TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115 STANDARDS AND LICENSURE REQUIREMENTS FOR COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.120 DEFINITIONS
Section 115.120 Definitions
For the purpose of this Part, the following terms are defined:
"Abuse." Any physical injury, sexual abuse or mental injury inflicted on an individual other than by accidental means. (Section 1-101.1 of the Code)
"Accreditation." A process establishing that a program complies with nationally-recognized standards of care as set by one of the following:
1998 Hospital Accreditation Standards (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1998);
1997-1998 Standards for Behavioral Health Care (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);
1996 Comprehensive Accreditation Manual for Health Care Networks (Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, 1996);
Council on Accreditation 1997 Standards for Behavioral Health Care Services and Community Support and Education Services (Council on Accreditation of Services for Families and Children (COA), 120 Wall Street, 11th Floor, New York, New York 10005, 1996);
1997 Personal Outcome Measures (The Council, 100 West Road, Suite 406, Towson, Maryland 21204, 1997);
Behavioral Health Standards Manual (CARF, The Rehabilitation Commission, 4891 East Grant Road, Tucson, Arizona 85711, 1998);
Standards Manual and Interpretative Guidelines for Employment and Community Support Services (CARF, The Rehabilitation Commission, 4891 East Grant Road, Tucson, Arizona 85711, 1998); or
Education Standards (National Accreditation Council for Agencies Serving the Blind and Visually Handicapped, 15 West 65th Street, New York, New York, 10023, 1994).
"Agency." A community mental health or developmental services organization licensed by the Department which is a sole proprietorship, association, partnership, corporation or organization, public or private, either for profit or not for profit, that certifies community-integrated living arrangements for individuals with a mental disability. (Section 3(b) of the Community-Integrated Living Arrangements Licensure and Certification Act)
"Agency supervision." Either continuous supervision or support or intermittent supervision or support as defined in this Section.
"Applicant." A person, group of persons, association, organization, partnership or corporation that applies for a license to provide community-integrated living arrangement services under this Part.
"Array of services." A range of activities and interventions designed to provide treatment, habilitation, training, rehabilitation and other community integrative supports.
"Authorized agency representative." The administrative head of an agency appointed by the agency's governing body with overall responsibility for fiscal and programmatic management.
"Aversive procedures." The application, contingent on the exhibition of a specific behavior that is not adaptive, of unpleasant or painful stimuli, or stimuli that have a potentially noxious affect.
"Certification." An affirmation by an agency that programs operated under this Part meet the Part's standards and provide services to promote community-integrated living.
"Code." The Mental Health and Developmental Disabilities Code [405 ILCS 5].
"Community-integrated living arrangement (CILA)." A living arrangement certified by an agency where eight or fewer individuals with a mental disability reside together in a home under the supervision of the agency and are provided with an array of services. (Section 3(d) of the Community-Integrated Living Arrangements Licensure and Certification Act)
"Community integration" or "integration into the community." On-going participation in community life including at least the following:
The amount of time spent out of the living arrangement in generic (non-disability) related activities such as church, Y.M.C.A., Y.W.C.A., education, library, clubs, shopping and amusements.
Participation in family activities and celebrations such as holidays, birthdays, reunions, communication (telephone and mail) and vacations.
"Confidentiality Act." The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].
"Consumer representatives." Persons chosen by individuals and representing the interests of individuals served by an agency such as family members, guardians and advocates.
"Continuous supervision or support." Direction or assistance provided to an individual under the auspices of the licensed agency. An employee or any other person compensated or in a volunteer capacity, but not the guardian of the individual, with responsibility for care of individuals served from the licensed agency, or another agency through which any portion of CILA services is being provided, must be physically present on-site all hours individuals are present. Continuous supervision or support may range from being in immediate line of sight to the individual receiving services, to present and accessible to the individual receiving services, depending on the individual's services plan.
"Day." A calendar day, unless otherwise indicated.
"Deemed status." If an agency has been accredited by an approved accrediting body as identified in the definition of "accreditation" in this Section, the Department shall deem the agency to be in substantial compliance with specific Sections of this Part. Deemed status, however, may be nullified by a finding by the Department that the agency is in substantial non-compliance with one or more of the designated Sections.
"Developmental disability." A disability which is attributable to mental retardation, cerebral palsy, epilepsy or autism; or to any other condition which results in an impairment similar to that caused by mental retardation and which requires services similar to those required by individuals with mental retardation. Such disability must originate before the age of 18, be expected to continue indefinitely, and constitute a substantial handicap. (Section 1-106 of the Code)
"Department." The Department of Human Services.
