State of Illinois
2021 and 2022


Introduced 2/8/2021, by Rep. Kathleen Willis


New Act

    Creates the Housing is Recovery Pilot Program Act. Creates the Housing is Recovery Pilot Program within the Department of Human Services, Division of Mental Health. Provides that the Program shall provide bridge rental subsidies for individuals at high risk of unnecessary institutionalization and individuals at high risk of overdose for purposes of stabilizing their mental illness or substance abuse disorder. Provides criteria for the award, computation, and payment of bridge rental subsidies. Sets forth the responsibilities of persons receiving from bridge rental subsidies. Provides for the identification and referral to the Program of persons eligible to receive bridge rental subsidies prior to their discharge from a hospital or release from a correctional facility. Provides standards for housing service providers, long-term housing, and temporary rental units. Provides that the Department will contract with an independent outside research organization to evaluate the Program's effectiveness, and shall report the results of the evaluation to the General Assembly after 5 years. Provides rulemaking authority. Defines terms. Effective immediately.

LRB102 05132 RLC 15153 b






HB0449LRB102 05132 RLC 15153 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the
5Housing is Recovery Pilot Program Act.
6    Section 3. Definitions. As used in this Act:
7    "Individual at high risk of unnecessary
8institutionalization" means a person who has a serious mental
9illness who is homeless (or will be homeless upon hospital
10discharge or correctional facility release) and who has had:
11        (1) three or more psychiatric inpatient hospital
12    admissions within the most recent 12-month period;
13        (2) three or more stays in a State or county
14    correctional facility in the State of Illinois within the
15    most recent 12-month period; or
16        (3) a disability determination due to a serious mental
17    illness and has been incarcerated in a State or county
18    correctional facility in Illinois for the most recent 12
19    consecutive months.
20    "Individual at high risk of overdose" means a person with
21a substance use disorder who is homeless (or will be homeless
22upon hospital discharge or correctional facility release) who
23has had:



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1        (A) three or more hospital inpatient or inpatient
2    detoxification admissions for a substance use disorder
3    within the most recent 12-month period;
4        (B) three or more stays in a State or county
5    correctional facility in the State of Illinois within the
6    most recent 12-month period; or
7        (C) one or more drug overdoses in the last 12 months.
8    "Engagement services" means home-based or community-based
9visits that assist the individual with maintaining his or her
10housing, and providing other wrap-around support, including
11linkage to mental health or substance use recovery support
12services. Such engagement services shall align with
13Medicaid-covered tenancy support services, and Medicaid
14community-based mental health and substance use treatment
15services, including case management, to ensure alignment with
16any existing or future Illinois Medicaid benefits, waivers or
17State plan amendments that include these services, and to
18maximize any potential federal Medicaid matching dollars that
19may be available to support engagement services.
20    "Homeless" means the definition used by the U.S.
21Department of Health and Human Services, Health Resources and
22Services Administration in Section 330(h)(5)(A) of the Public
23Health Services Act (42 U.S.C. 254(b)). Under Section
24330(h)(5)(A), a homeless individual is an individual who lacks
25housing (without regard to whether the individual is a member
26of a family), including an individual whose primary residence



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1during the night is a supervised public or private facility
2that provides temporary living accommodations, and an
3individual who is a resident in transitional housing. This
4includes individuals who are doubled up with other households.
5    "Serious mental illness" means at least one of the
6following psychiatric illnesses as defined in the most current
7edition of the Diagnostic and Statistical Manual published by
8the American Psychiatric Association:
9        (i) schizophrenia;
10        (ii) paranoid and other psychotic disorders;
11        (iii) bi-polar disorders;
12        (iv) major depressive disorders;
13        (v) obsessive-compulsive disorders;
14        (vi) schizoaffective disorders;
15        (vii) panic disorders; and
16        (viii) post-traumatic stress disorders.
17    "Substance use disorder" as defined in Section 1-10 of the
18Substance Use Disorder Act.
19    Section 5. Establishment of program. The Housing is
20Recovery pilot program shall be established and administered
21by the Department of Human Services, Division of Mental
22Health. The purpose of the program is to prevent a person with
23a serious mental illness who is at high risk of unnecessary
24institutionalization, or a person with a substance use
25disorder who is at high risk of overdose, due to homelessness,



