AUTHORITY: Implementing and authorized by Section 5-104 of the Mental Health and Developmental Disabilities Code [405 ILCS 5/5-104] and Sections 5, 15, 15.1, 15a, 15b and 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/5, 15, 15.1, 15a, 15b and 16].

SOURCE: Adopted and codified at 7 Ill. Reg. 11234, effective August 31, 1983; emergency amendment at 16 Ill. Reg. 2672, effective February 1, 1992, for a maximum of 150 days; recodified from the Department of Mental Health and Developmental Disabilities to the Department of Human Services at 21 Ill. Reg. 9321.

SUBPART A: GENERAL PROVISIONS

 

Section 125.10  Purpose

 

a)         The intent of this Part is to define and describe the role of the Department of Human Services once the decision has been made by direct service personnel that a recipient is a candidate for discharge from a State-operated facility.  A person shall not remain in a State-operated facility after it has been clinically and professionally determined that therapeutic services as defined within the Mental Health and Developmental Disabilities Code [405 ILCS 5] are no longer needed by the recipient. Adequate discharge planning, linkage and aftercare within an appropriate setting with individualized follow-up services will be provided for each recipient.  Recipients will not be discharged from State-operated facilities without assurance that linkage will occur, unless the recipient refuses individualized follow-up services.

 

b)         The policies and procedures within this document are consistent with the statutes which contain the Mental Health and Developmental Disabilities Code and the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705] and provide uniform direction to Department employees beginning with the decision to discharge a recipient and continuing through the follow-up process.  The approach contained in this Part should enhance the quality of delivery of services to recipients and provide for improved public accountability.

 

c)         This Part shall be used to assist in the orientation and training of staff as well as to provide guidance which may be necessary on a day-to-day basis.  It is written in such a way that the policy expectations of the Department in terms of the roles and responsibilities of those involved in the discharge/linkage/aftercare process are addressed, including:

 

1)         Central Office personnel;

 

2)         Department facility and regional personnel;

 

3)         Follow-up staff; and

 

4)         Community providers.

 

d)         The Department has always placed a special emphasis upon the necessity of continuity of care among service providers.  Evidence of collaborative interagency agreements which assure prompt access to needed services is a requirement for the receipt of Department of Mental Health and Developmental Disabilities grant funds.  Nationally recognized accreditation organizations have also emphasized the importance of this area through the development of standards concerning discharge planning, linkage and aftercare services.

 

e)         The programmatic issue of assuring linkage of a recipient of services to the receiving agency/facility as distinguished from the monitoring and tracking of the recipient through the system has been given special consideration.  Consequently, the Department's primary emphasis is to assure this linkage.  The contents of this Part reflect this emphasis.

 

f)         The provision and delivery of aftercare services to the recipient are the responsibility of the receiving agency/facility.  The assurance that the services are appropriate and continue to be provided are the responsibility of the case coordinator and/or the designated mandated follow-up staff.

 

g)         Facilitating the linkage of each recipient to a receiving agency while at the same time respecting the individual's rights as set forth in the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110]  requires that any recipient identifying information contained in the Department's automated linkage system be maintained on a time limited basis.  Confirmation of linkage for a time period, not exceeding 180 days from the date of absolute discharge from a state-operated facility is maintained in the automated linkage system.  An exception to this practice will exist for those recipients placed by the Department into licensed long-term care facilities.  In these cases, the Department will maintain recipient identifying information for a minimum of one year in order to fulfill the mandated follow-up responsibility specified in Sections 15 through 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 through 16].

 

h)         The policies and procedures contained in this Part articulate specific activities which must be accomplished.  Further, terminology used in this Part has been standardized to facilitate its usefulness as well as gain greater clarity in communications among responsible personnel.

 

Section 125.15  Definitions

 

For purposes of this Part, the following terms are defined:

 

            "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.

 

            "Case coordination."  The provision of assistance and advocacy services to a recipient for the purpose of assuring and/or coordinating the provision of necessary services and support.

 

            "Code."  The Mental Health and Developmental Disabilities Code [405 ILCS 5].

 

            "Community agency/facility."  A locally-operated organization which provides treatment/habilitation services to persons who are dysfunctional due to mental illness, developmental disability or alcohol abuse.  An agency/facility may have an agreement with the Department to provide services in consideration of payment through a grant or purchase care funding mechanism.  A grant funded agency must be in compliance with Grants (59 Ill. Adm. Code 103) and report its activities through the extramural information reporting system.

 

            "Department."  The Department of Human Services.

 

            "Individualized services plan."  A written plan for persons who are dysfunctional due to mental illness, developmental disability or alcohol abuse.  This plan includes an assessment of the recipient's treatment/habilitation needs, a description of the services recommended for treatment/ habilitation, the goals of each type of the element of service, the role of the family in the implementation of the plan, when indicated, an anticipated timetable for the accomplishment of the goals, and the name of the person or persons responsible for the implementation of the plan (Sections 3-209 and 4-309 of the Code [405 ILCS 5/3-209 and 4-309]).

 

            "Licensed long-term care facility."  A private home, institution, building, residence, or other place as defined by the Nursing Home Care Act [210 ILCS 45] whether operated for profit or not; a county home for the infirm and chronically ill which provides personal care, sheltered care, or nursing for three or more persons not related to the applicant or owner by blood or marriage; or an out-of-state facility meeting Illinois standards. Facilities included are those that are licensed by the Department of Public Health for skilled nursing, skilled/pediatric nursing, intermediate care, intermediate care for the developmentally disabled (ICF/DD), intermediate care for the developmentally disabled with 15 beds and under, sheltered care, and facilities for individuals under age 22.

 

            "Linkage."  Person to person contact between a recipient being discharged from a State-operated facility and the staff of a community agency/facility which has agreed to provide necessary aftercare services following the recipient's discharge.  Linkage may include, but is not limited to, the recipient's pre-discharge visit to the receiving agency/facility; the receiving agency/facility pre-discharge visit with the recipient at a State-operated facility; and/or post discharge initiation of service delivery.

 

            "Mandated follow-up."  The statutorily-required monitoring of recipients placed by the Department in licensed long-term care facilities utilizing on-site visits to the facility for the  purpose of observing the health, well-being and adjustment of the recipient as well as the appropriateness of the services and the suitability of the facility.  This monitoring activity must be provided for twelve months following placement, including weekly visits during the first month, or for longer periods as required (see Section 15 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15]).

 

            "Placement."  The act of Departmental staff, based upon the finalization of appropriate plans for discharge, linkage, and aftercare, in securing residential services in a licensed long-term care facility for a recipient discharged from a state-operated facility for whom Sections 15, 15a, 15b, and 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15, 15a, 15b and 16] mandates follow-up monitoring services.

 

            "Recipient of services" or "recipient."  A person who has received or is receiving treatment or habilitation (Section 1-123 of the Code [405 ILCS 5/1-123]).

