HB4096ham001 99TH GENERAL ASSEMBLY

Rep. Sara Feigenholtz

Filed: 4/20/2015

09900HB4096ham001 LRB099 07770 RLC 34365 a

AMENDMENT TO HOUSE BILL 4096

AMENDMENT NO. ______. Amend House Bill 4096 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Administrative Procedure Act is amended by changing Section 5-45 as follows:

(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)

Sec. 5-45. Emergency rulemaking.

(a) "Emergency" means the existence of any situation that any agency finds reasonably constitutes a threat to the public interest, safety, or welfare.

(b) If any agency finds that an emergency exists that requires adoption of a rule upon fewer days than is required by Section 5-40 and states in writing its reasons for that finding, the agency may adopt an emergency rule without prior notice or hearing upon filing a notice of emergency rulemaking with the Secretary of State under Section 5-70. The notice shall include the text of the emergency rule and shall be published in the Illinois Register. Consent orders or other court orders adopting settlements negotiated by an agency may be adopted under this Section. Subject to applicable constitutional or statutory provisions, an emergency rule becomes effective immediately upon filing under Section 5-65 or at a stated date less than 10 days thereafter. The agency's finding and a statement of the specific reasons for the finding shall be filed with the rule. The agency shall take reasonable and appropriate measures to make emergency rules known to the persons who may be affected by them.

(c) An emergency rule may be effective for a period of not longer than 150 days, but the agency's authority to adopt an identical rule under Section 5-40 is not precluded. No emergency rule may be adopted more than once in any 24 month period, except that this limitation on the number of emergency rules that may be adopted in a 24 month period does not apply to (i) emergency rules that make additions to and deletions from the Drug Manual under Section 5-5.16 of the Illinois Public Aid Code or the generic drug formulary under Section 3.14 of the Illinois Food, Drug and Cosmetic Act, (ii) emergency rules adopted by the Pollution Control Board before July 1, 1997 to implement portions of the Livestock Management Facilities Act, (iii) emergency rules adopted by the Illinois Department of Public Health under subsections (a) through (i) of Section 2 of the Department of Public Health Act when necessary to protect the public's health, (iv) emergency rules adopted pursuant to subsection (n) of this Section, (v) emergency rules adopted pursuant to subsection (o) of this Section, or (vi) emergency rules adopted pursuant to subsection (c-5) of this Section. Two or more emergency rules having substantially the same purpose and effect shall be deemed to be a single rule for purposes of this Section.

(c-5) To facilitate the maintenance of the program of group health benefits provided to annuitants, survivors, and retired employees under the State Employees Group Insurance Act of 1971, rules to alter the contributions to be paid by the State, annuitants, survivors, retired employees, or any combination of those entities, for that program of group health benefits, shall be adopted as emergency rules. The adoption of those rules shall be considered an emergency and necessary for the public interest, safety, and welfare.

(d) In order to provide for the expeditious and timely implementation of the State's fiscal year 1999 budget, emergency rules to implement any provision of Public Act 90-587 or 90-588 or any other budget initiative for fiscal year 1999 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (d). The adoption of emergency rules authorized by this subsection (d) shall be deemed to be necessary for the public interest, safety, and welfare.

(e) In order to provide for the expeditious and timely implementation of the State's fiscal year 2000 budget, emergency rules to implement any provision of this amendatory Act of the 91st General Assembly or any other budget initiative for fiscal year 2000 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (e). The adoption of emergency rules authorized by this subsection (e) shall be deemed to be necessary for the public interest, safety, and welfare.

(f) In order to provide for the expeditious and timely implementation of the State's fiscal year 2001 budget, emergency rules to implement any provision of this amendatory Act of the 91st General Assembly or any other budget initiative for fiscal year 2001 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (f). The adoption of emergency rules authorized by this subsection (f) shall be deemed to be necessary for the public interest, safety, and welfare.

