Section 132.25 Definitions
For the purposes of this Part,
the following terms are defined:
Accessibility
– Compliance with all appropriate provisions of the Americans With Disabilities
Act (ADA) of 1990 (42 USC 12101 et seq.), as amended, and section 504 of the
Rehabilitation Act of 1973 (29 USC 794), and the most recent standards
identified in the Illinois Accessibility Code (71 Ill. Adm. Code 400) and/or
ADA Accessibility Guidelines, whichever standard is more stringent.
Assertive
Community Treatment Program or ACT Program – An evidence-based program that
includes all components necessary to provide the assertive community treatment
model.
Applicant −An entity that seeks certification as a Certified
Specialty Provider (CSP) or CMHC under this Part
Centers for Medicare and Medicaid Services or CMMS – A federal agency
within the U.S. Department of Health and Human Services with responsibility for
Medicare, Medicaid, State Children's Health Insurance (SCHIP), Health Insurance
Portability and Accountability Act (HIPAA), and Clinical Laboratory Improvement
Amendments (CLIA).
Certifying State Agency or CSA − Departments responsible for
determining and monitoring compliance with this Part, i.e., Department of Human
Services or Department of Children and Family Services.
Client − An individual who is receiving community mental health
services eligible for Medical Assistance funding.
Certified
Comprehensive Community Mental Health Center or CMHC – An entity that meets the
requirements of Subparts C and D and has been certified by a Certifying State
Agency. Any entity certified as a CMHC under this Part shall be designated as
an Essential Community Behavioral Health Center by the Division of Mental
Health.
Certified
Specialty Provider or CSP – An entity that has chosen to meet the requirements
set forth in Subpart B to be eligible to provide specialty programs directly
funded by DHS-DMH and/or DCFS.
Community
Support Team Program – A program designed with the infrastructure and supports necessary
to provide team-based care consistent with DHS-DMH certification requirements.
Day − A
calendar day unless otherwise indicated.
Department – The
Illinois Department of Human Services (DHS)
Department of
Children and Family Services or DCFS – The State child welfare agency
responsible for:
protecting children who are reported to be
abused or neglected and to increase their families' capacity to safely care for
them;
providing for the well-being of children
in care; providing appropriate, permanent families as quickly as possible for
those children who cannot safely return home;
supporting early intervention and child
abuse prevention activities and working in partnerships with communities to
fulfill this mission.
Department of
Human Services or DHS − The State agency responsible for providing a wide
variety of safety net services to Illinois residents in poverty who are facing
other economic challenges or who have any of a variety of disabilities or
health challenges.
Department of
Human Services-Division of Mental Health or DHS-DMH – A program division of DHS
that, as the State Mental Health Authority pursuant to Department of Human
Services (Mental Health and Developmental Disabilities) Law [20 ILCS 1710], is
responsible for assuring that children, adolescents and adults throughout
Illinois have the availability of and access to public-funded mental health
services.
Emotional
Disturbance – For clients under age 21, symptoms of an emotional disorder
contained in the DSM-5 and ICD-10-CM that is the condition that will be the
main focus of treatment. For clients under age 6, DC 0-5 may be utilized to
develop an age appropriate diagnosis, then the crosswalk between the DSM 5/ICD
-10/DC 0-5 shall be used to identify which DSM-5/ICD-10 condition will be the
main focus of treatment. Emotional disturbance does not include organic
disorders such as dementia and those associated with known or unknown physical
conditions such as hallucinations, amnestic disorder and delirium; psychoactive
substance induced organic mental disorders; and intellectual disabilities,
autism spectrum disorders or psychoactive substance use disorders.
Enrollment
−The official act of registering an entity or an individual as a provider
in the Illinois Medical Assistance Program.
Guardian
− The court-appointed guardian or conservator of the person under the
Probate Act of 1975 [755 ILCS 5] or a temporary custodian or guardian of the
person of a child appointed by an Illinois juvenile court or a
legally-appointed guardian or custodian or other party granted legal care,
custody and control over a minor child by a juvenile court of competent
jurisdiction located in another state whose jurisdiction has been extended into
Illinois via the child's legally authorized placement in accordance with the
applicable interstate compact. (See the Juvenile Court Act of 1987 [705 ILCS
405] and the Interstate Compact on the Placement of Children [45 ILCS 15].)
Healthcare and Family Services or HFS − The State agency
responsible for administering Medicaid for Illinois.
Health Information Technology for Economic and Clinical Health (HITECH)
Act – Title XIII of Division A and Title IV of Division B of the American
Recovery and Reinvestment Act of 2009 (ARRA), P.L. 111-5 (Feb. 17, 2009).
Health Insurance Portability and Accountability Act or HIPAA − 42
USC 1320 et seq. and 45 CFR 160 and 164 (2003).
Illinois Medicaid Program Advanced Cloud Technology or IMPACT – The HFS
web-based Medicaid Management Information System platform.
Intensive Outpatient Program − A program designed with the
infrastructure and supports necessary to provide group therapeutic sessions consistent
with the clinical standards set forth in Subpart E.
Interdisciplinary Care − Professionals from a range of disciplines
working together to deliver comprehensive services and supports that address as
many of the client's needs as possible. This can be delivered by a range of
professionals and paraprofessionals functioning as a team under one
organizational umbrella or from a range of organizations, including private
practice, brought together as a unique team. As a client's condition changes
over time, the composition of the team may change to reflect the changing
clinical and psychosocial needs of the client.
Licensed Clinician – An individual who is:
A licensed practitioner of the healing arts (LPHA);
A licensed
social worker (LSW) possessing at least a master's degree in social work and
licensed under the Clinical Social Work and Social Work Practice Act [225 ILCS
20] with specialized training in mental health services or with at least two
years' experience in mental health services;
A licensed professional counselor (LPC) possessing at least a master's
degree and licensed under the Professional Counselor and Clinical Professional
Counselor Licensing Act [225 ILCS 107] with specialized training in mental
health services or with at least two years' experience in mental health
services;
A registered professional nurse (RPN) licensed under the Nurse Practice
Act [225 ILCS 65] with at least one year of clinical experience in a mental
health setting or who possesses a master's degree in psychiatric nursing; or
An occupational therapist (OT) licensed under the Illinois Occupational
Therapy Practice Act [225 ILCS 75] with at least one year of clinical
experience in a mental health setting.
