Rep. Sara Feigenholtz

Adopted in House Comm. on Oct 29, 2019

 

 


 

 


 
10100SB0391ham001LRB101 04152 KTG 64199 a

1
AMENDMENT TO SENATE BILL 391

2    AMENDMENT NO. ______. Amend Senate Bill 391 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.23 as follows:
 
6    (305 ILCS 5/5-5.23)
7    (Text of Section after amendment by P.A. 101-461)
8    Sec. 5-5.23. Children's mental health services.
9    (a) The Department of Healthcare and Family Services, by
10rule, shall require the screening and assessment of a child
11prior to any Medicaid-funded admission to an inpatient hospital
12for psychiatric services to be funded by Medicaid. The
13screening and assessment shall include a determination of the
14appropriateness and availability of out-patient support
15services for necessary treatment. The Department, by rule,
16shall establish methods and standards of payment for the

 

 

10100SB0391ham001- 2 -LRB101 04152 KTG 64199 a

1screening, assessment, and necessary alternative support
2services.
3    (b) The Department of Healthcare and Family Services, to
4the extent allowable under federal law, shall secure federal
5financial participation for Individual Care Grant expenditures
6made by the Department of Healthcare and Family Services for
7the Medicaid optional service authorized under Section 1905(h)
8of the federal Social Security Act, pursuant to the provisions
9of Section 7.1 of the Mental Health and Developmental
10Disabilities Administrative Act. The Department of Healthcare
11and Family Services may exercise the authority under this
12Section as is necessary to administer Individual Care Grants as
13authorized under Section 7.1 of the Mental Health and
14Developmental Disabilities Administrative Act.
15    (c) The Department of Healthcare and Family Services shall
16work collaboratively with the Department of Children and Family
17Services and the Division of Mental Health of the Department of
18Human Services to implement subsections (a) and (b).
19    (d) On and after July 1, 2012, the Department shall reduce
20any rate of reimbursement for services or other payments or
21alter any methodologies authorized by this Code to reduce any
22rate of reimbursement for services or other payments in
23accordance with Section 5-5e.
24    (e) All rights, powers, duties, and responsibilities
25currently exercised by the Department of Human Services related
26to the Individual Care Grant program are transferred to the

 

 

10100SB0391ham001- 3 -LRB101 04152 KTG 64199 a

1Department of Healthcare and Family Services with the transfer
2and transition of the Individual Care Grant program to the
3Department of Healthcare and Family Services to be completed
4and implemented within 6 months after the effective date of
5this amendatory Act of the 99th General Assembly. For the
6purposes of the Successor Agency Act, the Department of
7Healthcare and Family Services is declared to be the successor
8agency of the Department of Human Services, but only with
9respect to the functions of the Department of Human Services
10that are transferred to the Department of Healthcare and Family
11Services under this amendatory Act of the 99th General
12Assembly.
13        (1) Each act done by the Department of Healthcare and
14    Family Services in exercise of the transferred powers,
15    duties, rights, and responsibilities shall have the same
16    legal effect as if done by the Department of Human Services
17    or its offices.
18        (2) Any rules of the Department of Human Services that
19    relate to the functions and programs transferred by this
20    amendatory Act of the 99th General Assembly that are in
21    full force on the effective date of this amendatory Act of
22    the 99th General Assembly shall become the rules of the
23    Department of Healthcare and Family Services. All rules
24    transferred under this amendatory Act of the 99th General
25    Assembly are hereby amended such that the term "Department"
26    shall be defined as the Department of Healthcare and Family

 

 

