TITLE 59: MENTAL HEALTH
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AUTHORITY: Implementing and authorized by Section 1-17 of the Department of Human Services Act [20 ILCS 1305].
SOURCE: Adopted at 22 Ill. Reg. 19334, effective October 19, 1998; emergency amendment at 23 Ill. Reg. 4513, effective April 1, 1999, for a maximum of 150 days; amended at 23 Ill. Reg. 10812, effective August 23, 1999; emergency amendment at 26 Ill. Reg. 484, effective January 1, 2002, for a maximum of 150 days; amended at 26 Ill. Reg. 8352, effective May 24, 2002; amended at 32 Ill. Reg. 8132, effective May 16, 2008; emergency amendment at 33 Ill. Reg. 13489, effective September 10, 2009, for a maximum of 150 days; emergency expired February 6, 2010; amended at 34 Ill. Reg. 5239, effective March 25, 2010; emergency amendment at 38 Ill. Reg. 18242, effective August 13, 2014, for a maximum of 150 days; amended at 38 Ill. Reg. 19152, effective September 10, 2014; amended at 38 Ill. Reg. 22642, effective November 20, 2014; emergency amendment at 39 Ill. Reg. 13271, effective September 18, 2015, for a maximum of 150 days; amended at 39 Ill. Reg. 15134, effective November 6, 2015; amended at 40 Ill. Reg. 1824, effective January 5, 2016; amended at 41 Ill. Reg. 6516, effective May 26, 2017; amended at 42 Ill. Reg. 15437, effective July 26, 2018; amended at 43 Ill. Reg. 3878, effective March 15, 2019; amended at 47 Ill. Reg. 5663, effective April 4, 2023; amended at 48 Ill. Reg. 14653, effective September 27, 2024.
Section 50.10 Definitions
For the purposes of this Part, the following terms are defined:
"Abuse". See definitions for "Physical Abuse, Sexual Abuse, and Mental Abuse".
"Access". Admission to a community agency or facility for the purpose of conducting imminent risk assessments, conducting investigations, monitoring compliance with a written response, or completing any other statutorily assigned duty, such as annual unannounced site visits, including but not limited to conducting interviews and obtaining and reviewing any documents or records that the Office of Inspector General (OIG) believes to be pertinent to an investigation.
"Act". The Department of Human Services Act [20 ILCS 1305].
"Administrative Action". An action taken by the community agency or the facility in response to an OIG report, an intake referral, or the direction of the DHS Secretary (see 20 ILCS 1305/1-17(p) & (q)) that protects individuals from abuse, neglect, or financial exploitation or prevents recurrences of such abuse, neglect, or financial exploitation.
"Agency". See the definition for community agency.
"Aggravating Circumstance". A factor that is attendant to a finding and that tends to compound or increase the culpability of the accused employee/facility/agency.
"Allegation". An assertion, complaint, suspicion, or incident involving any of the following conduct by an employee, facility, or agency against an individual or individuals: mental abuse, physical abuse, sexual abuse, neglect, or financial exploitation.
"Authorized Representative". The administrative head or executive director of a community agency appointed by the community agency's governing body with overall responsibility for fiscal and programmatic management, or the facility director or hospital administrator of a Department facility. If this person is implicated in an investigation, the governing body of the community agency or the Secretary of the Department shall be deemed the authorized representative for that investigation.
"Bodily Harm". Any injury, damage, or impairment to an individual's physical condition, or making physical contact of an insulting or provoking nature with an individual.
"Community Agency" or "Agency". A community agency licensed, funded, or certified by the Department, but not licensed or certified by any other human services agency of the State, to provide mental health service or developmental disabilities service, or a program licensed, funded, or certified by the Department, but not licensed or certified by any other human services agency of the State, to provide mental health service or developmental disability service.
"Complainant". The person who reports a death or an allegation of abuse, neglect, or Financial Exploitation directly to OIG and is not the required reporter.
"Complaint". A report of a death or an allegation of abuse, neglect, or financial exploitation reported directly to the OIG Hotline.
"Completed Investigative Report". An investigative report approved for distribution by the Inspector General that summarizes the evidence obtained during the course of the investigation and that indicates whether the allegation of abuse, neglect, or financial exploitation is substantiated, unsubstantiated, or unfounded.
"Credible Evidence". Any evidence that relates to the allegation or incident and that is considered believable and reliable.
"Day". Working day, unless otherwise specified.
"Deflection". A situation in which an individual is presented for admission to a facility or agency and the facility staff or agency staff do not admit that individual. Deflection includes triage, redirection, and denial of admission.
"Department". The Department of Human Services.