(g) In order to provide for the expeditious and timely implementation of the State's fiscal year 2002 budget, emergency rules to implement any provision of this amendatory Act of the 92nd General Assembly or any other budget initiative for fiscal year 2002 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (g). The adoption of emergency rules authorized by this subsection (g) shall be deemed to be necessary for the public interest, safety, and welfare.

(h) In order to provide for the expeditious and timely implementation of the State's fiscal year 2003 budget, emergency rules to implement any provision of this amendatory Act of the 92nd General Assembly or any other budget initiative for fiscal year 2003 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (h). The adoption of emergency rules authorized by this subsection (h) shall be deemed to be necessary for the public interest, safety, and welfare.

(i) In order to provide for the expeditious and timely implementation of the State's fiscal year 2004 budget, emergency rules to implement any provision of this amendatory Act of the 93rd General Assembly or any other budget initiative for fiscal year 2004 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (i). The adoption of emergency rules authorized by this subsection (i) shall be deemed to be necessary for the public interest, safety, and welfare.

(j) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2005 budget as provided under the Fiscal Year 2005 Budget Implementation (Human Services) Act, emergency rules to implement any provision of the Fiscal Year 2005 Budget Implementation (Human Services) Act may be adopted in accordance with this Section by the agency charged with administering that provision, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (j). The Department of Public Aid may also adopt rules under this subsection (j) necessary to administer the Illinois Public Aid Code and the Children's Health Insurance Program Act. The adoption of emergency rules authorized by this subsection (j) shall be deemed to be necessary for the public interest, safety, and welfare.

(k) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2006 budget, emergency rules to implement any provision of this amendatory Act of the 94th General Assembly or any other budget initiative for fiscal year 2006 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative, except that the 24-month limitation on the adoption of emergency rules and the provisions of Sections 5-115 and 5-125 do not apply to rules adopted under this subsection (k). The Department of Healthcare and Family Services may also adopt rules under this subsection (k) necessary to administer the Illinois Public Aid Code, the Senior Citizens and Disabled Persons Property Tax Relief Act, the Senior Citizens and Disabled Persons Prescription Drug Discount Program Act (now the Illinois Prescription Drug Discount Program Act), and the Children's Health Insurance Program Act. The adoption of emergency rules authorized by this subsection (k) shall be deemed to be necessary for the public interest, safety, and welfare.

(l) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2007 budget, the Department of Healthcare and Family Services may adopt emergency rules during fiscal year 2007, including rules effective July 1, 2007, in accordance with this subsection to the extent necessary to administer the Department's responsibilities with respect to amendments to the State plans and Illinois waivers approved by the federal Centers for Medicare and Medicaid Services necessitated by the requirements of Title XIX and Title XXI of the federal Social Security Act. The adoption of emergency rules authorized by this subsection (l) shall be deemed to be necessary for the public interest, safety, and welfare.

(m) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2008 budget, the Department of Healthcare and Family Services may adopt emergency rules during fiscal year 2008, including rules effective July 1, 2008, in accordance with this subsection to the extent necessary to administer the Department's responsibilities with respect to amendments to the State plans and Illinois waivers approved by the federal Centers for Medicare and Medicaid Services necessitated by the requirements of Title XIX and Title XXI of the federal Social Security Act. The adoption of emergency rules authorized by this subsection (m) shall be deemed to be necessary for the public interest, safety, and welfare.

(n) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2010 budget, emergency rules to implement any provision of this amendatory Act of the 96th General Assembly or any other budget initiative authorized by the 96th General Assembly for fiscal year 2010 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative. The adoption of emergency rules authorized by this subsection (n) shall be deemed to be necessary for the public interest, safety, and welfare. The rulemaking authority granted in this subsection (n) shall apply only to rules promulgated during Fiscal Year 2010.

(o) In order to provide for the expeditious and timely implementation of the provisions of the State's fiscal year 2011 budget, emergency rules to implement any provision of this amendatory Act of the 96th General Assembly or any other budget initiative authorized by the 96th General Assembly for fiscal year 2011 may be adopted in accordance with this Section by the agency charged with administering that provision or initiative. The adoption of emergency rules authorized by this subsection (o) is deemed to be necessary for the public interest, safety, and welfare. The rulemaking authority granted in this subsection (o) applies only to rules promulgated on or after the effective date of this amendatory Act of the 96th General Assembly through June 30, 2011.