10100SB0391ham001- 4 -LRB101 04152 KTG 64199 a

1    Services and all references to the "Secretary" shall be
2    changed to the "Director of Healthcare and Family Services
3    or his or her designee". As soon as practicable hereafter,
4    the Department of Healthcare and Family Services shall
5    revise and clarify the rules to reflect the transfer of
6    rights, powers, duties, and responsibilities affected by
7    this amendatory Act of the 99th General Assembly, using the
8    procedures for recodification of rules available under the
9    Illinois Administrative Procedure Act, except that
10    existing title, part, and section numbering for the
11    affected rules may be retained. The Department of
12    Healthcare and Family Services, consistent with its
13    authority to do so as granted by this amendatory Act of the
14    99th General Assembly, shall propose and adopt any other
15    rules under the Illinois Administrative Procedure Act as
16    necessary to administer the Individual Care Grant program.
17    These rules may include, but are not limited to, the
18    application process and eligibility requirements for
19    recipients.
20        (3) All unexpended appropriations and balances and
21    other funds available for use in connection with any
22    functions of the Individual Care Grant program shall be
23    transferred for the use of the Department of Healthcare and
24    Family Services to operate the Individual Care Grant
25    program. Unexpended balances shall be expended only for the
26    purpose for which the appropriation was originally made.

 

 

10100SB0391ham001- 5 -LRB101 04152 KTG 64199 a

1    The Department of Healthcare and Family Services shall
2    exercise all rights, powers, duties, and responsibilities
3    for operation of the Individual Care Grant program.
4        (4) Existing personnel and positions of the Department
5    of Human Services pertaining to the administration of the
6    Individual Care Grant program shall be transferred to the
7    Department of Healthcare and Family Services with the
8    transfer and transition of the Individual Care Grant
9    program to the Department of Healthcare and Family
10    Services. The status and rights of Department of Human
11    Services employees engaged in the performance of the
12    functions of the Individual Care Grant program shall not be
13    affected by this amendatory Act of the 99th General
14    Assembly. The rights of the employees, the State of
15    Illinois, and its agencies under the Personnel Code and
16    applicable collective bargaining agreements or under any
17    pension, retirement, or annuity plan shall not be affected
18    by this amendatory Act of the 99th General Assembly. All
19    transferred employees who are members of collective
20    bargaining units shall retain their seniority, continuous
21    service, salary, and accrued benefits.
22        (5) All books, records, papers, documents, property
23    (real and personal), contracts, and pending business
24    pertaining to the powers, duties, rights, and
25    responsibilities related to the functions of the
26    Individual Care Grant program, including, but not limited

 

 

10100SB0391ham001- 6 -LRB101 04152 KTG 64199 a

1    to, material in electronic or magnetic format and necessary
2    computer hardware and software, shall be delivered to the
3    Department of Healthcare and Family Services; provided,
4    however, that the delivery of this information shall not
5    violate any applicable confidentiality constraints.
6        (6) Whenever reports or notices are now required to be
7    made or given or papers or documents furnished or served by
8    any person to or upon the Department of Human Services in
9    connection with any of the functions transferred by this
10    amendatory Act of the 99th General Assembly, the same shall
11    be made, given, furnished, or served in the same manner to
12    or upon the Department of Healthcare and Family Services.
13        (7) This amendatory Act of the 99th General Assembly
14    shall not affect any act done, ratified, or canceled or any
15    right occurring or established or any action or proceeding
16    had or commenced in an administrative, civil, or criminal
17    cause regarding the Department of Human Services before the
18    effective date of this amendatory Act of the 99th General
19    Assembly; and those actions or proceedings may be defended,
20    prosecuted, and continued by the Department of Human
21    Services.
22    (f) (Blank).
23    (g) Family Support Program. The Department of Healthcare
24and Family Services shall restructure the Family Support
25Program, formerly known as the Individual Care Grant program,
26to enable early treatment of youth, emerging adults, and

 

 

10100SB0391ham001- 7 -LRB101 04152 KTG 64199 a

1transition-age adults with a serious mental illness or serious
2emotional disturbance.
3        (1) As used in this subsection and in subsections (h)
4    through (s):
5            (A) "Youth" means a person under the age of 18.
6            (B) "Emerging adult" means a person who is 18
7        through 20 years of age.
8            (C) "Transition-age adult" means a person who is 21
9        through 25 years of age.
10        (2) The Department shall amend 89 Ill. Adm. Code 139 in
11    accordance with this Section and consistent with the
12    timelines outlined in this Section.
13        (3) Implementation of any amended requirements shall
14    be completed within 8 months of the adoption of any
15    amendment to 89 Ill. Adm. Code 139 that is consistent with
16    the provisions of this Section.
17        (4) To align the Family Support Program with the
18    Medicaid system of care, the services available to a youth,
19    emerging adult, or transition-age adult through the Family
20    Support Program shall include all Medicaid community-based
21    mental health treatment services and all Family Support
22    Program services included under 89 Ill. Adm. Code 139. No
23    person receiving services through the Family Support
24    Program or the Specialized Family Support Program shall
25    become a Medicaid enrollee unless Medicaid eligibility
26    criteria are met and the person is enrolled in Medicaid. No

