Section 132.25  Definitions

 

For the purposes of this Part, the following terms are defined:

 

Admission Note − A written report of an initial assessment and treatment plan that initiates Rule 132 services for clients who are admitted to a specialized substitute care living arrangement or for the client who does not have a completed mental health assessment and is admitted to ACT services or a residential facility designated by the public payer for the purpose of stabilizing a crisis.

 

Adult − An individual who is 18 years of age or older or a person who is emancipated pursuant to the Emancipation of Mature Minors Act [750 ILCS 30].

 

Applicant − An entity that seeks certification to provide Medicaid community mental health services under this Part.

 

Certified Recovery Support Specialist or CRSS − An individual who is certified and in good standing as a Recovery Support Specialist by the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc. (IAODAPCA).

 

Certifying State Agency − Departments responsible for determining and monitoring compliance with this Part:  Department of Healthcare and Family Services, Department of Human Services, Department of Children and Family Services or the Department of Corrections.

 

CGAS − The Children's Global Assessment Scale as published in the Archives of General Psychiatry, Volume 40, November 1983, pp. 1228-1231.

 

Client − An individual who is Medicaid-eligible and is receiving Medicaid community mental health services.

 

CMMS − Centers for Medicare and Medicaid Services.  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).

 

Collateral − A person with a relationship to a client and who is important in the treatment or recovery goals of the client or who is a resource to assist the client in meeting treatment or recovery goals.

 

Confidentiality Act − The Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110].

 

Contract − For purposes of this Part, a written agreement between the applicant/provider and a public payer.

 

Co-occurring − Co-existing mental health and substance use disorders or developmental disabilities.  Individuals eligible to receive services under this Part must have a diagnosis of mental illness.

 

Day − A calendar day unless otherwise indicated.

 

DCFS − The Illinois Department of Children and Family Services.

 

DHS − The Illinois Department of Human Services.

 

DOC − The Illinois Department of Corrections.

 

DSM-IV − The Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (1994) or DSM-IV-TR (2000), American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, Virginia 22209-3901.

 

Enrollment − The official enrollment of a provider in the medical assistance program by HFS on determination of compliance with 89 Ill. Adm. Code 140.11.

 

Family − A basic unit or constellation of one or more adults and children, foster or adoptive parents and children, and private individual guardians.

 

Family Resource Developer − A parent or care-giver who has navigated multiple child serving systems on behalf of a child or adolescent with Severe Emotional Disturbance (SED) as a consumer of the mental health system.  The individual has a high school diploma or equivalency and has demonstrated the ability to work collaboratively with families, children, agency staff and other providers in the community.

 

GAF − The Global Assessment of Functioning Scale contained in the DSM-IV.

 

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.  (The Juvenile Court Act of 1987 [705 ILCS 405]; Interstate Compact on the Placement of Children [45 ILCS 15])

 

HFS − The Illinois Department of Healthcare and Family Services.

 

HIPAA − The Health Insurance Portability and Accountability Act (42 USC 1320 et seq.) (45 CFR 160 and 164 (2003)).

 

ICD-9-CM − International Classification of Diseases, 9^th Revision, Clinical Modification (Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850 (2008)).

 

ITP − Individual treatment plan.

 

Level of Role Functioning − Refers to the client's abilities in critical areas such as vocational, educational, independent living, self-care, and social and family relationships.  To assess the severity of the impairment in role functioning, scales approved for use include, but are not limited to, the GAF Scale or the CGAS Scale.

 

Licensed Clinician − An individual who is either 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 nurse (RN) 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 − An Illinois licensed health care practitioner who, within the scope of State law, has the ability to independently make a clinical assessment, certify a diagnosis and recommend treatment for persons with a mental illness and who is one of the following: a physician; an advanced practice nurse with psychiatric specialty licensed under the Nurse Practice Act [225 ILCS 65]; a clinical psychologist licensed under the Clinical Psychologist Licensing Act [225 ILCS 15]; a licensed clinical social worker (LCSW) licensed under the Clinical Social Work and Social Work Practice Act [225 ILCS 20]; a licensed clinical professional counselor (LCPC) licensed under the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107]; or a licensed marriage and family therapist (LMFT) licensed under the Marriage and Family Therapist Licensing Act [225 ILCS 55] and 68 Ill. Adm. Code 1283.

 

Medicaid − Medical assistance authorized by HFS under the provisions of the Illinois Public Aid Code [305 ILCS 5/Art. V], the Children's Health Insurance Program Act [215 ILCS 106] and Titles XIX and XXI of the Social Security Act (42 USCA 1396 and 1397aa).

