HB4238ham001 102ND GENERAL ASSEMBLY

Rep. Greg Harris

Filed: 1/12/2022

10200HB4238ham001 LRB102 21402 KTG 32600 a

AMENDMENT TO HOUSE BILL 4238

AMENDMENT NO. ______. Amend House Bill 4238 by replacing everything after the enacting clause with the following:

"Article 5.

Section 5-1. Short title. This Article may be cited as the Rebuild Illinois Mental Health Workforce Act. References in this Article to "this Act" mean this Article.

Section 5-5. Purpose. The purpose of this Act is to preserve and expand access to Medicaid community mental health care in Illinois to prevent unnecessary hospitalizations and avoid the criminalization of mental health conditions.

Section 5-10. Medicaid funding for community mental health services. Medicaid funding for the specific community mental health services listed in this Act shall be adjusted and paid as set forth in this Act. Such payments shall be paid in addition to the base Medicaid reimbursement rate per service unit. The payment adjustments shall begin on July 1, 2022 for State Fiscal Year 2023 and shall continue for every State fiscal year thereafter.

(1) Individual Therapy Medicaid Add-on Payment for services provided under the H0004 Code:

(A) The Medicaid add-on payment for individual therapy provided by a qualified mental health professional shall be increased by $9 per service unit, for a total add-on payment of $15 per service unit.

(B) A Medicaid add-on payment of $9 per service unit for individual therapy provided by a mental health professional shall be established.

(2) Community Support - Individual Medicaid Add-on Payment for services provided under the H2015 Code: All community support - individual services shall receive a Medicaid add-on payment equal to $15 per service unit.

(3) Case Management Medicaid Add-on Payment for services provided under the T1016 code: All case management services shall receive a Medicaid add-on payment equal to $15 per service unit.

(4) Assertive Community Treatment Medicaid Add-on Payment for services provided under the H0039 code: The Medicaid add-on payment for assertive community treatment services shall increase by $8 per service unit, for a total add-on payment of $20 per service unit.

(5) Medicaid user-based directed payments.

(A) For each State fiscal year, a monthly directed payment shall be paid to a community mental health provider of community support team services based on the number of Medicaid users of community support team services documented by Medicaid fee-for-service and managed care encounter claims delivered by that provider in the base year. The Department of Healthcare and Family Services shall make the monthly directed payment to each provider entitled to directed payments under this Act by no later than the last day of each month throughout each State fiscal year.

(i) The monthly directed payment for a community support team provider shall be calculated as follows: The sum total number of individual Medicaid users of community support team services delivered by that provider throughout the base year, multiplied by $4,200 per Medicaid user, divided into 12 equal monthly payments for the State fiscal year.

(ii) As used in this subparagraph, "user" means an individual who received at least 200 units of community support team services (H2016) during the base year.

(B) For each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of assertive community treatment services based on the number of Medicaid users of assertive community treatment services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year.

(i) The monthly direct payment for an assertive community treatment provider shall be calculated as follows: The sum total number of Medicaid users of assertive community treatment services provided by that provider throughout the base year, multiplied by $6,000 per Medicaid user, divided into 12 equal monthly payments for that State fiscal year.

(ii) As used in this subparagraph, "user" means an individual that received at least 300 units of assertive community treatment services during the base year.

(C) The base year for directed payments under this Section shall be calendar year 2019 for State Fiscal Year 2023 and State Fiscal Year 2024. For the State fiscal year beginning on July 1, 2024, and for every State fiscal year thereafter, the base year shall be the calendar year that ended 18 months prior to the start of the State fiscal year in which payments are made.

Section 5-15. Applicable Medicaid services. The payments listed in Section 5-10 shall apply to Medicaid services provided through contracts with any Medicaid managed care organization or entity and for Medicaid services paid for directly by the Department of Healthcare and Family Services.

Section 5-20. Base Medicaid rates or add-on payments. No base Medicaid rate or Medicaid rate add-on payment or any other payment for the provision of Medicaid community mental health services in place on July 1, 2021 shall be diminished or changed to make the reimbursement changes required by this Act. Any payments required under this Act that are delayed due to implementation challenges or federal approval shall be made retroactive to July 1, 2022 for the full amount required by this Act regardless of the amount a provider bills Illinois' Medical Assistance Program (via a Medicaid managed care organization or the Department of Healthcare and Family Services directly) for such services.

Section 5-25. Federal approval and Medicaid federal financial participation. The Department of Healthcare and Family Services shall submit any necessary application to the federal Centers for Medicare and Medicaid Services immediately following the effective date of this Act for purposes of implementation of this Act. The payments required under this Act shall only be required as long as Illinois receives federal financial participation for such payments.

Article 10.

Section 10-1. Short title. This Article may be cited as the Substance Use Disorder Rate Equity Act.

Section 10-5. Funding for licensed or certified community-based substance use disorder treatment providers and services. Beginning in State Fiscal Year 2023, and every State fiscal year thereafter, the General Assembly shall appropriate sufficient funds to the Department of Human Services for reimbursement rates for licensed or certified community-based substance use disorder treatment providers and services under community service grant programs for persons with substance use disorders, including, but not limited to, all of the following services:

(1) Admission and Discharge Assessment.

(2) Level 1 (Individual).

(3) Level 1 (Group).

(4) Level 2 (Individual).

(5) Level 2 (Group).

(6) Case Management.

(7) Psychiatric Evaluation.

(8) Medication Assisted Recovery.

(9) Community Intervention.

(10) Early Intervention (Individual).

(11) Early Intervention (Group).

Reimbursement rates for such services shall be adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 2% in any State fiscal year. If there is a decrease in the Consumer Price Index-U, rates shall remain unchanged for that State fiscal year. The Department shall adopt rules, including emergency rules in accordance with the Illinois Administrative Procedure Act, to implement the provisions of this Section.

For the purposes of this Section, "consumer price index-u" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100.

Article 15.

Section 15-5. The Illinois Administrative Procedure Act is amended by adding Section 5-45.21 as follows:

(5 ILCS 100/5-45.21 new)

Sec. 5-45.21. Emergency rulemaking; Departments of Healthcare and Family Services and Human Services. To provide for the expeditious and timely implementation of the Substance Use Disorder Rate Equity Act, Section 55-30 of the Substance Use Disorder Act, and Section 5-5.05a of the Illinois Public Aid Code, emergency rules implementing the Substance Use Disorder Rate Equity Act and changes made to Section 55-30 of the Substance Use Disorder Act and Section 5-5.05a of the Illinois Public Aid Code may be adopted in accordance with Section 5-45 by the respective Department. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed one year after the effective date of this amendatory Act of the 102nd General Assembly.

Section 15-10. The Substance Use Disorder Act is amended by changing Section 55-30 as follows:

(20 ILCS 301/55-30)

Sec. 55-30. Rate increase.

(a) The Department shall by rule develop the increased rate methodology and annualize the increased rate beginning with State fiscal year 2018 contracts to licensed providers of community-based substance use disorder intervention or treatment, based on the additional amounts appropriated for the purpose of providing a rate increase to licensed providers. The Department shall adopt rules, including emergency rules under subsection (y) of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section.

(b) (Blank). Within 30 days after June 4, 2018 (the effective date of Public Act 100-587), the Division of Substance Use Prevention and Recovery shall apply an increase in rates of 3% above the rate paid on June 30, 2017 to all Medicaid and non-Medicaid reimbursable service rates. The Department shall adopt rules, including emergency rules under subsection (bb) of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this subsection (b).

(c) Beginning on July 1, 2022, the Division of Substance Use Prevention and Recovery shall increase reimbursement rates for all community-based substance use disorder treatment and intervention services by 47%, including, but not limited to, all of the following:

(1) Admission and Discharge Assessment.

(2) Level 1 (Individual).

(3) Level 1 (Group).

(4) Level 2 (Individual).

(5) Level 2 (Group).

(6) Case Management.

(7) Psychiatric Evaluation.

(8) Medication Assisted Recovery.

(9) Community Intervention;

(10) Early Intervention (Individual).

(11) Early Intervention (Group).

Beginning in State Fiscal Year 2023, and every State fiscal year thereafter, reimbursement rates for those community-based substance use disorder treatment and intervention services shall be adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 2% in any State fiscal year. If there is a decrease in the Consumer Price Index-U, rates shall remain unchanged for that State fiscal year. The Department shall adopt rules, including emergency rules in accordance with the Illinois Administrative Procedure Act, to implement the provisions of this Section.

As used in this subsection, "consumer price index-u" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100.

(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18; 100-759, eff. 1-1-19; 101-81, eff. 7-12-19.)

Section 15-15. Illinois Public Aid Code is amended by adding Section 5-45 as follows:

(305 ILCS 5/5-45 new)

Sec. 5-45. Reimbursement rates; substance use disorder treatment providers and facilities. Beginning on July 1, 2022, the Department of Human Services' Division of Substance Use Prevention and Recovery in conjunction with the Department of Healthcare and Family Services, shall provide for an increase in reimbursement rates by way of an increase to existing rates of 47% for all community-based substance use disorder treatment services, including, but not limited to, all of the following:

(1) Admission and Discharge Assessment.

(2) Level 1 (Individual).

(3) Level 1 (Group).

(4) Level 2 (Individual).

(5) Level 2 (Group).

(6) Psychiatric/Diagnostic.

(7) Medication Monitoring (Individual).

(8) Methadone as an Adjunct to Treatment.

No existing or future reimbursement rates or add-ons shall be reduced or changed to address the rate increase proposed under this Section. The Department of Healthcare and Family Services shall immediately, no later than 3 months following the effective date of this amendatory Act of the 102nd General Assembly, submit any necessary application to the federal Centers for Medicare and Medicaid Services for a waiver or State Plan amendment to implement the requirements of this Section. Beginning in State Fiscal year 2023, and every State fiscal year thereafter, reimbursement rates for those community-based substance use disorder treatment services shall be adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 2% in any State fiscal year. If there is a decrease in the Consumer Price Index-U, rates shall remain unchanged for that State fiscal year. The Department of Human Services shall adopt rules, including emergency rules under Section 5-45.1 of the Illinois Administrative Procedure Act, to implement the provisions of this Section.

As used in this Section, "consumer price index-u" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100.

Article 99.

Section 99-999. Effective date. This Act takes effect upon becoming law.".