"Egregious Neglect". A finding of neglect as determined by the Inspector General that represents a gross failure to adequately provide for, or a callous indifference to, the health, safety, or medical needs of an individual and results in an individual's death or other serious deterioration of an individual's physical condition or mental condition. See also "Neglect" definition.
"Employee". Any person who provides services at the facility or the Community Agency on or off site. The service relationship can be with the individual, the facility or agency. Also, "employee" includes any employee or contractual agent of the Department of Human Services or the Community Agency involved in providing or monitoring or administering mental health or developmental disability services. This includes but is not limited to, owners, operators, payroll personnel, contractors, subcontractors, and volunteers. For purposes of this Part, "employee" also includes someone who is no longer working for an agency or facility but is the subject of an ongoing investigation for which OIG has jurisdiction.
"Facility" or "State-operated facility". A mental health facility or developmental disabilities center operated by the Department.
"Final Investigative Report ". The version of the investigative report that is in place after the reconsideration and response period has ended.
"Financial Exploitation". Taking unjust advantage of an individual's assets, property or financial resources through deception, intimidation, or conversion for the employee's, facility's or agency's own advantage or benefit.
"Finding". The Office of Inspector General's determination regarding whether an allegation is substantiated, unsubstantiated or unfounded.
"Health Care Worker Registry" or "Registry". The Illinois Department of Public Health's Health Care Worker Registry created by the Nursing Home Care Act [210 ILCS 45].
"IDPH". The Illinois Department of Public Health.
"Imminent Danger". A preliminary determination of immediate, threatened, or impending risk of illness, mental injury, or physical injury or deterioration to an individual's health that requires immediate action.
"Individual". Any person receiving mental health services, developmental disabilities services, or both from a facility or agency, while either on-site or off-site.
"Insulting or provoking". Contact that offends a reasonable sense of personal dignity.
"Material Obstruction of an Investigation". The purposeful interference with an investigation of physical abuse, sexual abuse, neglect, or financial exploitation and includes, but is not limited to, the withholding or altering of documentation or recorded evidence; influencing, threatening, or impeding witness testimony; presenting untruthful information during an interview; failing to cooperate with an investigation conducted by OIG. If an employee, following a criminal investigation of physical abuse, sexual abuse, neglect, or financial exploitation, is convicted of an offense that is factually predicated on the employee presenting untruthful information during the course of the investigation, that offense constitutes material obstruction of an investigation. Material obstruction of an investigation does not include: an employee's lawful exercising of their constitutional right against self-incrimination, an employee invoking their lawful rights to union representation as provided by a collective bargaining agreement or the Illinois Public Labor Relations Act [5 ILCS 315], or a union representative's lawful activities providing representation under a collective bargaining agreement or the Illinois Public Labor Relations Act. Obstruction of an investigation is considered material when it could significantly impair an investigator's ability to gather all relevant facts. An employee shall not be placed on the Health Care Worker Registry for material obstruction of an investigation for presenting untruthful information during an interview conducted by the OIG, unless, prior to the interview, the employee was provided with any previous signed statements they made during the course of the investigation.
"Mental Abuse". The use of demeaning, intimidating or threatening words, signs, gestures, or other actions by an employee about an individual and in the presence of an individual or individuals that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.
"Mitigating Circumstance". A condition that is attendant to a finding and does not excuse or justify the conduct in question but may be considered in evaluating the severity of the conduct, the culpability of the accused, or both the severity of the conduct and the culpability of the accused employee/facility/agency.
"Neglect". An employee's, agency's, or facility's failure to provide adequate medical care, personal care, or maintenance, and that, as a consequence, causes an individual pain, injury, or emotional distress, results in either an individual's maladaptive behavior or the deterioration of an individual's physical condition or mental condition, or places an individual's health or safety at substantial risk of possible injury, harm, or death. See also "Egregious Neglect" definition.
"OIG". The Office of Inspector General of the Department.
"OIG Liaison". The community agency or facility staff who has been appointed to act as OIG's investigative point of contact and who is responsible for coordinating the agency's or facility's initial incident response (see 59 Ill. Adm. Code 50.30(f)).
"Physical Abuse". An employee's non-accidental (i.e., occurring with volition or consciousness; not occurring by chance) and inappropriate contact with an individual that causes bodily harm. "Physical Abuse" includes actions that cause bodily harm as a result of an employee/facility/agency directing an individual or person to physically abuse another individual.
"Preponderance of the Evidence". Proof sufficient to persuade the finder of fact that a fact sought to be proved is more likely true than not true.