(p) In order to provide for the expeditious and timely implementation of the provisions of Public Act 97-689, emergency rules to implement any provision of Public Act 97-689 may be adopted in accordance with this subsection (p) by the agency charged with administering that provision or initiative. The 150-day limitation of the effective period of emergency rules does not apply to rules adopted under this subsection (p), and the effective period may continue through June 30, 2013. The 24-month limitation on the adoption of emergency rules does not apply to rules adopted under this subsection (p). The adoption of emergency rules authorized by this subsection (p) is deemed to be necessary for the public interest, safety, and welfare.

(q) In order to provide for the expeditious and timely implementation of the provisions of Articles 7, 8, 9, 11, and 12 of this amendatory Act of the 98th General Assembly, emergency rules to implement any provision of Articles 7, 8, 9, 11, and 12 of this amendatory Act of the 98th General Assembly may be adopted in accordance with this subsection (q) by the agency charged with administering that provision or initiative. The 24-month limitation on the adoption of emergency rules does not apply to rules adopted under this subsection (q). The adoption of emergency rules authorized by this subsection (q) is deemed to be necessary for the public interest, safety, and welfare.

(r) In order to provide for the expeditious and timely implementation of the provisions of this amendatory Act of the 98th General Assembly, emergency rules to implement this amendatory Act of the 98th General Assembly may be adopted in accordance with this subsection (r) by the Department of Healthcare and Family Services. The 24-month limitation on the adoption of emergency rules does not apply to rules adopted under this subsection (r). The adoption of emergency rules authorized by this subsection (r) is deemed to be necessary for the public interest, safety, and welfare.

(s) In order to provide for the expeditious and timely implementation of the provisions of Sections 5-5b.1 and 5A-2 of the Illinois Public Aid Code, emergency rules to implement any provision of Section 5-5b.1 or Section 5A-2 of the Illinois Public Aid Code may be adopted in accordance with this subsection (s) by the Department of Healthcare and Family Services. The rulemaking authority granted in this subsection (s) shall apply only to those rules adopted prior to July 1, 2015. Notwithstanding any other provision of this Section, any emergency rule adopted under this subsection (s) shall only apply to payments made for State fiscal year 2015. The adoption of emergency rules authorized by this subsection (s) is deemed to be necessary for the public interest, safety, and welfare.

(t) In order to provide for the expeditious and timely implementation of the provisions of this amendatory Act of the 99th General Assembly, emergency rules to implement this amendatory Act of the 99th General Assembly may be adopted in accordance with this subsection (t) by the Department of Healthcare and Family Services. The 24-month limitation on the adoption of emergency rules does not apply to rules adopted under this subsection (t). The adoption of emergency rules authorized by this subsection (t) is deemed to be necessary for the public interest, safety, and welfare.

(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)

Section 10. The Mental Health and Developmental Disabilities Administrative Act is amended by changing Section 7.1 and 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, 75.14, 75.15, 75.16, and 75.17 as follows:

(20 ILCS 1705/7.1) (from Ch. 91 1/2, par. 100-7.1)

Sec. 7.1. To assist families to place children with mental illness, for whom no appropriate care is available in Department facilities, in licensed private facilities, the Department shall supplement the amount a family is able to pay, as determined by the Department and the amount available from other sources, provided the Department's share shall not exceed a uniform maximum rate to be determined from time to time by the Department. The Department of Healthcare and Family Services may exercise such authority under this Section as is necessary to implement the provisions of Section 5.23 of the Illinois Public Aid Code and to administer Individual Care Grants.

(Source: P.A. 88-380.)

(20 ILCS 1705/75 new)

Sec. 75. Purpose; transfer of certain rights, powers, duties, and functions; application of Sections 75.01 through 75.17.

