Illinois General Assembly - Full Text of HB4187
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Full Text of HB4187  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 10/20/2021, by Rep. Deb Conroy


New Act
305 ILCS 5/5-2.04 new

    Creates the Mental Health Inpatient Facility Access Act. Requires the Department of Human Services' Division of Mental Health to develop a written, strategic plan that comprehensively addresses improving access to inpatient psychiatric beds in State-operated mental health facilities for individuals needing a hospital level of care. Provides that the plan shall include annual training requirements for State-operated inpatient mental health facility clinicians, regular and periodic mental health assessments of individuals admitted to State-operated facilities, updated facility policies and procedures aimed at increasing opportunities for home visits and work programs that assist with community reintegration, steps to increase access to community-based mental health services that provide outpatient alternatives and step-down services, certification requirements for mental health clinicians, and other matters. Requires the plan to be made publicly available in one year. Prohibits the Department from making further reductions in State-operated inpatient mental health bed capacity. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, in collaboration with the Department of Human Services, to allow for hospital presumptive eligibility for Medicaid enrollment for individuals presenting in hospital emergency rooms who are in a psychiatric crisis and meet the federal criteria for hospital presumptive eligibility. Requires the Department of Healthcare and Family Services to amend its Illinois Continuity of Care and Administrative Simplification 1115 Waiver if necessary to implement hospital presumptive eligibility as permitted under the amendatory Act. Effective immediately.

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HB4187LRB102 21067 KTG 30021 b

1    AN ACT concerning mental 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 Mental
5Health Inpatient Facility Access Act.
6    Section 5. Findings. The General Assembly finds that:
7        (1) In 1955, Illinois had more than 30,000 adult
8    State-operated inpatient mental health beds.
9        (2) In 2019, prior to the COVID-19 pandemic, Illinois
10    had fewer than 1,200 adult State-operated inpatient mental
11    health beds.
12        (3) Due to the COVID-19 pandemic, there are now only
13    approximately 1,100 State-operated inpatient mental health
14    beds.
15        (4) More than 500,000 people in Illinois have serious
16    mental health conditions.
17        (5) While most people with even the most serious
18    mental health conditions can be successfully treated in
19    the community or in private hospitals, many will need
20    inpatient care from a State-operated inpatient mental
21    health facility.
22        (6) Given the small number of remaining beds in
23    State-operated inpatient mental health facilities, it is



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1    vital that adults who need a hospital-level of care are
2    able to obtain services in such facilities.
3        (7) Due to the lack of available inpatient mental
4    health beds:
5            (A) Many people in need of inpatient psychiatric
6        care wait for days or weeks in emergency departments
7        or non-psychiatric units of general hospitals where it
8        is difficult to provide them with safe and effective
9        mental health treatment.
10            (B) Persons found unfit to stand trial or not
11        guilty by reason of insanity and committed to the
12        custody of the Department of Human Services often wait
13        for weeks or months in county jails where it is
14        difficult to provide them with safe and effective
15        mental health treatment.
16            (C) Adults with a continuing need for mental
17        health services are discharged into the community
18        before their mental health condition makes such a
19        discharge safe and appropriate or before arrangements
20        have been made for needed long-term community mental
21        health services.
22            (D) Adults who need inpatient care are often
23        denied access to such care.
24    Section 10. Strategic plan on improving access to
25inpatient psychiatric beds. The Department of Human Services'



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1Division of Mental Health shall develop a written, strategic
2plan that comprehensively addresses improving access to
3inpatient psychiatric beds in State-operated mental health
4facilities for individuals needing a hospital level of care.
5This plan shall address achieving the best use of
6State-operated psychiatric beds across Illinois, with
7strategies specifically to mitigate inefficient use of
8forensic beds and reduce lengths of stays for the forensic
9population. A comprehensive approach to this plan shall
10include training and education, ongoing assessment of
11individuals receiving inpatient services, reviewing and
12updating policies and procedures, and increasing
13community-based capacity for individuals in all State-operated
14forensic beds. The plan shall include:
15        (1) Annual training. Required annual training for all
16    State-operated inpatient mental health facility clinicians
17    shall include:
18            (A) Best practices for evaluating whether
19        individuals found not guilty by reason of insanity or
20        unfit to stand trial meet the legal criteria for
21        inpatient treatment.
22            (B) Best practices for determining appropriate
23        treatment for individuals found not guilty by reason
24        of insanity or unfit to stand trial.
25            (C) The requirements of treatment plan reports.
26            (D) The types of mental health services available



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1        following discharge, including, but not limited to:
2        assertive community treatment, community support
3        teams, supportive housing, medication management,
4        psychotherapy, peer support services, specialized
5        mental health rehabilitation facilities, and nursing
6        homes.
7        (2) Regular and periodic assessment of mental health
8    condition and progress. At least once every year following
9    the admission of any individual under Section 5-2-4 of the
10    Unified Code of Corrections or Section 104-17 of the Code
11    of Criminal Procedure of 1963, the Director of the
12    Division of Mental Health, or his or her designee, shall
13    meet with the treatment team assigned to that individual
14    to review whether:
15            (A) The individual continues to meet the standard
16        for inpatient care.
17            (B) The individual may be appropriate for
18        unsupervised on-grounds privileges, off-grounds
19        privileges (with or without escort by personnel of the
20        Department of Human Services), home visits, and
21        participation in work programs.
22            (C) The current treatment plan is reasonably
23        expected to result in the improvement of the
24        individual's clinical condition so that the individual
25        no longer needs inpatient treatment, and, if not, what
26        other treatments or placements are available to meet