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1a lack of access to recovery support services, and repeating
2cycles of hospitalizations or justice system involvement from
3being institutionalized or dying. This will be accomplished by
4enabling affordable housing through the use of a bridge rental
5subsidy combined with access to recovery support services or
6treatment. The triple aim of Housing is Recovery is:
7        (1) preventing institutionalization and overdose
8    deaths;
9        (2) improving health outcomes and access to recovery
10    support services; and
11        (3) reducing State costs.
12    Section 10. Eligibility. An individual meeting the
13requirements listed in this Section shall be eligible to
14receive a Housing is Recovery bridge rental subsidy for
15purposes of stabilizing his or her mental illness or substance
16use disorder.
17        (1) An individual at high risk of unnecessary
18    institutionalization who is 21 years of age or older, or
19    is aging out of guardianship under the Department of
20    Children and Family Services, and who is eligible to
21    enroll in, or is enrolled in, Medicaid for purposes of
22    receiving mental health treatment pursuant to 89 Ill. Adm.
23    Code 140.
24        (2) An individual at high risk of overdose who is 21
25    years of age or older, or is aging out of guardianship



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1    under the Department of Children and Family Services, and
2    who is eligible to enroll in, or is enrolled in, Medicaid
3    for purposes of receiving substance use treatment.
4    Section 15. Housing is Recovery bridge rental subsidy. A
5bridge rental subsidy received by an individual (the "subsidy
6holder") pursuant to this Act shall mirror the subsidies
7issued by the Department of Human Services, Division of Mental
8Health through the Moving On Program. The rental subsidy shall
9be for scattered-site rental units owned by a landlord or for
10rental units secured through a master lease. The rental
11subsidy shall assist the subsidy holder with monthly rental
12payments for rent that does not exceed the Fair Market Rent
13published annually for that year by the U.S. Department of
14Housing and Urban Development. The Department of Human
15Services, Division of Mental Health, shall have the discretion
16to allow a subsidy to apply to rent up to 120% of the Fair
17Market Rent if this is justified by the lack of available
18affordable housing in the local housing market. Community
19Mental Health Centers certified pursuant to 59 Ill. Adm. Code
20132 or supported housing service providers participating in
21this pilot program shall be responsible for assisting the
22subsidy holder with maintaining his or her housing that is
23supported by the bridge rental subsidy and either providing or
24coordinating engagement services with a mental health or
25substance use treatment provider.



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1        (1) The subsidy holder shall be responsible for
2    contributing 30% of his or her income toward the cost of
3    rent (zero income does not preclude participation).
4        (2) The subsidy holder must agree to sign a lease with
5    a landlord or a sublease agreement with the Community
6    Mental Health Center or the housing services provider that
7    has a master lease for the rental unit and agree to
8    engagement services initiated by the supported housing
9    provider, the Community Mental Health Center or contracted
10    mental health or substance use treatment provider at least
11    2 times a month, with at least one of those visits being a
12    home visit. The engagement services shall be permitted in
13    a home-based or community-based setting, and do not
14    require a clinic visit.
15        (3) A goal of this program is to encourage the subsidy
16    holder to engage in mental health and substance use
17    recovery support services or treatment when the individual
18    is ready. However, this is a Housing First model that does
19    not require abstinence from substance or alcohol use and
20    does not require mental health or substance use treatment.
21        (4) If a subsidy holder does not have an income due to
22    a psychiatric disability, he or she shall be offered the
23    opportunity for assistance with filing a "SOAR
24    application" (Supplemental Security Income (SSI)/Social
25    Security Disability Income (SSDI), Outreach, Access and
26    Recovery application) by the Community Mental Health



