HB4096 99TH GENERAL ASSEMBLY

LRB099 07770 RLC 27903 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB4096

Introduced , by Rep. Sara Feigenholtz

SYNOPSIS AS INTRODUCED:

20 ILCS 1705/75 new
20 ILCS 1705/75.01 new
20 ILCS 1705/75.02 new
20 ILCS 1705/75.03 new
20 ILCS 1705/75.04 new
20 ILCS 1705/75.05 new
20 ILCS 1705/75.06 new
20 ILCS 1705/75.07 new
20 ILCS 1705/75.08 new
20 ILCS 1705/75.09 new
20 ILCS 1705/75.10 new
20 ILCS 1705/75.11 new
20 ILCS 1705/75.12 new
20 ILCS 1705/75.13 new
20 ILCS 1705/75.14 new

Amends the Mental Health and Developmental Disabilities Administrative Act. Defines the terms and provides procedures under which children are eligible to receive funds for an Individual Care Grant (ICG) for residential placement due to their mental illness, including alternative in-home or community services in lieu of residential placement, when clinically appropriate. Supersedes Department of Human Services rules.

A BILL FOR

AN ACT concerning State government.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Mental Health and Developmental Disabilities Administrative Act is amended by adding Sections 75, 75.01, 75.02, 75.03, 75.04, 75.05, 75.06, 75.07, 75.08, 75.09, 75.10, 75.11, 75.12, 75.13, and 75.14 as follows:

(20 ILCS 1705/75 new)

Sec. 75. Application of Sections 75.01 through 75.14; purpose.

(a) Sections 75.01 through 75.14 (this Part) shall supersede any rules of the Department regarding which children are eligible to receive funds for an Individual Care Grant hereinafter referred to as "ICG" for residential placement due to their mental illness, including alternative in-home or community services in lieu of residential placement, when clinically appropriate. Comprehensive services are to be funded to assist in reducing the child's severe symptoms of the illness and to maintain this reduction. Funds shall be provided to assist parents or guardians in obtaining these services at the appropriate level of care.

(b) This Part shall be in addition to the other statutory provisions regarding Individual Care Grants. This Part is intended to supplement and provide procedures for Individual Care Grants. However, if there is a conflict between anything contained in the other statutory provisions, those other statutory provisions shall prevail.

(20 ILCS 1705/75.01 new)

Sec. 75.01. Definitions.

For the purposes of this Part, unless the context otherwise requires:

"Children" means individuals under 18 years of age.

"Days" means calendar days.

"Department" means the Department of Human Services.

"Division of Mental Health" or "DMH" means the Department of Human Services, Division of Mental Health.

"Child support services" means time-limited funding to cover costs that would otherwise be prohibitive to the parents for the child to participate in community activities when those activities are related to objectives in the child's current individual services plan.

"ICG Coordinator" means staff employed by an Illinois screening, assessment and support services program to provide support, information and recommendations regarding available services, case coordination, and supports to youth applying for or with an Illinois ICG.

"Individual Services Plan" or "ISP" means the plan that identifies the child's goals and selects the level of care and associated services required to meet the goals.

"Individual Services Planning Team" means the team composed of family members, significant people in the lives of the child and family, representatives of the community's human service agencies and the youth's school system, who provide needed support to an identified child and family and which is responsible for the development, implementation, and monitoring of a unified Child and Family Plan that engages and involves the family and closely coordinates needed services and support.

"Licensed private facilities" means residential treatment facilities licensed by the Department of Children and Family Services under 89 Ill. Adm. Code 404, or, for out-of-state facilities, in accordance with Section 15.1 of the Mental Health and Developmental Disabilities Administrative Act, which have been accredited by the Joint Commission on the Accreditation of Healthcare Organizations hereinafter preferred to as "JCAHO" as a psychiatric facility serving children and adolescents or which have been surveyed and approved by the Department as meeting standards equivalent to standards for psychiatric facilities serving children and adolescents found in the 1997 Standards for Behavioral Health Care released by JCAHO.