 

 

10100SB0391ham001- 8 -LRB101 04152 KTG 64199 a

1    part of this Section creates an entitlement to services
2    through the Family Support Program, the Specialized Family
3    Support Program, or the Medicaid program.
4        (5) The Family Support Program shall align with the
5    following system of care principles:
6            (A) Treatment and support services shall be based
7        on the results of an integrated behavioral health
8        assessment and treatment plan using an instrument
9        approved by the Department of Healthcare and Family
10        Services.
11            (B) Strong interagency collaboration between all
12        State agencies the parent or legal guardian is involved
13        with for services, including the Department of
14        Healthcare and Family Services, the Department of
15        Human Services, the Department of Children and Family
16        Services, the Department of Juvenile Justice, and the
17        Illinois State Board of Education.
18            (C) Individualized, strengths-based practices and
19        trauma-informed treatment approaches.
20            (D) For a youth, full participation of the parent
21        or legal guardian at all levels of treatment through a
22        process that is family-centered and youth-focused. The
23        process shall include consideration of the services
24        and supports the parent, legal guardian, or caregiver
25        requires for family stabilization, and shall connect
26        such person or persons to services based on available

 

 

10100SB0391ham001- 9 -LRB101 04152 KTG 64199 a

1        insurance coverage.
2    (h) Eligibility for the Family Support Program.
3Eligibility criteria established under 89 Ill. Adm. Code 139
4for the Family Support Program shall include the following:
5        (1) Individuals applying to the program must be under
6    the age of 26.
7        (2) Requirements for parental or legal guardian
8    involvement are applicable to youth and to emerging adults
9    or transition-age adults who have a guardian appointed
10    under Article XIa of the Probate Act.
11        (3) Youth, emerging adults, and transition-age adults
12    are eligible for services under the Family Support Program
13    upon their third inpatient admission to a hospital or
14    similar treatment facility for the primary purpose of
15    psychiatric treatment within the most recent 12 months and
16    are hospitalized for the purpose of psychiatric treatment.
17        (4) School participation for emerging adults applying
18    for services under the Family Support Program may be waived
19    by request of the individual at the sole discretion of the
20    Department of Healthcare and Family Services.
21        (5) School participation is not applicable to
22    transition-age adults.
23    (i) Notification of Family Support Program and Specialized
24Family Support Program services.
25        (1) Within 12 months after the effective date of this
26    amendatory Act of the 101st General Assembly, the

 

 

10100SB0391ham001- 10 -LRB101 04152 KTG 64199 a

1    Department of Healthcare and Family Services, with
2    meaningful stakeholder input through a working group of
3    psychiatric hospitals, Family Support Program providers,
4    family support organizations, the Community and
5    Residential Services Authority, a statewide association
6    representing a majority of hospitals, a statewide
7    association representing physicians, and foster care
8    alumni advocates, shall establish a clear process by which
9    a youth's or emerging adult's parents, guardian, or
10    caregiver, or the emerging adult or transition-age adult,
11    is identified, notified, and educated about the Family
12    Support Program and the Specialized Family Support Program
13    upon a first psychiatric inpatient hospital admission, and
14    any following psychiatric inpatient admissions.
15    Notification and education may take place through a Family
16    Support Program coordinator, a mobile crisis response
17    provider, a Comprehensive Community Based Youth Services
18    provider, the Community and Residential Services
19    Authority, or any other designated provider or coordinator
20    identified by the Department of Healthcare and Family
21    Services. In developing this process, the Department of
22    Healthcare and Family Services and the working group shall
23    take into account the unique needs of emerging adults and
24    transition-age adults without parental involvement who are
25    eligible for services under the Family Support Program. The
26    Department of Healthcare and Family Services and the