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1    Center participating in the Housing is Recovery program
2    that is providing his or her mental health support or
3    treatment within 6 months of the initiation of mental
4    health services. If the subsidy holder is only receiving
5    housing support services, the housing services provider
6    must partner with a Community Mental Health Center to do
7    SOAR applications for individuals who elect to apply for a
8    psychiatric disability. A subsidy holder is not required
9    to apply for a disability determination.
10        (5) The subsidy holder, if he or she is eligible, must
11    apply for rental assistance or housing through the
12    appropriate Public Housing Authority within 6 months of
13    receiving a Housing is Recovery bridge rental subsidy or
14    agree to apply when it is permissible to do so, and also be
15    placed on the Illinois Housing Development Authority's
16    Statewide Referral Network.
17    Section 20. Identification and referral of eligible
18individuals prior to hospital discharge or correctional
19facility release for purposes of rapid housing post
20discharge/release and illness stability. The pilot program is
21intended to enable affordable housing to avoid
22institutionalization or overdose death by providing for
23connection to housing through a variety of settings, including
24in hospitals, county jails, prisons, homeless shelters and
25inpatient detoxification facilities and the referral process



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1established must take this into account. Within 2 months of
2the effective date of this Act, the Department of Human
3Services, Division of Mental Health, in partnership with the
4Department of Healthcare and Family Services and the
5Department of Human Services, Division of Substance Use
6Prevention and Recovery (SUPR), the Department of Corrections,
7and with meaningful stakeholder input through a working group
8of Community Mental Health Centers, homeless service
9providers, substance use treatment providers, hospitals with
10inpatient psychiatric units or detoxification units,
11representatives from county jails, persons with lived
12experience, and family support organizations, shall develop a
13process for identifying and referring eligible individuals for
14the Housing is Recovery program prior to hospital discharge or
15correctional system release, or other appropriate place for
16referral, including homeless shelters. The process developed
17shall aim to enable rapid access to housing
18post-discharge/release to avoid unnecessary
19institutionalization or a return to homelessness or unstable
20housing. The working group shall meet at least monthly prior
21to development of an administrative rule or policy established
22to carry out the intent of this Act. The Department of Human
23Services, Division of Mental Health, shall explore ways to
24collaborate with the U.S. Department of Housing and Urban
25Development's Coordinated Entry System and other ways for
26electronic referral. The Department of Human Services,



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1Division of Mental Health, and the Department of Healthcare
2and Family Services shall collaborate to ensure that the
3referral process aligns with any existing or future Medicaid
4waivers or State plan amendments for tenancy support services.
5    Section 25. Participating Community Mental Health Centers
6and housing service provider responsibilities for locating and
7transitioning the individual into housing, assisting in
8retaining housing, and the provision of engagement and
9recovery support services. The Department of Human Services,
10Division of Mental Health, shall select interested Community
11Mental Health Centers that are certified pursuant to 59 Ill.
12Adm. Code 132 and interested housing service providers for
13participation in the Housing is Recovery program.
14        (1) For purposes of incentivizing continuity of care,
15    the same participating Community Mental Health Center may
16    be responsible for providing both the housing support and
17    the mental health or substance use engagement, recovery
18    support services and treatment to a subsidy holder. If a
19    housing support services provider does not also provide
20    the mental health or substance use treatment services the
21    individual engages in, there must be strong coordination
22    of care between the housing services provider and the
23    treatment provider.
24        (2) The provider must demonstrate that the rental
25    units secured through this program pass minimum quality



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1    inspection standards.
2        (3) Community Mental Health Centers providing housing
3    support through this program shall be responsible for any
4    SOAR applications for a subsidy holder that has a
5    psychiatric disability who does not have SSI or SSDI if
6    the subsidy holder chooses to apply for disability. A
7    housing services provider delivering the housing support
8    services through this program must contract with a
9    Community Mental Health Center to provide assistance with
10    SOAR applications to subsidy holders electing to apply for
11    SSI or SSDI within 6 months of the subsidy holder
12    receiving the subsidy.
13        (4) Service providers shall be permitted to engage in
14    master leasing to secure apartments for those who are hard
15    to house due to criminal backgrounds, history of substance
16    use and stigma.
17    Section 30. Securing rental housing units for purposes of
18immediate temporary housing following hospital discharge or
19release from a correctional facility while a long-term rental
20unit is secured. Up to 20% of the available annual
21appropriation for the Housing is Recovery program shall be
22available to Community Mental Health Centers or the housing
23services provider for purposes of securing critical time
24intervention rental units to house an eligible individual
25immediately following discharge from a hospitalization or



