405 ILCS 142

in effect

405 ILCS 142/1

(405 ILCS 142/1) Sec. 1. Short title. This Act may be cited as the Psychiatric Residential Treatment Facilities (PRTF) Act. (Source: P.A. 104-147, eff. 8-1-25.)

(405 ILCS 142/5) Sec. 5. Definitions. As used in this Act: "Department" means the Department of Healthcare and Family Services. "Emergency safety intervention" means the use of restraint or seclusion as an immediate response to an emergency safety situation. "Medical assistance" means health care benefits provided under the Illinois Medical Assistance Program administered under Article V of the Illinois Public Aid Code. "Psychiatric residential treatment facility" or "PRTF" means a facility that is certified by the Department to provide subacute psychiatric services to individuals under age 21, or to individuals until their 22nd birthday if the individual was admitted to the PRTF before the individual's 21st birthday as described in 42 CFR 441, Subpart D, or any successor regulation, in an inpatient setting in accordance with a provider agreement with the Department. A PRTF is not: (1) a hospital under the Hospital Licensing Act; (2) a child care institution or child care facility under the Child Care Act of 1969; (3) a nursing home or long-term care facility under the Nursing Home Care Act; (4) a secure residential youth care facility under the Secure Residential Youth Care Facility Licensing Act; (5) a specialized mental health rehabilitation facility under the Specialized Mental Health Rehabilitation Act of 2013; or (6) any facility or institution required to be licensed under the ID/DD Community Care Act or the MC/DD Act. "Serious occurrences" means a serious injury to a resident as defined in 42 CFR 483.352, or any successor regulation, a resident's suicide attempt, or a resident's death. "Subacute psychiatric services" means inpatient psychiatric treatment services provided under the direction of a physician, in a non-acute (non-hospital) setting, for individuals under the age of 21 (or for individuals until their 22nd birthday if admitted to the PRTF before their 21st birthday) that require intensive services that cannot be delivered in a community setting. Subacute psychiatric services are short-term, comprehensive, recovery-oriented treatment delivered 24 hours a day, 7 days a week, with the focus of returning children to a less restrictive community setting as rapidly as possible. (Source: P.A. 104-147, eff. 8-1-25.)

405 ILCS 142/10

(405 ILCS 142/10) Sec. 10. PRTF services. (a) The Department shall establish an Illinois Psychiatric Residential Treatment Facilities (PRTF) program that is family-driven, youth-guided, and trauma-informed, and includes youth and family involvement in all aspects of care planning. The Illinois PRTF program design shall establish meaningful opportunities for youth and families to be involved in the design, monitoring, and oversight of PRTF services. (b) By September 1, 2027, the Department shall submit a State Plan Amendment to the Centers for Medicare and Medicaid Services to establish coverage of federally authorized, medically necessary inpatient psychiatric services delivered by a certified PRTF to medical assistance beneficiaries under 21 years of age. (c) The Department shall adopt rules to implement the Illinois PRTF program. The rules may establish the services, standards, and requirements for participation in the program to comply with all applicable federal statutes, regulations, requirements, and policies. The rules proposed by the Department may take into consideration the recommendations of the PRTF Advisory Committee, as outlined in Section 20. At a minimum, the rules shall include the following: (1) Certification and participation requirements for PRTF providers in compliance with all applicable federal laws, regulations, requirements, and policies, including those found at 42 CFR 441, Subpart D and 42 CFR 483, Subpart G or any successor regulations. (2) Monitoring and oversight of PRTF services, including on-site review protocols that include scheduled and unannounced on-site visits. Each provider seeking PRTF certification shall minimally have an on-site review prior to initiating services and all PRTFs shall have at least one on-site review annually thereafter. (3) Utilization management criteria to ensure that PRTF services are provided as medically necessary and emphasize clinically appropriate patient transitions back to the community, including, but not limited to, service authorization, documentation, and treatment plan requirements for initial stay reviews and continued stay reviews. (4) A limit on allowable beds at any one PRTF, not to exceed 40 total beds, unless waived in writing by the Director of the Department. (5) A limit on the number of new PRTF facilities to be certified in any State fiscal year. (6) A requirement that PRTFs are distinct, standalone non-hospital entities not physically attached or adjacent to any other type of facility engaged in providing congregate care. (7) A requirement that, in order to obtain PRTF certification, providers must undergo a survey from the State Survey Agency, the Department of Public Health, to establish the provider's compliance with the Conditions of Participation for PRTFs outlined in 42 CFR 483, Subpart G and the Interpretive Guidelines issued by the Centers for Medicare and Medicaid Services. (8) A requirement that, in order to obtain PRTF certification, providers be accredited from one of the following organizations identified in 42 CFR 441.151, or any successor regulations: (i) Joint Commission on Accreditation of Healthcare Organizations. (ii) The Commission on Accreditation of Rehabilitation Facilities. (iii) The Council on Accreditation of Services for Families and Children. (iv) Any other accrediting organization with comparable standards recognized by the Department. (9) Requirements for the reporting of emergency safety interventions and serious occurrences to the Department and the State-designated Protection and Advocacy System no later than the close of business the next business day after the intervention or occurrence. (Source: P.A. 104-147, eff. 8-1-25; 104-470, eff. 6-16-26.)