 

            "State-operated facility."  A mental health and/or developmental center operated by the State of Illinois, under the jurisdiction of the Department, which provides treatment/habilitation services for recipients who are mentally ill, developmentally disabled or those alcohol abusers who are a danger to themselves or others.

 

            "Termination."  The formal discontinuance of mandated follow-up monitoring of recipients placed in licensed long-term card facilities and/or the discontinuance of case coordination for recipients who were previously served in state-operated facilities.

 

Section 125.20  Recipient rights

 

a)         The rights of recipients of mental health and developmental disabilities services in the public as well as the private sector are set forth in Sections 2-100 through 2-111 of the Code [405 ILCS 5/2-100 through 2-111].

 

b)         The observation and protection of recipient rights, as specified in the statute, are applicable to all sections of this Part.

 

c)         As a general rule, individuals lose none of their rights, benefits, or privileges because they receive mental health or developmental disabilities services.  For example, a recipient does not lose the right to vote, attend religious services or any other rights guaranteed by federal and State constitutions and laws.

 

d)         A summary of rights to which the recipients of services are entitled include the following:

 

1)         Adequate and humane care and services in the least restrictive environment and an individualized services plan.

 

2)         To communicate with other people in private, without obstruction or censorship by the staff at the facility.  This right includes mail, telephone calls, and visits.  There are limits upon this right, e.g., communication by these means may be reasonably restricted by the facility director, but only to protect the recipient or others from harm, harassment or intimidation.  All letters addressed by a recipient to the Governor, members of the General Assembly, Attorney General, judges, state's attorneys, officers of the Department, or licensed attorneys at law must be forwarded at once to the persons to whom they are addressed without examination by the facility authorities.  Letters in reply from the officials and attorneys mentioned above must be delivered to the recipient without examination by the facility authorities.

 

3)         To receive, possess, and use personal property unless it is determined that certain items are harmful to the recipient or others.  On discharge all lawful property must be returned to the recipient.

 

4)         To use money as a recipient chooses, unless the recipient is under 18 or under a court imposed restriction, including the appointment of a guardian.

 

5)         To deposit money in a bank or place it for safekeeping with the facility.  If the facility deposits a recipient's funds, any interest earned will be the recipient's.  Neither the facility nor any of its employees may act as payee to receive any payment or assistance directed to a recipient, including Social Security and pension, annuity, or trust fund payments without informed consent of the recipient/guardian.

 

6)         To be paid for work a recipient was asked to perform which benefits the facility; the recipient may be required to do personal housekeeping chores without being paid.

 

7)         To refuse services, including medication.  If refused, the recipient will not be given such services except when necessary to prevent serious harm to self or others.

 

8)         To have restraints used only to protect the recipient from physically harming self or others, or as a part of a medical/surgical procedure.

 

9)         Seclusion used only to prevent the recipient from physically harming self or others.

 

10)         A recipient will not receive electro-convulsive therapy (electroshock) without informed consent as provided for in Section 2-110 of the Code [405 ILCS 5/2-110].

 

11)         Any unusual, hazardous, or experimental services require the recipient's written and informed consent.

 

12)         Except in emergencies, medical or dental services will not be provided without informed consent of the recipient/guardian.

 

13)         If recipient rights are restricted, the facility must notify the following (using form MHDD-4, "Notice Regarding Rights of Recipient"):

 

A)        Recipient and the person of the recipient's choice;

 

B)        Parent or guardian, if the recipient is under age 18;

 

C)        Court-appointed guardian for adult recipient;

 

D)        The Guardianship and Advocacy Commission, if so designated (see Section 2-201 of the Code [405 ILCS 5/2-201]).

SUBPART B: SYSTEM COMPONENTS

 

Section 125.30  Overview

 

a)         Department facilities are primarily intensive treatment/habilitation resources which provide therapeutic services to recipients unable to adjust to community settings.  As recipients respond to the intensive services provided in Department facilities, they are encouraged to attain greater degrees of independence  in alternate living situations within the community, either in their homes, or in residential facilities.

 

b)         The optimal transition of recipients from State-operated facilities requires active interaction among public and private sector service providers.  The components described in this Part, including the regional discharge/linkage/aftercare (DLA) plan, discharge planning, and interagency agreements, are designed to facilitate such interaction.  Full implementation of these components should result in the enhancement of the quality of the service system and provide improved public accountability.

 

Section 125.40  Regional DLA plan

 

a)         Each region shall develop a regional DLA plan which articulates how the region will implement the policies and procedures contained in this Part.

 

b)         The plan must be developed to assure the quality, effectiveness and continued appropriateness of aftercare services for each recipient discharged from state-operated facilities and to provide an audit trail which includes documentation and records to identify and track recipients, to evaluate quality and quantity of services delivered, to monitor fiscally and for compliance with related statutes and regulations as well as compliance with responsibilities and functions outlined in this Part.

 

c)         The content of the plan shall include:

 

1)         Discussion of the regional DLA network, its strengths, deficiencies and direction, and identification of those portions of the network with which there will be written interagency agreements.

 

2)         Designation of DLA staff responsibilities in the regional office, at state-operated facilities and/or community agencies for functions required by this Part.

 

3)         Designation of case coordinator model(s) to be used in the region.

 

4)         Assessment of licensed long-term care facility staff training needs and training plans to address these needs.

 

5)         Procedures for handling mandated follow-up monitoring, transfers and terminations.

 

6)         Interagency agreements.

 

7)         Procedures for reporting, with recipient consent, to the referring agency/facility that a recipient is not referred for aftercare treatment/habilitation services.

 

8)         Process for developing and maintaining required records and reporting.

 

9)         Procedures for the dissemination of regional DLA plan.

 

10)         Time frame for implementation of the DLA plan.

 

d)         The regional DLA plan shall be submitted, within 60 days after the effective date of the adoption of this Part, to the associate directors for the Secretary's approval.  The plan must assure regional compliance with this Part.  The Plan shall be reviewed annually and significant changes including but not limited to changes in the regional network, dropped or added interagency agreements, case coordinator model changes and available services shall be submitted to the associate directors for the Secretary's approval.

 

Section 125.50  Discharge planning

 

a)         During the earliest treatment/habilitation planning activities within a State-operated facility, active consideration must be given to the current and anticipated needs of the recipient.  While formal as well as informal planning is conducted with the recipient, the individualized services plan is recorded, as it evolves, in the recipient's record consistent with professional judgment and the provisions set forth in the Code, and Departmental and facility policy.  Establishing and maintaining the recipient's record is first and foremost a necessary practice which contributes to planning for and providing the most appropriate services.  In addition, recordkeeping establishes the necessary documentation which provides an audit trail which is used for a variety of accountability purposes such as securing facility certification and accreditation, responding to judicial inquiries and the assurance of general public accountability.