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1release from a correctional facility because locating an
2apartment unit for a longer-term one-year lease and the
3related move-in can take up to 3 months. Such temporary units
4may be used for immediate temporary housing, not to exceed 90
5days for purposes of preventing the individual from reentering
6homelessness or unstable housing, or avoiding unnecessary
7institutionalization. The Department of Human Services,
8Division of Mental Health, shall allow providers to certify
9that such rental units meet minimum housing quality standards
10and ensure a process by which community providers are able to
11secure vacant rental units for the purpose of immediate
12short-term housing post-hospital discharge or correctional
13system release while a longer term housing rental unit is
15    Section 35. Basic move-in expenses. The Housing is
16Recovery program shall include reasonable payment for the
17basic move-in expenses of the subsidy holder, including, but
18not limited to, payment of a security deposit and other
19move-in fees or expenses, and basic household supplies and
21    Section 40. Subsidy administration. The bridge rental
22subsidy administration (such as payment of rent to the
23landlord and other administration expenses) and quality
24inspection of the rental units may be done by community-based



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1organizations with experience and expertise in housing subsidy
2administration and by Community Mental Health Centers that the
3Department of Human Services, Division of Mental Health,
4determines have the administrative infrastructure for subsidy
5administration. Such organizations shall manage and administer
6all aspects of the subsidy (such as payment of rent, quality
7inspections) on behalf of the subsidy holder.
8    Section 45. Landlord education and stigma reduction plan
9and materials. The Department of Human Services, Division of
10Mental Health, with meaningful input from stakeholders, shall
11develop a plan for educating prospective landlords that may
12lease to individuals receiving a bridge rental subsidy through
13the Housing is Recovery program. This educational plan shall
14include written materials that indicate that individuals with
15psychiatric disabilities and substance use disorders often
16have criminal justice involvement due to their previously
17untreated mental health or substance use condition and periods
18of homelessness. Implementation of this plan shall be rolled
19out in conjunction with the implementation of the Housing is
20Recovery program.
21    Section 50. State agency coordination. The Department of
22Human Services, Division of Mental Health, shall partner with
23SUPR to ensure coordination of the services required pursuant
24to this Act and all substance use recovery support services



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1and treatment for which SUPR has oversight. The Department of
2Human Services, Division of Mental Health, shall also work
3with the Department of Healthcare and Family Services to
4maximize all recovery support services and treatment that are
5or can be covered by Medicaid.
6    Section 55. Provider and State agency education on the
7pilot program. The Department of Human Services, Division of
8Mental Health shall put together written materials on the
9Housing is Recovery program and eligibility criteria for
10purposes of educating participating providers, county jails,
11the Department of Corrections, hospitals and other relevant
12stakeholders on the program. The Department of Human Services,
13Division of Mental Health, shall engage in an ongoing
14education effort to ensure that all stakeholders are aware of
15the program and how to screen for eligibility and referral.
16    Section 60. Reimbursement for subsidy administration,
17housing support and engagement services and other program
18costs. The Department of Human Services, Division of Mental
19Health shall develop a reimbursement approach for community
20providers doing subsidy administration that covers all costs
21of subsidy administration, quality inspection and other
22services. The Department of Human Services, Division of Mental
23Health shall also develop a reimbursement approach that covers
24all costs incurred by Community Mental Health Centers and