"Parent or guardian" means a parent, biological, or adoptive, or an individual appointed as legal guardian by the court under the Probate Act of 1975. A parent or guardian does not include a governmental agency or social service agency, or any employee thereof, appointed by a court as guardian or custodian for application purposes.

"Residential facility" means a facility providing 24-hour supervised out-of-home therapeutic care, including, but not limited to: single or multiple site program sites or apartments that provide a 24-hour supervised environment.

"SASS" or "screening, assessment and support services" means intensive community-based mental health services that are provided to children who are at risk or who actually experience hospitalization due to psychiatric reasons.

"Secretary" means the Secretary of Human Services.

"Serious emotional disturbance" means an emotional disturbance affecting children and adolescents between the ages of one and 20 years of age. In order to qualify as a serious emotional disturbance, the disturbance must meet the following diagnostic and functional criteria:

(1) Diagnostic criteria: The focus of treatment provided to the child must be based on one of the following diagnoses in the most current version of the Diagnostic and Statistical Manual ("DSM"):

(A) schizophrenia spectrum and other psychotic disorders;

(B) bipolar and related disorders;

(C) depressive disorders;

(D) anxiety disorders;

(E) obsessive-compulsive and related disorders;

(F) trauma- and stressor-related disorders;

(G) dissociative disorders; and

(H) somatic symptom disorders.

(2) Functional Criteria: The functional impairment must be:

(A) the result of mental health problems for which the child is or will be receiving care;

(B) expected to persist in the absence of treatment;

(C) The functional impairment cannot be solely attributed to an intellectual, sensory, or health factor; and

(D) In order for the disturbance to be classified as a serious emotional disturbance, the youth must also meet criteria for functional impairment in at least 2 of the following areas:

(i) Functioning in self-care, or impairment in developmentally appropriate self-care skills, which is manifested by a person's consistent inability to take care of personal grooming, hygiene, clothes and meeting of nutritional needs, or medication non-compliance.

(ii) Functioning in community, or impairment in community functioning, which is manifested by a consistent lack of developmentally appropriate behavioral controls, decision-making, and judgment and value systems which results in involvement with police, juvenile justice, or the criminal justice system, or repeated psychiatric hospitalizations due to risk of harm to self or others or because he or she is a chronic runaway.

(iii) Functioning in social relationships, or impairment of social relationships, which is manifested by the consistent inability to develop and maintain satisfactory relationships with peers and adults.

(iv) Functioning in the family, or impairment in family functioning, which is manifested by a pattern of: (aa) disregard for safety and welfare of self or others, which includes, but is not limited to, self-harm, fire setting, and serious and chronic destructiveness which may lead to repeated psychiatric hospitalizations; (bb) significantly disruptive behavior exemplified by repeated or unprovoked violence to siblings or parents; or (cc) the inability to conform to reasonable limitations and expectations. The degree of impairment must be significant enough that it requires intensive supervision, beyond what is developmentally appropriate, by a parent or caregiver and may result in removal from the family or its equivalent.

(v) Functioning at school, or impairment in functioning at school, which is manifested by the inability to pursue educational goals in a normal time frame for example, consistently failing grades, repeated truancy, expulsion, property damage or violence towards others that cannot be remediated by a classroom setting, either traditional or specialized.

"Staff" means employees or persons under contract with the Department.

"Young adults" means individuals 18 through 21 years of age.

"Young adult support services" means time-limited funding for young adults to cover costs of services and supports, not included under other programs for which the person may be eligible, to aid the young adult in his or her transition to community living and funding that can be applied to the costs of a supported living arrangement or other appropriate transitional services that help to integrate the young adult into his or her adult roles in the community.

(20 ILCS 1705/75.02 new)

Sec. 75.02. Eligibility criteria for an individual care grant. In order to be eligible for ICG funding, the following criteria must be met:

(1) The parent or guardian must be a resident of this State, as defined in Section 2-10 of the Illinois Public Aid Code.