"Diagnosis." A category of disability stated in accordance with either the Classification in Mental Retardation, 10th Edition (American Association on Mental Retardation, 444 Capitol Street NW, Suite 846, Washington, D.C.2001-1512 (2002)), or the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IVTR) (American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington VA 22209-3901 (2000)).
"Economic self-sufficiency." The managing of financial resources which are needed to satisfy the daily needs of an individual including at least involvement in commerce, such as managing money, comparative shopping, selecting clothes, informed selection of foods, diet and purchasing and negotiating.
"Employee." Any person on the agency payroll.
"Entitlements." Government-related financial benefits available to individuals who qualify on the basis of need, disability and/or income, such as Title XVIII (Medicare) (42 USCA 1395b-1 (1996)), Title XIX (Medicaid) (42 USCA 1396a (1996)) and Veteran's Administration benefits (38 USCA 521, 541, 542 (1996)).
"Equivalency." Evidence to substantiate compliance with requirements of this Part by other means than indicated in this Part.
"Governing body." The policy-making authority of an agency that establishes policies concerning the agency's operation and the welfare of individuals; provides for the agency's administration by appointing an authorized agency representative to implement its policies; and exercises general oversight of the agency's operation, its fiscal affairs and programmatic content to implement the organization's mission.
"Guardian." The plenary or limited guardian or conservator of the individual appointed by the court for an individual over age 18 so long as the limited guardian's duties encompass concerns related to service requirements, or the natural or adoptive parent of a minor or a person acting as a parent of a minor.
"Habilitation." An effort directed toward the alleviation of a developmental disability or toward increasing the level of physical, mental, social or economic functioning of an individual with a developmental disability. Additionally, it may include efforts to prevent regression or decelerate loss of function. Habilitation may include, but is not limited to, diagnosis, evaluation, medical services, residential care, day care, special living arrangements, training, education, employment related services, protective services, counseling and other services provided to individuals with a developmental disability by developmental disabilities programs. (Section 1-111 of the Code)
"Host family." A residential setting that consists of one or more persons unrelated to the individual with developmental disabilities, employed by or contracting with the provider agency, who reside with the individual.
"Host family living arrangement − traditional care model." A 24-hour residential alternative to a typical shift staff arrangement. The setting is the residence for the person with a developmental disability and the full-time residence for the paid caregivers. It is owned, leased or rented by the paid caregivers. In these settings, host families consist of one or more persons who are unrelated to the individual with a developmental disability, and who contract with the provider agency.
"Host family living arrangement − shared living model." A 24-hour residential alternative to a typical shift staff arrangement. The setting is the residence for the person with a developmental disability and may house either full or part-time paid caregivers in which more than 50 percent of the residential coverage is provided by individuals other than shift staff employees. It is owned, leased or rented by the individuals, caregivers, or agency. In these settings, host families consist of one or more persons who are unrelated to the individual with a developmental disability, and who are employed by or contract with the provider agency. The difference between traditional care and shared living models is shift employees routinely share supervision, care and training responsibilities with the host family caregivers in the shared living model.
"Imminent risk." A preliminary determination of immediate, threatened or impending risk of illness, mental injury, or physical injury to an individual as would cause a reasonably prudent person to take immediate action and that is not immediately corrected, such as environmental or safety hazards.
"Independence in daily living." Demonstrated ability of an individual to provide for his or her own basic care without outside assistance such as:
Vocational development outside the living arrangement that enables individuals to participate in the workforce such as using on-the-job skills, riding a bus and crossing streets.
Personal care, i.e., maintaining own hygiene, personal space and social relationships.
Participation in citizenship activities such as awareness of community norms, voting and volunteering in community projects.
"Individual" or "individuals." A person or persons who receives or receive community-integrated living arrangement services.
"Individual integrated services plan" or "services plan." A written plan that includes an assessment of the individual's strengths and needs, a description of the array of services needed regardless of availability, objectives for each service, the role of the individual or guardian, significant others and family in the development and implementation of the plan when indicated, an anticipated timetable for the accomplishment of objectives, and the name of the person or persons responsible for the implementation of the plan.
"Informed consent." Permission freely granted by the individual or guardian based on full disclosure to the individual or guardian of the benefits and/or liabilities of participation in specific procedures and/or services, including releases of information, as part of the individual's services plan.
"Interdisciplinary process." A set of steps or systems initiated to assess the strengths and needs of an individual with a mental disability with input from the individual requesting and/or receiving services and from the disciplines providing or targeted to provide services in order to collaboratively develop and implement an individual integrated services plan, and to review and/or update the plan. Persons participating in the process shall include, at a minimum, the individual and his or her legal guardian, the individual's family, unless a legally competent individual chooses not to have the family involved or the family refuses to be involved, a qualified mental retardation professional or qualified mental health professional and other members of the community support team.