 

b)         As the facility related treatment and habilitation goals contained in the individualized services plan come closer to realization, greater attention must be paid to numerous DLA related considerations.  Prior to making the decision to discharge and refer a recipient, the recipient's readiness for that move must be assessed as well as the recipient's desire and agreement to participate.  In this assessment, consideration must be given, not only to the desires of the recipient and the recommendations of State-operated facility treatment/habilitation staff, but also the desires and recommendations of the recipient's guardian, family, follow-up monitoring staff, community agency staff previously involved with the recipient or likely to provide services after discharge, and staff of other involved State agencies (such as Department of Public Aid, Department of Children and Family Services, State Board of Education and the Department of Corrections).

Agency note:  Recipients who are drug abusers shall be referred to the state Office of Planning and Program Development, Dangerous Drugs Commission. The Commission shall participate in DLA planning and shall be responsible for assuring the treatment/habilitation services, placement and/or follow-up are provided to meet the individual recipient's aftercare needs.

 

c)         The following general areas must be addressed for all recipients regardless of the aftercare setting to which the recipients may be discharged:

 

1)         The need of the recipient for various services as detailed in the individualized services plan.

 

2)         The readiness and desires of the recipient or the recipient's guardian.

 

3)         The recipient's area of origin and/or location of social supports.

 

4)         The effectiveness of any previous individualized services plans or other services the recipient may have received in the community prior to the last admission to the State-operated facility.

 

5)         A general assessment of the recipient's intellectual and emotional state including the recipient's behavior.

 

6)         Medication needs of the recipient.

 

7)         Special procedures which must be followed related to the legal status of the recipient due to the relationship of the recipient to the criminal justice system.  This includes recipients who are legally classified as:

 

A)        Not guilty by reason of insanity (NGRI);

 

B)        Guilty but mentally ill;

 

C)        Unfit to stand trial, to plead or be sentenced;

 

D)        Hold order from the court.

AGENCY NOTE:  These recipients can only be released pursuant to the provisions of the Unified Code of Corrections [730 ILCS 5].  Further clarification on this subject is found in the publication entitled "Responsibilities of DMHDD for Persons Admitted as Unfit to Stand Trial, To Plead or Be Sentenced in Accordance With Public Act 81-1217", December, 1981.

 

8)         The availability of financial resources for recipients discharged from State-operated facilities including:

 

A)        Consideration of the recipient's ability to be self-supporting;

 

B)        Consideration of other sources of personal or family income;

 

C)        Assisting the recipient who does not return to independent or semi-independent living in accessing necessary financial support, e.g., Supplemental Security Income (SSI), Department of Public Aid, and/or other applicable funding;

 

D)        Reasonable assistance in accessing financial support for recipients returning to independent or semi-independent living.

 

9)         After considering the factors listed above, a decision may be made to discharge and refer the recipient to available and appropriate aftercare services.

 

10)         Before the actual discharge is completed the applicable items listed below on the discharge planning check list need to be completed:

 

A)        Secure the recipient's informed consent on form DMHDD-146, "Authorization for Release of Information", in order to communicate and share records with individuals and organizations regarding the recipient.

 

B)        Identify the location, when possible, of the aftercare living situation.  For a recipient being placed in long-term care, the licensed facility shall be identified.

 

C)        Facilitate appropriate contact and linkage with family and/or other individuals who can provide extended social support to the recipient (see Section 125.50(b)).

 

D)        Assist the recipient in accessing necessary financial resources. Special emphasis must be given to this activity when the recipient is not returning to independent or semi-independent living.  In these cases, applicable funding approval, such as the SSI approval letter or Department of Public Aid point count, shall be forwarded to the receiving facility.

 

E)        Refer the recipient to available support services including social, psychological, vocational and transportation, and assist in the actual linkage contact between the aftercare service provider(s) and the recipient.

 

F)         Notify the recipient, guardian, attorney or person who executed the application for admission of the intent to discharge.  Special attention as outlined in Section 125.50(c)(7) must be given to the discharge notification process for recipients who are associated with the criminal justice system.

 

G)        Notice of discharge has been given and any and all written objections relating to it have been heard and an administrative decision has been rendered.

 

H)        Complete part one of form DMHDD-20, "Discharge Summary", by the date of discharge and part two of DMHDD-20, within 48 hours following discharge. For recipients placed in a licensed long-term care facility, the DMHDD-20 must be transmitted at the time of placement.

 

I)         Forward as necessary, any relevant medical or dental reports to the appropriate aftercare agency/facility.

 

J)         Assure the provision of an adequate supply of medication sufficient to last until the first scheduled aftercare visit as contained in the recipient's DLA plan.

 

K)        Forward a copy of the guardianship papers to the aftercare service provider(s) if the recipient is legally incompetent.

 

L)        Assist the recipient in securing personal clothing, property and funds.

 

M)       Complete parts one and two of form DMHDD-189, "Recipient Transfer Summary", for all recipients being placed in a long-term care facility and transmit both parts of the form to the facility at the time of placement.

 

N)        Notify designated mandated follow-up staff of the placement of the recipient in a licensed long-term care facility.

 

O)        Transmit to the ICF/DD facility a copy of a psychological assessment completed within the past 36 months for recipients who are being placed there.

 

P)         Provide placement notification, when such agencies are the funding agencies, to the Department of Public Aid and the Social Security Administration, stating the recipient's name, address of the facility and date of placement.

 

Section 125.60  Discharge notification and objection process

 

a)         Written notice of discharge shall be given to the recipient, if 12 years of age or older; to the attorney of record and guardian, if any; and to the person who executed the application for admission.  This notice shall include the reason for the discharge and a statement of the right object (Section 3-903 of the Code).

 

b)         Whenever possible, notice of the discharge shall be given at least seven days prior to the intended discharge date from a mental health facility and 14 days prior to discharge from a developmental disabilities facility (Sections 3-903 and 4-704 of the Code).

 

c)         The recipient, if 12 years of age or older, may object to discharge, or the attorney or guardian of a recipient or the person who executed the application may object on behalf of a recipient.  Prior to discharge, a written objection shall be submitted to the director of the facility in which the recipient is located.  Upon receipt of an objection, the facility director shall promptly schedule a hearing, with the utilization review committee, to be held at the facility within seven days (Sections 3-207, 3-903, 4-209 and 4-704 of the Code).

 

d)         No discharge shall proceed pending a hearing on an objection, unless the person objecting to the discharge consents to discharge pending the outcome of the hearing (Sections 3-903 and 4-704 of the Code).

 

e)         At the hearing, the Department shall have the burden of proving that the recipient meets the standard for discharge under the Code and under Section 15 of Mental Health and Developmental Disabilities Administrative Act (Sections 3-903 and 4-704 of the Code).

 

f)         Within three days after the conclusion of the hearing, the utilization review committee shall submit its written recommendations to the facility director.  A copy of the recommendations shall be given to the recipient and the objector. (Sections 3-903 and 4-704 of the Code)

 

g)         Within seven days after receipt of the recommendations, the facility director shall provide written notice to the recipient and objector of either acceptance or rejection of the recommendations and reasons therefor.