(a) It is the purpose of this Part to transfer to the Department of Healthcare and Family Services certain rights, powers, and duties currently exercised by the Department of Human Services related to Individual Care Grants for children with complex behavioral health needs. This transfer is intended to make possible the more effective and efficient operation of Individual Care Grant services.

(b) Certain rights, powers, and duties currently exercised by the Department of Human Services related to Individual Care Grants for children with complex behavioral health needs are transferred to the Department of Healthcare and Family Services with the transfer and transition of the Individual Care Grant program to the Department of Healthcare and Family Services to be completed and implemented within 6 months after the effective date of this amendatory Act of the 99th General Assembly, as provided in Section 7.1 of this Act and Section 15 of this amendatory Act of the 99th General Assembly. For the purposes of the Successor Agency Act, the Department of Healthcare and Family Services is declared to be the successor agency of the Department of Human Services, but only with respect to the functions of the Department of Human Services that are transferred to the Department of Healthcare and Family Services under this amendatory Act of the 99th General Assembly.

(c) Sections 75.01 through 75.17 (this Part) shall supersede any rules of the Department of Human Services regarding which children are eligible to receive funds for an Individual Care Grant hereinafter referred to as "ICG" due to their mental illness, including intensive community services or residential placement, when clinically appropriate. Comprehensive services are to be funded to assist in reducing the child's severity of symptoms and illness to maintain the individual in the least restrictive setting that is clinically appropriate. With the goal of keeping families unified, funds shall be provided to assist parents or guardians in obtaining necessary services and support for children with complex behavioral health needs, not just children with psychosis.

(d) 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.

(e) This Part establishes the Children's Behavioral Health Cabinet. The Office of the Governor shall establish and chair a Children's Behavioral Health Cabinet that shall include the Directors of Healthcare and Family Services, Children and Family Services, and Juvenile Justice or their designees, the Secretary of Human Services or his or her designee, the State Superintendent of Education or his or her designee, family representatives, provider representatives, and other necessary stakeholders, as determined by the Office of the Governor, to inform the design and management of children's behavioral health services. The Children's Behavioral Health Cabinet shall meet at least quarterly. The Children's Behavioral Health Cabinet shall prepare an annual report to the General Assembly on or before January 30th of each year related to the implementation of any remedies in response to litigation against the Department of Healthcare and Family Services related to children's behavioral health and the general status of children's behavioral health in this State.

(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 Healthcare and Family Services.

"Director" means the Director of the Department of Healthcare and Family Services.

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

"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.

"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.

"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 short-term, crisis intervention mental health services that are provided to children who are at risk or who actually experience hospitalization due to psychiatric reasons.

"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. Stakeholder Committee.

(a) The Department of Healthcare and Family Services shall establish an ICG Stakeholder Committee comprised of parents, youth, provider representatives, representation from the Department of Children and Family Services, representation from the Department of Human Services, representation from the Department of Juvenile Justice, representation from the CCBYS program and other stakeholders as determined by the Department.

(b) The ICG Stakeholder Committee shall meet on a quarterly basis.

(c) All potential program changes shall be presented to the ICG Stakeholder Committee for discussion and input prior to implementation.

(20 ILCS 1705/75.03 new)

Sec. 75.03. 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:

(A) have a diagnosis, which the current symptoms do not represent a single acute episode from which rapid and substantial remission is likely, of: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; obsessive-compulsive and related disorders; trauma-related and stressor-related disorders; dissociative disorders; or somatic symptom disorders;

(B) must not be older than 17 1/2 years of age at the time of prior authorization;

(C) must meet medical necessity standards as established in Section 75.04 by the Department; and

(3) The child must not be under the guardianship of another State agency that has financial and legal responsibility for the youth.

(20 ILCS 1705/75.04 new)

Sec. 75.04. Medical necessity.