"Intermittent supervision or support." Supervision or support provided to an individual under the auspices of a licensed agency less than 24-hours per day. When employees are not on-site, supervision or support shall be provided by means of 24-hour on-call availability and by a variety of alternatives or supports, such as non-disabled roommates, paid neighbors, non-paid family members and other formal or informal arrangements.
"Linkage." Person-to-person contact to assure that the supports and services needed by the individual and specified in the individual integrated services plan are obtained or regularly made accessible and available to an individual who chooses to not use them initially. The qualified mental retardation professional or mental health professional under the supervision of the qualified mental health professional shall be responsible for assuring linkage.
"Living arrangement." An apartment, house or one or more units in a multi-unit dwelling where an individual has chosen to live or where the individual's guardian has chosen for him or her to live.
"Mental disability" or "mentally disabled." A developmental disability, a mental illness, or both.
"Mental health professional (MHP)." A mental health professional who provides services under the supervision of a qualified mental health professional, as defined below, in providing services specified in Subpart B of this Part to an individual and his or her family, as necessary. The mental health professional must possess a bachelor's degree in social work, sociology, psychology, counseling, rehabilitation, or art and recreation therapy or possess a practical nurse license pursuant to the Nursing and Advanced Practice Nursing Act [225 ILCS 65] or have a minimum of five years of supervised experience in a mental health service.
"Mental illness." For purposes of this Part, mental illness refers to the target population of adults with serious mental illness (SMI), as established by the Department's Office of Mental Health as follows:
Individuals with serious mental illness are adults whose emotional or behavioral functioning is so impaired as to interfere with their capacity to remain in the community without supportive treatment. The mental impairment is severe and persistent and may result in a limitation of their capacities for primary activities of daily living, interpersonal relationships, homemaking, self-care, employment or recreation. This impairment may limit their ability to seek or receive local, State or federal assistance such as housing, medical and dental care, rehabilitation services, income assistance and food stamps, or protective services.
The individual must have one of the following diagnoses that meets DSM-IV criteria and that is the focus of the treatment being provided:
Schizophreniform disorder (295.4)
Schizo-affective disorder (295.7)
Delusional disorder (297.1)
Shared psychotic disorder (297.3)
Brief psychotic disorder (298.8)
Psychotic disorder NOS (298.9)
Bipolar disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)
Cyclothymic disorder (301.13)
Major depression (296.2x, 296.3x)
Obsessive-compulsive disorder (300.30)
Anorexia nervosa (307.1)
Bulimia nervosa (307.51)
And the individual must meet the criteria for either treatment history or functional criteria as follows:
Treatment history. (Treatment history covers the client's lifetime treatment and is restricted to treatment for the DSM-IV diagnosis specified in this definition.) To qualify under treatment history, the individual must meet at least one of the following criteria:
Continuous treatment of six months or more, including treatment during adolescence, in one, or a combination of, the following modalities: inpatient treatment, day treatment or partial hospitalization;
Six months continuous residence in residential programming (e.g., long-term care facility or assisted, supported or supervised residential programs);
Two or more admissions of any duration to inpatient treatment, day treatment, partial hospitalization or residential programming within a 12-month period;
A history of using the following outpatient services over a one-year period, either continuously or intermittently; psychotropic medication management, case management, outreach and engagement services; or
Previous treatment in an outpatient modality, and a history of at least one mental health psychiatric hospitalization.
Functional criteria. (Functional criteria have been purposely narrowed to descriptors of the most serious levels of functional impairment and are not intended to reflect the full range of possible impairment.) To qualify under functional criteria, the individual must meet at least two of the following. The individual:
Has a serious impairment in social, occupational or school functioning;
Is unemployed or working only part-time due to mental illness and not for reasons of physical disability or some other role responsibility (e.g., student or primary caregiver for dependent family member); is employed in a sheltered setting or supportive work situation; or has markedly limited work skills;
Requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, other indicators);
Does not seek appropriate supportive community services, e.g., recreational, educational or vocational support services, without assistance;
Lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in his or her personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within a family setting);
Requires assistance in basic life and survival skills (must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless); or
Exhibits inappropriate or dangerous social behavior that results in demand for intervention by the mental health and/or judicial/legal system.