 

h)         If the facility director rejects the recommendations, or if the recipient or objector requests a review of the facility director's decision, the facility director shall promptly forward a copy of the decision, the recommendations, and the record of the hearing to the Secretary of the Department for final review.  The decision of the facility director or the decision of the Secretary of the Department, if his review was requested, shall be considered a final administrative decision.

 

i)          Any person affected by a final administrative decision of the Department may have such decisions reviewed only under and in accordance with the Administrative Review Law [735 ILCS 5/Art. III].  The Administrative Review Law, and the rules adopted pursuant thereto, apply to and govern all proceedings for the judicial review of final administrative decisions of the Department (Section 6-101 of the Code).

 

Section 125.70  Interagency agreements

 

a)         Recipients shall be referred from state-operated facilities to supportive community programs in ways which insure the continuity of needed services.  Interagency coordination then is an essential element for improving the capacity of the services system to provide necessary support. Written interagency agreements facilitate the establishment, as well as the understanding and observance of the agreements by various personnel associated with the organizations.

 

b)         Each Department region and/or State-operated facility must maintain current written linkage agreements as part of its DLA plan with appropriate community agencies involved in the network of services in that region.  The following elements are suggested for consideration in the development of these interagency agreements.

 

1)         Clear statement of the purpose of the agreement between parties, identifying specific programs to be effected, with delineation of goals and measurable objectives for the terms of the agreement.

 

2)         Definitions of any terms that could be ambiguous between the parties.

 

3)         Specific actions, roles and responsibilities of each party to the agreement as well as mutual responsibilities.

 

4)         Designation of staff position(s) within each agency responsible for:

 

A)        Implementing the agreement as specified;

 

B)        Monitoring the implementation;

 

C)        Negotiating change when necessary to update agreement;

 

D)        Resolving disagreements.

 

5)         General administrative procedures for parties affected by the agreement (i.e., specified time period for agreement, mechanism for updating/revising, scheduling meetings, confidentiality safequards, referral mechanisms, information sharing, and other assurances).

 

6)         Evaluation design specified and agreed upon by all parties to be used in monitoring implementation of agreement; identification of person(s) responsible for evaluating and sanctions agreed on to assure its implementation.

 

c)         It is important that each region and/or facility maintain these agreements and provide adequate staff to implement the provisions.  This may involve meeting regularly with staff from community agencies/facilities as well as including community agency/facility staff on state-operated treatment/habilitation teams.  Alcoholism agencies must be in conformance with 59 Ill. Adm. Code 107.50.

 

d)         Agencies which are performing mandated follow-up services for the Department shall enter into an agreement which, in essence, establishes the principle that mandated follow-up services are a statutory responsibility of the Department.  While performance of the function may be delegated to a community agency, responsibility for the function cannot be delegated. Therefore, the community agency acts as an agent of the Department in complying with this legal mandate.

 

e)         Additional policies and procedures required of community agencies receiving financial support from the Department are contained in Grants (59 Ill. Adm. Code 103) and in purchase of care program guidelines.  Designated regional staff are assigned to work with each community agency to facilitate compliance with the requirements.

 

Section 125.80  Recipient financial support

 

a)         During DLA planning, financial support for the recipient's continued treatment/habilitation services and other needs must be considered. Designated staff will assist the recipient, family or guardian in understanding their respective liabilities for treatment/habilitation and in accessing available financial resources.  The required authorizations to investigate or access assets, income or benefits must be secured.

 

b)         Sources to contact for information are the recipient, family or guardian at admission, during treatment/habilitation or prior to discharge.  Sources which may be considered include insurance carriers, funding agencies, e.g., Social Security offices, federal fiscal intermediaries (Blue Cross/Blue Shield or E.D.S. Federal Corporation), and the Department of Public Aid (the single State agency for Medicaid and administering agency for public assistance and the State supplement), and township assistance agencies.

 

c)         Resources which may be available for support based on recipient eligibility include:

 

1)         Private funding

 

A)        Recipient's personal funds, e.g., assets which are negotiable or can be liquidated;

 

B)        Income, from employment, from assets, estates, trusts, and facility trust funds;

 

C)        Family funds, e.g., voluntary or due to legal liability.

 

2)         Third party payments

 

A)        Private insurance (disability and/or medical) carried by the recipient or family;

 

B)        Health maintenance organization plans (HMOs);

 

C)        Black lung disease benefits (30 U.S.C.A. 924 (1981));

 

D)        Civilian Health and Medical Program of the Uniformed Services (CHAMPUS/CHAMPVA) (38 U.S.C.A. 601 (1981));

 

E)        Medicare, which is short-term hospital and medical insurance (42 U.S.C.A. 1395b-1 (1981));

 

F)         Medicaid, which is public medical assistance for the aged, blind and disabled (42 U.S.C.A. 1396a (1981)).

 

3)         Federal/state/local benefits/other

 

A)        Social Security Retirement and Survivors Benefits (SSDI) (42 U.S.C.A. 401 (1981)) which is based on wage earners and employers contributions;

 

B)        Supplemental Security Income (SSI) (42 U.S.C.A. 1381 (1981)), a federal income maintenance program for aged, blind and disabled, which also requires documentation to establish disability for the blind and disabled by the Department's Bureau of Disability Adjudication Services;

 

C)        Railroad Retirement benefits (45 U.S.C.A. 231 (1981)) and Veterans' Administration benefits (38 U.S.C.A. 521, 541, and 542 (1981)).

 

D)        General/township assistance, state supplemental payments and Bureau of Employment Security Benefits, Department of Labor.

 

E)        Private industry professional groups, labor unions and other organizations.

 

4)         Local school district services or funding

When a recipient aged 3 to 21 years is handicapped as defined in Section 14-1.02 of the School Code [105 ILCS 5/14-1.02] and has not been graduated from high school, the recipient is probably eligible to receive special education services from a local school district.  The parent or guardian should be assisted in obtaining these services or funding.

 

5)         Department sources

There is a variety of purchase of care programs for the mentally ill, developmentally disabled or alcohol abusers for which individuals may qualify.

 

Section 125.90  Competency

 

a)         A recipient age 18 or over is presumed legally competent.  A recipient is considered incompetent upon the filing of a petition with the court where the court adjudges a recipient to be a disabled person.  At the time of the hearing a guardian may be appointed.  (See Sections 11a-2 and 11a-3 of the Probate Act of 1975 [755 ILCS 5/11a-2 and 11a-3])

 

b)         Guardianship is ordered only to the extent necessitated by the recipient's actual mental, physical and adaptive limitations.

 

c)         A guardian may be appointed for a recipient, if, because of disability, there is a lack of sufficient understanding or capacity to make or communicate responsible decisions concerning personal care.  A guardian may be appointed for the estate of a disabled recipient, if, because of disability, the recipient is unable to manage an estate or financial affairs.