 

 

10100SB0391ham001- 11 -LRB101 04152 KTG 64199 a

1    working group shall ensure the appropriate provider or
2    coordinator is required to assist individuals and their
3    parents, guardians, or caregivers, as applicable, in the
4    completion of the application or referral process for the
5    Family Support Program or the Specialized Family Support
6    Program.
7        (2) Upon a youth's, emerging adult's or transition-age
8    adult's second psychiatric inpatient hospital admission,
9    prior to hospital discharge, the hospital must, if it is
10    aware of the patient's prior psychiatric inpatient
11    hospital admission, ensure that the youth's parents,
12    guardian, or caregiver, or the emerging adult or
13    transition-age adult, has have been notified of the Family
14    Support Program and the Specialized Family Support Program
15    prior to hospital discharge.
16        (3) Psychiatric lockout as last resort.
17            (A) Prior to referring any youth to the Department
18        of Children and Family Services for the filing of a
19        petition in accordance with subparagraph (c) of
20        paragraph (1) of Section 2-4 of the Juvenile Court Act
21        of 1987 alleging that the youth is dependent because
22        the youth was left in a psychiatric hospital beyond
23        medical necessity, the hospital shall attempt to
24        contact educate the youth and the youth's parents,
25        guardian, or caregiver about the Family Support
26        Program and the Specialized Family Support Program and

 

 

10100SB0391ham001- 12 -LRB101 04152 KTG 64199 a

1        shall assist with connections to the designated Family
2        Support Program coordinator in the service area by
3        providing educational materials developed by the
4        Department of Healthcare and Family Services. Once
5        this process has begun, any such youth shall be
6        considered a youth for whom an application for the
7        Family Support Program is pending with the Department
8        of Healthcare and Family Services or an active
9        application for the Family Support Program was being
10        reviewed by the Department for the purposes of
11        subsection (a) of Section 2-4b subparagraph (b) of
12        paragraph (1) of Section 2-4 of the Juvenile Court Act
13        of 1987, or for the purposes of subsection (a) of
14        Section 5-711 of the Juvenile Court Act of 1987.
15            (B) No state agency or hospital shall coach a
16        parent or guardian of a youth in a psychiatric hospital
17        inpatient unit to lock out or otherwise relinquish
18        custody of a youth to the Department of Children and
19        Family Services for the sole purpose of obtaining
20        necessary mental health treatment for the youth. In the
21        absence of abuse or neglect, a psychiatric lockout or
22        custody relinquishment to the Department of Children
23        and Family Services shall only be considered as the
24        option of last resort. Nothing in this Section shall
25        prohibit discussion of medical treatment options or a
26        referral to legal counsel.

 

 

10100SB0391ham001- 13 -LRB101 04152 KTG 64199 a

1        (4) Development of new Family Support Program
2    services.
3            (A) Development of specialized therapeutic
4        residential treatment for youth and emerging adults
5        with high-acuity mental health conditions. Through a
6        working group led by the Department of Healthcare and
7        Family Services that includes the Department of
8        Children and Family Services and residential treatment
9        providers for youth and emerging adults, the
10        Department of Healthcare and Family Services, within
11        12 months after the effective date of this amendatory
12        Act of the 101st General Assembly, shall develop a plan
13        for the development of specialized therapeutic
14        residential treatment beds similar to a qualified
15        residential treatment program, as defined in the
16        federal Family First Prevention Services Act, for
17        youth in the Family Support Program with high-acuity
18        mental health needs. The Department of Healthcare and
19        Family Services and the Department of Children and
20        Family Services shall work together to maximize
21        federal funding through Medicaid and Title IV-E of the
22        Social Security Act in the development and
23        implementation of this plan.
24            (B) Using the Department of Children and Family
25        Services' beyond medical necessity data over the last 5
26        years and any other relevant, available data, the

 

 

