Illinois Administrative Code › Title 59 - MENTAL HEALTH › Part 132 - MEDICAID COMMUNITY MENTAL HEALTH SERVICES PROGRAM › Subpart A - GENERAL PROVISIONS › Section 132.25 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Part, the following terms are
				  defined:
Accessibility - Compliance with all appropriate provisions of
				  the Americans With Disabilities Act (ADA) of 1990 (
				  42 USC 12101
				  et seq.), as amended, and section 504 of the Rehabilitation Act of 1973 (
				  29 USC
				  794 ), and the most recent standards
				  identified in the Illinois Accessibility Code (71 Ill. Adm. Code 400) and/or
				  ADA Accessibility Guidelines, whichever standard is more stringent.
Assertive Community Treatment Program or ACT Program - An
				  evidence-based program that includes all components necessary to provide the
				  assertive community treatment model.
Applicant -An entity that seeks certification as a Certified
				  Specialty Provider (CSP) or CMHC under this Part
Centers for Medicare and Medicaid Services or CMMS - A
				  federal agency within the U.S. Department of Health and Human Services with
				  responsibility for Medicare, Medicaid, State Children's Health Insurance
				  (SCHIP), Health Insurance Portability and Accountability Act (HIPAA), and
				  Clinical Laboratory Improvement Amendments (CLIA).
Certifying State Agency or CSA - Departments responsible for
				  determining and monitoring compliance with this Part, i.e., Department of Human
				  Services or Department of Children and Family Services.
Client - An individual who is receiving community mental
				  health services eligible for Medical Assistance funding.
Certified Comprehensive Community Mental Health Center or
				  CMHC - An entity that meets the requirements of Subparts C and D and has been
				  certified by a Certifying State Agency. Any entity certified as a CMHC under
				  this Part shall be designated as an Essential Community Behavioral Health
				  Center by the Division of Mental Health.
Certified Specialty Provider or CSP - An entity that has
				  chosen to meet the requirements set forth in Subpart B to be eligible to
				  provide specialty programs directly funded by DHS-DMH and/or DCFS.
Community Support Team Program - A program designed with the
				  infrastructure and supports necessary to provide team-based care consistent
				  with DHS-DMH certification requirements.
Day - A calendar day unless otherwise indicated.
Department - The Illinois Department of Human Services
				  (DHS)
Department of Children and Family Services or DCFS - The
				  State child welfare agency responsible for:
protecting children who are reported to be abused or
				  neglected and to increase their families' capacity to safely care for
				  them;
providing for the well-being of children in care; providing
				  appropriate, permanent families as quickly as possible for those children who
				  cannot safely return home;
supporting early intervention and child abuse prevention
				  activities and working in partnerships with communities to fulfill this
				  mission.
Department of Human Services or DHS - The State agency
				  responsible for providing a wide variety of safety net services to Illinois
				  residents in poverty who are facing other economic challenges or who have any
				  of a variety of disabilities or health challenges.
Department of Human Services-Division of Mental Health or
				  DHS-DMH - A program division of DHS that, as the State Mental Health Authority
				  pursuant to Department of Human Services (Mental Health and Developmental
				  Disabilities) Law [ 20 ILCS 1710 ], is responsible for assuring that children,
				  adolescents and adults throughout Illinois have the availability of and access
				  to public-funded mental health services.
Emotional Disturbance - For clients under age 21, symptoms of
				  an emotional disorder contained in the DSM-5 and ICD-10-CM that is the
				  condition that will be the main focus of treatment. For clients under age 6, DC
				  0-5 may be utilized to develop an age appropriate diagnosis, then the crosswalk
				  between the DSM 5/ICD -10/DC 0-5 shall be used to identify which DSM-5/ICD-10
				  condition will be the main focus of treatment. Emotional disturbance does not
				  include organic disorders such as dementia and those associated with known or
				  unknown physical conditions such as hallucinations, amnestic disorder and
				  delirium; psychoactive substance induced organic mental disorders; and
				  intellectual disabilities, autism spectrum disorders or psychoactive substance
				  use disorders.
Enrollment -The official act of registering an entity or an
				  individual as a provider in the Illinois Medical Assistance Program.
Guardian - The court-appointed guardian or conservator of the
				  person under the Probate Act of 1975 [ 755 ILCS 5 ] or a temporary custodian or
				  guardian of the person of a child appointed by an Illinois juvenile court or a
				  legally-appointed guardian or custodian or other party granted legal care,
				  custody and control over a minor child by a juvenile court of competent
				  jurisdiction located in another state whose jurisdiction has been extended into
				  Illinois via the child's legally authorized placement in accordance with the
				  applicable interstate compact. (See the Juvenile Court Act of 1987 [ 705 ILCS
				  405 ] and the Interstate Compact on the Placement of Children [ 45 ILCS 15
				  ].)
Healthcare and Family Services or HFS - The State agency
				  responsible for administering Medicaid for Illinois.
Health Information Technology for Economic and Clinical
				  Health (HITECH) Act - Title XIII of Division A and Title IV of Division B of
				  the American Recovery and Reinvestment Act of 2009 (ARRA),
				  P.L.
