Illinois General Assembly - Full Text of HB5465
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Full Text of HB5465  101st General Assembly




State of Illinois
2019 and 2020


Introduced , by Rep. Kathleen Willis


New Act

    Creates the Housing is Recovery Pilot Program Act. Creates the Housing is Recovery Pilot Program within the Division of Mental Health of the Department of Human Services. 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.

LRB101 20771 RLC 70460 b






HB5465LRB101 20771 RLC 70460 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, or
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 a
21substance 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, or
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. Department
21of Health and Human Services, Health Resources and Services
22Administration in Section 330(h)(5)(A) of the Public Health
23Services Act (42 U.S.C. 254(b)). Under Section 330(h)(5)(A), a
24homeless individual is an individual who lacks housing (without
25regard to whether the individual is a member of a family),
26including an individual whose primary residence during the



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1night is a supervised public or private facility that provides
2temporary living accommodations, and an individual who is a
3resident in transitional housing. This includes individuals
4who 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 by
21the Department of Human Services, Division of Mental Health.
22The purpose of the program is to prevent a person with a
23serious mental illness who is at high risk of unnecessary
24institutionalization, or a person with a substance use disorder
25who is at high risk of overdose, due to homelessness, a lack of



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1access to recovery support services, and repeating cycles of
2hospitalizations or justice system involvement from being
3institutionalized 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 is
19    aging out of guardianship under the Department of Children
20    and Family Services, and who is eligible to enroll in, or
21    is enrolled in, Medicaid for purposes of receiving mental
22    health treatment pursuant to 89 Ill. Adm. Code 140.
23        (2) An individual at high risk of overdose who is 21
24    years of age or older, or is aging out of guardianship
25    under the Department of Children and Family Services, and



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1    who is eligible to enroll in, or is enrolled in, Medicaid
2    for purposes of receiving substance use treatment.
3    Section 15. Housing is Recovery bridge rental subsidy. A
4bridge rental subsidy received by an individual (the "subsidy
5holder") pursuant to this Act shall mirror the subsidies issued
6by the Department of Human Services, Division of Mental Health
7through the Moving On Program. The rental subsidy shall be for
8scattered-site rental units owned by a landlord or for rental
9units secured through a master lease. The rental subsidy shall
10assist the subsidy holder with monthly rental payments for rent
11that does not exceed the Fair Market Rent published annually
12for that year by the U.S. Department of Housing and Urban
13Development. The Department of Human Services, Division of
14Mental Health shall have the discretion to allow a subsidy to
15apply to rent up to 120% of the Fair Market Rent if this is
16justified by the lack of available affordable housing in the
17local housing market. Community Mental Health Centers
18certified pursuant to 59 Ill. Adm. Code 132 or supported
19housing service providers participating in this pilot program
20shall be responsible for assisting the subsidy holder with
21maintaining his or her housing that is supported by the bridge
22rental subsidy and either providing or coordinating engagement
23services with a mental health or substance use treatment
25        (1) The subsidy holder shall be responsible for



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



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



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



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



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



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1used for immediate temporary housing, not to exceed 90 days for
2purposes of preventing the individual from reentering
3homelessness or unstable housing, or avoiding unnecessary
4institutionalization. The Department of Human Services,
5Division of Mental Health shall allow providers to certify that
6such rental units meet minimum housing quality standards and
7ensure a process by which community providers are able to
8secure vacant rental units for the purpose of immediate
9short-term housing post-hospital discharge or correctional
10system release while a longer term housing rental unit is
12    Section 35. Basic move-in expenses. The Housing is Recovery
13program shall include reasonable payment for the basic move-in
14expenses of the subsidy holder, including, but not limited to,
15payment of a security deposit and other move-in fees or
16expenses, and basic household supplies and furnishings.
17    Section 40. Subsidy administration. The bridge rental
18subsidy administration (such as payment of rent to the landlord
19and other administration expenses) and quality inspection of
20the rental units may be done by community-based organizations
21with experience and expertise in housing subsidy
22administration and by Community Mental Health Centers that the
23Department of Human Services, Division of Mental Health
24determines have the administrative infrastructure for subsidy



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



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1covered by Medicaid.
2    Section 55. Provider and State agency education on the
3pilot program. The Department of Human Services, Division of
4Mental Health shall put together written materials on the
5Housing is Recovery program and eligibility criteria for
6purposes of educating participating providers, county jails,
7the Department of Corrections, hospitals and other relevant
8stakeholders on the program. The Department of Human Services,
9Division of Mental Health shall engage in an ongoing education
10effort to ensure that all stakeholders are aware of the program
11and how to screen for eligibility and referral.
12    Section 60. Reimbursement for subsidy administration,
13housing support and engagement services and other program
14costs. The Department of Human Services, Division of Mental
15Health shall develop a reimbursement approach for community
16providers doing subsidy administration that covers all costs of
17subsidy administration, quality inspection and other services.
18The Department of Human Services, Division of Mental Health
19shall also develop a reimbursement approach that covers all
20costs incurred by Community Mental Health Centers and housing
21services providers for identifying and securing rental units
22for subsidy holders, including all travel related to finding
23and locating an apartment and move-in of the subsidy holder,
24quality inspections for temporary housing units, completing



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



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1        (2) The individual has a stay in a correctional
2    facility exceeding 6 consecutive months. During a
3    correctional facility stay of less than 6 months, the
4    program will continue to pay the subsidized portion of the
5    rent in order to maintain the housing unit for the subsidy
6    holder.
7        (3) A subsidy does not terminate if the subsidy holder
8    is required to move multiple times due to landlord eviction
9    or does not engage in treatment, as the target population
10    for this pilot program is expected to have multiple
11    barriers to remaining housed.
12    Section 70. Developing public-private partnerships to
13expand affordable housing options for those with serious mental
14illnesses. The Department of Human Services, Division of Mental
15Health shall work with the Department of Healthcare and Family
16Services, Medicaid managed care organizations and hospitals
17across the State to develop public-private partnerships to
18incentivize private funding from hospitals and managed care
19organizations to match State dollars invested in the Housing is
20Recovery program for purposes of preventing repeated
21preventable hospitalizations, overdose deaths and unnecessary
23    Section 75. Data collection and program evaluation.
24    (a) For purposes of evaluating the effectiveness of the



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1Housing is Recovery program and for making improvements to the
2program, the Department of Human Services, Division of Mental
3Health shall contract with an independent outside research
4organization with expertise in housing services for
5individuals with serious mental illnesses and substance use
6disorders to evaluate the program's effectiveness on enabling
7housing stability, reducing hospitalizations and justice
8system involvement, encouraging engagement in mental health
9and substance use treatment, fostering employment engagement,
10and reducing institutionalization and overdose deaths. Such
11evaluation shall commence after 4 years of implementation of
12the program and shall be submitted to the General Assembly by
13the end of the fifth year of implementation. For purposes of
14assisting with this evaluation, the working group established
15pursuant to Section 20 shall also make recommendations to the
16Department of Human Services, Division of Mental Health
17regarding what data must be tracked by providers and the
18Department of Human Services, Division of Mental Health to
19evaluate the program and to make future changes to the program
20to ensure its effectiveness in meeting the triple aim stated in
21Section 5.
22    (b) Beginning after the first 12 months of implementation
23and on an annual basis, the Department of Human Services,
24Division of Mental Health shall track and make public the
25following information: (1) the number of individuals receiving
26subsidies in reporting period (12-month average); (2)



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