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Public Act 102-0066


 

Public Act 0066 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0066
 
HB0449 EnrolledLRB102 05132 RLC 15153 b

    AN ACT concerning health.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 1. Short title. This Act may be cited as the
Housing is Recovery Pilot Program Act.
 
    Section 3. Definitions. As used in this Act:
    "Individual at high risk of unnecessary
institutionalization" means a person who has a serious mental
illness who is homeless (or will be homeless upon hospital
discharge or correctional facility release) and who has had:
        (1) three or more psychiatric inpatient hospital
    admissions within the most recent 12-month period;
        (2) three or more stays in a State or county
    correctional facility in the State of Illinois within the
    most recent 12-month period; or
        (3) a disability determination due to a serious mental
    illness and has been incarcerated in a State or county
    correctional facility in Illinois for the most recent 12
    consecutive months.
    "Individual at high risk of overdose" means a person with
a substance use disorder who is homeless (or will be homeless
upon hospital discharge or correctional facility release) who
has had:
        (A) three or more hospital inpatient or inpatient
    detoxification admissions for a substance use disorder
    within the most recent 12-month period;
        (B) three or more stays in a State or county
    correctional facility in the State of Illinois within the
    most recent 12-month period; or
        (C) one or more drug overdoses in the last 12 months.
    "Engagement services" means home-based or community-based
visits that assist the individual with maintaining his or her
housing, and providing other wrap-around support, including
linkage to mental health or substance use recovery support
services. Such engagement services shall align with
Medicaid-covered tenancy support services, and Medicaid
community-based mental health and substance use treatment
services, including case management, to ensure alignment with
any existing or future Illinois Medicaid benefits, waivers or
State plan amendments that include these services, and to
maximize any potential federal Medicaid matching dollars that
may be available to support engagement services.
    "Homeless" means the definition used by the U.S.
Department of Health and Human Services, Health Resources and
Services Administration in Section 330(h)(5)(A) of the Public
Health Services Act (42 U.S.C. 254(b)). Under Section
330(h)(5)(A), a homeless individual is an individual who lacks
housing (without regard to whether the individual is a member
of a family), including an individual whose primary residence
during the night is a supervised public or private facility
that provides temporary living accommodations, and an
individual who is a resident in transitional housing. This
includes individuals who are doubled up with other households.
    "Serious mental illness" means meeting both the diagnostic
and functioning criteria consistent with the definition of
Serious Mental Illness in the most current edition of the
Illinois Department of Human Services/Division of Mental
Health Community Mental Health Provider Manual.
    "Substance use disorder" as defined in Section 1-10 of the
Substance Use Disorder Act.
 
    Section 5. Establishment of program. Subject to
appropriation, the Housing is Recovery pilot program shall be
established and administered by the Department of Human
Services, Division of Mental Health. The purpose of the
program is to prevent a person with a serious mental illness
who is at high risk of unnecessary institutionalization, or a
person with a substance use disorder who is at high risk of
overdose, due to homelessness, a lack of access to recovery
support services, and repeating cycles of hospitalizations or
justice system involvement from being institutionalized or
dying. This will be accomplished by enabling affordable
housing through the use of a bridge rental subsidy combined
with access to recovery support services or treatment. The
triple aim of Housing is Recovery is:
        (1) preventing institutionalization and overdose
    deaths;
        (2) improving health outcomes and access to recovery
    support services; and
        (3) reducing State costs.
 
    Section 10. Eligibility. An individual meeting the
requirements listed in this Section shall be eligible to
receive a Housing is Recovery bridge rental subsidy for
purposes of stabilizing his or her mental illness or substance
use disorder.
        (1) An individual at high risk of unnecessary
    institutionalization who is 21 years of age or older, or
    is aging out of guardianship under the Department of
    Children and Family Services, and who is eligible to
    enroll in, or is enrolled in, Medicaid for purposes of
    receiving mental health treatment pursuant to 89 Ill. Adm.
    Code 140.
        (2) An individual at high risk of overdose who is 21
    years of age or older, or is aging out of guardianship
    under the Department of Children and Family Services, and
    who is eligible to enroll in, or is enrolled in, Medicaid
    for purposes of receiving substance use treatment.
 
    Section 15. Housing is Recovery bridge rental subsidy. A
bridge rental subsidy received by an individual (the "subsidy
holder") pursuant to this Act shall mirror the subsidies
issued by the Department of Human Services, Division of Mental
Health through the Moving On Program. The rental subsidy shall
be for scattered-site rental units owned by a landlord or for
rental units secured through a master lease. The rental
subsidy shall assist the subsidy holder with monthly rental
payments for rent that does not exceed the Fair Market Rent
published annually for that year by the U.S. Department of
Housing and Urban Development. The Department of Human
Services, Division of Mental Health, shall have the discretion
to allow a subsidy to apply to rent up to 120% of the Fair
Market Rent if this is justified by the lack of available
affordable housing in the local housing market. Community
Mental Health Centers certified pursuant to 59 Ill. Adm. Code
132 or supported housing service providers participating in
this pilot program shall be responsible for assisting the
subsidy holder with maintaining his or her housing that is
supported by the bridge rental subsidy and either providing or
coordinating engagement services with a mental health or
substance use treatment provider.
        (1) The subsidy holder shall be responsible for
    contributing 30% of his or her income toward the cost of
    rent (zero income does not preclude participation).
        (2) The subsidy holder must agree to sign a lease with
    a landlord or a sublease agreement with the Community
    Mental Health Center or the housing services provider that
    has a master lease for the rental unit and agree to
    engagement services initiated by the supported housing
    provider, the Community Mental Health Center or contracted
    mental health or substance use treatment provider at least
    2 times a month, with at least one of those visits being a
    home visit. The engagement services shall be permitted in
    a home-based or community-based setting, and do not
    require a clinic visit.
        (3) A goal of this program is to encourage the subsidy
    holder to engage in mental health and substance use
    recovery support services or treatment when the individual
    is ready. However, this is a Housing First model that does
    not require abstinence from substance or alcohol use and
    does not require mental health or substance use treatment.
        (4) If a subsidy holder does not have an income due to
    a psychiatric disability, he or she shall be offered the
    opportunity for assistance with filing a "SOAR
    application" (Supplemental Security Income (SSI)/Social
    Security Disability Income (SSDI), Outreach, Access and
    Recovery application) by the Community Mental Health
    Center participating in the Housing is Recovery program
    that is providing his or her mental health support or
    treatment within 6 months of the initiation of mental
    health services. If the subsidy holder is only receiving
    housing support services, the housing services provider
    must partner with a Community Mental Health Center to do
    SOAR applications for individuals who elect to apply for a
    psychiatric disability. A subsidy holder is not required
    to apply for a disability determination.
        (5) The subsidy holder, if he or she is eligible, must
    apply for rental assistance or housing through the
    appropriate Public Housing Authority within 6 months of
    receiving a Housing is Recovery bridge rental subsidy or
    agree to apply when it is permissible to do so, and also be
    placed on the Illinois Housing Development Authority's
    Statewide Referral Network.
 
    Section 20. Identification and referral of eligible
individuals prior to hospital discharge or correctional
facility release for purposes of rapid housing post
discharge/release and illness stability. The pilot program is
intended to enable affordable housing to avoid
institutionalization or overdose death by providing for
connection to housing through a variety of settings, including
in hospitals, county jails, prisons, homeless shelters and
inpatient detoxification facilities and the referral process
established must take this into account. Within 2 months of
the effective date of this Act, the Department of Human
Services, Division of Mental Health, in partnership with the
Department of Healthcare and Family Services and the
Department of Human Services, Division of Substance Use
Prevention and Recovery (SUPR), the Department of Corrections,
and with meaningful stakeholder input through a working group
of Community Mental Health Centers, homeless service
providers, substance use treatment providers, hospitals with
inpatient psychiatric units or detoxification units,
representatives from county jails, persons with lived
experience, and family support organizations, shall develop a
process for identifying and referring eligible individuals for
the Housing is Recovery program prior to hospital discharge or
correctional system release, or other appropriate place for
referral, including homeless shelters. The process developed
shall aim to enable rapid access to housing
post-discharge/release to avoid unnecessary
institutionalization or a return to homelessness or unstable
housing. The working group shall meet at least monthly prior
to development of an administrative rule or policy established
to carry out the intent of this Act. The Department of Human
Services, Division of Mental Health, shall explore ways to
collaborate with the U.S. Department of Housing and Urban
Development's Coordinated Entry System and other ways for
electronic referral. The Department of Human Services,
Division of Mental Health, and the Department of Healthcare
and Family Services shall collaborate to ensure that the
referral process aligns with any existing or future Medicaid
waivers or State plan amendments for tenancy support services.
 
    Section 25. Participating Community Mental Health Centers
and housing service provider responsibilities for locating and
transitioning the individual into housing, assisting in
retaining housing, and the provision of engagement and
recovery support services. The Department of Human Services,
Division of Mental Health, shall select interested Community
Mental Health Centers that are certified pursuant to 59 Ill.
Adm. Code 132 and interested housing service providers for
participation in the Housing is Recovery program.
        (1) For purposes of incentivizing continuity of care,
    the same participating Community Mental Health Center may
    be responsible for providing both the housing support and
    the mental health or substance use engagement, recovery
    support services and treatment to a subsidy holder. If a
    housing support services provider does not also provide
    the mental health or substance use treatment services the
    individual engages in, there must be strong coordination
    of care between the housing services provider and the
    treatment provider.
        (2) The provider must demonstrate that the rental
    units secured through this program pass minimum quality
    inspection standards.
        (3) Community Mental Health Centers providing housing
    support through this program shall be responsible for any
    SOAR applications for a subsidy holder that has a
    psychiatric disability who does not have SSI or SSDI if
    the subsidy holder chooses to apply for disability. A
    housing services provider delivering the housing support
    services through this program must contract with a
    Community Mental Health Center to provide assistance with
    SOAR applications to subsidy holders electing to apply for
    SSI or SSDI within 6 months of the subsidy holder
    receiving the subsidy.
        (4) Service providers shall be permitted to engage in
    master leasing to secure apartments for those who are hard
    to house due to criminal backgrounds, history of substance
    use and stigma.
 
    Section 30. Securing rental housing units for purposes of
immediate temporary housing following hospital discharge or
release from a correctional facility while a long-term rental
unit is secured. Up to 20% of the available annual
appropriation for the Housing is Recovery program shall be
available to Community Mental Health Centers or the housing
services provider for purposes of securing critical time
intervention rental units to house an eligible individual
immediately following discharge from a hospitalization or
release from a correctional facility because locating an
apartment unit for a longer-term one-year lease and the
related move-in can take up to 3 months. Such temporary units
may be used for immediate temporary housing, not to exceed 90
days for purposes of preventing the individual from reentering
homelessness or unstable housing, or avoiding unnecessary
institutionalization. The Department of Human Services,
Division of Mental Health, shall allow providers to certify
that such rental units meet minimum housing quality standards
and ensure a process by which community providers are able to
secure vacant rental units for the purpose of immediate
short-term housing post-hospital discharge or correctional
system release while a longer term housing rental unit is
secured.
 
    Section 35. Basic move-in expenses. The Housing is
Recovery program shall include reasonable payment for the
basic move-in expenses of the subsidy holder, including, but
not limited to, payment of a security deposit and other
move-in fees or expenses, and basic household supplies and
furnishings.
 
    Section 40. Subsidy administration. The bridge rental
subsidy administration (such as payment of rent to the
landlord and other administration expenses) and quality
inspection of the rental units may be done by community-based
organizations with experience and expertise in housing subsidy
administration and by Community Mental Health Centers that the
Department of Human Services, Division of Mental Health,
determines have the administrative infrastructure for subsidy
administration. Such organizations shall manage and administer
all aspects of the subsidy (such as payment of rent, quality
inspections) on behalf of the subsidy holder.
 
    Section 45. Landlord education and stigma reduction plan
and materials. The Department of Human Services, Division of
Mental Health, with meaningful input from stakeholders, shall
develop a plan for educating prospective landlords that may
lease to individuals receiving a bridge rental subsidy through
the Housing is Recovery program. This educational plan shall
include written materials that indicate that individuals with
psychiatric disabilities and substance use disorders often
have criminal justice involvement due to their previously
untreated mental health or substance use condition and periods
of homelessness. Implementation of this plan shall be rolled
out in conjunction with the implementation of the Housing is
Recovery program.
 
    Section 50. State agency coordination. The Department of
Human Services, Division of Mental Health, shall partner with
SUPR to ensure coordination of the services required pursuant
to this Act and all substance use recovery support services
and treatment for which SUPR has oversight. The Department of
Human Services, Division of Mental Health, shall also work
with the Department of Healthcare and Family Services to
maximize all recovery support services and treatment that are
or can be covered by Medicaid.
 
    Section 55. Provider and State agency education on the
pilot program. The Department of Human Services, Division of
Mental Health shall put together written materials on the
Housing is Recovery program and eligibility criteria for
purposes of educating participating providers, county jails,
the Department of Corrections, hospitals and other relevant
stakeholders on the program. The Department of Human Services,
Division of Mental Health, shall engage in an ongoing
education effort to ensure that all stakeholders are aware of
the program and how to screen for eligibility and referral.
 
    Section 60. Reimbursement for subsidy administration,
housing support and engagement services and other program
costs. The Department of Human Services, Division of Mental
Health shall develop a reimbursement approach for community
providers doing subsidy administration that covers all costs
of subsidy administration, quality inspection and other
services. The Department of Human Services, Division of Mental
Health shall also develop a reimbursement approach that covers
all costs incurred by Community Mental Health Centers and
housing services providers for identifying and securing rental
units for subsidy holders, including all travel related to
finding and locating an apartment and move-in of the subsidy
holder, quality inspections for temporary housing units,
completing and submitting SOAR applications, the costs
associated with obtaining necessary documents associated with
obtaining a lease for the subsidy holder (such as obtaining a
State ID); for engagement services not covered by Medicaid;
and for any other reasonable and necessary costs associated
with the program outlined in this Act. Reimbursement shall
also include all costs associated with collecting and tracking
data for purposes of program evaluation and improvement. At
the discretion of the Department of Human Services, Division
of Mental Health, up to 5% of the annual appropriation may be
applied to growing mental health or substance use treatment or
recovery support capacity if a participating provider in the
Housing is Recovery program demonstrates an inability to take
eligible individuals due to such capacity limitations.
 
    Section 65. Subsidy termination. The subsidy holder shall
continue to hold the subsidy until he or she receives a housing
voucher or rental subsidy through a Public Housing Authority
unless:
        (1) The individual has a stay in a nursing home,
    Institution for Mental Disease (IMD) or specialized mental
    health rehabilitation facility (SMHRF) exceeding 6
    consecutive months. During a stay in nursing home, IMD or
    SMHRF of less than 6 months, the program will continue to
    pay the subsidized portion of the rent in order to
    maintain the housing unit for the subsidy holder upon
    discharge.
        (2) The individual has a stay in a correctional
    facility exceeding 6 consecutive months. During a
    correctional facility stay of less than 6 months, the
    program will continue to pay the subsidized portion of the
    rent in order to maintain the housing unit for the subsidy
    holder.
        (3) A subsidy does not terminate if the subsidy holder
    is required to move multiple times due to landlord
    eviction or does not engage in treatment, as the target
    population for this pilot program is expected to have
    multiple barriers to remaining housed.
 
    Section 70. Developing public-private partnerships to
expand affordable housing options for those with serious
mental illnesses. The Department of Human Services, Division
of Mental Health shall work with the Department of Healthcare
and Family Services, Medicaid managed care organizations and
hospitals across the State to develop public-private
partnerships to incentivize private funding from hospitals and
managed care organizations to match State dollars invested in
the Housing is Recovery program for purposes of preventing
repeated preventable hospitalizations, overdose deaths and
unnecessary institutionalization.
 
    Section 75. Data collection and program evaluation.
    (a) For purposes of evaluating the effectiveness of the
Housing is Recovery program and for making improvements to the
program, the Department of Human Services, Division of Mental
Health shall contract with an independent outside research
organization with expertise in housing services for
individuals with serious mental illnesses and substance use
disorders to evaluate the program's effectiveness on enabling
housing stability, reducing hospitalizations and justice
system involvement, encouraging engagement in mental health
and substance use treatment, fostering employment engagement,
and reducing institutionalization and overdose deaths. Such
evaluation shall commence after 4 years of implementation of
the program and shall be submitted to the General Assembly by
the end of the fifth year of implementation. For purposes of
assisting with this evaluation, the working group established
pursuant to Section 20 shall also make recommendations to the
Department of Human Services, Division of Mental Health,
regarding what data must be tracked by providers and the
Department of Human Services, Division of Mental Health, to
evaluate the program and to make future changes to the program
to ensure its effectiveness in meeting the triple aim stated
in Section 5.
    (b) Beginning after the first 12 months of implementation
and on an annual basis, the Department of Human Services,
Division of Mental Health, shall track and make public the
following information: (1) the number of individuals receiving
subsidies in reporting period (12-month average); (2)
participant demographics including age, race, gender identity,
and primary language; (3) the average duration of time
individuals are enrolled in the program (by months); (4) the
number of individuals removed from the program and reasons for
removal; (5) the number of grievances filed by participants
and a summary of grievance type; and (6) program referral
sources. Reports shall be generated on an annual basis and
publicly posted on the Department of Human Services website.
 
    Section 80. Act subject to appropriation. This Act is
subject to appropriation. The appropriation shall be divided
equally between bridge subsidies issued to individuals who are
at high risk of unnecessary institutionalization and those who
are at high risk of overdose.
 
    Section 85. Rulemaking authority. Any administrative rules
necessary to implement this Act shall be filed within 12
months following the effective date of this Act.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 7/9/2021