(2) The child must have a severe emotional disturbance and must not be older than 17 1/2 years of age at the time of application. The course of the illness should indicate that the symptoms do not represent an acute episode from which rapid and substantial remission is likely.

(3) The child must not be under the guardianship of another State agency that has financial and legal responsibility for the youth. However, a child that becomes a ward of the State solely for purposes of obtaining residential treatment for a serious emotional disturbance, and when there is no evidence of abuse or neglect of the child, shall be eligible for an ICG if all other criteria are satisfied.

(4) The child must be enrolled in a public, private, or parochial school that satisfies the compulsory school attendance requirements set forth in Section 26-1 of the School Code.

(20 ILCS 1705/75.03 new)

Sec. 75.03. Emergency Individual Care Grants.

(a) To be eligible for an emergency temporary individual care grant;

(1) the child and family must meet the eligibility requirements in Section 75.02.

(2) A child in institutional care (psychiatric hospital, juvenile detention center, or similar facility) who is ready for discharge and who is not able to return home due to the safety of the child, family, or individual may be awarded a temporary emergency grant for a period of 90 days.

(3) The attending child and adolescent psychiatrist must recommend that the child is in need of on-going 24 hour supervision, such as residential placement.

(b) For purposes of this Section, paragraph (3) of Section 75.02 of this Act shall not apply if custody will end at discharge.

(c) During the 90-day period a complete application must be prepared and submitted in accordance with this Part.

(d) Section 75.08 applies to decisions under this Section.

(20 ILCS 1705/75.04 new)

Sec. 75.04. Parent or guardian responsibilities; resources.

(a) The parent or guardian of a child receiving an ICG must participate in the child's care, treatment, and discharge to family and community.

(b) When a youth is placed in residential care, the residential provider shall apply for all public sources of financial support available to or for the child, including but not limited to Social Security Administration ("SSA") benefits and supplemental security income ("SSI") authorized under Section 1381 of Title 42 of the United States Code, and these funds must be applied to the costs of residential care, to the extent provided by law.

(c) Upon placement in residential care, if the child is not already receiving benefits from SSA, the parent or guardian shall authorize the residential placement staff to initiate an application for SSI immediately after placement or on the 90th day, depending on family income levels. If the child is receiving benefits from SSA upon admission into residential care, the parent or guardian shall authorize the residential placement staff to initiate an application on behalf of the residential agency to become payee for SSA benefits.

(d) The parent or guardian must notify the Department of any changes in the level of financial support from public sources. Declaration of ineligibility, reduction of benefits, or loss of benefits through the actions of another governmental agency shall not affect the Department's continued funding, unless these actions are the consequence of the parent or guardian's failure to pursue benefits or comply with this Section.

(e) All financial assets of the child exceeding an exempt amount established by the Department must be applied to the costs of residential care. The determination that certain assets may be exempt is subject to the Department's review and approval.

(f) If the child is covered by private medical insurance, it is primary coverage for community or residential services. The ICG shall be considered secondary coverage.

(g) The parent or guardian must notify the Department of any changes of address for the parent or guardian.

(h) The parent or guardian must notify the Department of any changes of guardianship or custody.

(20 ILCS 1705/75.05 new)

Sec. 75.05. Secretary's level appeal for ICG denial.

(a) The parent or guardian may appeal the denial of eligibility for an ICG to the Secretary in writing. The appeal must be received by the Department from the parent or guardian within 40 days after the date of the denial correspondence from the ICG Program Office. The written appeal must provide in detail each basis on which the appeal is being made, specifically stating each reason that the denial of eligibility is alleged to be improper. Additional information may be provided and shall be considered as part of the review process. This information shall be provided with the appeal letter.

(b) A Secretary's level review shall be performed within 30 days after the receipt of the parent or guardian's appeal.

(c) A Secretary's level review shall be made by one reviewer selected by the Secretary. The reviewer shall be a licensed physician who is board eligible in child psychiatry from the American Board of Psychiatry and Neurology and shall have had no professional or personal relationship with the child and family to be reviewed. The reviewer shall not be the original reviewer of the ICG.

(d) Following a Secretary's level review of the original application package, of the original determination, and of the parent or guardian's appeal, the reviewer shall make a recommendation to the Secretary as to whether the child is eligible for an ICG or is not eligible for an ICG.

(e) The Secretary shall make the final administrative decision as to whether the child is eligible for an ICG or is not eligible for an ICG. The final administrative decision shall be sent in writing to the parent or guardian within 40 days after the receipt of the parent or guardian's written appeal. The Secretary shall further indicate the basis for the final administrative decision.

(f) The Secretary's decision shall constitute the Department's final administrative decision and no application for a re-hearing shall be accepted. The decision is then reviewable in accordance with the Administrative Review Law.

(20 ILCS 1705/75.06 new)

Sec. 75.06. Individual Services Plan Development.

(a) When the individual has been determined eligible for an ICG, the ICG Program Office shall refer the parent or guardian to the appropriate SASS agency for the purpose of developing an individual services plan.

(b) The parent or guardian shall determine whether to use the ICG for community services, if available, or residential placement. The ICG Coordinator/SASS Coordinator shall provide support, information, and recommendations regarding available services.

(c) The development or implementation of an individual services plan may be deferred for one or more of the following conditions:

(1) continuing hospitalization is required;

(2) extended absence from the family due to the child running away or a court-ordered transfer of custody or guardianship to a governmental agency; or

(3) the parent or guardian does not wish to initiate any services with ICG funding or fails to participate in the individual services planning.

(d) If the individual services plan is not developed or implemented within one year after the date of approval for eligibility, the parent or guardian must reapply to obtain ICG funding.

(e) On an ongoing basis, but at least annually, the ISP shall be updated. In keeping with family-driven, youth-guided principles established for systems of care by the American Academy of Child and Adolescent Psychiatry, the parent or guardian shall form an individual services planning team to make recommendations. The parent or guardian shall determine whether to use the ICG for community services, if available, or for residential placement. At the individual services planning meeting, the parent or guardian shall receive information and recommendations for appropriate services. This may include data from assessment tools. The planning team must recommend services that currently exist, or that can be obtained or created.

(f) The ISP team may be reconvened at any time upon request of the parent or guardian or other members.

(g) A recommendation to move a child to a lower level of care must include a minimum of 90 days of preparation for this transition. Whenever possible, changes should occur at natural school transitions such as the beginning of the school year, or the beginning or end of a semester, in order to cause as little disruption as possible for the child.

(20 ILCS 1705/75.07 new)

Sec. 75.07. Alternative In-home or Community Services.

(a) DMH or its representative shall review individual services plans as well as discharge plans and may approve funding for alternative in-home or community services as described in this Section. The plan shall be reviewed and revised every 6 months by the parent or guardian and appropriate service providers and must:

(1) identify specific problems to be addressed;

(2) integrate all of the services to be provided;

(3) define specific goals and objectives and the projected duration and costs of services;

(4) reflect the parent or guardian's approval of the identified service providers; and

(5) identify the licensed physician, clinical psychologist, clinical social worker, or clinical professional counselor under whose clinical direction the services will be provided and obtain, by signature, his or her approval of the plan.

(b) In-home or community services include, but are not limited to, case management, community support, crisis intervention, mentoring, respite and young adult support services. The complete list of ICG community services shall be included in the current version of the ICG Parent Handbook and the ICG Provider Handbook.

(c) ICG funding shall not be used to replace grant-in-aid funded services or other services for which the child and family may be eligible through federal, State, or local funding.

(d) Limits of hours and costs shall be authorized on a case by case basis by the Department.

(20 ILCS 1705/75.08 new)

Sec. 75.08. Residential Placement.

(a) At the individual services planning meeting, SASS staff will discuss with the parent or guardian the potentially appropriate facilities based on such factors as the child's age, sex, and mental health condition, as well as locations and programs of facilities, and the requirements for placement and parental involvement, and shall, at the parent's or guardian's direction and with appropriately executed consents, prepare clinical referral packets to be sent to the facilities.

