Bill Amendment: IL SB0391 | 2019-2020 | 101st General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: MED ASSISTANCE-MENTAL HEALTH

Status: 2019-12-20 - Public Act . . . . . . . . . 101-0616 [SB0391 Detail]

Download: Illinois-2019-SB0391-House_Amendment_001.html

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Rep. Sara Feigenholtz

Filed: 10/28/2019

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AMENDMENT TO SENATE BILL 391
AMENDMENT NO. ______. Amend Senate Bill 391 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.23 as follows:
(305 ILCS 5/5-5.23)
(Text of Section after amendment by P.A. 101-461)
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

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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 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 the 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 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.
(e) All rights, powers, duties, and responsibilities
currently exercised by the Department of Human Services related
to the Individual Care Grant program are transferred to the

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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. 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.
(1) Each act done by the Department of Healthcare and
Family Services in exercise of the transferred powers,
duties, rights, and responsibilities shall have the same
legal effect as if done by the Department of Human Services
or its offices.
(2) Any rules of the Department of Human Services that
relate to the functions and programs transferred by this
amendatory Act of the 99th General Assembly that are in
full force on the effective date of this amendatory Act of
the 99th General Assembly shall become the rules of the
Department of Healthcare and Family Services. All rules
transferred under this amendatory Act of the 99th General
Assembly are hereby amended such that the term "Department"
shall be defined as the Department of Healthcare and Family

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Services and all references to the "Secretary" shall be
changed to the "Director of Healthcare and Family Services
or his or her designee". As soon as practicable hereafter,
the Department of Healthcare and Family Services shall
revise and clarify the rules to reflect the transfer of
rights, powers, duties, and responsibilities affected by
this amendatory Act of the 99th General Assembly, using the
procedures for recodification of rules available under the
Illinois Administrative Procedure Act, except that
existing title, part, and section numbering for the
affected rules may be retained. The Department of
Healthcare and Family Services, consistent with its
authority to do so as granted by this amendatory Act of the
99th General Assembly, shall propose and adopt any other
rules under the Illinois Administrative Procedure Act as
necessary to administer the Individual Care Grant program.
These rules may include, but are not limited to, the
application process and eligibility requirements for
recipients.
(3) All unexpended appropriations and balances and
other funds available for use in connection with any
functions of the Individual Care Grant program shall be
transferred for the use of the Department of Healthcare and
Family Services to operate the Individual Care Grant
program. Unexpended balances shall be expended only for the
purpose for which the appropriation was originally made.

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The Department of Healthcare and Family Services shall
exercise all rights, powers, duties, and responsibilities
for operation of the Individual Care Grant program.
(4) Existing personnel and positions of the Department
of Human Services pertaining to the administration of the
Individual Care Grant program shall be 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. The status and rights of Department of Human
Services employees engaged in the performance of the
functions of the Individual Care Grant program shall not be
affected by this amendatory Act of the 99th General
Assembly. The rights of the employees, the State of
Illinois, and its agencies under the Personnel Code and
applicable collective bargaining agreements or under any
pension, retirement, or annuity plan shall not be affected
by this amendatory Act of the 99th General Assembly. All
transferred employees who are members of collective
bargaining units shall retain their seniority, continuous
service, salary, and accrued benefits.
(5) All books, records, papers, documents, property
(real and personal), contracts, and pending business
pertaining to the powers, duties, rights, and
responsibilities related to the functions of the
Individual Care Grant program, including, but not limited

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to, material in electronic or magnetic format and necessary
computer hardware and software, shall be delivered to the
Department of Healthcare and Family Services; provided,
however, that the delivery of this information shall not
violate any applicable confidentiality constraints.
(6) Whenever reports or notices are now required to be
made or given or papers or documents furnished or served by
any person to or upon the Department of Human Services in
connection with any of the functions transferred by this
amendatory Act of the 99th General Assembly, the same shall
be made, given, furnished, or served in the same manner to
or upon the Department of Healthcare and Family Services.
(7) This amendatory Act of the 99th General Assembly
shall not affect any act done, ratified, or canceled or any
right occurring or established or any action or proceeding
had or commenced in an administrative, civil, or criminal
cause regarding the Department of Human Services before the
effective date of this amendatory Act of the 99th General
Assembly; and those actions or proceedings may be defended,
prosecuted, and continued by the Department of Human
Services.
(f) (Blank).
(g) Family Support Program. The Department of Healthcare
and Family Services shall restructure the Family Support
Program, formerly known as the Individual Care Grant program,
to enable early treatment of youth, emerging adults, and