"Program". Any DHS-licensed, DHS-funded, or DHS-certified service provided to persons with either mental illness or developmental disabilities by a community agency or by a State-operated facility. Program includes, but is not limited to, day training, employment and workshop opportunities, and transportation services.
"Recommendation". An admonition rendered by OIG, separate from a finding, that requires action by the facility, agency, or Department to correct a systemic issue, problem, or deficiency identified during an investigation.
"Referral". OIG directing an OIG-received complaint to another entity for possible investigation or administrative action.
"Required Reporter". Any employee/facility/agency who suspects, witnesses, or is informed of an allegation of any one or more of the following: mental abuse, physical abuse, sexual abuse, neglect, or financial exploitation.
"Routine Programmatic Operations". Refers to services provided as part of the individual's habilitation plan, treatment plan or as a regular or ongoing component of the community agency's or facility's general services or practices.
"Secretary". The leader of the Department.
"Sexual Abuse". Any sexual contact or intimate physical contact between an employee and an individual, including an employee's coercion or encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, sexual behavior, or intimate physical behavior. "Sexual Abuse" also includes:
an employee's actions that result in the sending or showing of sexually explicit images to an individual via computer, cellular phone, electronic mail, portable electronic device, or other media, with or without contact with the individual; or
an employee's posting of sexually explicit images of an individual online or elsewhere, whether or not there is contact with the individual. Sexual Abuse does not include allowing individuals to, of their volition, view movies or images of a sexual nature or read text containing sexual content unless the individual's guardian prohibits the viewing of those movies or images or reading of that material.
"Sexual Contact". Inappropriate sexual contact between an employee and an individual involving either an employee's genital area, anus, buttocks, or breasts or an individual's genital area, anus, buttocks, or breasts. "Sexual Contact" also includes sexual contact between individuals that is coerced or encouraged by an employee.
"Sexually Explicit Images". Includes, but is not limited to, any material that depicts nudity, sexual conduct, or sadomasochistic abuse, or that contains explicit and detailed verbal descriptions or narrative accounts of sexual excitement, sexual conduct, or sadomasochistic abuse. This does not include those images contained in sex education materials used by employees to educate individuals.
"Substantiated". A preponderance of the evidence supports the allegation.
"Unfounded". No credible evidence supports the allegation.
"Unsubstantiated". There is credible evidence, but less than a preponderance of the evidence, to support the allegation.
"Victim". An individual who has been subjected to alleged abuse, neglect, or financial exploitation.
(Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024)
Section 50.20 Reporting an Allegation of Abuse, Neglect, or Financial Exploitation and Death Reports
a) Reporting – by a Facility, Community Agency, or Employee
1) If an employee witnesses, is told of, or suspects an incident of physical abuse, sexual abuse, mental abuse, financial exploitation, neglect, or a death has occurred, the employee, community agency, or facility shall report the allegation to the OIG Hotline according to the community agency's or facility's procedures. The employee, community agency, or facility shall report the allegation immediately, but no later than the time frames specified in subsections (a)(2) and (3). Such an employee or representative of a community agency or facility shall be deemed the "Required Reporter" for purposes of this Part. Such reporting shall additionally meet any requirements of 59 Ill. Adm. Code 115, 119 and 132 and Department administrative directives, as applicable.
2) Within four hours after the initial discovery of an incident of alleged physical abuse, sexual abuse, mental abuse, financial exploitation or neglect, the required reporter shall report the following allegations by phone to the OIG Hotline:
A) Any allegation of abuse by an employee;
B) Any allegation of neglect by an employee, community agency, or facility;
C) Any allegation of financial exploitation by an employee, community agency, or facility; and
D) Any injury or death of an individual that occurs within a facility or community agency program when abuse or neglect may be suspected.
E) At a minimum, required reporters to the OIG Hotline shall provide details concerning:
i) Information about the victim, including name, date of birth, sex, disability, identification number, and/or social security number (if known);
ii) Information about the incident, including what happened, when it happened, where it happened, how it happened, and the identification of all witnesses;
iii) Information about the accused employee (if known), including name, contact information, and if the accused employee/facility/agency is presently working with or will be working with the victim; and
iv) Information about the person initiating the complaint, including name, contact information, relationship to the victim, and the need for anonymity (if applicable).
3) Within 24 hours after initial discovery of a death, the required reporter shall call the OIG Hotline and report (as described in Section 50.30):
A) Any death occurring within 14 calendar days after discharge or transfer of an individual from an agency residential program or facility;
B) Any death of an individual occurring within 24 hours after deflection from an agency residential program or facility;
C) Any other death of an individual occurring within an agency residential program or facility or at any other site licensed, funded, or certified by the Department even though not alleged to be a result of abuse or neglect.
