Public Act 100-1016
 
SB2951 EnrolledLRB100 18740 KTG 33974 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 1. Short title. This Act may be cited as the Early 
Mental Health and Addictions Treatment Act.
 
    Section 5. Medicaid Pilot Program; early treatment for 
youth and young adults.  
    (a) The General Assembly finds as follows:
        (1) Most mental health conditions begin in adolescence 
    and young adulthood, yet it can take an average of 10 years 
    before the right diagnosis and treatment are received.
        (2) Over 850,000 Illinois youth under age 25 will 
    experience a mental health condition.
        (3) Early treatment of significant mental health 
    conditions can enable wellness and recovery and prevent a 
    life of disability or early death from suicide.
        (4) Early treatment leads to higher rates of school 
    completion and employment.
        (5) Illinois' mental health system is aimed at adults 
    with advanced mental illnesses who have become disabled, 
    rather than focusing on youth in the early stages of a 
    mental health condition to prevent progression.
        (6) Many states are implementing programs and services 
    for the early treatment of significant mental health 
    conditions in youth.
        (7) The cost of early community-based treatment is a 
    fraction of the cost of a life of multiple 
    hospitalizations, disability, criminal justice 
    involvement, and homelessness, the common trajectory for 
    someone with a serious mental health condition.
        (8) Early treatment for adolescents and young adults 
    with mental health conditions will save lives and State 
    dollars.
    (b) As the sole Medicaid State agency, the Department of 
Healthcare and Family Services, in partnership with the 
Department of Human Services' Division of Mental Health and 
with meaningful input from stakeholders, shall develop a pilot 
program under which a qualifying adolescent or young adult, as 
defined in subsection (d), may receive community-based mental 
health treatment from a youth-focused community support team 
for early treatment, as provided in subsection (e), that is 
specifically tailored to the needs of youth and young adults in 
the early stages of a serious emotional disturbance or serious 
mental illness for purposes of stabilizing the youth's 
condition and symptoms and preventing the worsening of the 
illness and debilitating or disabling symptoms. The pilot 
program shall be implemented across a broad spectrum of 
geographic regions across the State. 
    (c) Federal waiver or State Plan amendment; implementation 
timeline.
        (1) Federal approval.  The Department of Healthcare and 
    Family Services shall submit any necessary application to 
    the federal Centers for Medicare and Medicaid Services for 
    a waiver or State Plan amendment to implement the pilot 
    program described in this Section no later than September 
    30, 2019. If the Department determines the pilot program 
    can be implemented without federal approval, the 
    Department shall implement the program no later than 
    December 31, 2019.  The Department shall not draft any rules 
    in contravention of this timetable for pilot program 
    development and implementation.  This pilot program shall 
    be implemented only to the extent that federal financial 
    participation is available.
        (2) Implementation.  After federal approval is secured, 
    if federal approval is required, the Department of 
    Healthcare and Family Services shall implement the pilot 
    program within 6 months after the date of federal approval.
    (d) Qualifying adolescent or young adult. As used in this 
Section, "qualifying adolescent or young adult" means a person 
age 16 through 26 who is enrolled in the Medical Assistance 
Program under Article V of the Illinois Public Aid Code and has 
a diagnosis of a serious emotional disturbance as interpreted 
by the federal Substance Abuse and Mental Health Services 
Administration or a serious mental illness listed in the most 
recent edition of the Diagnostic and Statistical Manual of 
Mental Disorders.  Because the purpose of the pilot program is 
treatment in the early stages of a significant mental health 
condition or emotional disturbance for purposes of preventing 
progression of the illness, debilitating symptoms and 
disability, a qualifying adolescent or young adult shall not be 
required to demonstrate disability due to the mental health 
condition, show a reduction in functioning as a result of the 
condition, or have a reality impairment (psychosis) to be 
eligible for services through the pilot program.  A qualifying 
adolescent or young adult who is determined to be eligible for 
pilot program services before the age of 21 shall continue to 
be eligible for such services without interruption through age 
26 as long as he or she remains enrolled in the Medical 
Assistance Program.