 

d)         The appointment of a limited guardian does not constitute a finding of legal incompetence.  The appointment of a plenary guardian constitutes a finding of legal incompetence (see Section 11a-14 of the Probate Act of 1975 [755 ILCS 5/11a-14]).

 

e)         The Code does not require the appointment of a guardian prior to discharge.

SUBPART C: INFORMATION SYSTEMS PROCEDURES

 

Section 125.100  Overview

 

a)         Public accountability of the Department's efforts to assist recipients of mental health, developmental disability, or alcoholism services in accessing appropriate levels of aftercare according to their needs is achieved by documenting the process for discharge planning, linkage and aftercare services.  Depending on the types of community agencies/facilities involved, this documentation is accomplished at the present time through an information system which is either automated or manual.  The uniform method of reporting to be used by all receiving Department organizational units and grant agencies is the Department's extramural system and its subsystem, the aftercare linkage system (ACL). The description of this system and reporting instructions are found in the Department's extramural systems manual, revised July 1, 1980.  This current computer system does not allow for recording of the referral to more than one provider.  Therefore, it is necessary to indicate the primary agency/facility to whom the recipient is being referred for aftercare treatment/habilitation services even though the discharge plan calls for multiple service providers.  The primary agency/facility for a recipient being placed in a licensed long-term care facility must be that designated agency/facility or Department organizational unit which has responsibility for the mandated follow-up monitoring services.

            AGENCY NOTE:  For the purpose of documenting the linkage and mandated follow-up monitoring services provided to recipients being placed in a licensed long-term care facility, the receiving agency to whom the recipient is referred shall be either the designated Department organizational unit or the designated grant agency.  The linkage of the recipient to the licensed long-term care facility is documented through noting the home code of the facility in which the recipient is placed, using form DMHDD-1001, "Inpatient Statistical Reporting Form".

 

b)         For referral to non-grant agencies or non-state-operated facilities the method of reporting is similar but the documentation is effected through other reporting mechanisms set forth in this Part.

 

c)         Accurate recording of the discharge/linkage/aftercare status for each person discharged from Department facilities is fundamental to the effective management of the DLA system.  The process explained in this Part is absolutely necessary to document the successful linkage and provision of aftercare services to the discharged recipient to be documented within the Department.

 

d)         When the discharge plan has been completed and the recipient is ready for discharge, documentation is necessary to indicate the recipient's agreed upon referral according to the following categories:

 

1)         Referred for aftercare treatment/habilitation services

 

A)        To a Department grant agency;

 

B)        To a Department organizational unit;

 

C)        To a Department purchase care facility;

 

D)        To a non-Department funded agency;

 

E)        To a licensed, registered, or certified private practitioner;

 

F)         To a Veterans Administration (VA) facility;

 

G)        Remanded by the court to another setting; or

 

H)        Transferred to another state.

 

2)         Not referred for aftercare treatment/habilitation services

 

A)        Recipient refused aftercare services;

 

B)        Aftercare, provided within the formal human service system structure, is not required; or

 

C)        Left against staff advice.

 

Section 125.110  Reporting responsibilities and methods

 

The duties and responsibilities of all Department DLA staff and the responsibilities agreed to by the receiving agency/facility shall be broadly outlined within the regional DLA plan.  Active participation includes, but is not limited to representation on a discharge planning team and participation in the development of the individualized services plan, by communication and consultation with designated follow-up staff, of the community agency/facility in discharge planning is highly desirable as linkage can be more readily achieved and the recipient may be more willing to follow through on the discharge plan.  Outlined below are those responsibilities which must be incorporated into and provided for in the regional DLA plan.

 

a)         Designated DLA staff responsibilities for referral to agencies reporting through the extramural system consist of ensuring the accomplishment of the following functions:

 

1)         Securing recipient's agreement for linkage to an agency for aftercare treatment/habilitation services and consent for release of information confirming that the recipient has received initial service in accordance with the discharge plan (form DMHDD-146, "Authorization for Release of Information").

 

2)         Communication with the proposed receiving agency to achieve the following:

 

A)        Obtaining the agency's identification (ID) number for the recipient (current number if an open case); or the ID number for a recipient whose case has been closed and is now being reopened; or the new ID number assigned to a recipient being opened to the agency for the first time;

 

B)        Active participation by the receiving agency in the development of the discharge plan;

 

C)        Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan;

 

D)        Prompt completion and dispatch of the completed parts one and two of form DMHDD-20, "Discharge Summary", within 48 hours after discharge, excluding Saturdays, Sundays and holidays.

 

3)         Communication with proposed receiving licensed long-term care facility for those recipients being placed in such settings to achieve the following:

 

A)        Active participation in the development of the discharge plan;

 

B)        Confirmation of the date of placement;

 

C)        Copies of the completed form DMHDD-20, parts one and two, "Discharge Summary", and form DMHDD-189, parts one and two, "Recipient Transfer Summary", must accompany the recipient at the time of placement.

 

4)         Retention of all Department forms used in the discharge process in the recipient's State-operated facility medical record.

 

b)         Designated DLA staff responsibilities for referral to agencies/facilities not reporting through the system consist of ensuring the accomplishment of the following functions:

 

1)         Recipient's agreement for linkage to an agency/facility for aftercare treatment/habilitation services and consent for release of information confirming that recipient has received initial service in accordance with the discharge plan (form DMHDD-146, "Authorization for Release of Information").

 

2)         Communication with proposed receiving agency/facility to achieve the following:

 

A)        Active participation by the receiving agency/facility in the development of the discharge plan;

 

B)        Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan;

 

C)        Prompt receipt (within 48 hours after discharge, excluding Saturdays, Sundays and holidays) of copies of the completed form DMHDD-20, "Discharge Summary", parts one and two;

 

D)        Confirmation of the initial service provided to the recipient after discharge.

 

3)         Notification of the Department's Bureau of Information Services of recipient information, including confirmation of receipt of initial service after discharge, on the form DMHDD-1001 series, "Inpatient Statistical Reporting Form".

 

4)         Retention of all Department forms used in the discharge process in the recipient's State-operated facility medical record.

 

c)         Responsibilities of receiving agency reporting through the extramural system ensuring the accomplishment of the following functions:

 

1)         Recipient's authorization for release of information to the Department discharging facility for the confirmation of linkage and initial service delivery after discharge.

 

2)         Communication with the discharging facility to achieve the following:

 

A)        Providing the agency's ID number for the recipient (current number if an open case); or the ID number for a recipient whose case had been closed and is now being reopened; or the new ID number assigned to a recipient being opened to the agency for the first time;

 

B)        Active participation in the development of the discharge plan;

 

C)        Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient is to see) to receive the initial service indicated in the discharge plan.

 

3)         Confirmation and accounting for services provided to the recipient through the extramural system and the aftercare linkage system.

 

d)         Responsibilities of receiving agency/facility not reporting through the extramural system consist of ensuring communication with the discharging facility to achieve the following:

 

1)         Active participation in the development of the discharge plan.