(a) The Department of Healthcare and Family Services shall, in collaboration with the Department of Human Services and the Department of Children and Family Services, establish the appropriate clinical standards for Community ICG Services and Residential ICG Services, using the Child and Adolescent Needs and Strengths (CANS) Assessment, within 6 months of the effective date of this Part. The Department of Healthcare and Family Services shall review the clinical threshold with the Department of Human Services and the Department of Children and Family Services, annually.

(b) Through the use of the CANS Assessment, a child's needs shall be stratified across tiers of service intensity. ICG community services shall have a different clinical threshold than ICG residential services.

(c) Families shall be notified of the intensity of services for which their child qualifies: ICG community or ICG residential. A family may always select to substitute lower intensity services for higher intensity services.

(d) The Department of Healthcare and Family Services shall continue to use the existing methods of determining clinical appropriateness until it transitions to the utilization of the CANS Assessment, as detailed in this Section.

(e) Children placed in a residential setting shall undergo a continued stay review, as established by the Department of Healthcare and Family Services. A child placed in ICG community services shall undergo a clinical review every 6 months.

(20 ILCS 1705/75.05 new)

Sec. 75.05. 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 75.03;

(2) a child receiving inpatient psychiatric care (for example at a psychiatric hospital 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; and

(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) During the 90-day period complete the ICG prior authorization process in accordance with this Part.

(c) Section 75.11 applies to decisions under this Section.

(20 ILCS 1705/75.06 new)

Sec. 75.06. ICG application reform, prior authorization process, re-authorization process.

(a) The Department of Healthcare and Family Services shall replace the existing ICG application process with a simplified service prior authorization process on or before 6 months after the effective date of this amendatory Act of the 99th General Assembly.

(b) The Department's simplified service prior authorization process shall include the following:

(1) demographic details regarding the child;

(2) clinical diagnosis verified by an LPHA within the last 6 months;

(3) completed CANS scores;

(4) history of inpatient and residential care;

(5) history of SASS services;

(6) history of behavioral health services;

(7) signed authorization detailing need for residential care by a LPHA;

(8) family details, including a signed statement of engagement indicating that the family will participate in treatment and that the child will have a place of residency upon discharge from treatment.

(c) The Department of Healthcare and Family Services shall establish a process for reviewing and authorizing prior authorization requests within 5 days of submission.

(d) The Department of Healthcare and Family Services shall re-authorize grants every 6 months, so long as the child is under the age of 21.

(e) The parent or guardian, child (if appropriate), and provider shall be notified in writing, 6 weeks prior to the anniversary date of the Department of Healthcare and Family Services decision to re-authorize or terminate funding.

(20 ILCS 1705/75.07 new)

Sec. 75.07. 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 is willing to accept the child home upon discharge to the 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 42 U.S.C. 1381, 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 Healthcare and Family Services 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 of Healthcare and Family Services 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 Healthcare and Family Services of any changes of address for the parent or guardian.

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

(20 ILCS 1705/75.08 new)

Sec. 75.08. ICG service appeals, denials, and complaints. The Department of Healthcare and Family Services shall adopt rules for addressing service appeals, grant denials (including re-authorization determinations) and complaints related to the ICG program. The appeals and denial process shall include a Director's Level Review process and funding of a child's ICG shall continue through all appeals processes.

(20 ILCS 1705/75.09 new)

Sec. 75.09. Individual Services Plan Development.

(a) When the individual has been determined eligible for community or residential 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 ICG Coordinator/SASS Coordinator shall provide support, information, and recommendations regarding available services and help the family determine the right services to meet the needs of the child and stabilize the family.

(c) The individual service plan shall be developed with the parent or guardian and appropriate service providers and must be reviewed and re-authorized every 6 months. The individual service plan shall include:

(1) identifying specific problems to be addressed;

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

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

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

(5) identifying 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 approval of the plan.

(d) 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.

(e) If the individual services plan is not developed or implemented within 6 months of the ICG award, the parent or guardian must re-authorize the awarded ICG grant.

(f) A recommendation to move a child to a lower level of care must include a minimum of 30 days of preparation for this transition.

(20 ILCS 1705/75.10 new)

Sec. 75.10. Alternative In-home services.