    (e) Community-based treatment model. The pilot program 
shall create youth-focused community support teams for early 
treatment.  The community-based treatment model shall be a 
multidisciplinary, team-based model specifically tailored for 
adolescents and young adults and their needs for wellness, 
symptom management, and recovery.  The model shall take into 
consideration area workforce, community uniqueness, and 
cultural diversity. All services shall be evidence-based or 
evidence-informed as applicable, and the services shall be 
flexibly provided in-office, in-home, and in-community with an 
emphasis on in-home and in-community services.  The model shall 
allow for and include each of the following:
        (1) Community-based, outreach treatment, and 
    wrap-around services that begin in the early stages of a 
    serious mental illness or serious emotional disturbance 
    (functional impairment shall not be required for service 
    eligibility under the pilot program).
        (2) Youth specific engagement strategies to encourage 
    participation and retention in services.
        (3) Same-age or similar-age peer services to foster 
    resiliency.
        (4) Family psycho-education and family involvement.
        (5) Expertise or knowledge in school and university 
    systems, special education and work, volunteer and social 
    life for youth.
        (6) Evidence-informed and young person-specific 
    psychotherapies.
        (7) Care coordination for primary care.
        (8) Medication management.
        (9) Case management for problem solving to address 
    practicable problems, including criminal justice 
    involvement and housing challenges; and assisting the 
    young person or family in organizing all treatment and 
    goals.
        (10) Supported education and employment to keep the 
    young person engaged in school and work to attain 
    self-sufficiency.
        (11) Trauma-informed expertise for youth.
        (12) Substance use treatment expertise.
    (f) Pay-for-performance payment model. The Department of 
Healthcare and Family Services, with meaningful input from 
stakeholders, shall develop a pay-for-performance payment 
model aimed at achieving high-quality mental health and overall 
health and quality of life outcomes for the youth, rather than 
a fee-for-service payment model. The payment model shall allow 
for service flexibility to achieve such outcomes, shall cover 
actual provider costs of delivering the pilot program services 
to enable sustainability, and shall include all provider costs 
associated with the data collection for purposes of the 
analytics and outcomes reporting required under subsection 
(h).  The Department shall ensure that the payment model works 
as intended by this Section within managed care.
    (g) Rulemaking.  The Department of Healthcare and Family 
Services, in partnership with the Department of Human Services' 
Division of Mental Health and with meaningful input from 
stakeholders, shall develop rules for purposes of 
implementation of the pilot program contemplated in this 
Section within 6 months of federal approval of the pilot 
program.  If the Department determines federal approval is not 
required for implementation, the Department shall develop 
rules with meaningful stakeholder input no later than December 
31, 2019.
    (h) Pilot program analytics and outcomes reports.  The 
Department of Healthcare and Family Services shall engage a 
third party partner with expertise in program evaluation, 
analysis, and research at the end of 5 years of implementation 
to review the outcomes of the pilot program in stabilizing 
youth with significant mental health conditions early on in 
their condition to prevent debilitating symptoms and 
disability and enable youth to reach their full potential.  For 
purposes of evaluating the outcomes of the pilot program, the 
Department shall require providers of the pilot program 
services to track the following annual data:
        (1) days of inpatient hospital stays of service 
    recipients;
        (2) periods of homelessness of service recipients and 
    periods of housing stability;
        (3) periods of criminal justice involvement of service 
    recipients;
        (4) avoidance of disability and the need for 
    Supplemental Security Income;
        (5) rates of high school, college, or vocational school 
    engagement and graduation for service recipients;
        (6) rates of employment annually of service 
    recipients;
        (7) average length of stay in pilot program services;
        (8) symptom management over time; and
        (9) youth satisfaction with their quality of life, 
    pre-pilot and post-pilot program services.