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transition-age adults with a serious mental illness or serious
emotional disturbance.
(1) As used in this subsection and in subsections (h)
through (s):
(A) "Youth" means a person under the age of 18.
(B) "Emerging adult" means a person who is 18
through 20 years of age.
(C) "Transition-age adult" means a person who is 21
through 25 years of age.
(2) The Department shall amend 89 Ill. Adm. Code 139 in
accordance with this Section and consistent with the
timelines outlined in this Section.
(3) Implementation of any amended requirements shall
be completed within 8 months of the adoption of any
amendment to 89 Ill. Adm. Code 139 that is consistent with
the provisions of this Section.
(4) To align the Family Support Program with the
Medicaid system of care, the services available to a youth,
emerging adult, or transition-age adult through the Family
Support Program shall include all Medicaid community-based
mental health treatment services and all Family Support
Program services included under 89 Ill. Adm. Code 139. No
person receiving services through the Family Support
Program or the Specialized Family Support Program shall
become a Medicaid enrollee unless Medicaid eligibility
criteria are met and the person is enrolled in Medicaid. No

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part of this Section creates an entitlement to services
through the Family Support Program, the Specialized Family
Support Program, or the Medicaid program.
(5) The Family Support Program shall align with the
following system of care principles:
(A) Treatment and support services shall be based
on the results of an integrated behavioral health
assessment and treatment plan using an instrument
approved by the Department of Healthcare and Family
Services.
(B) Strong interagency collaboration between all
State agencies the parent or legal guardian is involved
with for services, including the Department of
Healthcare and Family Services, the Department of
Human Services, the Department of Children and Family
Services, the Department of Juvenile Justice, and the
Illinois State Board of Education.
(C) Individualized, strengths-based practices and
trauma-informed treatment approaches.
(D) For a youth, full participation of the parent
or legal guardian at all levels of treatment through a
process that is family-centered and youth-focused. The
process shall include consideration of the services
and supports the parent, legal guardian, or caregiver
requires for family stabilization, and shall connect
such person or persons to services based on available

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insurance coverage.
(h) Eligibility for the Family Support Program.
Eligibility criteria established under 89 Ill. Adm. Code 139
for the Family Support Program shall include the following:
(1) Individuals applying to the program must be under
the age of 26.
(2) Requirements for parental or legal guardian
involvement are applicable to youth and to emerging adults
or transition-age adults who have a guardian appointed
under Article XIa of the Probate Act.
(3) Youth, emerging adults, and transition-age adults
are eligible for services under the Family Support Program
upon their third inpatient admission to a hospital or
similar treatment facility for the primary purpose of
psychiatric treatment within the most recent 12 months and
are hospitalized for the purpose of psychiatric treatment.
(4) School participation for emerging adults applying
for services under the Family Support Program may be waived
by request of the individual at the sole discretion of the
Department of Healthcare and Family Services.
(5) School participation is not applicable to
transition-age adults.
(i) Notification of Family Support Program and Specialized
Family Support Program services.
(1) Within 12 months after the effective date of this
amendatory Act of the 101st General Assembly, the

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Department of Healthcare and Family Services, with
meaningful stakeholder input through a working group of
psychiatric hospitals, Family Support Program providers,
family support organizations, the Community and
Residential Services Authority, a statewide association
representing a majority of hospitals, a statewide
association representing physicians, and foster care
alumni advocates, shall establish a clear process by which
a youth's or emerging adult's parents, guardian, or
caregiver, or the emerging adult or transition-age adult,
is identified, notified, and educated about the Family
Support Program and the Specialized Family Support Program
upon a first psychiatric inpatient hospital admission, and
any following psychiatric inpatient admissions.
Notification and education may take place through a Family
Support Program coordinator, a mobile crisis response
provider, a Comprehensive Community Based Youth Services
provider, the Community and Residential Services
Authority, or any other designated provider or coordinator
identified by the Department of Healthcare and Family
Services. In developing this process, the Department of
Healthcare and Family Services and the working group shall
take into account the unique needs of emerging adults and
transition-age adults without parental involvement who are
eligible for services under the Family Support Program. The
Department of Healthcare and Family Services and the

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working group shall ensure the appropriate provider or
coordinator is required to assist individuals and their
parents, guardians, or caregivers, as applicable, in the
completion of the application or referral process for the
Family Support Program or the Specialized Family Support
Program.
(2) Upon a youth's, emerging adult's or transition-age
adult's second psychiatric inpatient hospital admission,
prior to hospital discharge, the hospital must, if it is
aware of the patient's prior psychiatric inpatient
hospital admission, ensure that the youth's parents,
guardian, or caregiver, or the emerging adult or
transition-age adult, has have been notified of the Family
Support Program and the Specialized Family Support Program
prior to hospital discharge.
(3) Psychiatric lockout as last resort.
(A) Prior to referring any youth to the Department
of Children and Family Services for the filing of a
petition in accordance with subparagraph (c) of
paragraph (1) of Section 2-4 of the Juvenile Court Act
of 1987 alleging that the youth is dependent because
the youth was left in a psychiatric hospital beyond
medical necessity, the hospital shall attempt to
contact educate the youth and the youth's parents,
guardian, or caregiver about the Family Support
Program and the Specialized Family Support Program and

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shall assist with connections to the designated Family
Support Program coordinator in the service area by
providing educational materials developed by the
Department of Healthcare and Family Services. Once
this process has begun, any such youth shall be
considered a youth for whom an application for the
Family Support Program is pending with the Department
of Healthcare and Family Services or an active
application for the Family Support Program was being
reviewed by the Department for the purposes of
subsection (a) of Section 2-4b subparagraph (b) of
paragraph (1) of Section 2-4 of the Juvenile Court Act
of 1987, or for the purposes of subsection (a) of
Section 5-711 of the Juvenile Court Act of 1987.
(B) No state agency or hospital shall coach a
parent or guardian of a youth in a psychiatric hospital
inpatient unit to lock out or otherwise relinquish
custody of a youth to the Department of Children and
Family Services for the sole purpose of obtaining
necessary mental health treatment for the youth. In the
absence of abuse or neglect, a psychiatric lockout or
custody relinquishment to the Department of Children
and Family Services shall only be considered as the
option of last resort. Nothing in this Section shall
prohibit discussion of medical treatment options or a
referral to legal counsel.

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(4) Development of new Family Support Program
services.
(A) Development of specialized therapeutic
residential treatment for youth and emerging adults
with high-acuity mental health conditions. Through a
working group led by the Department of Healthcare and
Family Services that includes the Department of
Children and Family Services and residential treatment
providers for youth and emerging adults, the
Department of Healthcare and Family Services, within
12 months after the effective date of this amendatory
Act of the 101st General Assembly, shall develop a plan
for the development of specialized therapeutic
residential treatment beds similar to a qualified
residential treatment program, as defined in the
federal Family First Prevention Services Act, for
youth in the Family Support Program with high-acuity
mental health needs. The Department of Healthcare and
Family Services and the Department of Children and
Family Services shall work together to maximize
federal funding through Medicaid and Title IV-E of the
Social Security Act in the development and
implementation of this plan.
(B) Using the Department of Children and Family
Services' beyond medical necessity data over the last 5
years and any other relevant, available data, the

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Department of Healthcare and Family Services shall
assess the estimated number of these specialized
high-acuity residential treatment beds that are needed
in each region of the State based on the number of
youth remaining in psychiatric hospitals beyond
medical necessity and the number of youth placed
out-of-state who need this level of care. The
Department of Healthcare and Family Services shall
report the results of this assessment to the General
Assembly by no later than December 31, 2020.
(C) Development of an age-appropriate therapeutic
residential treatment model for emerging adults and
transition-age adults. Within 30 months after the
effective date of this amendatory Act of the 101st
General Assembly, the Department of Healthcare and
Family Services, in partnership with the Department of
Human Services' Division of Mental Health and with
significant and meaningful stakeholder input through a
working group of providers and other stakeholders,
shall develop a supportive housing model for emerging
adults and transition-age adults receiving services
through the Family Support Program who need
residential treatment and support to enable recovery.
Such a model shall be age-appropriate and shall allow
the residential component of the model to be in a
community-based setting combined with intensive

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community-based mental health services.
(j) Workgroup to develop a plan for improving access to
substance use treatment. The Department of Healthcare and
Family Services and the Department of Human Services' Division
of Substance Use Prevention and Recovery shall co-lead a
working group that includes Family Support Program providers,
family support organizations, and other stakeholders over a
12-month period beginning in the first quarter of calendar year
2020 to develop a plan for increasing access to substance use
treatment services for youth, emerging adults, and
transition-age adults who are eligible for Family Support
Program services.
(k) Appropriation. Implementation of this Section shall be
limited by the State's annual appropriation to the Family
Support Program. Spending within the Family Support Program
appropriation shall be further limited for the new Family
Support Program services to be developed accordingly:
(1) Targeted use of specialized therapeutic
residential treatment for youth and emerging adults with
high-acuity mental health conditions through appropriation
limitation. No more than 12% of all annual Family Support
Program funds shall be spent on this level of care in any
given state fiscal year.
(2) Targeted use of residential treatment model
established for emerging adults and transition-age adults
through appropriation limitation. No more than one-quarter

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of all annual Family Support Program funds shall be spent
on this level of care in any given state fiscal year.
(l) Exhausting third party insurance coverage first.
(A) A parent, legal guardian, emerging adult, or
transition-age adult with private insurance coverage shall
work with the Department of Healthcare and Family Services,
or its designee, to identify insurance coverage for any and
all benefits covered by their plan. If insurance
cost-sharing by any method for treatment is
cost-prohibitive for the parent, legal guardian, emerging
adult, or transition-age adult, Family Support Program
funds may be applied as a payer of last resort toward
insurance cost-sharing for purposes of using private
insurance coverage to the fullest extent for the
recommended treatment. If the Department, or its agent, has
a concern relating to the parent's, legal guardian's,
emerging adult's, or transition-age adult's insurer's
compliance with Illinois or federal insurance requirements
relating to the coverage of mental health or substance use
disorders, it shall refer all relevant information to the
applicable regulatory authority.
(B) The Department of Healthcare and Family Services
shall use Medicaid funds first for an individual who has
Medicaid coverage if the treatment or service recommended
using an integrated behavioral health assessment and
treatment plan (using the instrument approved by the

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Department of Healthcare and Family Services) is covered by
Medicaid.
(C) If private or public insurance coverage does not
cover the needed treatment or service, Family Support
Program funds shall be used to cover the services offered
through the Family Support Program.
(m) Service authorization. A youth, emerging adult, or
transition-age adult enrolled in the Family Support Program or
the Specialized Family Support Program shall be eligible to
receive a mental health treatment service covered by the
applicable program if the medical necessity criteria
established by the Department of Healthcare and Family Services
are met.
(n) Streamlined application. The Department of Healthcare
and Family Services shall revise the Family Support Program
applications and the application process to reflect the changes
made to this Section by this amendatory Act of the 101st
General Assembly within 8 months after the adoption of any
amendments to 89 Ill. Adm. Code 139.
(o) Study of reimbursement policies during planned and
unplanned absences of youth and emerging adults in Family
Support Program residential treatment settings. The Department
of Healthcare and Family Services shall undertake a study of
those standards of the Department of Children and Family
Services and other states for reimbursement of residential
treatment during planned and unplanned absences to determine if

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reimbursing residential providers for such unplanned absences
positively impacts the availability of residential treatment
for youth and emerging adults. The Department of Healthcare and
Family Services shall begin the study on July 1, 2019 and shall
report its findings and the results of the study to the General
Assembly, along with any recommendations for or against
adopting a similar policy, by December 31, 2020.
(p) Public awareness and educational campaign for all
relevant providers. The Department of Healthcare and Family
Services shall engage in a public awareness campaign to educate
hospitals with psychiatric units, crisis response providers
such as Screening, Assessment and Support Services providers
and Comprehensive Community Based Youth Services agencies,
schools, and other community institutions and providers across
Illinois on the changes made by this amendatory Act of the
101st General Assembly to the Family Support Program. The
Department of Healthcare and Family Services shall produce
written materials geared for the appropriate target audience,
develop webinars, and conduct outreach visits over a 12-month
period beginning after implementation of the changes made to
this Section by this amendatory Act of the 101st General
Assembly.
(q) Maximizing federal matching funds for the Family
Support Program and the Specialized Family Support Program. The
Department of Healthcare and Family Services, as the sole
Medicaid State agency, shall seek approval from the federal

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Centers for Medicare and Medicaid Services within 12 months
after the effective date of this amendatory Act of the 101st
General Assembly to draw additional federal Medicaid matching
funds for individuals served under the Family Support Program
or the Specialized Family Support Program who are not covered
by the Department's medical assistance programs. The
Department of Children and Family Services, as the State agency
responsible for administering federal funds pursuant to Title
IV-E of the Social Security Act, shall submit a State Plan to
the federal government within 12 months after the effective
date of this amendatory Act of the 101st General Assembly to
maximize the use of federal Title IV-E prevention funds through
the federal Family First Prevention Services Act, to provide
mental health and substance use disorder treatment services and
supports, including, but not limited to, the provision of
short-term crisis and transition beds post-hospitalization for
youth who are at imminent risk of entering Illinois' youth
welfare system solely due to the inability to access mental
health or substance use treatment services.
(r) Outcomes and data reported annually to the General
Assembly. Beginning in 2021, the Department of Healthcare and
Family Services shall submit an annual report to the General
Assembly that includes the following information with respect
to the time period covered by the report:
(1) The number and ages of youth, emerging adults, and
transition-age adults who requested services under the

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Family Support Program and the Specialized Family Support
Program and the services received.
(2) The number and ages of youth, emerging adults, and
transition-age adults who requested services under the
Specialized Family Support Program who were eligible for
services based on the number of hospitalizations.
(3) The number and ages of youth, emerging adults, and
transition-age adults who applied for Family Support
Program or Specialized Family Support Program services but
did not receive any services.
(s) Rulemaking authority. Unless a timeline is otherwise
specified in a subsection, if amendments to 89 Ill. Adm. Code
139 are needed for implementation of this Section, such
amendments shall be filed by the Department of Healthcare and
Family Services within one year after the effective date of
this amendatory Act of the 101st General Assembly.
(Source: P.A. 101-461, eff. 1-1-20.)
Section 99. Effective date. This Act takes effect upon
becoming law.".