				  111-5 (Feb. 17, 2009).
Health Insurance Portability and Accountability Act or HIPAA
				  -
				  42 USC
				  1320 et seq. and 45 CFR 160 and 164
				  (2003).
Illinois Medicaid Program Advanced Cloud Technology or IMPACT
				  - The HFS web-based Medicaid Management Information System platform.
Intensive Outpatient Program - A program designed with the
				  infrastructure and supports necessary to provide group therapeutic sessions
				  consistent with the clinical standards set forth in Subpart E.
Interdisciplinary Care - Professionals from a range of
				  disciplines working together to deliver comprehensive services and supports
				  that address as many of the client's needs as possible. This can be delivered
				  by a range of professionals and paraprofessionals functioning as a team under
				  one organizational umbrella or from a range of organizations, including private
				  practice, brought together as a unique team. As a client's condition changes
				  over time, the composition of the team may change to reflect the changing
				  clinical and psychosocial needs of the client.
Licensed Clinician - An individual who is:
A licensed practitioner of the healing arts (LPHA);
A licensed social worker (LSW) possessing at least a master's
				  degree in social work and licensed under the Clinical Social Work and Social
				  Work Practice Act [ 225 ILCS 20 ] with specialized training in mental health
				  services or with at least two years' experience in mental health
				  services;
A licensed professional counselor (LPC) possessing at least a
				  master's degree and licensed under the Professional Counselor and Clinical
				  Professional Counselor Licensing Act [ 225 ILCS 107 ] with specialized training
				  in mental health services or with at least two years' experience in mental
				  health services;
A registered professional nurse (RPN) licensed under the
				  Nurse Practice Act [ 225 ILCS 65 ] with at least one year of clinical
				  experience in a mental health setting or who possesses a master's degree in
				  psychiatric nursing; or
An occupational therapist (OT) licensed under the Illinois
				  Occupational Therapy Practice Act [ 225 ILCS 75 ] with at least one year of
				  clinical experience in a mental health setting.
Licensed Practitioner of the Healing Arts or LPHA - A LPHA is
				  defined as one of the following (additional information can be found in 89 Ill.
				  Adm. Code
				  140.453 ):
Physician;
Licensed advanced practice registered nurse with psychiatric
				  specialty;
Licensed clinical psychologist;
Licensed clinical professional counselor;
Licensed marriage and family therapist; or
Licensed clinical social worker.
Medical Assistance - Health care benefits authorized by HFS
				  under Article V of the Illinois Public Aid Code [ 305 ILCS 5 ].
Mental Health Professional or MHP - An individual who
				  provides services under the supervision of a Qualified Mental Health
				  Professional (additional information can be found in 89 Ill. Adm. Code 140.453)
				  and who possesses:
A bachelor's degree in counseling and guidance,
				  rehabilitation counseling, social work, education, vocational counseling,
				  psychology, pastoral counseling, family therapy, or a related human service
				  field;
A bachelor's degree in any other field with two years of
				  supervised clinical experience in a mental health setting;
A practical nurse license under the Illinois Nurse Practice
				  Act [ 225 ILCS 65 ];
A certificate of psychiatric rehabilitation from a
				  DHS-approved program, plus a high school diploma or GED, plus 2 years of
				  experience in providing mental health services;
A recovery support specialist certified by, and in good
				  standing with, the Illinois Alcohol and Other Drug Abuse Professional
				  Certification Association, Inc.;
A family partnership professional certificate from and in
				  good standing with the Illinois Alcohol and Other Drug Abuse Professional
				  Certification Association, Inc.;
An occupational therapy assistant licensed under the Illinois
				  Occupational Therapy Practice Act [ 225 ILCS 75 ] with at least one year of
				  experience in a mental health setting;
A minimum of a high school diploma or GED and 5 years
				  supervised clinical experience in mental health or human services; or
Any individual employed as an MHP prior to July 1, 2013 may
				  continue to be so designated unless employment changes.
Mental Health Setting - A location, public or private, in a
				  group or individual practice, in a mental health center, hospital or clinic
				  where services intended to reduce symptoms of mental illness are provided to
				  persons with mental illness.
Mental Illness - For clients age 18 and older, a mental
				  disorder diagnosis contained in the DSM-5 and ICD-10-CM. Mental illness does
				  not include organic disorders such as dementia and those associated with known
				  or unknown physical conditions such as hallucinations, amnestic disorder and
				  delirium; psychoactive substance induced organic mental disorders; and
				  intellectual disabilities, autism spectrum disorders or psychoactive substance
				  use disorders.
Natural Setting - A setting where an individual who has not
				  been diagnosed with a mental illness typically spends time, including home,
				  work, churches, community centers, libraries, parks, recreation centers,
				  educational settings, courthouses, jails or other public buildings. These sites
				  are not licensed, certified or accredited as a treatment setting nor typically
				  identified as treatment sites.
Natural Support - Persons identified by the client who are
				  not paid to provide support, e.g., family, friends, pastor, colleague,
				  landlord.