    (i) The Department of Healthcare and Family Services shall 
deliver a final report to the General Assembly on the outcomes 
of the pilot program within one year after 4 years of full 
implementation,  and after 7 years of full implementation, 
compared to typical treatment available to other youth with 
significant mental health conditions, as well as the cost 
savings associated with the pilot program taking into account 
all public systems used when an individual with a significant 
mental health condition does not have access to the right 
treatment and supports in the early stages of his or her 
illness.
    The reports to the General Assembly shall be filed with the 
Clerk of the House of Representatives and the Secretary of the 
Senate in electronic form only, in the manner that the Clerk 
and the Secretary shall direct. 
    Post-pilot program discharge outcomes shall be collected 
for all service recipients who exit the pilot program for up to 
3 years after exit. This includes youth who exit the program 
with planned or unplanned discharges. The post-exit data 
collected shall include the annual data listed in paragraphs 
(1) through (9) of subsection (h). Data collection shall be 
done in a manner that does not violate individual privacy laws. 
Outcomes for enrollees in the pilot and post-exit outcomes 
shall be included in the final report to the General Assembly 
under this subsection (i) within one year of 4 full years of 
implementation, and in an additional report within one year of 
7 full years of implementation in order to provide more 
information about post-exit outcomes on a greater number of 
youth who enroll in pilot program services in the final years 
of the pilot program.
 
    Section 10. Medicaid pilot program for opioid and other

drug addictions.
    (a) Legislative findings.  The General Assembly finds as 
follows:
        (1) Illinois continues to face a serious and ongoing 
    opioid epidemic.
        (2) Opioid-related overdose deaths rose 76% between 
    2013 and 2016.
        (3) Opioid and other drug addictions are life-long 
    diseases that require a disease management approach and not 
    just episodic treatment.
        (4) There is an urgent need to create a treatment 
    approach that proactively engages and encourages 
    individuals with opioid and other drug addictions into 
    treatment to help prevent chronic use and a worsening 
    addiction and to significantly curb the rate of overdose 
    deaths.
    (b) With the goal of early initial engagement of 
individuals who have an opioid or other drug addiction in 
addiction treatment and for keeping individuals engaged in 
treatment following detoxification, a residential treatment 
stay, or hospitalization to prevent chronic recurrent drug use, 
the Department of Healthcare and Family Services, in 
partnership with the Department of Human Services' Division of 
Alcoholism and Substance Abuse and with meaningful input from 
stakeholders, shall develop an Assertive Engagement and 
Community-Based Clinical Treatment Pilot Program for early 
treatment of an opioid or other drug addiction. The pilot 
program shall be implemented across a broad spectrum of 
geographic regions across the State.
    (c) Assertive engagement and community-based clinical 
treatment services. All services included in the pilot program 
established under this Section shall be evidence-based or 
evidence-informed as applicable and the services shall be 
flexibly provided in-office, in-home, and in-community with an 
emphasis on in-home and in-community services.  The model shall 
take into consideration area workforce, community uniqueness, 
and cultural diversity. The model shall, at a minimum, allow 
for and include each of the following:
        (1) Assertive community outreach, engagement, and 
    continuing care strategies to encourage participation and 
    retention in addiction treatment services for both initial 
    engagement into addiction treatment services, and for 
    post-hospitalization, post-detoxification, and 
    post-residential treatment.
        (2) Case management for purposes of linking 
    individuals to treatment, ongoing monitoring, problem 
    solving, and assisting individuals in organizing their 
    treatment and goals.  Case management shall be covered for 
    individuals not yet engaged in treatment for purposes of 
    reaching such individuals early on in their addiction and 
    for individuals in treatment.
        (3) Clinical treatment that is delivered in an 
    individual's natural environment, including in-home or 
    in-community treatment, to better equip the individual 
    with coping mechanisms that may trigger re-use.
        (4) Coverage of provider transportation costs in 
    delivering in-home and in-community services in both rural 
    and urban settings.  For rural communities, the model shall 
    take into account the wider geographic areas providers are 
    required to travel for in-home and in-community pilot 
    services for purposes of reimbursement.
        (5) Recovery support services.
        (6) For individuals who receive services through the 
    pilot program but disengage for a short duration (a period 
    of no longer than 9 months), allow seamless treatment 
    re-engagement in the pilot program.