Licensed Practitioner of the Healing Arts or LPHA − A LPHA is
defined as one of the following (additional information can be found in 89 Ill.
Adm. Code 140.453):
Physician;
Licensed advanced practice registered nurse with psychiatric specialty;
Licensed clinical psychologist;
Licensed clinical professional counselor;
Licensed marriage and family therapist; or
Licensed clinical social worker.
Medical
Assistance − Health care benefits authorized by HFS under Article V of
the Illinois Public Aid Code [305 ILCS 5].
Mental Health
Professional or MHP − An individual who provides services under the
supervision of a Qualified Mental Health Professional (additional information
can be found in 89 Ill. Adm. Code 140.453) and who possesses:
A bachelor's
degree in counseling and guidance, rehabilitation counseling, social work,
education, vocational counseling, psychology, pastoral counseling, family
therapy, or a related human service field;
A bachelor's
degree in any other field with two years of supervised clinical experience in a
mental health setting;
A practical
nurse license under the Illinois Nurse Practice Act [225 ILCS 65];
A certificate
of psychiatric rehabilitation from a DHS-approved program, plus a high school
diploma or GED, plus 2 years of experience in providing mental health services;
A recovery
support specialist certified by, and in good standing with, the Illinois
Alcohol and Other Drug Abuse Professional Certification Association, Inc.;
A family
partnership professional certificate from and in good standing with the
Illinois Alcohol and Other Drug Abuse Professional Certification Association,
Inc.;
An
occupational therapy assistant licensed under the Illinois Occupational Therapy
Practice Act [225 ILCS 75] with at least one year of experience in a mental
health setting;
A minimum of a
high school diploma or GED and 5 years supervised clinical experience in mental
health or human services; or
Any individual
employed as an MHP prior to July 1, 2013 may continue to be so designated
unless employment changes.
Mental Health
Setting – A location, public or private, in a group or individual practice, in
a mental health center, hospital or clinic where services intended to reduce
symptoms of mental illness are provided to persons with mental illness.
Mental Illness
− For clients age 18 and older, a mental disorder diagnosis contained in
the DSM-5 and ICD-10-CM. Mental illness does not include organic disorders such
as dementia and those associated with known or unknown physical conditions such
as hallucinations, amnestic disorder and delirium; psychoactive substance
induced organic mental disorders; and intellectual disabilities, autism
spectrum disorders or psychoactive substance use disorders.
Natural
Setting − A setting where an individual who has not been diagnosed with a
mental illness typically spends time, including home, work, churches, community
centers, libraries, parks, recreation centers, educational settings,
courthouses, jails or other public buildings. These sites are not licensed,
certified or accredited as a treatment setting nor typically identified as
treatment sites.
Natural
Support – Persons identified by the client who are not paid to provide support,
e.g., family, friends, pastor, colleague, landlord.
Notice of Violation
or NOV – A written document that specifies the standards within this Part with
which the entity/CMHC is not compliant.
Psychiatric
Resource −
A physician licensed under the Medical
Practice Act of l987 [225 ILCS 60] to practice medicine or osteopathy with
training in mental health services or one year of clinical experience, under
supervision, in treating problems related to mental illness, or specialized
training (i.e., the treatment of children and adolescents);
A psychiatrist (a physician
licensed under the Medical Practice Act of l987 [225 ILCS 60]) who has
successfully completed a training program in psychiatry approved by the
American Medical Association, the American Osteopathic Association or other
training program identified as equivalent by the Department;
An advanced practice registered nurse
(APRN) with a psychiatric specialty licensed in Illinois under Article 65 of
the Nurse Practice Act [225 ILCS 65]; or
A prescribing psychologist
licensed in Illinois pursuant to the Clinical Psychologist Licensing Act [225
ILCS 15], practicing within his or her scope of practice and adhering to all
applicable federal and State administrative rules and policies, with sufficient
credentials to prescribe psychotropic medications in Illinois.
Psychosocial Rehabilitation
Program or PSR − A facility-based program designed with the
infrastructure and supports necessary to provide intensive skill development in
a classroom-based setting, consistent with clinical standards set forth in Subpart
E.
Public Payer − A State
agency or a unit of local government that is responsible for payment for
services provided to a client.
"Qualified Mental Health
Professional" or "QMHP" means one of the following:
Any individual
identified as an LPHA.
A registered professional nurse
who holds a valid license in the state of practice, is legally authorized under
state law or rule to practice as registered nurse or registered professional
nurse, so long as that practice is not in conflict with the Illinois Nurse
Practice Act, and has training in mental health services or one year of
clinical experience, under supervision, in treating problems related to mental
illness, or specialized training in the treatment of children and adolescents.
An occupational therapist who
holds a valid license in the state of practice and is authorized under state
law or rule to practice as an occupational therapist, so long as that practice
is not in conflict with the Illinois Occupational Therapy Practice Act, with at
least one year of clinical experience in a mental health setting. If the state
of practice does not provide a legal authority for licensure, the individual
must meet the requirements of 42 CFR 484.4 for an occupational therapist.
An individual who possesses a
master's or doctoral degree in counseling and guidance, rehabilitation counseling,
social work, psychology, pastoral counseling, family therapy, or a related
field and has:
Successfully completed 1,000 hours
of practicum and/or internship under clinical and educational supervision; or
One year of documented clinical experience
under the supervision of a QMHP.
Rehabilitative Services Associate
or RSA − An RSA assists in the provision of rehabilitative services under
the supervision of a QMHP (additional information can be found in 89 Ill. Adm.
Code 140.453) and must:
Be at least 21 years of age;
Have demonstrated skills in the
field of services to adults or children;
Have demonstrated the ability to
work within agency structure and accept supervision; and
Have demonstrated the ability to
work constructively with clients, other providers and the community.
SAMHSA −
The federal Substance Abuse and Mental Health Services Administration responsible
for guidance to the State Mental Health Authorities, including administration
of the federal block grant, defining and identifying evidence-based practices,
and translation of research to practice.
Safety Net – A collection of services provided,
in collaboration with health care and social service providers throughout the
community, to the uninsured and other vulnerable populations. The collection of services is designed to help prevent individuals
from further emotional, mental, physical and economic decompensation, while promoting stability and empowerment.
Specialty
Certification – The confirmation from DHS-DMH, the Illinois State Mental Health
Authority, that a program meets the required clinical standards set forth in Subpart
E.
