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)].