If the individual does not currently meet the functional criteria listed above, but is currently receiving treatment and has a history within the past five years of functional impairment meeting two of the functional criteria listed above that persisted for at least 12 months, and there is documentation supporting the professional judgment that regression in functional impairment would occur without continuing treatment, then the individual will be determined to have met the functional criteria.
"Mental retardation." The essential feature of mental retardation is significantly subaverage general intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, work, leisure, health, and safety. The onset must occur before age 18 years. (See DSM-IV.)
"Moral turpitude." Moral quality of being inherently base, depraved, vile or wicked.
"Natural environment." Locations and settings where an individual lives, works and socializes and carries out activities of daily living.
"Natural supports." Unpaid assistance provided to an individual with a developmental disability typically by a person who has some type of friendship, kinship or other relationship (co-worker, member of the same social group) with the individual, whom the individual accepts into his or her life and with whom the individual has chosen to spend time. A natural support includes an informal agreement to assist in a particular way for some duration of time (i.e., not just a one time action done out of courtesy).
"Neglect." The failure to provide adequate medical or personal care or maintenance, which failure results in physical or mental injury to an individual or in the deterioration of an individual's physical or mental condition.
"Notice of violation." A report submitted to an agency by the Bureau of Accreditation, Licensure and Certification (BALC) listing the agency's deficiencies with this Part noted during a survey.
"OCAPS." The Department's Office of Clinical, Administrative and Program Support (OCAPS); Bureau of Accreditation, Licensure and Certification (BALC).
"Paraprofessional." An employee or contractual worker not designated as a professional by virtue of license, certification, or education, and who assists a professional.
"Plan of correction." A written plan submitted by an agency to the Bureau of Accreditation, Licensure and Certification (BALC), in response to a notice of violation, that describes the steps the agency will take in order to bring a program or services into compliance, and the time-frames for completion of each step.
"Pre-admission screening (PAS) agent." Contracted community agency acting as a Department agent to provide comprehensive documentation for Illinois' pre-admission screening system and to incorporate the requirements imposed by the Centers for Medicare and Medicaid Services (CMS) to support reimbursement claims under Title XIX of the Social Security Act (42 USCA 1396 (1996)).
"Professional." An employee or contractual worker designated as a professional by virtue of license, certification, or education.
"Progress notes." Narrative documentation in an individual's record of service provision and its relationship to the individual integrated services plan.
"Psychotropics." Drugs used for antipsychotic, antidepressant, antimanic and/or antianxiety purposes as listed in the American Hospital Formulary Services (AHFS) Drug Information Manual (American Society of Health-System Pharmacists, 7272 Wisconsin Avenue, Bethesda MD 20814 (2002)) (AGENCY NOTE: This document is published annually and updated quarterly.); the Physician's Desk Reference (PDR) (Medical Economics Company, Five Paragon Drive, Montvale NJ 07645-1742 (2002)) (AGENCY NOTE: This document is published annually.); and the Drug Facts and Comparisons (Facts and Comparisons, 111 West Port Plaza, Suite 300, St. Louis MO 63146-3098 (2002)) (AGENCY NOTE: This document is published annually and updated monthly.).
"Qualified mental health professional (QMHP)." One of the following:
A physician licensed under the Medical Practice Act of 1987 [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 in the treatment of children and adolescents;
A psychiatrist (a physician licensed under the Medical Practice Act of 1987) who has successfully completed a training program in psychiatry approved by the American Medical Association or the American Osteopathic Association or other training program identified as equivalent by the Department;
A psychologist licensed under the Clinical Psychologist Licensing Act [225 ILCS 15] with specialized training in mental health services;
A social worker possessing a master's or doctoral 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;
A registered nurse licensed under the Nursing and Advanced Practice Nursing Act [225 ILCS 65] with at least one year of clinical experience in a mental health service or a master's degree in psychiatric nursing;
An occupational therapist registered pursuant to the Illinois Occupational Therapy Practice Act [225 ILCS 75] with at least one year of clinical experience in a mental health setting;
An individual with a master's degree and at least one year of clinical experience in mental health services and who holds a license to practice marriage and family therapy pursuant to the Marriage and Family Therapy Licensing Act [225 ILCS 55]; or
An individual possessing a master's or doctoral degree in counseling and guidance, rehabilitation counseling, social work, vocational counseling, psychology, pastoral counseling or family therapy, or related field, who has successfully completed a practicum and/or internship that includes a minimum of 1,000 hours, or who has one year of clinical experience under the supervision of a qualified mental health professional or who is a licensed social worker holding a master's degree with two years of experience in mental health services, or who is a permanently licensed professional counselor under the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107] holding a master's degree with one year of experience in mental health services.