4) Screening, delaying, or withholding reports of incidents or allegations of abuse or neglect from OIG is strictly prohibited. Failure to report incidents or allegations of abuse or neglect to OIG within the required timeframe is a Class A misdemeanor (see 20 ILCS 1305/1-17(k)(1)).
5) Retaliation
It is a violation of Section 1-17(k)(3) of the Act for any employee or administrator of an agency or facility to take retaliatory action against an employee who acts in good faith in conformance with the employee's duties as a required reporter.
6) Other Community Agency and Facility Requirements
A) Reporting to OIG shall not relieve the community agency or facility from any statutory or regulatory reporting requirements applicable to the community agency or facility. Authorized representatives are therefore not restricted or prohibited from taking action to protect residents or patients in accordance with or as required by IDPH to ensure compliance with Intermediate Care Facility Providers for Developmental Disability (ICF/DD) standards, including, but not limited to:
i) 42 CFR 483.420, Condition of participation: Client protections; and
ii) State Operations Manual Appendix J - Guidance to Surveyors: Intermediate Care Facilities for Individuals with Intellectual Disabilities, available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Qso18-16-ICFIID.
B) If the authorized representative, their designee, or the OIG Liaison reviews an agency's or facility's internal documents regarding an allegation of abuse, neglect, financial exploitation, or the death of an individual at the respective community agency or facility, they shall not delete, delay, withhold, limit, or otherwise restrict any of the information contained in the documents. Information may be added by the authorized representative or their designee for clarification purposes only. Failure to report incidents or allegations of abuse, neglect, or financial exploitation within the required timeframe is a Class A misdemeanor (see 20 ILCS 1305/1-17(k)(1)).
b) OIG Hotline
The OIG Hotline (#1-800-368-1463) shall be communicated to individuals and guardians at the time of admission and the number shall be posted in plain sight at each community agency and facility location where individuals receive services.
c) Material Obstruction of an Investigation
The OIG Hotline will document information received alleging material obstruction of an investigation pertaining to an allegation of abuse, neglect, financial exploitation, and death. If, after issuing the completed investigative report or final investigative report in an investigation of alleged abuse, neglect, or financial exploitation, OIG receives information alleging potential material obstruction of an investigation, OIG may reopen the related case or open a new case to investigate.
d) Other Reports of Allegations of Abuse, Neglect, financial exploitation, and Deaths
1) Any other person, individual, family member, guardian or advocate who witnesses, is told of, or suspects an incident of alleged abuse, neglect, financial exploitation, or a death of an individual has occurred, may report the incident to OIG by telephoning the OIG Hotline, or in writing by fax or other electronic reporting system offered by OIG to the OIG Hotline or mail at:
Department of Human Services
Office of Inspector General
901 Southwind Road
Springfield, Illinois 62703
2) Notifications
A) Within three working days after receipt of an allegation, OIG shall notify the authorized representative of the community agency or facility or their designee that an allegation has been received unless such notification compromises the integrity of the investigation, such as, an allegation involving the authorized representative or their designee.
B) Within 24 hours after notification of an allegation, the authorized representative of the community agency or facility shall notify the victim or guardian (if applicable) and the accused employee that an allegation has been received. If the authorized representative or designee is unable to reach the guardian by phone, a letter of notification shall be sent within 24 hours.
C) Immediately, but no later than within three working days after receipt of an allegation, OIG shall also contact the complainant regarding the allegation.
e) Training and Technical Assistance
1) Agencies and facilities shall have a policy detailing procedures for reporting allegations of abuse, neglect, financial exploitation, and deaths as set forth in Sections 50.10 and 50.20.
2) All employees, as defined in Section 50.10, shall be trained in Part 50 requirements upon being hired and at least biennially thereafter.
3) Each facility and community agency is required to have an employee who is designated as the OIG Liaison.
4) Community agency or facility employees designated as OIG Liaisons or whose duties include completing the initial incident response as set forth in Section 50.30(f) are required to take OIG's Section 50.30(f) training.
5) Any employee, community agency, or facility may request training or technical assistance from OIG in identifying, reporting, investigating, and preventing abuse, neglect, financial exploitation, reporting of deaths, or participation in applicable OIG-sponsored training as referenced in Section 1-17(h) of the Act.
f) Misleading Reports
Nothing in this Part protects persons who knowingly make false or misleading reports from disciplinary and other actions available to either the community agency or facility. Nothing in this Part prohibits OIG, other enforcement authorities, or any employee jeopardized by such reporting from pursuing any and all allowable remedies.
(Source: Amended at 48 Ill. Reg. 14653, effective September 27, 2024)