 

2)         Definite appointment for the recipient (day, time, location, and the name of the staff person the recipient  is to see) to receive the initial service indicated in the aftercare services plan.

 

3)         Confirmation of the initial service provided to the recipient after discharge.

SUBPART D: FOLLOW-UP SERVICES

 

Section 125.120  Overview

 

This Subpart describes the process by which the Department and/or designated staff assures the quality, the effectiveness and the continued appropriateness of aftercare services for each DLA recipient needing case coordination and/or mandated follow-up monitoring services which are intended to assure the following:

 

a)         The recipient's rights and desires have been taken into consideration through mutual planning, if feasible.

 

b)         The recipient's family has been included in the placement process, whenever possible, consistent with confidentiality requirements.

 

c)         The receiving agency/facility is best able to meet the recipient's needs.

 

1)         An individualized services plan has been completed by the discharging facility and accepted by the receiving agency/facility.

 

2)         Firm recipient referral has been effected and the recipient is being served by the receiving agency/facility.

 

3)         The joint planning process for the recipient's progress provides for the continuity of services within the services network.

 

d)         On an ongoing basis, a recipient is not being abused, neglected, or improperly cared for, and health needs are being met.

 

e)         The designated staff will offer appropriate treatment/habilitation alternatives as clinically indicated and assists, as appropriate, in transfers.

 

Section 125.130  Case coordination

 

a)         Case coordination is a mechanism for assuring and coordinating services to meet the needs of those recipients who require this service. It provides the necessary advocacy function to facilitate the linkage of a recipient who has identified service needs to the available resources.  The case coordinator principally focuses on the service delivery system from the vantage point of the individual recipient in need of the service, and engages in resource identification and linkage.

 

b)         Case coordination attends to the practical level of synchronizing the efforts of multiple service providers and other supportive resources which enable the recipient to live successfully in a community setting.  However, the case coordination function does not displace the responsibility of other service providers to work directly with the recipient or with the family, community supportive resources or other service organizations as provided for in the individualized services plan.  Rather, the case coordinating function complements and integrates the usual services for those recipients whose need is so substantial so as to require an extraordinary level of service attention.  Case coordinators rely, in large part, on:

 

1)         Working knowledge of the nature and consequences of the recipient's disability;

 

2)         Functional knowledge of the service delivery system, recipient eligibility requirements and procedures;

 

3)         A working understanding of potential recipient resources, particularly those available through federal, State and local governmental agencies; and

 

4)         The ability to work cooperatively with the many individuals and organizations which can provide services and assistance to the recipient.

 

c)         Typical settings – Case coordination shall be provided through various organizational entities:

 

1)         By the Department;

 

2)         Through an entity which also provides direct recipient services or other indirect services; or

 

3)         Through a free-standing entity whose sole function is the provision of case coordination services.

 

d)         Typical activities – Activities a case coordinator engages in may include:

 

1)         Assessment of service need:  Participates with direct service staff in assessing an individual's needs and readiness to move into alternate services or settings, utilizing clinical evaluation of intellectual, emotional and functioning levels.  Where appropriate, standardized assessment instruments, such as the Illinois Client Information System (ICIS) for developmentally disabled recipients, will be used in conjunction with the professional evaluation of need.

 

2)         Development of recipient individualized services plan:  Participates with responsible program staff in developing a plan for the most effective and appropriate continuum of generic and specialized services.

 

3)         Arrangement for service delivery:  Assists recipient in identifying appropriate providers of care, screening and assistance in the eligibility process for Department or Department-supported programs as well as other public or private programs, and facilitating the linkage of recipients to service provider(s), and case coordination in a new location, if appropriate.

 

4)         Coordination and advocacy with service providers:  Is responsible for enabling continuity, accessibility and the most effective delivery of services as prescribed in the individualized services plan including the facilitation of coordination activities among multiple providers.

 

5)         Follow-up:  Conducts scheduled activities to monitor and evaluate the recipient's progress toward established service goals, and the need for continuing services.  While follow-up activities focus on recipient status, they also may provide commentary on service irregularities or deficiencies and provide recommendations on the status and quality of care provided by the service delivery system.

 

Section 125.140  Mandated follow-up monitoring services

 

a)         Provisions contained within Sections 15 through 16 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15 through 16] mandate specific types of follow-up services for recipients who are being discharged from Department State-operated facilities and placed in licensed long-term care facilities, as defined by Section 1-113 of the Nursing Home Care Act [210 ILCS 45/1-113].

 

b)         Before discharge from a state-operated facility can be considered, a clinical and professional decision must have been made that a recipient will derive benefits from a proposed placement, is legally competent (or is in the process of having legal competency restored), has a guardian if declared legally incompetent (or is in the process of having a guardian appointed), and requires the medical and personal care and/or supervision as described in the Nursing Home Care Act.  The lack of a guardian, however, shall not inhibit discharge planning and placement once it has been deemed that continuing State-operated treatment/habilitation services will no longer be of benefit to a recipient.  Department staff will do all that is possible to obtain suitable guardians; however, if these efforts prove to be unsuccessful the regional office of the Guardianship and Advocacy Commission shall be contacted and all appropriate information, such as but nor limited to, the recipient, the recipient's condition, the inability to locate a person to serve as guardian and the need for guardianship, forwarded.

 

c)         Mandated follow-up services may be delegated by the Department to community agencies.  This delegation shall be based on but not limited to caseload needs, availability of staff and available resources.  This arrangement, however, will require a special contract between the Department and the agency.  This contract establishes that the community agency acts as an agency of the Department and is bound by this Part.  In addition, employees of any community agency that has a long-term care monitoring contract with the Department, is subject to the same conflict of interest rule as Department employees (59 Ill. Adm. Code 101.80).

 

d)         As required by the Mental Health and Developmental Disabilities Confidentiality Act the recipient's confidentiality shall be protected.

 

Section 125.150  Pre-placement guidelines

 

a)         In order to fulfill statutory directive as well as providing due process for persons placed in licensed long-term care facilities, designated DLA staff shall assure that requirements of the Mental Health and Developmental Disabilities Code summarized in Section 125.40 and of the Nursing Home Care Act are followed.

 

b)         Consideration shall also be given to the interests and the needs of the recipient and the capacity of the facility to address those needs.

 

1)         Out-of-region placement of  recipients is permissible and requires written approval between the designated regional staff of the regions involved.  Approval will be based on criteria in Section 125.160(f)(1).

 

2)         The Department shall not place discharged recipients in facilities located outside of the State of Illinois unless appropriate facilities are not available within the State, or if placement in a contiguous state results in locating a recipient in a facility closer to home or family.

 

3)         When it becomes necessary for arrangements to be made for placement in a state other than Illinois, the designated DLA staff shall notify the appropriate regional administrator who approves of the transfer based on criteria in Section 125.160(f)(1), and who shall notify the Department's  Interstate Services Branch.