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1        the individual's needs and safety.
2        (3) Updated policies and procedures.
3            (A) Revise facility policies and procedures to
4        increase opportunities for home visits and work
5        programs that assist with community reintegration.
6        This shall include a review of unsupervised on-grounds
7        privileges, off-grounds privileges (with or without
8        escort by personnel of the Department of Human
9        Services), home visits, and participation in work or
10        educational programs to ensure that policies do not
11        limit the ability to approve these activities. The
12        plan shall also address the frequency for which
13        individuals are assessed to be eligible for these
14        activities.
15            (B) Ensure all individuals found unfit to stand
16        trial or not guilty by reason of insanity, who can be
17        treated on an outpatient basis are recommended for
18        outpatient services.
19            (C) Develop benchmarks to ensure that:
20                (i) every individual found unfit to stand
21            trial or not guilty by reason of insanity who has
22            been committed by a court to the Department for
23            treatment shall be admitted to a Department
24            facility within 30 days of such commitment order;
25            and
26                (ii) no individual who needs inpatient



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1            psychiatric care remains in an emergency
2            department of any hospital or in any other
3            non-psychiatric unit longer than 48 hours.
4        (4) Building community treatment capacity.
5            (A) Specific steps to increase access to
6        community-based mental health services that provide
7        (i) outpatient alternatives to those being assessed
8        for inpatient stays at State-operated inpatient mental
9        health facilities and (ii) step-down services for
10        those no longer meeting inpatient stay criteria,
11        specifically the population of individuals found not
12        guilty by reason of insanity. Such steps must
13        specifically identify community-based treatment
14        alternatives and how these services will be funded.
15            (B) Specific steps to ensure each State-operated
16        inpatient mental health facility has sufficient
17        qualified psychiatrists, psychologists, social
18        workers, peer support professionals, and other staff
19        so that the Department may provide adequate and humane
20        care and services for all patients. That plan shall
21        include:
22                (i) an assessment of whether the salary and
23            other benefits provided to professional staff are
24            sufficient to attract and retain staff.
25                (ii) an assessment of the annual budget needed
26            to attract and retain staff.



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1                (iii) an assessment of any other impediments
2            to attracting and retaining staff, and a
3            mitigation plan for those impediments; and
4                (iv) a detailed plan for recruiting
5            psychiatrists, psychologists, social workers, peer
6            support professionals, and other mental health
7            staff.
8        (5) Certification of mental health clinicians. The
9    Division of Mental Health shall create a system of
10    training, qualification, and credentialing for all
11    psychiatrists, clinical social workers, clinical
12    psychologists, and qualified examiners who conduct any
13    evaluations, as employees, agents, or vendors of the
14    Division concerning:
15            (A) findings of unfitness to stand trial and all
16        other evaluations of individuals receiving treatment
17        in accordance with Section 104-10 of the Code of
18        Criminal Procedure of 1963:
19            (B) individuals receiving treatment in accordance
20        with Section 5-2-4 of the Unified Code of Corrections;
21            (C) whether individuals are subject to involuntary
22        admission on an inpatient or outpatient basis in
23        accordance with the Mental Health and Developmental
24        Disabilities Code; and
25            (D) whether individuals are subject to
26        court-ordered treatment in accordance with Section



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1        2-107.1 of the Mental Health and Developmental
2        Disabilities Code.
3        Such evaluations shall include any treatment reports
4    required under the Code of Criminal Procedure of 1963 or
5    the Mental Health and Developmental Disabilities Code.
6        (6) There shall be stakeholder input during the
7    planning process from the Division of Mental Health's
8    forensic workgroup.
9    Section 15. Implementation. The strategic plan developed
10by the Division of Mental Health shall be finalized and made
11publicly available one year after the effective date of this
12Act. The plan shall include:
13        (1) Benchmarks and timelines for implementing each
14    provision of the plan.
15        (2) Strategy for obtaining resources needed to
16    implement each provision of the plan.
17        (3) Ongoing stakeholder engagement during the
18    implementation of the plan through the Division of Mental
19    Health's forensic workgroup.
20    Section 20. Prohibition on reduction of State-operated
21psychiatric inpatient beds. The Department shall make no
22further reductions in State-operated inpatient mental health
23bed capacity.



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1    Section 25. The Illinois Public Aid Code is amended by
2adding Section 5-2.04 as follows:
3    (305 ILCS 5/5-2.04 new)
4    Sec. 5-2.04. Hospital presumptive eligibility; behavioral
5health hospitalizations. The Department of Healthcare and
6Family Services, in collaboration with the Department of Human
7Services' Division of Mental Health, shall allow for hospital
8presumptive eligibility for Medicaid enrollment for
9individuals presenting in hospital emergency rooms who are in
10a psychiatric crisis and meet the federal criteria for
11hospital presumptive eligibility. The Department and the
12Division of Mental Health, with meaningful stakeholder input,
13shall develop a process by which those individuals are linked
14to a community-based mental health provider or any other
15appropriate organization to facilitate enrollment in Medicaid
16immediately following hospital or emergency room discharge and
17linkage to community-based treatment. If the Department's
18Illinois Continuity of Care and Administrative Simplification
191115 Waiver, which includes waiving the federal requirement of
20hospital presumptive eligibility for Medicaid enrollment, is
21required to be amended to implement this Section, then the
22Department shall amend the 1115 Waiver within 60 days after
23the effective date of this amendatory Act of the 102nd General
25    Section 99. Effective date. This Act takes effect upon



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1becoming law.