 

Medical Necessity or Medically Necessary − A mental health intervention is medically necessary if: 

 

the individual has a diagnosis of mental illness or serious emotional disorder as defined in ICD-9-CM or DSM-IV;

 

mental health services are identified as appropriate to the individual's needs as identified in a mental health assessment; and

 

the intervention could not have been omitted without adversely affecting the individual's functioning. 

 

The LPHA shall recommend that medical or remedial services are necessary to reduce the physical or mental disability of an individual and to restore an individual to the maximum possible functioning level.  A service is not medically necessary if it is provided solely for the convenience of the individual, his or her family or the provider.

 

Mental Health Professional or MHP − An individual who provides services under the supervision of a qualified mental health professional and who possesses: a bachelor's degree; a practical nurse license under the Nurse Practice Act [225 ILCS 65]; a certificate of psychiatric rehabilitation from a DHS-approved program plus a high school diploma plus 2 years experience in providing mental health services; a recovery support specialist certified and in good standing with the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc., plus one year experience in providing mental health services; 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; or a minimum of 5 years supervised experience in mental health or human services.  A supervised internship in a mental health setting counts toward the experience in providing mental health services.  Any individual meeting the minimum credentials for an LPHA or QMHP under this Part is deemed to also meet the credentialing requirements of an MHP.

 

Mental Illness − A mental or emotional disorder diagnosis contained in the DSM-IV or ICD-9-CM, authorized by the public payer funding the services under this Part and the condition that will be the main focus of treatment for services under this Part.  Mental illness does not include organic disorders such as dementia and those associated with known or unknown physical conditions such as hallucinosis, amnestic disorder and delirium; psychoactive substance induced organic mental disorders; and mental retardation or psychoactive substance use disorders.

 

Natural Setting − A setting where an individual not identified as mentally ill typically spends time, including home, school, work, churches, community centers, libraries, parks, recreation centers, etc.  These sites are not licensed, certified or accredited as a treatment setting nor typically identified as treatment sites.

 

Off-site − Locations other than a certified provider site as described in Section 132.90.  A place of residence that is owned or leased by a provider and occupied by a client also will be considered off-site unless there is a certified site connected to the residence.

 

On-site − Location that is a certified provider site as described in Section 132.90.

 

Part 132 Services − The community mental health services described in this Part.

 

Physician − A physician licensed under the Medical Practice Act of 1987 [225 ILCS 60] to practice medicine in all its branches.

 

Provider − An entity certified to provide Medicaid community mental health services in accordance with this Part.

 

Public Payer − HFS, a State agency or a unit of local government that is responsible for payment for services under this Part provided to a client pursuant to a contract with the provider.

 

Qualified Mental Health Professional or QMHP − One of the following:

 

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 2 years experience in mental health services;

 

A licensed professional counselor 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 nurse (RN) 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;

 

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; or

 

An individual possessing at least a master's 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 or internship that included a minimum of 1,000 hours of supervised direct service, or who has one year of clinical experience under the supervision of a QMHP.

 

Any individual meeting the minimum credentials for an LPHA under this part is deemed to also meet the credentialing requirements of a QMHP.

 

Rehabilitative Services Associate or RSA − An RSA 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 the provider's structure and accept supervision, and have demonstrated the ability to work constructively with clients, treatment resources and the community.  Any individual meeting the minimum credentials for an MHP, QMHP or LPHA under this Part is deemed to also meet the credentialing requirements of an RSA.

 

SASS − A program of intensive mental health services provided by an agency certified to provide Part 132 services and under contract to provide screening, assessment and support services to children with a mental illness or emotional disorder who are at risk for psychiatric hospitalization.

 

Specialized Substitute Living Arrangement − A living arrangement providing services to a client supervised by a provider licensed under the Child Care Act of 1969 [225 ILCS 10] or any comparable Act in another state when the provider is under contract to the State agency.

 

State Agency − Department of Healthcare and Family Services, Department of Juvenile Justice, Department of Human Services, Department of Children and Family Services or the Department of Corrections.

 

Unit of Local Government − A county, municipal corporation, or other local government entity organized under the laws of the State of Illinois that, pursuant to an executed intergovernmental agreement with HFS, has agreed to pay for Medicaid community mental health services.

 

(Source:  Amended at 32 Ill. Reg. 9981, effective July 1, 2008)