Notice of Violation or NOV - A written document that
				  specifies the standards within this Part with which the entity/CMHC is not
				  compliant.
Psychiatric Resource -
A physician licensed under the Medical Practice Act of l987 [
				  225 ILCS 60 ] to practice medicine or osteopathy with training in mental health
				  services or one year of clinical experience, under supervision, in treating
				  problems related to mental illness, or specialized training (i.e., the
				  treatment of children and adolescents);
A psychiatrist (a physician licensed under the Medical
				  Practice Act of l987 [ 225 ILCS 60 ]) who has successfully completed a training
				  program in psychiatry approved by the American Medical Association, the
				  American Osteopathic Association or other training program identified as
				  equivalent by the Department;
An advanced practice registered nurse (APRN) with a
				  psychiatric specialty licensed in Illinois under Article 65 of the Nurse
				  Practice Act [ 225 ILCS 65 ] ; or
A prescribing psychologist licensed in Illinois pursuant to
				  the Clinical Psychologist Licensing Act [ 225 ILCS 15 ], practicing within his
				  or her scope of practice and adhering to all applicable federal and State
				  administrative rules and policies, with sufficient credentials to prescribe
				  psychotropic medications in Illinois.
Psychosocial Rehabilitation Program or PSR - A facility-based
				  program designed with the infrastructure and supports necessary to provide
				  intensive skill development in a classroom-based setting, consistent with
				  clinical standards set forth in Subpart E.
Public Payer - A State agency or a unit of local government
				  that is responsible for payment for services provided to a client.
"Qualified Mental Health Professional" or "QMHP" means one of
				  the following:
Any individual identified as an LPHA.
A registered professional nurse who holds a valid license in
				  the state of practice, is legally authorized under state law or rule to
				  practice as registered nurse or registered professional nurse, so long as that
				  practice is not in conflict with the Illinois Nurse Practice Act, and has
				  training in mental health services or one year of clinical experience, under
				  supervision, in treating problems related to mental illness, or specialized
				  training in the treatment of children and adolescents.
An occupational therapist who holds a valid license in the
				  state of practice and is authorized under state law or rule to practice as an
				  occupational therapist, so long as that practice is not in conflict with the
				  Illinois Occupational Therapy Practice Act, with at least one year of clinical
				  experience in a mental health setting. If the state of practice does not
				  provide a legal authority for licensure, the individual must meet the
				  requirements of
				  42 CFR
				  484.4 for an occupational therapist.
An individual who possesses a master's or doctoral degree in
				  counseling and guidance, rehabilitation counseling, social work, psychology,
				  pastoral counseling, family therapy, or a related field and has:
Successfully completed 1,000 hours of practicum and/or
				  internship under clinical and educational supervision; or
One year of documented clinical experience under the
				  supervision of a QMHP.
Rehabilitative Services Associate or RSA - An RSA assists in
				  the provision of rehabilitative services under the supervision of a QMHP
				  (additional information can be found in 89 Ill. Adm. Code 140.453) and
				  must:
Be at least 21 years of age;
Have demonstrated skills in the field of services to adults
				  or children;
Have demonstrated the ability to work within agency structure
				  and accept supervision; and
Have demonstrated the ability to work constructively with
				  clients, other providers and the community.
SAMHSA - The federal Substance Abuse and Mental Health
				  Services Administration responsible for guidance to the State Mental Health
				  Authorities, including administration of the federal block grant, defining and
				  identifying evidence-based practices, and translation of research to
				  practice.
Safety Net - A collection of services provided, in
				  collaboration with health care and social service providers throughout the
				  community, to the uninsured and other vulnerable populations. The collection of
				  services is designed to help prevent individuals from further emotional,
				  mental, physical and economic decompensation, while promoting stability and
				  empowerment.
Specialty Certification - The confirmation from DHS-DMH, the
				  Illinois State Mental Health Authority, that a program meets the required
				  clinical standards set forth in Subpart E.
State Mental Health Authority or SMHA - The entity within a
				  state with federal and state statutorily assigned responsibility for planning,
				  organizing, delivering and monitoring the programs that provide critical mental
				  health services, through the development of safety net programs that provide
				  critical care to individuals with serious mental illnesses who lack insurance
				  and/or have high levels of service needs. In Illinois, DHS-DMH is charged with
				  this responsibility, which includes the development and implementation of a
				  plan for comprehensive community mental health systems and reporting a set of
				  standardized utilization and outcome measures.
Supervision of Treatment Services - The dedicated time an
				  LPHA or QMHP spends with his or her supervisees discussing the supervisees'
				  work. This may include reviewing individual cases, treatment plans, group
				  counseling, individual counseling, progress made by clients, or problem solving
				  when progress is not occurring or when individuals are not engaged in the
				  therapeutic process. Supervision may be done individually or in groups.
Treatment, Habilitation and Support Services -
				  Services designed to:
help individuals develop skills that promote
				  independence and improved levels of social and vocational functioning and
				  personal growth; and
provide nontreatment support services necessary for
				  successful community living
[
				  405
				  ILCS 30/2(e)
				  ]
.