State Mental
Health Authority or SMHA – The entity within a state with federal and state
statutorily assigned responsibility for planning, organizing, delivering and
monitoring the programs that provide critical mental health services, through
the development of safety net programs that provide critical care to
individuals with serious mental illnesses who lack insurance and/or have high
levels of service needs. In Illinois, DHS-DMH is charged with this
responsibility, which includes the development and implementation of a plan for
comprehensive community mental health systems and reporting a set of
standardized utilization and outcome measures.
Supervision of
Treatment Services – The dedicated time an LPHA or QMHP spends with his or her
supervisees discussing the supervisees' work. This may include reviewing
individual cases, treatment plans, group counseling, individual counseling,
progress made by clients, or problem solving when progress is not occurring or
when individuals are not engaged in the therapeutic process. Supervision may
be done individually or in groups.
Treatment,
Habilitation and Support Services – Services designed to:
help individuals
develop skills that promote independence and improved levels of social and
vocational functioning and personal growth; and
provide
nontreatment support services necessary for successful community living [405
ILCS 30/2(e)].
 |
TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.30 CLIENT RIGHTS
Section 132.30 Client Rights
To assure that a client's rights are protected and that all
services provided to clients comply with the law, all providers under this Part
shall ensure that:
a) A
client's rights shall be protected in accordance with Chapter 2 of the Mental
Health and Developmental Disabilities Code [405 ILCS 5].
b) The
right of a client to confidentiality shall be governed by the Mental Health and
Developmental Disabilities Confidentiality Act and the federal Health Insurance
Portability and Accountability Act of 1996.
c) Staff shall inform the
client upon intake and annually of the following:
1) The
rights in accordance with subsections (a) and (b);
2) The
right to contact the Illinois Guardianship and Advocacy Commission and Equip
for Equality, Inc. The provider shall offer assistance to a client in
contacting these groups, giving each client the address and telephone number of
the Guardianship and Advocacy Commission and Equip for Equality, Inc.;
3) The
right to be free from abuse, neglect and exploitation;
4) The
right to be provided mental health services in the least restrictive setting;
5) The
client's right or the guardian's right to present grievances up to and
including the provider's Executive Director or comparable position. The client
or guardian will be informed of how his or her grievances will be handled at
the provider level. A record of, and the response to, those grievances shall
be maintained by the provider. The Executive Director's decision on the
grievance shall constitute a final administrative decision (except when the
decisions are reviewable by the provider's governing board, in which case the
governing board's decision is the final authority at the provider level);
6) The
right not to have services reduced, denied, suspended or terminated for
exercising any rights;
7) The
right to contact the public payer or its designee and to be informed of the
public payer's process for reviewing grievances;
8) The
right to have disabilities accommodated as required by the Americans With
Disabilities Act, section 504 of the Rehabilitation Act and the Human Rights
Act [775 ILCS 5]; and
9) The
right to contact HFS or its designee and to be informed by HFS or its designee
of the client's healthcare benefit and the process for reviewing grievances.
d) The
sharing of information consistent with this Section shall be communicated in a
language or a method of communication that the client understands. Documentation
that this information was shared in that manner shall be noted in the clinical
record.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.35 INTER-DEPARTMENTAL ADMINISTRATION AND COORDINATION OF SERVICES
Section 132.35 Inter-Departmental
Administration and Coordination of Services
a) DHS-DMH
and DCFS, pursuant to an executed interagency agreement with the Department,
shall ensure the administration and coordination of mental health services.
b) Specific
service details of Medicaid Rehabilitation Option (MRO) qualified mental health
services pursuant to section 1905(a)(13)(C) of the Social Security Act are
found in 89 Ill. Adm. Code 140.453(e) and (f).
SUBPART B: CERTIFIED SPECIALTY PROVIDER (CSP)
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.40 DEFINITION AND CHARACTERISTICS
Section 132.40 Definition and Characteristics
a) The
Department shall make CSP certification available on a voluntary basis to
entities seeking CSP designation. CSP certification may be required for
receipt of DHS-DMH and DCFS funding.
b) A CSP
is an entity providing community-based mental health services under the
direction of an LPHA in a specific geographic area or to a specialized
population. At a minimum, a CSP:
1) Provides services
necessary to prevent unnecessary institutionalization.
2) Collaborates
with other entities supporting the needs of individuals, including, but not
limited to, primary care providers, coordination entities and/or managed care
entities.
3) Meets
all of the requirements outlined in Subpart D, as demonstrated by having been
issued a certificate by a CSA in accordance with the requirements set forth in
this Part.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.45 GENERAL REQUIREMENTS
Section 132.45 General Requirements
a) The
CSP shall operate in a manner compliant with all applicable State and federal
laws, regulations, and adopted policies and procedures.
b) The
CSP shall establish and maintain policies and procedures to be used by all CSP
staff in the administration of programs and the delivery of services from any
CSP site or location.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.50 QUALITY SYSTEMS REQUIREMENTS
Section 132.50 Quality Systems Requirements
a) The
CSP shall establish and maintain continuous quality improvement systems to
ensure quality of care provided in the least restrictive setting supporting the
ongoing purchase of services.
b) The
CSP shall establish and maintain a Utilization Review Plan for the ongoing
review and assessment of delivered services and client outcomes to ensure
services are cost effective and result in the expected outcomes.
c) The
CSP shall establish and maintain a system for obtaining feedback from
individuals served and community stakeholders.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.55 PERSONNEL AND STAFFING REQUIREMENTS
Section 132.55 Personnel and Staffing Requirements
The CSP shall:
a) Establish
and maintain a comprehensive set of personnel policies and procedures,
minimally addressing hiring, training, evaluation, disciplining, termination,
and other personnel matters related to staffing. Establish and maintain job
descriptions detailing the duties and qualifications for all positions,
including volunteers, interns and unpaid personnel. Establish and maintain
individual personnel records for all personnel, paid and unpaid, minimally
including the following components:
1) Documentation
of current education, experience, licensure and certification;
2) Employment
status of the individual (e.g., hire date, employee/contractor, termination
date, etc.);
3) Review
of individual employee's performance within the last 12 months; and
4) Documentation
of training and continuing education units, as applicable.
b) Upon
hire, perform sufficient background checks for all employees, volunteers,
interns, unpaid personnel, or other individuals who are agents of the CSP or
CMHC. At a minimum, the review shall include:
1) Searching the Illinois Department of Public Health's
(DPH) Health Care Worker Registry concerning the person. If the Registry has
information substantiating a finding of abuse or neglect against the person,
the provider shall not employ them in any capacity.
2) Performing background checks in compliance with
requirements set forth in the Health Care Worker Background Check Act [225 ILCS
46] and in DPH rules at 77 Ill. Adm. Code 955.
3) Reviewing the Provider Sanctions List,
provided by the HFS Office of Inspector General (HFS-OIG), to ensure the
provider is not on the list of sanctioned providers. The CSP/CMHC shall not
employ or contract with any provider found on the List.
c) The provisions
of Section 132.55(b), except for subsection (b)(3), do not apply to Peer
Support Workers (PSWs) providing services as part of a Violence Prevention
Community Support Team (VP-CST) pursuant to 89 Ill. Adm. Code 140.453. PSWs
delivering VP-CST must meet the background check requirements outlined in 89
Ill. Adm. Code 140.TABLE P.
d) Annually,
at a minimum, comply with all requirements set forth in the Health Care Worker
Background Check Act and in DPH rules.
e) Ensure
that all assessment activities and subsequent individual treatment plans are
developed with the active involvement of a QMHP and the clinical review of an
LPHA.
f) Ensure
management and oversight of all treatment staff by a QMHP. Management and
oversight may be face to face or virtual, to include group supervision as well
as supervision by teleconference and videoconference. All treatment staff must
have access to a QMHP who is available for immediate consultation and
supervision of treatment services.
g) All
staff shall receive, at a minimum, one hour of supervision per month delivered
face to face, or by teleconference or videoconference.
1) Group
supervision is acceptable and the size of the group shall be conducive to the
topic being discussed.
2) Supervision
must be documented in a written record.
3) LPHAs
are not required to have supervision under this Section.
4) QMHPs
must be supervised by an LPHA. MHPs and RSAs must be supervised by, at a
minimum, a QMHP.
(Source: Amended at 48 Ill. Reg. 12012,
effective July 25, 2024)
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.60 RECORDKEEPING REQUIREMENTS
Section 132.60 Recordkeeping Requirements
a) The CSP shall maintain
records, including but not limited to the following:
1) Clinical records;
2) Service billing files;
3) Organizational records,
including policies and procedures;
4) Personnel records; and
5) All other documents
required in this Part.
b) Required
records shall be retained for a period of not less than 10 calendar years from
the date of service, or origin of the record, except that, if an audit is
initiated within the required retention period, the records shall be retained
until the audit is completed and every exception resolved. This provision is
not to be construed as a statute of limitations.
c) Required
records shall be readily available for inspection, audit and copying during
normal business hours by personnel representing the CSA, the public payer, HFS,
CMMS, or U.S. Department of Health and Human Services, as applicable.
d) The
compilation, storage of, and accessibility to records, including electronic
records, shall be governed by written policies and procedures, in accordance
with the Confidentiality Act, HIPAA, HITECH, and all other applicable State and
federal laws.
e) Clinical
records and other client information, regardless of format, shall be secured
from theft, loss or fire.
f) Electronic
or digital signature of records is acceptable when the CSP has established the
necessary policies and procedures to:
1) safeguard
the issuance and identity of users;
2) ensure
uniqueness in issuance of signature;
3) regularly
review the usage of signature;
4) ensure
adequate safeguards within the system upon application of signature to
documents; and
5) audit
users to remove unnecessary, unused, and abuses on a regular frequency.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.65 PHYSICAL PLANT LOCATION REQUIREMENTS
Section 132.65 Physical Plant Location Requirements
a) At a
minimum, a CSP shall have a single discrete physical location, owned, leased or
controlled by the entity seeking certification.
b) All
additional locations where treatment services occur, if owned, leased or
controlled by the CSP, must be certified. Locations meeting the definition of natural
settings do not need to be certified.
c) All
locations must meet the following physical plant requirements for
certification:
1) Provide
a safe, functional, sanitary and comfortable environment for clients and staff
that is conducive to the provision of behavioral health services.
A) A
safe, functional and sanitary environment includes the establishment and
maintenance of policies and procedures specific to the operation of each
specific physical plant, including an emergency disaster plan, fire evacuation
plan, and procedures for managing the basic mechanics of the site.
B) A
comfortable environment shall be reflective of trauma informed care, ensuring
that the interventions being provided and the populations being served have
access to an environment that ensures the physical, psychological and emotional
safety of both employees and populations being served;
2) Meet
health and safety standards and State health care occupancy regulations as
applicable;
3) Be
deemed accessible in accordance with the ADA, the Illinois Accessibility Code,
and the ADA Accessibility Guidelines, whichever is more stringent. Providers
must maintain a written policy for reasonable accommodations for the provision
of services to clients unable to access the provider's sites due to physical
inaccessibility;
4) Be in
compliance with approved State and local building and fire ordinances and codes
as follows:
A) Fire
safety in accordance with rules of the Office of the State Fire Marshal at 41
Ill. Adm. Code 100.
B) Building
requirements in compliance with the uniform or national building code adopted
by local or county ordinance.
SUBPART C: CERTIFIED COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER (CMHC)
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.70 DEFINITION, CHARACTERISTICS AND INCENTIVES
Section 132.70
Definition, Characteristics and Incentives
a) Certified
Comprehensive Community Mental Health Centers are a specialty service provider
type embedded in the community with knowledge and expertise in providing
services to adults with or at risk of serious mental illnesses (SMI) and/or
children and youth with or at risk of serious emotional disturbances (SED.
CMHCs respond to the unique mental health needs of the community with a
continuum of services ranging from prevention/promotion through treatment and
recovery. CMHCs collaborate with other social service and health care
providers to deliver integrated care to individuals in the identified
geographic service area. CMHCs must be nonprofit or local government entities.
b) CMHCs
shall:
1) Comply
with all requirements of a CSP as articulated in Subpart B, in addition to the
requirements set forth in this Subpart C.
2) Operate
within a system of care that provides treatment, habilitation and support
services.
3) Provide
a comprehensive strengths-based array of mental health services within an
identified geographic service area.
4) Provide
care to individuals with or at risk for SMI/SED by using a person-centered approach
to care performed by an interdisciplinary team.
5) Serve
individuals who have complex needs as a result of child welfare, justice or
multisystem involvement, medical co-morbidity, homelessness, dual disorders,
etc.
6) Ensure
the connectability of services in the service area for individuals across the
life span.
7) Provide
services in the client's natural settings.
8) Provide
a safety net for individuals with SMI/SED who are indigent.
9) Provide
outreach and engagement to individuals in need of mental health services.
10) Provide
evidence-based and evidence-informed developmentally appropriate practices in a
proficient manner.
11) Provide
for a screening prior to a referral to a more intensive level of care.
12) Provide
education and resources to the public on mental health issues, including
suicide prevention and wellness.
13) Prioritize
principles of recovery, system of care, trauma informed care, and culturally
relevant practices.
14) Provide
access or linkage to psychiatric services and other health and social services.
c) CMHCs
are the only entities that may pursue certifications of the following programs:
1) Assertive Community
Treatment Programs; and
2) Psychosocial
Rehabilitation Programs.
d) DHS-DMH
will recognize certified CMHCs as preferred provider types when awarding State
grant funds to support mental health treatment programs and services as State
laws permit.
e) DHS-DMH
will recognize certified CMHCs as preferred provider types when pursuing
federal or other grants within DMH or when awarding federal pass-through funds
as federal and State laws permit.
f) DHS-DMH
will recognize certified CMHCs as preferred provider types when establishing
technical assistance and training programs.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.75 GENERAL REQUIREMENTS
Section 132.75 General Requirements
a) Establish
and maintain policies and procedures to be used by all CMHC staff in the
administration of CMHC programs and the delivery of services from any CMHC site
or location.
1) Policies
detailing the organization's clear commitment to person-centered recovery and resilience
principles and the empowerment of families and individuals served. Programs
and services should promote personal choice, self-help measures, the
strengthening of natural supports, the use of education and interventions in
natural settings, and the reduction of the utilization of institutional levels
of care.
2) Policies
detailing how clients will actively participate in the development, planning
and oversight of programs and services.
3) Policies
and procedures to ensure co-morbid physical healthcare needs are addressed for
clients as needed. A CMHC that is not licensed to provide Level 1 and Level 2
Substance Use services and enrolled to participate in the Illinois Medical
Assistance Program shall develop policies and procedures to ensure clients
receive referrals for services as needed.
4) Policies
and procedures to ensure SAMHSA's principles of trauma informed approaches are
embedded into the organizational structure and clinical practices of the CMHC.
b) Ensure
the availability of services that are culturally and linguistically appropriate
and responsive to the needs of clients served, including but not limited to
children/youth, military families, those in the criminal justice system, and
the LGBTQ population.
c) Ensure
the availability of and/or linkage to a psychiatric resource for the purpose of
consultation, evaluation, prescription and management of medication as needed
by clients served by the CMHC. This may be secured through various
arrangements, including but not limited to employment, contractual relationship
or mutual agreement.
d) Identify
a specific geographic service area in which the CMHC will operate and organize
the delivery of services and programs and provide interventions to clients.
e) Maintain
insurance against professional and physical liabilities.
f) Ensure
the estimated incidence and prevalence of serious mental illness and severe
emotional disturbance are collected. Providers must participate in DHS-DMH
surveys to collect data to meet federal reporting requirements via registration
information and/or ad hoc surveys.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.80 PERSONNEL AND STAFFING REQUIREMENTS
Section 132.80 Personnel and Staffing Requirements
Establish and maintain an organizational structure that
includes a staffing structure and management system consistent with the following:
a) Employ
a full-time LPHA to oversee and direct the clinical functions of the CMHC;
b) Maintain
staff with training and credentialing to provide interdisciplinary
person-centered care, evidence based/informed practices, developmentally
appropriate trauma informed care, and culturally and linguistically responsive
services.
c) When
good cause is established by the organization, an exception to the full-time
status of the LPHA may be granted by the Department in accordance with the
process and criteria outlined in this subsection (c).
1) The
organization shall submit a request for consideration of waiver to the Department
detailing the reasons for the request.
2) The
organization shall provide a detailed staffing plan that includes the number
and credential levels of all staff providing direct services that include a
calculation of the hours of clinical supervision necessary to meet the
requirements of Section 132.55(g)(4).
3) The
organization shall provide a projected number of individuals to be served on
annual basis and calculation of the hours required for provision of clinical
oversight and direction of all clinical functions related to those services.
This calculation shall be based on a needs assessment of the service area
completed by the organization.
4) The
organization shall propose a staffing equivalency for clinical oversight and
direction by the LPHA that is sufficient to meet the needs identified in
Section 132.80(c)(2) and (3).
5) The
organization shall describe a plan to ensure access to clinical direction and
oversight of an LPHA by less-credentialed staff in the event of emergent
situations.
6) Request
for an exception must be submitted to the Department for consideration at least
30 calendar days prior to the anticipated need for the exception.
(Source: Amended at 48 Ill. Reg. 12012,
effective July 25, 2024)
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.85 ADDITION AND REMOVAL OF PHYSICAL PLANT LOCATIONS
Section 132.85 Addition and Removal of Physical Plant
Locations
a) Upon
enrollment and establishment of the CMHC, the entity may seek to add additional
physical plant locations to operate as part of the CMHC, pursuant to Section 132.65.
All CMHC requirement documentation and plans must be updated to reflect the
addition of the physical plant location and must meet standards established in Subparts
B and C.
b) The CMHC
must notify the CSA and HFS of a change in status if any physical plant
location is removed from the CMHC or becomes inactive. Furthermore, such a
change must note if the removal or inactive status impacts the CMHC's ability
to meet the standards detailed in Subparts B and C.
c) The
addition, removal or other potential changes in status reported by the CMHC to
the CSA and HFS may result in a review of documents and plans consistent with Subparts
B, C and D, resulting in certification, compliance review, or failure of the CMHC
to retain status as a CMHC.
SUBPART D: ENROLLMENT AND CERTIFICATION REQUIREMENTS OF CERTIFIED COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTERS AND CERTIFIED SPECIALTY PROGRAMS
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.95 CERTIFIED SPECIALTY PROVIDERS (CSP) AND CERTIFIED COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER (CMHC) CERTIFICATION PROCESS
Section 132.95 Certified Specialty Providers (CSP) and
Certified Comprehensive Community Mental Health Center (CMHC) Certification
Process
a) The
IMPACT portal is the enrollment site for the HFS Provider Participation Unit. Entities
seeking certification as a CMHC shall request enrollment through the IMPACT
portal. Any entity enrolled through the IMPACT portal may request certification
from a CSA as a CSP or CMHC.
b) During
the IMPACT application process, entities shall determine what population they
will be serving and will be directed to the appropriate CSA to complete the
certification process.
1) If an
entity intends to contract for services with more than one CSA, it shall submit
its certification application to the State agency that provides the most
funding for community mental health services.
2) If
the funding from both CSAs is equal, the provider shall submit the application
to DHS.
c) The
entity shall contact the CSA in writing to request the application packet.
DHS-BALC:
401 S. Clinton, 7th Floor
Chicago IL 60627
DHS.BALC@illinois.gov
DCFS:
DCFS.Medicaid@illinois.gov
d) IMPACT
will issue notice of initial enrollment to the provider and the CSAs within 10
days. The CSA shall review the provider information provided through the
IMPACT portal.
e) Upon review of all
submitted materials, the CSA shall determine that:
1) The
submitted materials meet the standards of a CSP or CMHC established in Subparts
B and C; or
2) The
submitted materials do not meet the standards established in Subparts B and C.
f) If
the CSA determines that the submitted materials meet the standards established
in Subparts B and C, the CSA shall issue a provisional certification
determination to HFS, if applicable, and the entity within 30 days after
reviewing materials and reaching a determination.
1) The
effective date of provisional certification shall indicate the type of
certification awarded and the date that the application was approved.
2) A
provisional certificate shall be in effect for 12 months, unless extended by
the CSA.
3) An
entity issued a provisional certificate shall enroll in any information system
required by the CSA.
g) If
the CSA determines that the submitted materials do not meet the standards
established in Subparts B and C, the CSA shall issue the applicant a Notice of
Violation within 30 days after the review. The NOV shall provide the entity 30
days to remedy the violations.
1) If
the entity intends to proceed with certification as a CSP or CMHC, the entity
may submit notice and documentation of corrections to the CSA to address all
identified violations by the due date indicated on the NOV.
2) If
the notice and documentation of corrections is found to address all of the
identified violations included in the NOV, then the CSA shall continue with the
certification process outlined in this Part.
3) If
the entity pursuing CMHC certification fails to supply the necessary materials
or the supplied materials fail to meet the standards detailed in this Part, the
CSA shall notify HFS and the entity in writing of the entity's failure to
obtain certification as a CMHC and right to appeal pursuant to Section 132.110.
4) If
the entity pursing CSP certification fails to supply the necessary materials or
the supplied materials fail to meet the standards detailed in this Part, the
CSA shall notify the entity in writing of the entity's failure to obtain
certification as a CSP and right to appeal pursuant to Section 132.110.
h) The
CSA may supply technical assistance through the certification process as deemed
necessary.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.100 INITIAL ON-SITE CERTIFICATION
Section 132.100 Initial On-site Certification
a) The
CSA shall be granted access to all physical plant locations.
b) The
CSA shall be granted access to all records, upon request, during any
certification or other compliance review activities.
c) On-site
Certification
1) The
CSA shall perform an on-site review within the provisional certification period
outlined in Section 132.95(f) to confirm the findings of the provisional certification
determination. If the CSA determines the CSP or CMHC to be:
A) In
compliance, the CSA shall notify the CSP or CMHC. For providers enrolled in
the IMPACT system, the CSA shall notify HFS of the change in certification
status from provisional to full certification.
B) Not in
compliance, the CSA shall issue the CSP or CMHC a Notice of Violation within 15
days after the on-site review. The entity shall respond to the NOV by the due
date indicated on the NOV, which shall be approximately 30 days after the date
of the NOV.
2) The CSP
or CMHC shall submit notice and a Plan of Correction to the CSA to address all
identified violations by the due date indicated on the NOV.
3) If
the notice and Plan of Correction is found to address all of the identified violations,
the CSA shall assure implementation of the Plan of Correction. The program
certification status must be in "good standing" with the CSA. The
CSA shall notify the CSP or CMHC of the change in certification status from
provisional to full certification. For entities enrolled in the IMPACT Portal,
the CSA shall notify HFS of the change in certification status from provisional
to full certification.
4) If
the CSP or CMHC fails to supply a Plan of Correction or fails to implement its
approved Plan of Correction and is "not in good standing" with the
CSA, as detailed in this Part, the CSA shall notify the entity in writing of its
failure to retain certification and right to appeal pursuant to Section 132.100.
For entities enrolled in IMPACT, the CSA shall also notify HFS of the entity's
failure to retain certification.
5) If
the CSA finds evidence of suspected fraud or abuse relating to Medical
Assistance, the CSA shall refer that evidence to HFS-OIG for further action.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.105 CERTIFICATION REVIEW CYCLE
Section 132.105 Certification Review Cycle
a) The
CSA may perform a review for compliance with the standards of this Part at any CSP
or CMHC, at will, regardless of deemed status and without prior notice to the entity.
b) The CSAs
shall, at a minimum, review one-third of all CSPs and CMHCs on an annual basis,
ensuring that all CSPs and CMHCs are reviewed within a three year period. If
the CSA determines the entity to be:
1) In
compliance with Subparts B, C and D, the CSA shall notify the entity of
retention of certification. For entities enrolled in the IMPACT system, the
CSA shall notify HFS of retention of certification.
2) Not
in compliance, the CSA shall issue the entity a Notice of Violation within 15
days after the on-site review. The entity shall respond to the NOV by the due
date indicated on the NOV, which shall be approximately 30 days after the date
of the NOV.
A) The
entity shall submit a Plan of Correction to the CSA to address all identified violations
by the due date indicated on the NOV.
B) If the
Plan of Correction is found to address all of the identified violations
included in the NOV, the CSA shall assure implementation of the Plan of
Correction, which will determine the certification status. The program
certification status must be in "good standing" with the CSA. The
CSA shall notify the entity of retention of certification. For an entity
enrolled in IMPACT, the CSA shall also notify HFS of the entity's retention of
certification.
c) If
the entity fails to supply the necessary materials or the supplied materials
fail to meet the standards detailed in Subparts B, C and D, the CSA shall
notify the entity of its failure to retain certification and the right to
appeal pursuant to Section 132.340. For entities enrolled in IMPACT, the CSA
shall also notify HFS in writing of the entity's failure to retain
certification.
d) If
the CSA finds evidence of suspected fraud or abuse relating to Medical
Assistance, the CSA shall refer that evidence to HFS Office of Inspector
General for further action.
e) Revocation
of Certification
1) The
CSA may revoke an entity's certification at any time for any of the following
reasons:
A) The
entity meets any of the grounds for termination set forth in 89 Ill. Adm. Code
140.16;
B) The
entity is convicted of defrauding the Medical Assistance Program under Article
VIIIA of the Illinois Public Aid Code; or
C) The entity
fails to comply with the requirements of Subpart B, C or D.