        (7) Supported education and employment.
        (8) Working with the individual's family, school, and 
    other community support systems.
        (9) Service flexibility to enable recovery and 
    positive health outcomes.
    (d) Federal waiver or State Plan amendment; implementation 
timeline.  The Department shall follow the timeline for 
application for federal approval and implementation outlined 
in subsection (c) of Section 5.  The pilot program contemplated 
in this Section shall be implemented only to the extent that 
federal financial participation is available.
    (e) Pay-for-performance payment model.  The Department of 
Healthcare and Family Services, in partnership with the 
Department of Human Services' Division of Alcoholism and 
Substance Abuse and with meaningful input from stakeholders, 
shall develop a pay-for-performance payment model aimed at 
achieving high quality treatment and overall health and quality 
of life outcomes, rather than a fee-for-service payment model.  
The payment model shall allow for service flexibility to 
achieve such outcomes, shall cover actual provider costs of 
delivering the pilot program services to enable 
sustainability, and shall include all provider costs 
associated with the data collection for purposes of the 
analytics and outcomes reporting required in subsection (g).  
The Department shall ensure that the payment model works as 
intended by this Section within managed care.
    (f) Rulemaking.  The Department of Healthcare and Family 
Services, in partnership with the Department of Human Services' 
Division of Alcoholism and Substance Abuse and with meaningful 
input from stakeholders, shall develop rules for purposes of 
implementation of the pilot program within 6 months after 
federal approval of the pilot program.  If the Department 
determines federal approval is not required for 
implementation, the Department shall develop rules with 
meaningful stakeholder input no later than December 31, 2019.
    (g) Pilot program analytics and outcomes reports.  The 
Department of Healthcare and Family Services shall engage a 
third party partner with expertise in program evaluation, 
analysis, and research at the end of 5 years of implementation 
to review the outcomes of the pilot program in treating 
addiction and preventing periods of symptom exacerbation and 
recurrence.  For purposes of evaluating the outcomes of the 
pilot program, the Department shall require providers of the 
pilot program services to track all of the following annual 
data:
        (1) Length of engagement and retention in pilot program 
    services.
        (2) Recurrence of drug use.
        (3) Symptom management (the ability or inability to 
    control drug use).
        (4) Days of hospitalizations related to substance use 
    or residential treatment stays.
        (5) Periods of homelessness and periods of housing 
    stability.
        (6) Periods of criminal justice involvement.
        (7) Educational and employment attainment during 
    following pilot program services.
        (8) Enrollee satisfaction with his or her quality of 
    life and level of social connectedness, pre-pilot and 
    post-pilot services.
    (h) The Department of Healthcare and Family Services shall 
deliver a final report to the General Assembly on the outcomes 
of the pilot program within one year after 4 years of full 
implementation, and after 7 years of full implementation, 
compared to typical treatment available to other youth with 
significant mental health conditions, as well as the cost 
savings associated with the pilot program taking into account 
all public systems used when an individual with a significant 
mental health condition does not have access to the right 
treatment and supports in the early stages of his or her 
illness.
    The reports to the General Assembly shall be filed with the 
Clerk of the House of Representatives and the Secretary of the 
Senate in electronic form only, in the manner that the Clerk 
and the Secretary shall direct.
    Post-pilot program discharge outcomes shall be collected 
for all service recipients who exit the pilot program for up to 
3 years after exit. This includes youth who exit the program 
with planned or unplanned discharges. The post-exit data 
collected shall include the annual data listed in paragraphs 
(1) through (8) of subsection (g). Data collection shall be 
done in a manner that does not violate individual privacy laws. 
Outcomes for enrollees in the pilot and post-exit outcomes 
shall be included in the final report to the General Assembly 
under this subsection (h) within one year of 4 full years of 
implementation, and in an additional report within one year of 
7 full years of implementation in order to provide more 
information about post-exit outcomes on a greater number of 
youth who enroll in pilot program services in the final years 
of the pilot program.
 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.