il-v50i40-89-ill-adm-code-139: 89 Ill. Adm. Code 139 — Children's Behavioral Health

1) Heading of the Part: Children's Behavioral Health 2) Code Citation: 89 Ill. Adm. Code 139 3) Section Numbers: Proposed Actions: 139.700 New Section 139.710 New Section 139.720 New Section 139.730 New Section 139.740 New Section 139.750 New Section 139.760 New Section 4) Statutory Authority: Implements Section 7.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and the Custody Relinquishment Prevention Act [20 ILCS 540]. 5) A Complete Description of the Subjects and Issues Involved: This proposed rulemaking will add a new subsection to 89 Ill. Adm. Code 139 to include the Children's Mental Health Screening, Assessment and Support Services Program. Per the Children's Mental Health Act of 2003 [405 ILCS 49]. This was a shared program between this Department, DHS and DCFS, and was designed to meet the requirements in the Illinois Children's Mental Health Act: Protocols for implementing screening and assessment of children prior to any admission to an inpatient hospital for psychiatric services, pursuant to subsection (a) of Section 5-5.23 of the Illinois Public Aid Code. The pre-hospitalization screening program developed to meet this requirement is known as the Screening, Assessment and Support Services (SASS) program and was previously funded and administered by the Department, DHS and DCFS via an Intergovernmental Agreement (IGA) and an interagency funding mechanism. The Department was fiscally responsible for Medicaid-eligible individuals, DCFS was fiscally responsible for DCFS Youth in Care, and DHS was fiscally responsible for individuals who were not eligible for Medicaid or other insurance coverage but met other eligibility requirements outlined in Rule 131. Pursuant to Public Act 99-0479, statutory authority for this program was transferred to this Department. However, administrative rules for this program remain in the Administrative Code under DHS. Both DCFS and DHS requested that the Department become the sole agency administering and funding SASS, and this change occurred in 2021 with the termination of the IGA. The Department was awarded both DCFS' and DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS DHS' SASS appropriation to solely administer the SASS program. DHS is now moving forward with repealing their Rule 131, since they no longer administer or fund the SASS program. As such, this Department is moving herein to add the relevant language from 59 Ill. Adm. Code 131 to its administrative rules. 6) Published studies or reports, and sources of underlying data, used to compose this rulemaking: None 7) Will this proposed rulemaking replace an emergency rule currently in effect? No 8) Does this rulemaking contain an automatic repeal date? No 9) Does this proposed rulemaking contain incorporations by reference? No 10) Are there any other proposed rulemakings pending on this Part? No 11) Statement of Statewide Policy Objectives: This rulemaking does not affect units of local government. 12) Time, Place, and Manner in which interested persons may comment on this proposed rulemaking: Any interested parties may submit comments, data, views, or arguments concerning this proposed rulemaking. All comments must be in writing and should be addressed to: Chris Gange Acting General Counsel Illinois Department of Healthcare and Family Services 201 South Grand Avenue E., 3 Floor Springfield IL 62763-0002 (217) 782-1233 HFS.Rules@illinois.gov The Department requests the submission of written comments within 45 days after the publication of this Notice. The Department will consider all written comments it receives during the first notice period as required by Section 5-40 of the Illinois Administrative Procedure Act [5 ILCS 100/5-40]. 13) Initial Regulatory Flexibility Analysis: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS A) Description of the type of small business, not for profit corporations or small municipalities subject to the proposed rulemaking amendment: None B) Description of the proposed reporting, bookkeeping and other procedures required for compliance with the rulemaking amendment: None C) Description of the types of professional skills necessary for compliance: None 14) Small Business Economic Impact Analysis: None 15) Regulatory Agenda on which this rulemaking was summarized: July 2026 16) Any other information or justification for the proposed rule or amendment that the agency believes would be helpful to the public regarding the proposed rule or amendment. For example, a discussion or analysis of the benefits of the proposed rule or amendment is projected to have on the Illinois public, consumers, investors or other similar groups: None The full text of the Proposed Amendments begins on the next page: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS TITLE 89: SOCIAL SERVICES CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES SUBCHAPTER d: MEDICAL PROGRAMS PART 139 CHILDREN'S BEHAVIORAL HEALTH SUBPART A: INDIVIDUAL CARE GRANT: FAMILY SUPPORT PROGRAM Section 139.100 Purpose 139.105 Incorporation by Reference 139.110 Definitions 139.115 Family Support Program Requirements 139.120 Family Support Program Parent or Legal Guardian Responsibilities 139.125 Application Process and Requirements 139.130 Application Determination Process 139.135 Authorization Process for Family Support Program Participation 139.140 Family Support Program Services 139.145 Family Support Program Service Planning 139.150 Family Support Program Discharge SUBPART B: INDIVIDUAL CARE GRANT: SPECIALIZED FAMILY SUPPORT PROGRAM Section 139.200 Purpose 139.205 Specialized Family Support Program Requirements 139.210 Specialized Family Support Program Parent or Legal