2) The
CSA shall notify the entity in writing of the entity's revocation of
certification and right to appeal pursuant to Section 132.110. For providers
enrolled in the IMPACT system, the CSA shall notify HFS.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.110 APPEAL OF CERTIFICATION DETERMINATION
Section 132.110 Appeal of Certification Determination
a) An entity may appeal the
following actions detailed in this Part:
1) Refusal
to issue a provisional certification;
2) Refusal
to issue full certification;
3) Refusal
to retain certification; or
4) Revocation
of certification.
b) If
the CSA determines that provisional certification or certification shall not be
issued, that certification shall not be retained, or that an entity's
certification shall be revoked, the CSA shall send written notice to DHS and
the entity within 30 days after that determination. The notice shall contain
the specific requirements with which the entity has not complied, the CSA's
proposed action, and the entity's rights as follows:
1) If
the entity chooses to appeal the CSA's decision, the entity shall submit a
written request for a hearing to the DHS Bureau of Hearings, within 20 days
after the date of the notice.
2) If an
appeal is initiated by a CMHC with provisional certification or certification,
the entity may continue to provide services pending a final administrative
decision unless the entity's continued provision of services would present an
imminent risk of harm.
3) Hearing
Process
A) The DHS
rules at 89 Ill. Adm. Code 508 (Administrative Hearings) shall apply.
B) The
sole issue at the hearing shall be whether the provider is in compliance with
certification requirements set forth in this Part or meets the criteria for
revocation of certification set forth in this Part.
C) The
burden of proof in hearings conducted pursuant to this Section shall be on the
appealing entity.
4) If
the final administrative decision pursuant to appeal is that certification
shall not be issued or retained, or that an entity's certification shall be revoked,
the notice shall specify that the decision shall take effect upon receipt by
the entity and that the entity shall not be certified as a CMHC during the
pendency of any proceeding for judicial review of the hearing decision, except
by court order.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.115 NONTRANSFERABILITY
Section 132.115 Nontransferability
a) CMHC
certification is assignable or transferable consistent with the policies and
procedures established by the HFS Provider Participation Unit related to the
assignment and transferability of an entity's enrollment status with HFS.
b) CMHC
certification is not assignable or transferable between or among entity-owned
or leased physical plant locations without an on-site review of the location to
ensure compliance with this Part.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.120 DEEMED STATUS
Section 132.120 Deemed Status
a) The CSA, in qualifying an entity as a CMHC for participation
and enrollment in the Illinois Medical Assistance Program as governed by the
Social Security Act and all applicable federal regulations, shall grant deemed
status to accredited CMHCs, pursuant to Section 3 of the Community Services Act
[405 ILCS 30] and this Section.
1) "Deemed status" means that, if an entity is actively
accredited by an Acknowledged Accrediting Organization (AAO) or Standard
identified in subsection (a)(2), the CSA shall deem the entity to meet all
qualifying requirements of this Part covered by the AAO, as determined by DHS
in collaboration with the AAOs, consistent with subsection (b).
2) Acknowledged Accrediting Organizations and Standards
A) The Joint Commission, One Renaissance Boulevard, Oakbrook
Terrace IL 60181; Standards for Behavioral Health Care Accreditation; Standards
for Hospital Accreditation
B) Council on Accreditation (COA), 45 Broadway, 29th Floor,
New York NY 10006; Standards for Private Organization/Behavioral Health
Services Accreditation; Standards for Public Agency/Behavioral Health Services
Accreditation
C) The Council on Quality and Leadership, 100 West Road, Suite
300, Towson MD 21204; Standards for Quality Assurances Accreditation; Standards
for Person-Centered Excellence Accreditation; Standards for Person-Centered
Excellence Accreditation with Distinction
D) Commission on Accreditation of Rehabilitation Facilities
(CARF), 6951 East Southpoint Road, Tucson AZ 85756-9407; Standards for Behavioral
Health Accreditation
E) Healthcare Facilities Accreditation Program (HFAP), 142 E.
Ontario Street, Chicago IL 60611; Standards for Behavioral Health Accreditation
b) Determination of Covered Standards. In an effort to afford
entities and CMHCs a streamlined certification process, DHS shall complete a
process to determine covered standards pursuant to Section 3(d-10) of the
Community Services Act;
1) Due to the proprietary nature of the intellectual property
retained by the AAO within its standards, DHS shall require the AAO to complete
the following documents:
A) Crosswalk of Standards. On and after January 1, 2019, and upon
any material changes to any standard, the Crosswalk of Standards shall be
completed and submitted by the AAOs with their Attestation of Accrediting
Standards. The AAO can provide an updated Crosswalk of Standards, including
new standards, at any time. The standards received by the CSA by January 31 of
any given year will be considered for deeming at the start of the next State
Fiscal Year.
B) Attestation of Accrediting Standards. The Attestation of
Accrediting Standards shall be completed, signed and submitted to DHS prior to
May 30 of any given year when material changes to the standards that are
matched to requirements in this Part are made, in attestation for the following
State Fiscal Year to begin on July 1.
C) The Crosswalk of Standards and Attestation of Accrediting Standards
shall be submitted to:
DHS Bureau of
Accreditation, Licensure and Certification
401 S. Clinton
Street, 7th Floor
Chicago IL 60607
2) The CSAs reserve the right to request additional detail
regarding any submitted Crosswalk of Standards or Attestation of Accrediting
Standards.
3) Entities and CMHCs accredited by an AAO or Standard shall be
deemed to have met any certification requirements of this Part that are
determined by DHS pursuant to this Section to be covered by the accreditation
standards of that AAO.