10100SB0391ham001- 14 -LRB101 04152 KTG 64199 a

1        Department of Healthcare and Family Services shall
2        assess the estimated number of these specialized
3        high-acuity residential treatment beds that are needed
4        in each region of the State based on the number of
5        youth remaining in psychiatric hospitals beyond
6        medical necessity and the number of youth placed
7        out-of-state who need this level of care. The
8        Department of Healthcare and Family Services shall
9        report the results of this assessment to the General
10        Assembly by no later than December 31, 2020.
11            (C) Development of an age-appropriate therapeutic
12        residential treatment model for emerging adults and
13        transition-age adults. Within 30 months after the
14        effective date of this amendatory Act of the 101st
15        General Assembly, the Department of Healthcare and
16        Family Services, in partnership with the Department of
17        Human Services' Division of Mental Health and with
18        significant and meaningful stakeholder input through a
19        working group of providers and other stakeholders,
20        shall develop a supportive housing model for emerging
21        adults and transition-age adults receiving services
22        through the Family Support Program who need
23        residential treatment and support to enable recovery.
24        Such a model shall be age-appropriate and shall allow
25        the residential component of the model to be in a
26        community-based setting combined with intensive

 

 

10100SB0391ham001- 15 -LRB101 04152 KTG 64199 a

1        community-based mental health services.
2    (j) Workgroup to develop a plan for improving access to
3substance use treatment. The Department of Healthcare and
4Family Services and the Department of Human Services' Division
5of Substance Use Prevention and Recovery shall co-lead a
6working group that includes Family Support Program providers,
7family support organizations, and other stakeholders over a
812-month period beginning in the first quarter of calendar year
92020 to develop a plan for increasing access to substance use
10treatment services for youth, emerging adults, and
11transition-age adults who are eligible for Family Support
12Program services.
13    (k) Appropriation. Implementation of this Section shall be
14limited by the State's annual appropriation to the Family
15Support Program. Spending within the Family Support Program
16appropriation shall be further limited for the new Family
17Support Program services to be developed accordingly:
18        (1) Targeted use of specialized therapeutic
19    residential treatment for youth and emerging adults with
20    high-acuity mental health conditions through appropriation
21    limitation. No more than 12% of all annual Family Support
22    Program funds shall be spent on this level of care in any
23    given state fiscal year.
24        (2) Targeted use of residential treatment model
25    established for emerging adults and transition-age adults
26    through appropriation limitation. No more than one-quarter

 

 

10100SB0391ham001- 16 -LRB101 04152 KTG 64199 a

1    of all annual Family Support Program funds shall be spent
2    on this level of care in any given state fiscal year.
3    (l) Exhausting third party insurance coverage first.
4        (A) A parent, legal guardian, emerging adult, or
5    transition-age adult with private insurance coverage shall
6    work with the Department of Healthcare and Family Services,
7    or its designee, to identify insurance coverage for any and
8    all benefits covered by their plan. If insurance
9    cost-sharing by any method for treatment is
10    cost-prohibitive for the parent, legal guardian, emerging
11    adult, or transition-age adult, Family Support Program
12    funds may be applied as a payer of last resort toward
13    insurance cost-sharing for purposes of using private
14    insurance coverage to the fullest extent for the
15    recommended treatment. If the Department, or its agent, has
16    a concern relating to the parent's, legal guardian's,
17    emerging adult's, or transition-age adult's insurer's
18    compliance with Illinois or federal insurance requirements
19    relating to the coverage of mental health or substance use
20    disorders, it shall refer all relevant information to the
21    applicable regulatory authority.
22        (B) The Department of Healthcare and Family Services
23    shall use Medicaid funds first for an individual who has
24    Medicaid coverage if the treatment or service recommended
25    using an integrated behavioral health assessment and
26    treatment plan (using the instrument approved by the

 

 

10100SB0391ham001- 17 -LRB101 04152 KTG 64199 a

1    Department of Healthcare and Family Services) is covered by
2    Medicaid.
3        (C) If private or public insurance coverage does not
4    cover the needed treatment or service, Family Support
5    Program funds shall be used to cover the services offered
6    through the Family Support Program.
7    (m) Service authorization. A youth, emerging adult, or
8transition-age adult enrolled in the Family Support Program or
9the Specialized Family Support Program shall be eligible to
10receive a mental health treatment service covered by the
11applicable program if the medical necessity criteria
12established by the Department of Healthcare and Family Services
13are met.
14    (n) Streamlined application. The Department of Healthcare
15and Family Services shall revise the Family Support Program
16applications and the application process to reflect the changes
17made to this Section by this amendatory Act of the 101st
18General Assembly within 8 months after the adoption of any
19amendments to 89 Ill. Adm. Code 139.
20    (o) Study of reimbursement policies during planned and
21unplanned absences of youth and emerging adults in Family
22Support Program residential treatment settings. The Department
23of Healthcare and Family Services shall undertake a study of
24those standards of the Department of Children and Family
25Services and other states for reimbursement of residential
26treatment during planned and unplanned absences to determine if