(b) The list of facilities appropriate for placement through the ICG program is comprised of facilities which:

(1) meet the standards for licensed private facilities as defined in administrative rules;

(2) have an educational program approved by the Illinois State Board of Education;

(3) have a per diem rate that includes residential services, such as room and board, but does not include tuition as established for purchased care services under the rules of the Illinois Purchased Care Review Board in 89 Ill. Adm. Code 900, the Department of Children and Family Services in 89 Ill. Adm. Code 356, or the Department in Section 54 of the Mental Health and Developmental Disabilities Administrative Act; and

(4) have entered into a contract with the Department for these services during the current fiscal period.

(c) If appropriate placement for a child cannot be obtained from a contracted provider, the Department may contract with other private facilities meeting the standards provided in subsections (b)(1) and (2) of this Section.

(d) The Department may negotiate for additional services from facilities to augment existing services or to develop a specialized resource for a child.

(e) An individual service plan shall be developed within 30 days after placement, including expected duration and outcomes, by facility staff in consultation with the parent or guardian and the child. This individual service plan shall be reviewed and updated quarterly, including documentation of parental participation and consideration of discharge to in-home or community services. These updated plans and progress reports shall be provided quarterly to the Department or its designee. Together with the goals as stated in the case record summary, these documents shall be the basis for the Department's review and approval for continuing funding for placement, including alternative in-home or community service which are part of the discharge plan.

(f) Parent or guardian responsibilities during placement include the following:

(1) participation in and cooperation with the facility's requirements for the child's care, treatment, and discharge to the family and community;

(2) completion and submission of any forms and documents as may be required by the Department;

(3) the usual and customary costs of parenthood or guardianship, including:

(A) clothing;

(B) medical and dental costs;

(C) personal allowance and incidentals; and

(D) transportation costs, to and from the facility; and

(4) notifying the local education agency that the child has been placed in a residential facility and requesting their participation in educational planning. The local education agency is responsible for the tuition costs of residential placement under State law.

(g) Prior to residential placement, if the youth has not yet been identified as eligible for special education services, the parent or guardian should initiate a case study evaluation through their local school district.

(20 ILCS 1705/75.09 new)

Sec. 75.09. Discharge from residential services.

(a) When discharge from residential services is anticipated, a discharge plan must be developed by the child's ISP team. This Individual Service Plan must follow the discharge protocol established by DMH in order to ensure that community services are in place before discharge. The parent or guardian with support from an ICG Coordinator shall identify and procure appropriate community services.

(b) If the child is leaving the ICG program upon discharge, appropriate child and adolescent or adult services must be engaged.

(20 ILCS 1705/75.10 new)

Sec. 75.10. Service appeals.

(a) Service decisions may be appealed. Service decisions include the level of care, for example (residential versus community and other levels established in this Section) and denial of individual services within the levels. The following persons may appeal:

(1) the parent of a youth with an ICG;

(2) the legal guardian of a youth with an ICG; or

(3) an 18 to 21 year old with an ICG who are their own legal guardian.

(b) The reviewer of the appeal must be a licensed physician who is board certified or board eligible in child and adolescent psychiatry from the American Board of Psychiatry and Neurology and has been instructed by Section 7.1 of the Mental Health and Developmental Disabilities Administrative Act and shall have had no professional or personal relationship, or financial interest with the child and family to be reviewed. The reviewer must conduct an in-person assessment of the child, using a validated assessment tool. The reviewer must state the clinical basis for his or her decision. If the reviewer disagrees with the service recommendations of the treating clinician, school district, or parent or guardian, the reviewer must state:

(1) why he or she disagrees;

(2) specify an alternative plan based on available services;

(3) and state why the alternative plan is clinically preferable and appropriate for the child.

The alternative plan shall be reviewed after the Level of Care ("LOC") group makes recommendations.