 

4)         The Department is responsible for providing follow-up services to all recipients placed residentially in out-of-state facilities and shall indicate the regional DLA plan how follow-up services will be provided.  A recipient cannot be placed in an out-of-state facility if it is not licensed by the state in which the facility is located. Subsequent to placement, if an appropriate facility within the State becomes available at a distance equal to or closer to the recipient's home or family, the recipient shall be returned and placed at this facility.

AGENCY NOTE:  Three months after an out-of-state placement has been made, the Department must send copies of visitation reports to the recipient's parent(s), guardian or nearest responsible relative (see Section 15.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15.1]).

 

Section 125.160  Follow-up monitoring guidelines

 

Designated mandated follow-up staff shall assure compliance with the provisions of the Mental Health and Developmental Disabilities Administrative Act and compliance with the following Departmental policies.

 

a)         Recipient monitoring

 

1)         Provide or contract for the provision of individual monthly monitoring of recipients placed in a licensed long-term care facility for at least 12 months, including visits on a weekly basis during the first month.

 

2)         Interview the recipient during the course of follow-up visits and discuss program involvement and/or other needs with staff in the licensed long-term care facility.

 

3)         Observe, review and document the following:

 

A)        The recipient's comments and concerns;

 

B)        The recipient's overall adjustment to the facility; and

 

C)        The adequacy of the recipient's current individualized services plan as maintained by the facility.

 

4)         The adequacy of the programs and services available in the facility and in the community for meeting the needs of the recipient which may include, but are not limited to:

 

A)        Activities;

 

B)        Social (re)habilitation;

 

C)        Restoration nursing;

 

D)        Diagnostic testing; and

 

E)        Psychological and social services.

 

5)         Sufficiency of the nursing and medical services to meet the physical health needs of the recipient.

AGENCY NOTE:  For the conditionally discharged recipient, designated staff must visit or consult with the recipient and the family on the condition of the recipient and advise the family of care that will be most favorable for the recipient.  This visitation and contact requirement shall remain in effect while the recipient is on conditional discharge and shall terminate when such status is terminated.

 

b)         Reporting and records

 

1)         Reports of deaths, accidents and unusual occurrences

 

A)        All deaths of recipients, or accidents and unusual occurrences, such as reports of abuse, neglect and improper care, involving a recipient, shall be reported by the facility by telephone within twelve hours to the designated mandated follow-up staff, guardians (including the Office of the State Guardian, where appointed) and next of kin and confirmed in writing no later than the next working day with a complete statement of circumstances.  The facility must promptly notify the coroner of all deaths pursuant to Section 3-3013 of the Counties Code [55 ILCS 5/3-3013].

 

B)        Designated staff shall close cases in which death occurs in the Department's extramural reporting system by filing form DMHDD-1006, "Case Information".

 

2)         Monthly facility report – Designated staff shall report on the results of their onsite visits to each facility on the monthly evaluation report for long-term care facilities.  Copies of this report shall be submitted to the licensed long-term care facility and to the designated regional staff, with a copy being retained by the designated mandated follow-up staff.

 

3)         Semiannual facility report

 

A)        The regional administrator will submit to the associate directors, semiannually, a summary of the monthly facility reports for each facility within the region.

 

B)        These reports may be used for the evaluation and continued approval or denial of placements in licensed long-term care facilities.

 

4)         Monthly and annual information report

            Monthly and annually a report shall be produced for Central Office and regional use by the Department's Bureau of Information Services including the following information by disability:

 

A)        The total number of facilities serving the Department's mandated follow-up recipients;

 

B)        The total number of Department recipients placed during the current month and year-to-date;

 

C)        The total number of Department mandated follow-up recipients in each facility;

 

D)        The total number of Department mandated follow-up recipients being monitored on a weekly and monthly basis;

 

E)        The number of mandated follow-up recipients readmitted to state-operated facilities from licensed long-term facilities for the current month and year-to-date;

 

F)         The number of mandated follow-up recipients transferred to another licensed long-term care facility, to a State-operated facility, to independent living for the current month and year-to-date;

 

G)        The number of deaths of Department mandated follow-up recipients for the current month and year-to-date; and

 

H)        The total number of drug abusers for the current month and year-to-date.

 

c)         Program development and monitoring

 

1)         When necessary, designated mandated follow-up staff may provide training as outlined in Section 15 of the Mental Health and Developmental Disabilities Administrative Act as outlined to assist facilities in meeting the unique needs of persons previously served by the Department.

 

2)         Designated mandated follow-up staff will assist a facility in arranging for resources to program for these populations, e.g., activity programs, treatment/habilitation programs and other specialized programs. These program development functions may include:

 

A)        Providing time limited direct services in an effort to train facility staff;

 

B)        Providing workshops on special programs or procedures;

 

C)        Consulting with program staff or licensed long-term care facilities regarding the development of individualized services plans;

 

D)        Developing methods of implementation; and

 

E)        Evaluating programs available in the licensed long-term care facility.

 

3)         At least annually, the Department must review facility training records prescribed by Department of Public Health standards for licensure of long-term care facilities (Minimum Standards for the Licensure of Long-Term Care Facilities for the Developmentally Disabled (77 Ill. Adm. Code 350); Minimum Standards for the Licensure of Long-Term Care Facilities – Persons Under Twenty-Two (22) Years of Age (Divisions 1 through 73); Minimum Standards for the Licensure of Long-Term Care Facilities – Sheltered Care Facilities (77 Ill. Adm. Code 330); and Minimum Standards for the Licensure of Long-Term Care Facilities – Skilled Nursing Facilities and Intermediate Care Facilities (77 Ill. Adm. Code 300)) and make recommendations regarding future training needs.  Specific recommendations regarding orientation and inservice staff training must be included in the semiannual facility report. This report must also contain a judgment as to the sufficiency and capability of the staff in the facility.

 

4)         Program development and monitoring activities must be documented and maintained in a file readily available to the appropriate region office.

AGENCY NOTE:   Designated mandated follow-up staff shall not provide consulting services for the purpose of meeting Department of Public Health licensure requirements, nor can fees be charged for the program development services provided by the Department or its contracted agents performing follow-up monitoring services.

 

d)         Termination from mandated follow-up services

 

1)         Termination of follow-up monitoring services occurs after the 12-month period, except in cases of death, discharge to other than a licensed long-term care facility, or discharged for leaving against staff advice. Termination which is an individualized programmatic and clinical decision is based on the following criteria:

 

A)        A clinical determination has been made that mandated follow-up services to the recipient are no longer necessary to maintain adjustment in the licensed long-term care facility.

 

B)        Appropriate and necessary linkage to community resources have been established which will enable the recipient to function independently.

 

C)        The developmentally disabled recipient is receiving specialized programmatic services to meet the objectives for further personal development as contained in the individualized services plan, and that procedural continuity is established which is essential to maintain adaptive levels and/or to prevent behavioral/developmental regression.

