Illinois Administrative Code › Title 59 - MENTAL HEALTH › Part 112 - TREATMENT AND HABILITATION SERVICES › Section 112.10 - Utilization review hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Utilization review hearings shall be conducted in accordance with Sections
			 3-207, 3-405, 3-903, 3-910, 4-209, 4-312, 4-704 and 4-709 of the Code. When a
			 person who is evaluated as being mildly or moderately mentally retarded,
			 resides in a Department mental health facility and objects to the facility
			 director's certification of the treatment and habilitation plan or the
			 appropriateness of the setting, a utilization review hearing shall be conducted
			 in accordance with Section
			 112.20(g).
b) Definitions
"Aftercare." The continuation of needed care and services of a
				recipient discharged from a state-operated facility within an appropriate
				setting with individualized follow-up services.
"Code." The Mental Health and Developmental Disabilities Code
				[405 ILCS 5 ].
"Day." As used in this Section and in Section
				112.20
				means calendar day unless otherwise indicated.
"Department." The Department of Human Services.
"Discharge." The full release of any person admitted under the
				provisions of the Code, or transferred under the provisions of Sections 3-8-5,
				3-8-6, 3-10-5 and 3-10-6 of the Unified Code of Corrections [730 ILCS 5/8-5, 8
				-6, 10-5 and 10-6] for treatment or habilitation.
"Facility Director." The director or hospital administrator of
				a mental health or developmental disabilities facility.
"Guardian." The plenary guardian of the person or limited
				guardian of the person with specific court authority to make mental health
				decisions on the person's behalf. (Section 11a-14 of the Probate Act of 1975
				[755 ILCS
				5/11a-14 ].) It does not include a guardian ad litem
				or person in loco parentis or with power of attorney.
"Guardian ad litem." A person appointed by the court to defend
				or represent the interests of a minor or alleged legally disabled during a
				guardianship proceeding or in other matters. This person has no right to
				interfere with the minor's or alleged legally disabled person or estate.
"In loco parentis." Any individual, other than a parent or
				legal guardian, who has the primary functional responsibility of providing
				food, shelter, medical care and education to a minor.
"Person subject to involuntary admission." A person who is
				mentally ill and who because of his or her illness:
is reasonably expected to inflict serious physical harm on
				him/herself or another in the near future; or
is unable to provide for his or her basic physical needs so as
				to guard himself or herself from serious harm. (Section 1-119 of the
				Code)
"Responsible relative." The spouse or, if the recipient is
				under 18 years of age, the parent of a recipient of services. (Section 1-124 of
				the Code)
"Secretary." The Secretary of the Department of Human Services
				or his or her designee, or the Manager of the Office of Clinical Services when
				applicable pursuant to Section 1-108 of the Code.
"Transfer." The movement of a recipient from one Department
				facility to another Department facility or to a Veterans' Administration
				facility. This does not include movement from a Department facility to a
				non-Department facility (other than to a Veterans' Administration facility) or
				movement between separate units or discrete portions of the same facility. It
				also does not include the discharge of a recipient.
c) Notice requirements
1) Notice of denial of admission
Whenever a person seeking admission to a Department facility is
				denied admission by the facility, the person shall be given within two hours
				written notice of his or her right to request a review of the denial of the
				facility's decision on the Notice of Denial of Admission and Right to Request
				Review form.
2) Notice of
			 non-emergency transfer
A) Whenever a recipient
			 who has been in a Department facility for more than seven days is to be
			 transferred to another facility, the facility director shall give written
			 notice of the proposed transfer on the "Notice of Transfer" form, to the
			 persons identified in Sections 4-206 and 4-709 of the Code at least 14 days
			 prior to the scheduled transfer.