4) Non-deemed requirements and applicable violations identified
in the AAO report shall be reviewed for compliance by the CSA.
c) The CMHC shall demonstrate current accreditation status by
submission to the CSA of a certificate of accreditation and the most recent
accreditation report.
d) If the CMHC's accreditation is suspended, lost or
discontinued, the CMHC shall notify the CSA of that change within 30 days after
the effective date of the change.
e) The CMHC shall submit its complete accreditation report to the
CSA within 30 days after receipt from the AAO.
f) Deemed status may be nullified in part or in whole by a
complaint or report to the CSA that the CMHC is noncompliant with Subpart B, C or
D.
g) Upon notification of loss or discontinuance of accreditation
or nullification of deemed status, the CSA shall prepare to review the CMHC
pursuant to Section 132, applying all of the standards of Subparts B, C and D.
SUBPART E: SPECIALTY PROGRAM CERTIFICATION AND COMPETENCY
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.125 CAPACITY AND ORGANIZATIONAL READINESS
Section 132.125 Capacity and Organizational Readiness
Entities requesting certification shall demonstrate
sufficient capacity and organizational readiness to deliver specialty programs
safely, effectively, and in a manner consistent with evidence-based and
developmentally appropriate practices.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.130 INTERDISCIPLINARY CARE
Section 132.130 Interdisciplinary Care
Organizations certified as competent in interdisciplinary
care have access to the range of professionals and paraprofessionals necessary
to meet the variety of mental health needs of individuals in their community. Components
of this certification include:
a) Demonstration
of collaboration across disciplines, as described in the organization's policy
and practices;
b) Demonstration
of clinical leadership by an LPHA;
c) Demonstration
of team development as informed by the clinical needs of the client;
d) Demonstration
of training in evidence-based/evidence-informed practices,
e) Demonstration
of the infrastructure necessary to support cross-training and shared learning;
f) Demonstration
of the ability to appropriately share client information across multiple
providers to support ongoing collaboration, treatment planning, and after care;
and
g) Demonstration
of a staff-to-client ratio sufficient to meet the needs of individual clients.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.135 ASSERTIVE COMMUNITY TREATMENT PROGRAM
Section 132.135 Assertive Community Treatment Program
Components of this certification include:
a) Demonstration
of ability to conduct thorough assessments of individuals with dual diagnoses
of mental illness and substance use disorder;
b) Demonstration
of ability to provide the evidence-based treatment model for Assertive
Community Treatment;
c) Demonstration
of ability to meet the six-member-team-based requirements of ACT, including but
not limited to:
1) Supervision
by a licensed clinician, as defined in Section 132.25, who is the team leader;
2) A full time RN;
3) Program
support provided by a psychiatrist and a program administrative assistant;
4) An individual certified
in substance abuse treatment;
5) An individual who can
provide rehabilitative counseling; and
6) A Certified Recovery
Support Specialist;
d) Demonstration
that the team can maintain a client-to-staff ratio of no more than 10 clients
to one full time staff member, which shall not include the psychiatrist and program
administrative assistant;
e) Demonstration
of the ability for the ACT team to meet daily (a minimum of four times/week) to
conduct an organizational staff meeting; and
f) Demonstration
of the ability to meet the training and documentation requirements included in
the provider manual.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.140 PSYCHOSOCIAL REHABILITATION PROGRAM
Section 132.140 Psychosocial Rehabilitation Program
Components of this certification include:
a) Demonstration
of a QMHP providing on-site supervision 50% of the program time;
b) Demonstration
that, at minimum, an RSA provides the PSR services;
c) Demonstration
of ability to maintain a maximum client-to-staff ratio of 15 to one;
d) Demonstration
that, at minimum, one staff member has documented experience and training to
provide services and interventions to individuals with co-occurring psychiatric
and substance use disorders;
e) Demonstration
of ability to provide PSR services on site;
f) Demonstration
of coordination of access to the mental health services identified in the
individual treatment plan; and
g) Demonstration
that training and documentation requirements included in the provider manual
are met.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.145 COMMUNITY SUPPORT TEAM PROGRAM
Section 132.145 Community Support Team Program
Components of this
certification include:
a) Demonstration
of ability to meet staffing requirement that each team includes a minimum of
three and a maximum of six full-time equivalent employees, consisting of no
more than eight different staff members.
b) Demonstration
of ability to meet the requirement to staff the program with a QMHP who is the
full-time team leader and functions as a practitioner on the team.
c) Demonstration
of ability to maintain a maximum client-to-staff ratio of 18 to one.
d) Demonstration
that the team includes at least one Certified Recovery Support Specialist
(CRSS) or Certified Family Partnership Professional (CFPP) as a team member.
e) Demonstration
of ability to provide 60% of CST services in a natural setting.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.150 INTENSIVE OUTPATIENT PROGRAM
Section 132.150 Intensive Outpatient Program
Components of this certification include:
a) Demonstration of QMHP
providing program supervision and oversight.
b) Demonstration
of ability to maintain a maximum client-to-staff ratio of four to one for
children and adolescents and eight to one for adults.
c) Demonstration
that services are available a minimum of four hours per day, five days per
week.
| TITLE 59: MENTAL HEALTH
CHAPTER IV: DEPARTMENT OF HUMAN SERVICES
PART 132
MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM
SECTION 132.155 SPECIALTY CERTIFICATION PROCESS
Section 132.155 Specialty Certification Process
a) The
provider shall submit to DHS.DMH.SPC@illinois.gov information that demonstrates
compliance with the components listed in this Subpart E for each specialty
program in which it is seeking certification.
b) CMHCs
shall be awarded deemed status, pursuant to Section 132.120, for components
that are covered by accreditation or certification.
c) DMH
will review all submitted materials to determine eligibility for special
program certification within 90 days after receipt.
1) If
the provider is eligible for special program certification, DHS-DMH will issue
a certificate to the provider and inform HFS of the certification status.
A) Special program certification
will be effective on date of issue.
B) Recertification of a specialty
program shall occur annually.
2) If
the provider is ineligible for special program certification, DHS-DMH will
issue a Notice of Violation that will provide the entity 30 days to remedy the
violations.
A) If the
entity submits documentation of corrections by the due date indicated on the NOV,
DHS-DMH will review and make a determination within
10 days after receipt; and
B) DHS-DMH will notify the
entity of the outcome within 15 days.
3) The
appeals process for a specialty certification shall follow the process defined
in 89 Ill. Adm. Code 140.Table N.
d) DHS-DMH
may supply technical assistance through the certification process as deemed
necessary.
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