(c) The following is the process for the Appeal Review:

(1) the documentation for the level of care appeal shall be mailed by the Child and Adolescent Office via United States Postal Service mail with tracking and delivery confirmation to the psychiatrist selected by the Secretary of Human Services to review change in level of care appeals;

(2) the appeal must be reviewed and a decision returned within 5 business weeks; and

(3) The reviewer must use the quarterly reports, the identified tool, and a statement of need from the ISP team in making the review and additional documents may be reviewed to determine whether to uphold or deny the appeal; and

(d) The following shall be the service status during appeal:

(1) When a reduction in service level is being appealed the higher level service shall remain in place during the appeal.

(2) When an increase in service level is being appealed, the higher level may be put in place if the attending psychiatrist certifies that child or family safety is at risk at the existing level of service.

(20 ILCS 1705/75.11 new)

Sec. 75.11. Termination of funding or services.

(a) ICG funding shall be terminated in any of the following circumstances:

(1) failure of the parent or guardian to meet annual reporting and eligibility requirements;

(2) the child is no longer enrolled in an approved educational program at the elementary or high school level, or attainment of age 21, whichever occurs first;

(3) completion of residential treatment or alternative in-home or community services;

(4) the parent or guardian is no longer an Illinois resident; however, funding and placement for the child may continue until completion of the school year;

(5) guardianship of the child is ordered by the court to a State agency;

(6) the child's resources, private or public, are sufficient to pay the costs of care; or

(7) any 12-month period without receiving residential or alternative in-home or community services.

(b) The parent or guardian's objection to termination may be addressed under the Secretary's level appeal process in accordance with this Part. ICG funding shall continue during the appeal process.

(20 ILCS 1705/75.12 new)

Sec. 75.12. Monitoring.

(a) Pursuant to the ICG program, the Department retains the right for on-site inspection to monitor the care, treatment, and progress of children funded through the ICG program.

(b) Subsequent to any of these monitoring activities, the Department may require termination of placement and the development and implementation of a discharge plan, including alternative residential or in-home or community services.

(c) If the Department terminates placement, the parent or guardian may appeal that determination under Section 75.08 of this Part. ICG funding shall continue during the appeal process.

(20 ILCS 1705/75.13 new)

Sec. 75.13. Grant renewal process.

(a) The ICG is a grant that shall be reviewed annually up to age 21 of the child and may be renewed with documentation of continuing clinical need at the appropriate level of care as well as proof of enrollment in an approved education program at the elementary or high school level, and documentation of the parent or guardian's participation in the child's care, treatment, and discharge to family and community. For purposes of this Section, clinical need is defined as continued severe symptoms, maintenance of reduced symptoms, and development of appropriate life skills.

(b) The ICG Program Office staff shall commence a review of the child's care, his or her current educational status and parent or guardian's participation 3 months prior to the anniversary date of the child's entry to the ICG program. The ICG Program Office shall rely on the current individual services plan of the provider serving the child, the provider's quarterly reports, proof of enrollment in an approved educational program at the elementary or high school level, and the parent or guardian's report.

(c) The parent or guardian shall be notified by the ICG Program Office of the review and shall be invited to provide information as to the child's needs, level of care, and parent or guardian participation.

(d) The parent or guardian, child (if appropriate), and provider shall be notified 6 weeks prior to the anniversary date of the Department's decision to renew or terminate funding.

(e) If ICG funding is terminated under the grant renewal process, the parent or guardian may appeal that determination under Section 75.08 of this Part. ICG funding will continue during the appeal process.

(20 ILCS 1705/75.14 new)

Sec. 75.14. Bed holds.

(a) The Department may reimburse a community agency for up to 120 consecutive or non-consecutive nights per State fiscal year for an individual on a programmatically approved absence from the residential facility.

(b) An agency shall not be reimbursed for an individual's absence after the date of discharge or when his or her treatment plan includes removal from the agency program or after the date of the agency's knowledge of the individual's pending termination.

(c) A bed hold billing request by an agency that falls within a 60 day cumulative limit per State fiscal year shall be authorized if it is consistent with the Department's policies and procedures.

(d) Any absence that would exceed 60 cumulative days per State fiscal year must be communicated to and approved by the Individual Care Grant Program staff.