B)
			 Notice of transfer and the right to object shall be given to recipients being
			 transferred to the Chester Mental Health Center even when such recipients have
			 been in the Department facility for less than seven days and to the adult
			 recipient's attorney, guardian, if any, and responsible relative and to the
			 minor recipient's attorney, parent, guardian or person in loco parentis who
			 executed the application for admission in accordance with Section 3-910 of the
			 Code. Except in an emergency, as specified in subsection (c)(3) of this
			 Section, no transfer shall proceed pending the facility director's decision or
			 any administrative or judicial review of that decision which is permitted by
			 law. (See subsection (e)(3) for waiver provisions.)
3) Notice of emergency transfer
In an emergency, when the health of the recipient or the
				physical safety of the recipient or others is imminently imperiled and
				appropriate care and services are not available where the recipient is located,
				a recipient shall be transferred to another facility as soon as transfer
				arrangements can be made, provided that notice is given in accordance with
				subsection (c)(2) of this Section, as soon as possible but not later than 48
				hours after the transfer. If an emergency transfer cannot be effected within 48
				hours after the decision to transfer, the transfer shall proceed only as a
				non-emergency transfer with prior written notice of the right to object as
				provided in Sections 3-910 and 4-709 of the Code and subsection (c)(2) of this
				Section.
4) Notice of
			 discharge
A) Recipient in a mental health
			 facility
i) Adult - Notice shall be given to
			 the adult recipient, the recipient's attorney, and guardian, if any, on the
			 "Notice of Discharge" form, at least seven days prior to the date of intended
			 discharge.
ii) Minor - Notice shall
			 be given to his or her attorney, his or her parent, guardian, or person in loco
			 parentis who executed the application for admission, and to the minor if he or
			 she is 12 years of age or older, on the "Notice of Discharge" form, at least
			 seven days prior to the date of intended discharge.
B) Recipient in a developmental disabilities
			 facility
i) Notice shall be given at least 14
			 days prior to the date of discharge.
ii) Notice shall be given on the "Notice of
			 Discharge" form, to the recipient, if he or she is 12 years of age or older, to
			 the recipient's attorney and guardian, if any, to the person who executed the
			 application for admission and to the resident school district if the recipient
			 is receiving educational services.
C) Discharge pending a hearing or review
No discharge shall proceed pending the facility director's
				decision or any administrative or judicial review of that decision which is
				permitted by law, except that persons temporarily admitted under Section 4-311
				of the Code shall not stay beyond 30 days plus the additional time up to the
				hearing.
5)
			 Notice contents
A) All notices for transfers
			 or discharge shall include:
i) The reasons for
			 the transfer or discharge;
ii) A
			 statement of the right to object; and
iii) The address and telephone number of the
			 Guardianship and Advocacy Commission.
B) All notices of denial of admission shall
			 include:
i) A statement of the right to
			 request a review of the denial; and
ii) The address and telephone number of the
			 Guardianship and Advocacy Commission.
C) If the recipient's or guardian's primary
			 language is not English or if the recipient or guardian is hearing impaired
			 and/or vision impaired, arrangements must be made to provide for an adequate
			 explanation in the person's primary language in accordance with the
			 Department's rule at 59 Ill. Adm. Code
			 111.20 or preferred
			 method of communication of the recipient's right to request a review.
			 Arrangements will be made to secure the services of an interpreter who is
			 fluent in the recipient's or guardian's primary language to explain the notice
			 to the recipient or guardian.
6) Manner of service of notices
All notices required by Sections 3-405(a), 3-903(a), 3-910,
				4-312(a), 4-704(a) and 4-709 of the Code shall be served personally on the
				recipient and/or objector whenever possible. A copy of the notice, signed by
				the recipient in acknowledgment of service, shall be placed in the recipient's
				clinical record. When personal service is not possible, first class mail shall
				be used to serve notice on the recipient and/or objector and any other person
				entitled to receive notice.
7) Aftercare and case coordination
Aftercare and case coordination shall be provided to all
				discharged and conditionally discharged recipients in accordance with the
				Department's rules at 59 Ill. Adm. Code 125 (Recipient
				Discharge/Linkage/Aftercare).