Guardian Responsibilities 139.215 Specialized Family Support Program Referral Requirements 139.220 Specialized Family Support Program Components 139.225 Specialized Family Support Program Discharge SUBPART C: COMMUNITY AND RESIDENTIAL SERVICES Section 139.300 Family Support Services 139.305 Family Support Program Residential Treatment 139.310 Specialized Family Support Program Transition Bed Services DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS SUBPART D: PROVIDERS OF FAMILY SUPPORT SERVICES Section 139.400 Family Support Program Residential Treatment Providers 139.405 Specialized Family Support Program: Transition Bed Services Providers SUBPART E: UTILIZATION CONTROLS Section 139.500 Medical Necessity and Utilization Review of Services SUBPART F: APPEALS Section 139.600 FSP and SFSP Recipient Appeals 139.610 FSP and SFSP Provider Appeals SUBPART G: CHILDREN'S MENTAL HEALTH SCREENING, ASSESSMENT AND SUPPORT SERVICES PROGRAM Section 139.700 Purpose 139.710 Definitions 139.720 Eligibility 139.730 Screening Requirement 139.740 Program Services 139.750 Billing for Services 139.760 Accountability AUTHORITY: Implements Section 7.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and the Custody Relinquishment Prevention Act [20 ILCS 540]. SOURCE: Adopted at 42 Ill. Reg. 8258, effective May 4, 2018; amended at 50 Ill. Reg. ______, effective ____________. SUBPART G: CHILDREN'S MENTAL HEALTH SCREENING, ASSESSMENT AND SUPPORT SERVICES PROGRAM Section 139.700 Purpose This Part establishes criteria for payment of certain mental health and related services that are provided to children enrolled in the Screening, Assessment and Support Services (SASS) Program. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.710 Definitions For the purposes of this Part, the following terms are defined: "CARES" – Crisis and referral entry services. The agent under contract with the Department to perform certain administrative functions on the State agency's behalf. "CBS" – Community-based behavioral services. "SASS" – Screening, assessment and support services. "SASSAgent" –Aprovider of CBS enrolled with the Department to screen children in behavioral health crisis who are believed to be in need of admission to an inpatient facility. "SASS Period" –A90-day period beginning with the date that the SASS agent begins initial screening of a child in behavioral health crisis. The period may be extended beyond 90 days if it has been determined to be clinically necessary. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.720 Eligibility Achild eligible for services provided under this Part is an individual who, through the Department-approved standardized acuity assessment used for the SASS program, is determined to meet criteria indicating behavioral health crisis and who meets one of the following criteria: a) An individual under 21 years of age who is enrolled, pursuant to 89 Ill.Adm. Code 118 or 120, in one of the medical programs administered by the Department, DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS except that any child who is enrolled in a managed care organization is not eligible; or b) Subject to funding that is appropriated and available to the Department for the SASS program, an individual who is under 18 years of age and who meets one of the following criteria: 1) An individual who, following submission of a completed application, does not qualify under subsection (a) of this Section 139.720; 2) An individual who has no other means of payment as determined by the Department, and is seeking public payment for services covered under this Part; or 3) An individual whose family is unable, unwilling, or refuses to apply for medical assistance, or if the SASS agent, hospital or community mental health provider finds it impossible to assist the family in applying, may be permitted an exception to this requirement only in these instances. A request for an exception may be made by contacting the Department. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.730 Screening Requirement a) Children in behavioral health crisis who may be in need of admission to an inpatient psychiatric facility and for whom public payment for the admission may be sought must be referred to CARES. b) If determined to be appropriate, CARES shall refer the child to a SASS agent. c) The SASS agent shall screen and determine if the child can be safely stabilized in the community or if psychiatric hospitalization is recommended for stabilization. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.740 Program Services a) Community-based Behavioral Services 1) Children, as a result of the pre-psychiatric hospitalization screening required under Section 139.730, for whom it has been determined by a SASS agent that appropriate alternative resources are available in the community shall be referred to those services by the SASS agent. Community-based behavioral services (CBS) shall be reimbursed by the Department only under the following conditions: A) The CBS provider is enrolled with the Department to participate in the Illinois medical assistance program. B) The service is provided in accordance with the plan of care developed by the SASS agent or other CBS provider. C) The service is provided during the SASS period. D) The patient was a child at the time of screening and met eligibility requirements specified in Section 139.720(b). 