 

D)        The recipient has substantially achieved the objectives outlined in the individualized services plan.

 

E)        The facility has demonstrated its ability to provide the necessary continuing support and appropriate programming to the recipient.

AGENCY NOTE:  When the decision to terminate has been made, designated staff shall check the follow-up notes and recipient records to insure that the recipient's recorded progress clinically supports the decision to terminate.  In cases of developmentally disabled individuals on conditional discharge, who are being considered for termination from mandated follow-up services, a copy of the community placement termination summary will be forwarded to the regional administrator or designee as the recommendation for termination.  The regional administrator or designee must give approval before the termination is effected.

 

2)         The termination of recipients from mandated follow-up services, however, does not necessarily mean that contact with these persons shall cease.  Statutorily required follow-up monitoring services and reporting shall cease, services including but not limited to those covered in the individualized services plan may continue to be provided.  Supportive services and/or case coordination, if appropriate, should be provided based on the recipient's on-going needs.

 

e)         Continuing mandated follow-up status

            Monthly comments will be forwarded to the designated Department region staff on each community placement recipient who exceeds one year in continuing mandated follow-up status.  Comments will relate to specifics pertaining to inadequate adjustment of the recipient or any other cause considered significant enough to maintain the case in mandated status.

 

f)         Transfers of recipients

 

1)         Transfers, when necessary, from one long-term care facility to another may be to assure the recipient's health and well being.  Primary attention shall be given to the needs and choices of the individual recipient (a recipient cannot be moved against the recipient's will except in an emergency).  A transfer is indicated if the facility cannot meet the current needs of the recipient; or the recipient has been neglected, abused or improperly cared for; or if the facility is not in substantial compliance with previously cited licensure standards or has not developed an acceptable plan of correction as determined by the Illinois Department of Public Health.

 

2)         If a transfer is indicated, designated staff shall cooperate in the transfer of mandated follow-up recipients from one licensed long-term care facility to another.  The regional DLA plan shall specify how transfer activities shall be coordinated with involved State agencies.

 

3)         In times of disaster or emergency, designated staff may need to be involved in the transfer of recipients who have been terminated from mandated follow-up monitoring services.

            AGENCY NOTE:  Designated staff must document all transfer activities and maintain the documentation in the recipient's record.

 

4)         Routine transfers

 

A)        All recipients shall be transferred insofar as possible, in or near the communities in which the recipients reside or in which the recipients' families or significant others, such as a guardian or a friend, reside. The same considerations and procedures followed for the initial planning for discharge/linkage/aftercare shall apply (see Section 125.40).

 

B)        Transfers may be initiated at the request of the recipient or legally responsible party.  Transfers may also be initiated by the long-term care facility's administrator.  Under such situations, designated staff will work with the Department of Public Aid and other involved agencies.

 

5)         Inter-region transfers

            Recipients may be moved between regions provided there is a prior agreement with both regional administrators or their designated agents involved in the transfer.

 

6)         Emergency transfers

 

A)        The Department of Public Health under Sections 3-401 through 3-423 of the Nursing Home Care Act [210 ILCS 45/3-401 through 3-423] and the Department under Section 15 of the Mental Health and Developmental Disabilities Administrative Act are empowered to take specific action to transfer recipients who are not receiving appropriate services and/or when conditions exist in a facility which imperil the health or pose a serious and imminent threat to the life or safety of those recipients.

 

B)        Both Departments must make all reasonable efforts to eliminate any threats to the safety  and well-being of any recipient, through consultation with the facility, the attending physician, and the recipient, spouse, parents, responsible relative or guardian (see Section 15 of the Mental Health and Developmental Disabilities Administrative Act).

 

C)        The Department of Public Health is given broad statutory authority and primary responsibility to transfer any individual who is not receiving appropriate services in licensed long-term care facilities.  The Department's legal authority deals specifically with individual recipients who have been placed by the Department in these facilities.

 

D)        The Department must work in close cooperation with the Department of Public Health to effect the transfer of recipients whose life or safety is in imminent danger.  However, the Department may, in the proper exercise of its statutory mandate, initiate action to provide for the health and welfare of mandated follow-up recipients residing in a facility.

 

Section 125.170  Staff action in emerging or extraordinary circumstances

 

a)         Designated mandated follow-up staff shall personally observe the recipient, review individual progress and adjustment within the placement setting, and review the following considerations:

 

1)         The recipient's rights and desires have been taken into consideration;

 

2)         The receiving agency/facility continues to meet recipient needs;

 

3)         The individualized services plan is being constantly updated by staff of the receiving agency;

 

4)         Joint planning for the recipient's progress continues; and

 

5)         On an on-going basis, the recipient has not been abused, neglected or improperly cared for.

 

b)         As mandated follow-up or other visits are made, designated staff shall review for:

 

1)         Prolonged understaffing;

 

2)         Suspected abuse/neglect;

 

3)         Inappropriate level of care;

 

4)         Unattended medical needs;

 

5)         Unexplained weight loss or gain;

 

6)         Filth, dirt and odors; and

 

7)         Inquiries from family, media or elected officials.

 

c)         If these or other untoward or extraordinary situations such as room temperature extremes, contagious diseases and natural catastrophes are noted, the following steps shall be undertaken and fully documented:

 

1)         Consultation with the licensed long-term care facility administrator and/or appropriate staff shall occur to discuss any deficient conditions. This consultation and any actions agreed to shall be fully documented.  If resolution is achieved, further steps need not be taken.  Regional offices of the Department of Public Health shall be kept informed.

 

2)         If resolution is not reached, immediate verbal reports to the regional and central offices of the Department of Public Health, as well as to the regional administrator and appropriate associate directors of the Department must be made, followed by written confirmation within 24 hours.

 

3)         Initiate regional interagency review with involved state agencies and formulate necessary action to resolve the situation.  The right to a neutral hearing as provided for in Sections 3-703 through 3-802 of the Nursing Home Care Act [210 ILCS 45/3-703 through 3-802] and Sections 2-704, 3-207, 3-903, 4-209 and 4-709 of the Code must, however, be observed.

 

4)         If a regional solution is not reached, the appropriate associate directors are notified and requested to facilitate resolution with the appropriate state agencies.

 

5)         If resolution is not reached, the region will be instructed to initiate transfer by:

 

A)        Consulting with each recipient potentially involved in the transfer and documenting the recipient's response and notifying family or legal guardian;

 

B)        Locating and arranging for suitable alternative placement;

 

C)        Coordinating the transfer with the Department of Public Health and applicable funding agencies;

 

D)        Assuring that records required in this Part are maintained and personal effects are properly safeguarded; and

 

E)        Submitting a follow-up report to the associate directors.

 

d)         Report of abuse or neglect of a recipient by an owner, licensee, administrator, employee, or agent of a facility shall be made to local law enforcement officials as provided in the Abuse and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30].