405 ILCS 142/15

(405 ILCS 142/15) Sec. 15. PRTF capacity analysis. (a) The Department shall establish, and update as needed, a methodology for completing a statewide PRTF capacity analysis for the purposes of identifying capacity needs for PRTF services under the Illinois Medical Assistance Program. The Department shall utilize the PRTF capacity analysis to inform its certification and enrollment of PRTF providers. The capacity analysis shall minimally include: (1) An analysis of aggregate service utilization data for Medicaid eligible individuals under the age of 21, including community-based services, behavioral health crisis services, and inpatient psychiatric hospitalization services. (2) Identification of locations across the State with demonstrated need for PRTF services and locations with demonstrated surplus of PRTF service capacity. (3) Consideration of specialized treatment needs based on increased utilization of out-of-state facilities to address specialized treatment needs. (4) Other factors of consideration identified by the Department as necessary to support access to care, compliance with the federal Medicaid program, and all other applicable federal or State laws, regulations, policies, requirements, and programs impacting Illinois' children's behavioral health service delivery system. (5) Recommendations to the Department and the PRTF Advisory Committee on capacity needs within the Illinois PRTF program. The recommendations shall seek to avoid the concentration of PRTF facilities in any particular community or area of the State to promote access for families or guardians to visit patients when appropriate. (b) The Department's methodology, completed analyses, and outcomes shall be published on its website, with an initial PRTF capacity analysis to be published by no later than April 1, 2027. (c) The Department's PRTF capacity analysis shall be updated at a minimum of every 5 years and shall be performed consistent with the Department's published methodology. (Source: P.A. 104-147, eff. 8-1-25; 104-470, eff. 6-16-26.)

405 ILCS 142/20 PRTF Advisory Committee

(405 ILCS 142/20) Sec. 20. PRTF Advisory Committee. (a) The Department shall establish a PRTF Advisory Committee responsible for reviewing and providing guidance on the Department's policies and implementations of the Illinois PRTF program. The PRTF Advisory Committee shall be made up of no more than 12 members, including State agency staff familiar with children's behavioral health services, and shall minimally include the following members: (1) the Director of Healthcare and Family Services, or the Director's designee, who shall also be the Chair of the Committee; (2) the Director of Public Health, or the Director's designee; (3) the Secretary of Human Services, or the Secretary's designee; (4) the Superintendent of the Illinois State Board of Education, or the Superintendent's designee; (5) the Director of Children and Family Services, or the Director's designee; (6) the Chief Officer for Children's Behavioral Health Transformation; and (7) external stakeholders that include, at a minimum each of the following: (i) a psychiatrist, board certified to serve children and adolescents; (ii) one or more providers of community-based children's behavioral health services; (iii) one or more individuals representing the voice of families with children familiar with Illinois' publicly funded children's behavioral health system; and (iv) other individuals determined by the Department to be beneficial to the outcomes of the Advisory Committee. (b) The PRTF Advisory Committee shall meet on a schedule and in a format defined by the Chair. (c) The Department may adopt rules to implement this Section. (Source: P.A. 104-147, eff. 8-1-25.)

405 ILCS 142/25

(405 ILCS 142/25) Sec. 25. PRTF accountability reporting. For all PRTF providers certified to participate in the Illinois Medical Assistance Program, the Department shall publish on its website counts of reported emergency safety interventions and serious occurrences by State fiscal year and quarter. (Source: P.A. 104-147, eff. 8-1-25.)

405 ILCS 142

405 ILCS 142/1

405 ILCS 142/5 Definitions

405 ILCS 142/10

405 ILCS 142/15

405 ILCS 142/20 PRTF Advisory Committee

405 ILCS 142/25

405 ILCS 142/105

405 ILCS 142/110

405 ILCS 142/115

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