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 January 1, 2026, 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.)