(a) The Department of Healthcare and Family Services or its representative shall review individual services plans as well as discharge plans and may approve funding for alternative in-home services as described in this Section.

(b) Alternative in-home services include, but are not limited to, care coordination, community support, crisis stabilization services, mentoring, respite support services, and young adult support services.

(c) ICG funding shall not be used to replace services authorized under 59 Ill. Adm. Code, Part 132 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 1705/75.11 new)

Sec. 75.11. Residential placement.

(a) SASS staff shall discuss with the parent or guardian the potentially appropriate facilities based on factors such 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 paragraphs (1) and (2) of subsection (b) 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 1705/75.12 new)

Sec. 75.12. Discharge from residential services.

(a) An Individual Service Plan must follow the discharge protocol established by the Division of Mental Health 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 1705/75.13 new)

Sec. 75.13. Termination of funding or services. ICG funding shall be terminated in any of the following circumstances:

(1) failure of the parent or guardian to meet prior authorization, re-authorization, or 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;

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

(8) Upon the completion of the annual ICG renewal process, it is determined that the child no longer would clinically benefit from the services being provided.

(20 ILCS 1705/75.14 new)

Sec. 75.14. Monitoring. The Department shall establish policies and procedures related to the monitoring of residential, community, and alternative in-home services providers.

(20 ILCS 1705/75.15 new)

Sec. 75.15. Bed holds.

(a) The Department shall adopt rules regarding bed holds and may not reimburse a provider for more than 40 bed nights per State fiscal year per individual.

(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.

(20 ILCS 1705/75.16 new)

Sec. 75.16. Children's Behavioral Health Reform.

(a) The Department of Healthcare and Family Services shall seek to maximize federal financial participation for all services covered under this Part and to fully integrate the ICG program into the Children's Behavioral Health Reform efforts established by the Department. To the extent that full integration of the ICG program into the Department of Healthcare and Family Services behavioral health care coordination entity creates a conflict with any Part of this Act, the Department shall establish provisional policies that shall be in effect for the term of the agreement between the Department of Healthcare and Family Services and any such care coordination entity.

(b) The Department shall establish an updated ICG Program design. The Department shall work collaboratively with the Division of Mental Health and the Department of Children and Family Services as it establishes an implementation plan for Children's Behavioral Health Reform and adopt new rules detailing the operation of an updated ICG Program that coordinates service delivery and design before December 31, 2016.

(20 ILCS 1705/75.17 new)

Sec. 75.17. Repeal. Sections 75 through 75.17 are repealed on January 1, 2018.

Section 15. The Illinois Public Aid Code is amended by changing Section 5-5.23 as follows:

(305 ILCS 5/5-5.23)

Sec. 5-5.23. Children's mental health services.

(a) The Department of Healthcare and Family Services, by rule, shall require the screening and assessment of a child prior to any Medicaid-funded admission to an inpatient hospital for psychiatric services to be funded by Medicaid. The screening and assessment shall include a determination of the appropriateness and availability of out-patient support services for necessary treatment. The Department, by rule, shall establish methods and standards of payment for the screening, assessment, and necessary alternative support services.

(b) The Department of Healthcare and Family Services, to the extent allowable under federal law, shall secure federal financial participation for Individual Care Grant expenditures made by the Department of Healthcare and Family Services of Human Services for the Medicaid optional service authorized under Section 1905(h) of the federal Social Security Act, pursuant to the provisions of Section 7.1 of the Mental Health and Developmental Disabilities Administrative Act. The Department of Healthcare and Family Services may exercise such authority under this Section as is necessary to administer Individual Care Grants as authorized under Section 7.1 of the Mental Health and Developmental Disabilities Administrative Act.

(c) The Department of Healthcare and Family Services shall work collaboratively with the Department of Children and Family Services and the Division of Mental Health of jointly with the Department of Human Services to implement subsections (a) and (b).

(d) On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.

(Source: P.A. 97-689, eff. 6-14-12.)

Section 99. Effective date. This Act takes effect upon becoming law.".