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1housing services providers for identifying and securing rental
2units for subsidy holders, including all travel related to
3finding and locating an apartment and move-in of the subsidy
4holder, quality inspections for temporary housing units,
5completing and submitting SOAR applications, the costs
6associated with obtaining necessary documents associated with
7obtaining a lease for the subsidy holder (such as obtaining a
8State ID); for engagement services not covered by Medicaid;
9and for any other reasonable and necessary costs associated
10with the program outlined in this Act. Reimbursement shall
11also include all costs associated with collecting and tracking
12data for purposes of program evaluation and improvement. At
13the discretion of the Department of Human Services, Division
14of Mental Health, up to 5% of the annual appropriation may be
15applied to growing mental health or substance use treatment or
16recovery support capacity if a participating provider in the
17Housing is Recovery program demonstrates an inability to take
18eligible individuals due to such capacity limitations.
19    Section 65. Subsidy termination. The subsidy holder shall
20continue to hold the subsidy until he or she receives a housing
21voucher or rental subsidy through a Public Housing Authority
23        (1) The individual has a stay in a nursing home,
24    Institution for Mental Disease (IMD) or specialized mental
25    health rehabilitation facility (SMHRF) exceeding 6



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1    consecutive months. During a stay in nursing home, IMD or
2    SMHRF of less than 6 months, the program will continue to
3    pay the subsidized portion of the rent in order to
4    maintain the housing unit for the subsidy holder upon
5    discharge.
6        (2) The individual has a stay in a correctional
7    facility exceeding 6 consecutive months. During a
8    correctional facility stay of less than 6 months, the
9    program will continue to pay the subsidized portion of the
10    rent in order to maintain the housing unit for the subsidy
11    holder.
12        (3) A subsidy does not terminate if the subsidy holder
13    is required to move multiple times due to landlord
14    eviction or does not engage in treatment, as the target
15    population for this pilot program is expected to have
16    multiple barriers to remaining housed.
17    Section 70. Developing public-private partnerships to
18expand affordable housing options for those with serious
19mental illnesses. The Department of Human Services, Division
20of Mental Health shall work with the Department of Healthcare
21and Family Services, Medicaid managed care organizations and
22hospitals across the State to develop public-private
23partnerships to incentivize private funding from hospitals and
24managed care organizations to match State dollars invested in
25the Housing is Recovery program for purposes of preventing



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1repeated preventable hospitalizations, overdose deaths and
2unnecessary institutionalization.
3    Section 75. Data collection and program evaluation.
4    (a) For purposes of evaluating the effectiveness of the
5Housing is Recovery program and for making improvements to the
6program, the Department of Human Services, Division of Mental
7Health shall contract with an independent outside research
8organization with expertise in housing services for
9individuals with serious mental illnesses and substance use
10disorders to evaluate the program's effectiveness on enabling
11housing stability, reducing hospitalizations and justice
12system involvement, encouraging engagement in mental health
13and substance use treatment, fostering employment engagement,
14and reducing institutionalization and overdose deaths. Such
15evaluation shall commence after 4 years of implementation of
16the program and shall be submitted to the General Assembly by
17the end of the fifth year of implementation. For purposes of
18assisting with this evaluation, the working group established
19pursuant to Section 20 shall also make recommendations to the
20Department of Human Services, Division of Mental Health,
21regarding what data must be tracked by providers and the
22Department of Human Services, Division of Mental Health, to
23evaluate the program and to make future changes to the program
24to ensure its effectiveness in meeting the triple aim stated
25in Section 5.



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1    (b) Beginning after the first 12 months of implementation
2and on an annual basis, the Department of Human Services,
3Division of Mental Health, shall track and make public the
4following information: (1) the number of individuals receiving
5subsidies in reporting period (12-month average); (2)
6participant demographics including age, race, gender identity,
7and primary language; (3) the average duration of time
8individuals are enrolled in the program (by months); (4) the
9number of individuals removed from the program and reasons for
10removal; (5) the number of grievances filed by participants
11and a summary of grievance type; and (6) program referral
12sources. Reports shall be generated on an annual basis and
13publicly posted on the Department of Human Services website.
14    Section 80. Act subject to appropriation. This Act is
15subject to appropriation. The appropriation shall be divided
16equally between bridge subsidies issued to individuals who are
17at high risk of unnecessary institutionalization and those who
18are at high risk of overdose.
19    Section 85. Rulemaking authority. Any administrative rules
20necessary to implement this Act shall be filed within 12
21months following the effective date of this Act.
22    Section 99. Effective date. This Act takes effect upon
23becoming law.