attempt to

contact educate the youth and the youth's parents,

guardian, or caregiver about the Family Support

Program and the Specialized Family Support Program and

shall assist with connections to the designated Family

Support Program coordinator in the service area by

providing educational materials developed by the

Department of Healthcare and Family Services. Once

this process has begun, any such youth shall be

considered a youth for whom an application for the

Family Support Program is pending with the Department

of Healthcare and Family Services or an active

application for the Family Support Program was being

reviewed by the Department for the purposes of

subsection (a) of Section 2-4b subparagraph (b) of

paragraph (1) of Section 2-4 of the Juvenile Court Act

of 1987, or for the purposes of subsection (a) of

Section 5-711 of the Juvenile Court Act of 1987.

(B) No state agency or hospital shall coach a

parent or guardian of a youth in a psychiatric hospital

inpatient unit to lock out or otherwise relinquish

custody of a youth to the Department of Children and

Family Services for the sole purpose of obtaining

necessary mental health treatment for the youth. In the

absence of abuse or neglect, a psychiatric lockout or

custody relinquishment to the Department of Children

and Family Services shall only be considered as the

option of last resort. Nothing in this Section shall

prohibit discussion of medical treatment options or a

referral to legal counsel.

(4) Development of new Family Support Program

services.

(A) Development of specialized therapeutic

residential treatment for youth and emerging adults

with high-acuity mental health conditions. Through a

working group led by the Department of Healthcare and

Family Services that includes the Department of

Children and Family Services and residential treatment

providers for youth and emerging adults, the

Department of Healthcare and Family Services, within

12 months after the effective date of this amendatory

Act of the 101st General Assembly, shall develop a plan

for the development of specialized therapeutic

residential treatment beds similar to a qualified

residential treatment program, as defined in the

federal Family First Prevention Services Act, for

youth in the Family Support Program with high-acuity

mental health needs. The Department of Healthcare and

Family Services and the Department of Children and

Family Services shall work together to maximize

federal funding through Medicaid and Title IV-E of the

Social Security Act in the development and

implementation of this plan.

(B) Using the Department of Children and Family

Services' beyond medical necessity data over the last 5

years and any other relevant, available data, the

Department of Healthcare and Family Services shall

assess the estimated number of these specialized

high-acuity residential treatment beds that are needed

in each region of the State based on the number of

youth remaining in psychiatric hospitals beyond

medical necessity and the number of youth placed

out-of-state who need this level of care. The

Department of Healthcare and Family Services shall

report the results of this assessment to the General

Assembly by no later than December 31, 2020.

(C) Development of an age-appropriate therapeutic

residential treatment model for emerging adults and

transition-age adults. Within 30 months after the

effective date of this amendatory Act of the 101st

General Assembly, the Department of Healthcare and

Family Services, in partnership with the Department of

Human Services' Division of Mental Health and with

significant and meaningful stakeholder input through a

working group of providers and other stakeholders,

shall develop a supportive housing model for emerging

adults and transition-age adults receiving services

through the Family Support Program who need

residential treatment and support to enable recovery.

Such a model shall be age-appropriate and shall allow

the residential component of the model to be in a

community-based setting combined with intensive

community-based mental health services.

(j) Workgroup to develop a plan for improving access to

substance use treatment. The Department of Healthcare and

Family Services and the Department of Human Services' Division

of Substance Use Prevention and Recovery shall co-lead a

working group that includes Family Support Program providers,

family support organizations, and other stakeholders over a

12-month period beginning in the first quarter of calendar year

2020 to develop a plan for increasing access to substance use

treatment services for youth, emerging adults, and

transition-age adults who are eligible for Family Support

Program services.

(k) Appropriation. Implementation of this Section shall be

limited by the State's annual appropriation to the Family

Support Program. Spending within the Family Support Program

appropriation shall be further limited for the new Family

Support Program services to be developed accordingly:

(1) Targeted use of specialized therapeutic

residential treatment for youth and emerging adults with

high-acuity mental health conditions through appropriation

limitation. No more than 12% of all annual Family Support

Program funds shall be spent on this level of care in any

given state fiscal year.

(2) Targeted use of residential treatment model

established for emerging adults and transition-age adults

through appropriation limitation. No more than one-quarter

of all annual Family Support Program funds shall be spent

on this level of care in any given state fiscal year.

(l) Exhausting third party insurance coverage first.

