Illinois General Assembly - Full Text of HB0449
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Full Text of HB0449  102nd General Assembly




HB0449 EngrossedLRB102 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 meeting both the diagnostic
6and functioning criteria consistent with the definition of
7Serious Mental Illness in the most current edition of the
8Illinois Department of Human Services/Division of Mental
9Health Community Mental Health Provider Manual.
10    "Substance use disorder" as defined in Section 1-10 of the
11Substance Use Disorder Act.
12    Section 5. Establishment of program. Subject to
13appropriation, the Housing is Recovery pilot program shall be
14established and administered by the Department of Human
15Services, Division of Mental Health. The purpose of the
16program is to prevent a person with a serious mental illness
17who is at high risk of unnecessary institutionalization, or a
18person with a substance use disorder who is at high risk of
19overdose, due to homelessness, a lack of access to recovery
20support services, and repeating cycles of hospitalizations or
21justice system involvement from being institutionalized or
22dying. This will be accomplished by enabling affordable
23housing through the use of a bridge rental subsidy combined
24with access to recovery support services or treatment. The
25triple aim of Housing is Recovery is:



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1        (1) preventing institutionalization and overdose
2    deaths;
3        (2) improving health outcomes and access to recovery
4    support services; and
5        (3) reducing State costs.
6    Section 10. Eligibility. An individual meeting the
7requirements listed in this Section shall be eligible to
8receive a Housing is Recovery bridge rental subsidy for
9purposes of stabilizing his or her mental illness or substance
10use disorder.
11        (1) An individual at high risk of unnecessary
12    institutionalization who is 21 years of age or older, or
13    is aging out of guardianship under the Department of
14    Children and Family Services, and who is eligible to
15    enroll in, or is enrolled in, Medicaid for purposes of
16    receiving mental health treatment pursuant to 89 Ill. Adm.
17    Code 140.
18        (2) An individual at high risk of overdose who is 21
19    years of age or older, or is aging out of guardianship
20    under the Department of Children and Family Services, and
21    who is eligible to enroll in, or is enrolled in, Medicaid
22    for purposes of receiving substance use treatment.
23    Section 15. Housing is Recovery bridge rental subsidy. A
24bridge rental subsidy received by an individual (the "subsidy



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1holder") pursuant to this Act shall mirror the subsidies
2issued by the Department of Human Services, Division of Mental
3Health through the Moving On Program. The rental subsidy shall
4be for scattered-site rental units owned by a landlord or for
5rental units secured through a master lease. The rental
6subsidy shall assist the subsidy holder with monthly rental
7payments for rent that does not exceed the Fair Market Rent
8published annually for that year by the U.S. Department of
9Housing and Urban Development. The Department of Human
10Services, Division of Mental Health, shall have the discretion
11to allow a subsidy to apply to rent up to 120% of the Fair
12Market Rent if this is justified by the lack of available
13affordable housing in the local housing market. Community
14Mental Health Centers certified pursuant to 59 Ill. Adm. Code
15132 or supported housing service providers participating in
16this pilot program shall be responsible for assisting the
17subsidy holder with maintaining his or her housing that is
18supported by the bridge rental subsidy and either providing or
19coordinating engagement services with a mental health or
20substance use treatment provider.
21        (1) The subsidy holder shall be responsible for
22    contributing 30% of his or her income toward the cost of
23    rent (zero income does not preclude participation).
24        (2) The subsidy holder must agree to sign a lease with
25    a landlord or a sublease agreement with the Community
26    Mental Health Center or the housing services provider that



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



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



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



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



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1    housing services provider delivering the housing support
2    services through this program must contract with a
3    Community Mental Health Center to provide assistance with
4    SOAR applications to subsidy holders electing to apply for
5    SSI or SSDI within 6 months of the subsidy holder
6    receiving the subsidy.
7        (4) Service providers shall be permitted to engage in
8    master leasing to secure apartments for those who are hard
9    to house due to criminal backgrounds, history of substance
10    use and stigma.
11    Section 30. Securing rental housing units for purposes of
12immediate temporary housing following hospital discharge or
13release from a correctional facility while a long-term rental
14unit is secured. Up to 20% of the available annual
15appropriation for the Housing is Recovery program shall be
16available to Community Mental Health Centers or the housing
17services provider for purposes of securing critical time
18intervention rental units to house an eligible individual
19immediately following discharge from a hospitalization or
20release from a correctional facility because locating an
21apartment unit for a longer-term one-year lease and the
22related move-in can take up to 3 months. Such temporary units
23may be used for immediate temporary housing, not to exceed 90
24days for purposes of preventing the individual from reentering
25homelessness or unstable housing, or avoiding unnecessary



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1institutionalization. The Department of Human Services,
2Division of Mental Health, shall allow providers to certify
3that such rental units meet minimum housing quality standards
4and ensure a process by which community providers are able to
5secure vacant rental units for the purpose of immediate
6short-term housing post-hospital discharge or correctional
7system release while a longer term housing rental unit is
9    Section 35. Basic move-in expenses. The Housing is
10Recovery program shall include reasonable payment for the
11basic move-in expenses of the subsidy holder, including, but
12not limited to, payment of a security deposit and other
13move-in fees or expenses, and basic household supplies and
15    Section 40. Subsidy administration. The bridge rental
16subsidy administration (such as payment of rent to the
17landlord and other administration expenses) and quality
18inspection of the rental units may be done by community-based
19organizations with experience and expertise in housing subsidy
20administration and by Community Mental Health Centers that the
21Department of Human Services, Division of Mental Health,
22determines have the administrative infrastructure for subsidy
23administration. Such organizations shall manage and administer
24all aspects of the subsidy (such as payment of rent, quality



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



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1    Section 55. Provider and State agency education on the
2pilot program. The Department of Human Services, Division of
3Mental Health shall put together written materials on the
4Housing is Recovery program and eligibility criteria for
5purposes of educating participating providers, county jails,
6the Department of Corrections, hospitals and other relevant
7stakeholders on the program. The Department of Human Services,
8Division of Mental Health, shall engage in an ongoing
9education effort to ensure that all stakeholders are aware of
10the program and how to screen for eligibility and referral.
11    Section 60. Reimbursement for subsidy administration,
12housing support and engagement services and other program
13costs. The Department of Human Services, Division of Mental
14Health shall develop a reimbursement approach for community
15providers doing subsidy administration that covers all costs
16of subsidy administration, quality inspection and other
17services. The Department of Human Services, Division of Mental
18Health shall also develop a reimbursement approach that covers
19all costs incurred by Community Mental Health Centers and
20housing services providers for identifying and securing rental
21units for subsidy holders, including all travel related to
22finding and locating an apartment and move-in of the subsidy
23holder, quality inspections for temporary housing units,
24completing and submitting SOAR applications, the costs
25associated with obtaining necessary documents associated with



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



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



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



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