2) Payment shall be made utilizing rates of reimbursement established under the Department's CBS fee-schedule. b) Pharmacy Services 1) The Department shall pay for certain prescribed drugs dispensed to a child who meets eligibility requirements in Section 139.720(b). Pharmacy services, other than those provided by an inpatient psychiatric facility, shall be reimbursed only under the following conditions: A) The pharmacy provider is enrolled with the Department to participate in the Illinois medical assistance program. B) The service was provided during the SASS period. C) The patient was a child at the time of screening. D) The prescribed drug has been determined by the Department as appropriate for the treatment of serious emotional disturbance or mental illness or related symptoms. 2) Payment shall be made utilizing rates of reimbursement established under the provisions of 89 Ill.Adm. Code 140.444 and 140.445. c) Transportation Services 1) The Department shall pay for certain emergency and non-emergency transportation services provided to a child who meets eligibility criteria specified in Section 139.720(b). Transportation services, other than those provided by an inpatient psychiatric facility, shall be reimbursed only under the following conditions: A) The transportation provider is enrolled with the Department to participate in the Illinois medical assistance program; B) The transportation provided complies with all requirements and limitations of 89 Ill.Adm. Code 140.490 and 140.491; C) The transportation is in support of the plan of care developed by the SASS agent and is to or from a source of medical care covered under this Part; D) The service was provided during the SASS period; and E) The patient was a child at the time of screening. 2) Payment shall be made utilizing rates of reimbursement established under 89 Ill.Adm. Code 140.492 and 140.493. d) Inpatient Psychiatric Services 1) The Department shall pay for certain inpatient psychiatric services provided to a child who meets eligibility criteria specified in Section 139.720(b). Inpatient psychiatric services, other than those provided by an inpatient psychiatric facility operated by Illinois Department of Human Services, shall be reimbursed only under the following conditions: A) The inpatient facility is enrolled with the Department to participate in the Illinois medical assistance program and meets the special DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS requirements for inpatient psychiatric services found at 89 Ill. Adm. Code 148.40(a); B) Prior to admission, the individual shall be screened by a SASS agent to determine the appropriateness of an inpatient admission and the ability for the individual to be safely stabilized in the community; C) The admission is approved by the Department or its agent; D) Prior to discharge, the SASS agent participated in the development of the discharge plan; E) The date of admission was during the SASS period; and F) The patient was a child at the time of admission. 2) Payment shall be made utilizing rates of reimbursement established for the medical assistance program under 89 Ill.Adm. Code 148.110 and 89 Ill. Adm. Code 149, subject to utilization review or pre- or post-payment reviews, as applicable. e) Psychiatric Physician Services Achild eligible for psychiatric physician services must be currently enrolled in a SASS program and must meet the requirements under Section 139.720(b). 1) Physician services shall be reimbursed only under the following conditions: A) The physician is enrolled with the Department to participate in the Illinois MedicalAssistance Program. B) The service is one of the following: i) Psychiatric diagnostic interview examination inpatient and outpatient by a SASS staff psychiatrist; ii) Individual psychotherapy, insight oriented behavior modifying and/or supportive that is approximately 20-80 DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS minutes face to face with the patient with medical evaluation and management services provided in a hospital inpatient setting only, during an inpatient psychiatric stay; or iii) Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, approximately 20-80 minutes face to face with the patient with medical evaluation and management services. C) The service was provided during the SASS period. D) The patient was a child at the time of screening. 2) Payment shall be made utilizing rates of reimbursement established under the provisions of 89 Ill.Adm. Code 140.410 through 140.414. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.750 Billing for Services All program services described in this Part are provided and billed to the Department in accordance with the Department's policies as found in the HFS Handbook for Providers of Medical Services (found at https://hfs.illinois.gov/medicalproviders/handbooks.html), including any necessary prior authorization for the service. (Source: Added at 50 Ill. Reg. ______, effective ____________) Section 139.760 Accountability a) All payments made under this Part are subject to post-payment review and audit pursuant to the applicable rules under which the rates of reimbursement were established (see 89 Ill.Adm. Code 140.30, 140.410 through 140.414, 140.444, 140.455, 140.492, 140.493; 89 Ill.Adm. Code 148.110; and 89 Ill.Adm. Code 149. b) The Department shall implement a systematic process to assess the accessibility, effectiveness, and quality of services provided under this Part. DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES NOTICE OF PROPOSED AMENDMENTS c) Hospitals and CBS providers providing services under this Part are required to participate and cooperate fully in any monitoring and quality improvement efforts undertaken by the Department. d) The Department reserves the right to ensure that appropriate standards of treatment and service delivery are maintained for any individual child or for the system, including on-site inspection and individual consultation. (Source: Added at 50 Ill. Reg. ______, effective ____________) DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT