Bill Text: IL HB4187 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: 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.

Spectrum: Strong Partisan Bill (Democrat 10-1)

Status: (Introduced - Dead) 2022-04-11 - Rule 19(a) / Re-referred to Rules Committee [HB4187 Detail]

Download: Illinois-2021-HB4187-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB4187 Introduced , by Rep. Deb Conroy SYNOPSIS AS INTRODUCED:
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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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning mental 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 Mental
Health Inpatient Facility Access Act.
Section 5. Findings. The General Assembly finds that:
(1) In 1955, Illinois had more than 30,000 adult
State-operated inpatient mental health beds.
(2) In 2019, prior to the COVID-19 pandemic, Illinois
had fewer than 1,200 adult State-operated inpatient mental
health beds.
(3) Due to the COVID-19 pandemic, there are now only
approximately 1,100 State-operated inpatient mental health
beds.
(4) More than 500,000 people in Illinois have serious
mental health conditions.
(5) While most people with even the most serious
mental health conditions can be successfully treated in
the community or in private hospitals, many will need
inpatient care from a State-operated inpatient mental
health facility.
(6) Given the small number of remaining beds in
State-operated inpatient mental health facilities, it is

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

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Division of Mental Health shall 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.
This plan shall address achieving the best use of
State-operated psychiatric beds across Illinois, with
strategies specifically to mitigate inefficient use of
forensic beds and reduce lengths of stays for the forensic
population. A comprehensive approach to this plan shall
include training and education, ongoing assessment of
individuals receiving inpatient services, reviewing and
updating policies and procedures, and increasing
community-based capacity for individuals in all State-operated
forensic beds. The plan shall include:
(1) Annual training. Required annual training for all
State-operated inpatient mental health facility clinicians
shall include:
(A) Best practices for evaluating whether
individuals found not guilty by reason of insanity or
unfit to stand trial meet the legal criteria for
inpatient treatment.
(B) Best practices for determining appropriate
treatment for individuals found not guilty by reason
of insanity or unfit to stand trial.
(C) The requirements of treatment plan reports.
(D) The types of mental health services available

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

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

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

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

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

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Section 25. The Illinois Public Aid Code is amended by
adding Section 5-2.04 as follows:
(305 ILCS 5/5-2.04 new)
Sec. 5-2.04. Hospital presumptive eligibility; behavioral
health hospitalizations. The Department of Healthcare and
Family Services, in collaboration with the Department of Human
Services' Division of Mental Health, shall 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. The Department and the
Division of Mental Health, with meaningful stakeholder input,
shall develop a process by which those individuals are linked
to a community-based mental health provider or any other
appropriate organization to facilitate enrollment in Medicaid
immediately following hospital or emergency room discharge and
linkage to community-based treatment. If the Department's
Illinois Continuity of Care and Administrative Simplification
1115 Waiver, which includes waiving the federal requirement of
hospital presumptive eligibility for Medicaid enrollment, is
required to be amended to implement this Section, then the
Department shall amend the 1115 Waiver within 60 days after
the effective date of this amendatory Act of the 102nd General
Assembly.
Section 99. Effective date. This Act takes effect upon

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becoming law.