 

 

10100SB0391ham001- 18 -LRB101 04152 KTG 64199 a

1reimbursing residential providers for such unplanned absences
2positively impacts the availability of residential treatment
3for youth and emerging adults. The Department of Healthcare and
4Family Services shall begin the study on July 1, 2019 and shall
5report its findings and the results of the study to the General
6Assembly, along with any recommendations for or against
7adopting a similar policy, by December 31, 2020.
8    (p) Public awareness and educational campaign for all
9relevant providers. The Department of Healthcare and Family
10Services shall engage in a public awareness campaign to educate
11hospitals with psychiatric units, crisis response providers
12such as Screening, Assessment and Support Services providers
13and Comprehensive Community Based Youth Services agencies,
14schools, and other community institutions and providers across
15Illinois on the changes made by this amendatory Act of the
16101st General Assembly to the Family Support Program. The
17Department of Healthcare and Family Services shall produce
18written materials geared for the appropriate target audience,
19develop webinars, and conduct outreach visits over a 12-month
20period beginning after implementation of the changes made to
21this Section by this amendatory Act of the 101st General
22Assembly.
23    (q) Maximizing federal matching funds for the Family
24Support Program and the Specialized Family Support Program. The
25Department of Healthcare and Family Services, as the sole
26Medicaid State agency, shall seek approval from the federal

 

 

10100SB0391ham001- 19 -LRB101 04152 KTG 64199 a

1Centers for Medicare and Medicaid Services within 12 months
2after the effective date of this amendatory Act of the 101st
3General Assembly to draw additional federal Medicaid matching
4funds for individuals served under the Family Support Program
5or the Specialized Family Support Program who are not covered
6by the Department's medical assistance programs. The
7Department of Children and Family Services, as the State agency
8responsible for administering federal funds pursuant to Title
9IV-E of the Social Security Act, shall submit a State Plan to
10the federal government within 12 months after the effective
11date of this amendatory Act of the 101st General Assembly to
12maximize the use of federal Title IV-E prevention funds through
13the federal Family First Prevention Services Act, to provide
14mental health and substance use disorder treatment services and
15supports, including, but not limited to, the provision of
16short-term crisis and transition beds post-hospitalization for
17youth who are at imminent risk of entering Illinois' youth
18welfare system solely due to the inability to access mental
19health or substance use treatment services.
20    (r) Outcomes and data reported annually to the General
21Assembly. Beginning in 2021, the Department of Healthcare and
22Family Services shall submit an annual report to the General
23Assembly that includes the following information with respect
24to the time period covered by the report:
25        (1) The number and ages of youth, emerging adults, and
26    transition-age adults who requested services under the

 

 

10100SB0391ham001- 20 -LRB101 04152 KTG 64199 a

1    Family Support Program and the Specialized Family Support
2    Program and the services received.
3        (2) The number and ages of youth, emerging adults, and
4    transition-age adults who requested services under the
5    Specialized Family Support Program who were eligible for
6    services based on the number of hospitalizations.
7        (3) The number and ages of youth, emerging adults, and
8    transition-age adults who applied for Family Support
9    Program or Specialized Family Support Program services but
10    did not receive any services.
11    (s) Rulemaking authority. Unless a timeline is otherwise
12specified in a subsection, if amendments to 89 Ill. Adm. Code
13139 are needed for implementation of this Section, such
14amendments shall be filed by the Department of Healthcare and
15Family Services within one year after the effective date of
16this amendatory Act of the 101st General Assembly.
17(Source: P.A. 101-461, eff. 1-1-20.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.".