"Qualified mental retardation professional (QMRP)." A QMRP must:
Have at least one year of experience working directly with individuals with mental retardation or other developmental disabilities and be one of the following:
A doctor of medicine or osteopathy licensed pursuant to the Medical Practice Act of 1987;
A registered nurse licensed pursuant to the Nursing and Advanced Practice Nursing Act;
An occupational therapist or occupational therapist assistant certified by the American Occupational Therapy Association or other comparable body (Illinois Occupational Therapy Practice Act);
A physical therapist certified by the American Physical Therapy Association or other comparable body (Illinois Physical Therapy Act [225 ILCS 90]);
A physical therapist assistant registered by the American Physical Therapy Association or a graduate of a two-year college-level program approved by the American Physical Therapy Association or comparable body;
A psychologist with at least a master's degree in psychology from an accredited school (Clinical Psychologist Licensing Act);
A social worker with a bachelor's degree from a college or university or graduate degree from a school of social work accredited or approved by the Council on Social Work Education or another comparable body (the Clinical Social Work and Social Work Practice Act);
A speech-language pathologist or audiologist with a certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech Language Hearing Association or comparable body or meeting the education requirements for licensure and being in the process of accumulating the supervised experience required for licensure (the Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110]);
A professional recreation staff person with a bachelor's degree in recreation or in a specialty area such as art, dance, music or physical therapy;
A professional dietician registered by the American Dietetics Association;
A human services professional with a bachelor's degree in a human services field, including but not limited to sociology, special education, rehabilitation counseling and psychology.
"Quality assurance." A systematic and objective approach to monitoring and evaluating the appropriateness, adequacy and quality of services and supports that enable individuals with a mental illness or developmental disability to achieve defined outcomes in their lives.
"Relative." Spouse, parent, stepparent, son, daughter, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any such person denoted by the prefix "grand" or "great" or the spouse of any of the persons specified in this definition.
"Relief." A paid service for caregivers that provides support to individuals with developmental disabilities in host family living arrangements. Relief services enable the caregivers to have free time apart from the individuals with developmental disabilities.
"Residence." See "living arrangement."
"Respite." Services provided to individuals who are unable to care for themselves, furnished on a short-term basis due to the absence of or need for relief of those persons normally providing care.
"Seclusion." Sequestration by placement of an individual alone in a room from which he or she has no means of leaving. When an individual is placed in a behavior modification program pursuant to his or her integrated services plan, he or she may be removed from a situation that affords positive reinforcement to an area where reinforcement is not available for a reasonable period of time not to exceed 30 minutes and such restrictions shall not constitute seclusion. (Section 1-126 of the Code)
"Secretary." The Secretary of the Department or his or her designee.
"Self-administration of medications." An individual's ability to correctly take prescribed medications independently or with prompts when the individual has a mental illness or, if the individual has a developmental disability, has been assessed and determined to be at Level 4 with the Department approved self-administration of medication tool, in accordance with 59 Ill. Adm. Code 116.
"Site." Any living arrangement under one continuous roof in which individuals receiving CILA services live.
"Skills training." Activities that focus on the development of daily living skills that enable individuals to achieve optimal independent functioning and economic self-sufficiency.
"Substantial compliance." An evaluation result that determines that a surveyed program meets the requirements set forth in this Part sufficiently to be at a Level 1, 2 or 3, as described in Section 115.440, and in good standing.
"Survey." A process to determine the degree of compliance with this Part that an agency has maintained. This includes surveyor observation and an on-site examination of the following: policies, procedures, records of individuals, written plans, and the physical plant. Interviews of individuals and employees and observation of a sample of CILA sites are also a part of the survey.
"Tardive dyskinesia." An abnormal involuntary movement disorder associated with the long-term use of antipsychotic medications. It may be persistent or transient and is characterized by a variable mixture of facial, ocular, oral, lingual, truncal or limb movements.
"Time-out." Contingent removal from a situation in which reinforcement occurs into a situation from which reinforcement does not occur, for a reasonable period of time not to exceed 30 minutes.
"Treatment." An effort to accomplish an improvement in the mental condition or related behavior of an individual. Treatment includes, but is not limited to, hospitalization, partial hospitalization, outpatient services, examination, diagnosis, evaluation, care, training, psychotherapy, pharmaceuticals and other services provided for individuals by mental health agencies or psychiatric hospitals. (Section 1-128 of the Code)
"Waiver." An action by the Department in which exceptions to this Part are granted on application by an agency for a period not to exceed the duration of the current license.
(Source: Amended at 27 Ill. Reg. 5376, effective March 17, 2003)