(A) A parent, legal guardian, emerging adult, or

transition-age adult with private insurance coverage shall

work with the Department of Healthcare and Family Services,

or its designee, to identify insurance coverage for any and

all benefits covered by their plan. If insurance

cost-sharing by any method for treatment is

cost-prohibitive for the parent, legal guardian, emerging

adult, or transition-age adult, Family Support Program

funds may be applied as a payer of last resort toward

insurance cost-sharing for purposes of using private

insurance coverage to the fullest extent for the

recommended treatment. If the Department, or its agent, has

a concern relating to the parent's, legal guardian's,

emerging adult's, or transition-age adult's insurer's

compliance with Illinois or federal insurance requirements

relating to the coverage of mental health or substance use

disorders, it shall refer all relevant information to the

applicable regulatory authority.

(B) The Department of Healthcare and Family Services

shall use Medicaid funds first for an individual who has

Medicaid coverage if the treatment or service recommended

using an integrated behavioral health assessment and

treatment plan (using the instrument approved by the

Department of Healthcare and Family Services) is covered by

Medicaid.

(C) If private or public insurance coverage does not

cover the needed treatment or service, Family Support

Program funds shall be used to cover the services offered

through the Family Support Program.

(m) Service authorization. A youth, emerging adult, or

transition-age adult enrolled in the Family Support Program or

the Specialized Family Support Program shall be eligible to

receive a mental health treatment service covered by the

applicable program if the medical necessity criteria

established by the Department of Healthcare and Family Services

are met.

(n) Streamlined application. The Department of Healthcare

and Family Services shall revise the Family Support Program

applications and the application process to reflect the changes

made to this Section by this amendatory Act of the 101st

General Assembly within 8 months after the adoption of any

amendments to 89 Ill. Adm. Code 139.

(o) Study of reimbursement policies during planned and

unplanned absences of youth and emerging adults in Family

Support Program residential treatment settings. The Department

of Healthcare and Family Services shall undertake a study of

those standards of the Department of Children and Family

Services and other states for reimbursement of residential

treatment during planned and unplanned absences to determine if

reimbursing residential providers for such unplanned absences

positively impacts the availability of residential treatment

for youth and emerging adults. The Department of Healthcare and

Family Services shall begin the study on July 1, 2019 and shall

report its findings and the results of the study to the General

Assembly, along with any recommendations for or against

adopting a similar policy, by December 31, 2020.

(p) Public awareness and educational campaign for all

relevant providers. The Department of Healthcare and Family

Services shall engage in a public awareness campaign to educate

hospitals with psychiatric units, crisis response providers

such as Screening, Assessment and Support Services providers

and Comprehensive Community Based Youth Services agencies,

schools, and other community institutions and providers across

Illinois on the changes made by this amendatory Act of the

101st General Assembly to the Family Support Program. The

Department of Healthcare and Family Services shall produce

written materials geared for the appropriate target audience,

develop webinars, and conduct outreach visits over a 12-month

period beginning after implementation of the changes made to

this Section by this amendatory Act of the 101st General

Assembly.

(q) Maximizing federal matching funds for the Family

Support Program and the Specialized Family Support Program. The

Department of Healthcare and Family Services, as the sole

Medicaid State agency, shall seek approval from the federal

Centers for Medicare and Medicaid Services within 12 months

after the effective date of this amendatory Act of the 101st

General Assembly to draw additional federal Medicaid matching

funds for individuals served under the Family Support Program

or the Specialized Family Support Program who are not covered

by the Department's medical assistance programs. The

Department of Children and Family Services, as the State agency

responsible for administering federal funds pursuant to Title

IV-E of the Social Security Act, shall submit a State Plan to

the federal government within 12 months after the effective

date of this amendatory Act of the 101st General Assembly to

maximize the use of federal Title IV-E prevention funds through

the federal Family First Prevention Services Act, to provide

mental health and substance use disorder treatment services and

supports, including, but not limited to, the provision of

short-term crisis and transition beds post-hospitalization for

youth who are at imminent risk of entering Illinois' youth

welfare system solely due to the inability to access mental

health or substance use treatment services.

(r) Outcomes and data reported annually to the General

Assembly. Beginning in 2021, the Department of Healthcare and

Family Services shall submit an annual report to the General

Assembly that includes the following information with respect

to the time period covered by the report:

(1) The number and ages of youth, emerging adults, and

transition-age adults who requested services under the

Family Support Program and the Specialized Family Support

Program and the services received.

(2) The number and ages of youth, emerging adults, and

transition-age adults who requested services under the

Specialized Family Support Program who were eligible for

services based on the number of hospitalizations.

(3) The number and ages of youth, emerging adults, and

transition-age adults who applied for Family Support

Program or Specialized Family Support Program services but

did not receive any services.

(s) Rulemaking authority. Unless a timeline is otherwise

specified in a subsection, if amendments to 89 Ill. Adm. Code

139 are needed for implementation of this Section, such

amendments shall be filed by the Department of Healthcare and

Family Services within one year after the effective date of

this amendatory Act of the 101st General Assembly.

(Source: P.A. 101-461, eff. 1-1-20.)