102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3438

 

Introduced 1/18/2022, by Sen. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
New Act
5 ILCS 100/5-45.21 new

    Creates the Mental Health Assessment Reform Act. Provides that the purpose of the Act is to remove barriers to care in the Medicaid mental health assessment and treatment planning process. Provides that, within 3 months after the effective date of the Act, the Department of Healthcare and Family Services shall clearly identify the minimum information necessary to establish and document medical necessity in an individual's medical record for each community mental health general rehabilitation option service through the use of the Department's standardized assessment and treatment planning tool required in the integrated assessment and treatment planning process. Requires minimum medical necessity documentation requirements to be publicly available to all community mental health centers and behavioral health clinics. Provides that an individual is immediately eligible to receive any community mental health service upon documentation of the specified medical necessity criteria in his or her medical record, and the provider shall be reimbursed for such delivered services. Provides that the integrated assessment and treatment planning process shall be required no more frequently than annually for specified community mental health services. Contains provisions requiring the Department to establish a workgroup to resolve certain issues identified by the Department with the assessment tool and the integrated assessment and treatment planning process. Requires the Department to submit a report to the General Assembly that outlines the issues and recommendations discussed by the workgroup. Contains provisions concerning the Department's development of a billing code, modifier, or other mechanism to reimburse providers for the full time spent on the integrated assessment and treatment planning process; assessment tool training; and other matters. Requires the Department to seek federal approval, if required to implement the Act. Permits the Department, with input from the Department's workgroup, to adopt emergency rules in accordance with the Illinois Administrative Procedure Act. Effective immediately.


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A BILL FOR

 

SB3438LRB102 22893 KTG 32045 b

1    AN ACT concerning mental health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Mental
5Health Assessment Reform Act.
 
6    Section 3. Purpose. The purpose of this Act is to remove
7major barriers to care in the Medicaid mental health
8assessment and treatment planning process.
 
9    Section 5. Clear delineation of eligibility criteria for
10Medicaid community mental health services. Within 3 months
11after the effective date of this Act and in accordance with
12this Section, the Department of Healthcare and Family Services
13shall clearly identify the minimum information necessary to
14establish and document medical necessity in an individual's
15medical record for each community mental health general
16rehabilitation option service through the use of the
17Department's standardized assessment and treatment planning
18tool (assessment tool) required in the integrated assessment
19and treatment planning process. Such minimum medical necessity
20documentation requirements through the use of the assessment
21tool shall be publicly available to all community mental
22health centers and behavioral health clinics.

 

 

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1        (1) Documenting medical necessity. The information
2    required to be gathered and documented through the
3    assessment tool to establish medical necessity for a
4    mental health service shall be no broader than what is
5    required to establish eligibility, duration, and frequency
6    for such service:
7            (A) Mental health symptoms or functional
8        impairment.
9            (B) A mental health diagnosis listed in the most
10        recent edition of the Diagnostic and Statistical
11        Manual of Mental Health Disorders or the International
12        Classification of Diseases.
13            (C) Any other information necessary solely for
14        purposes of determining eligibility, duration, and
15        frequency for a community-based mental health service.
16            (D) A recommendation for such service by an
17        appropriate mental health or medical professional for
18        the treatment of a mental health condition or symptoms
19        or to improve functional impairment.
20        (2) Improved access to care. An individual shall
21    immediately be eligible to receive any community mental
22    health service or services upon documentation of the
23    specified medical necessity criteria in his or her medical
24    record and the provider shall be reimbursed for such
25    delivered services. An individual's background,
26    experiences, health, or other information that is not

 

 

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1    necessary to a medical necessity determination for a
2    community mental health service shall be left to the
3    clinical discretion of the provider as to the relevance
4    for developing a treatment plan in the integrated
5    assessment and treatment planning process. The absence of
6    discretional information in an individual's integrated
7    assessment and treatment planning or medical record that
8    is unrelated to medical necessity shall not be used by the
9    Department or any contracted third party to delay or deny
10    a community mental health service. The integrated
11    assessment and treatment planning process shall remain
12    open for no less than 90 days to allow providers to gather
13    the relevant and appropriate information from an
14    individual to complete the integrated assessment and
15    treatment planning process.
16        (3) No further assessment or treatment planning
17    documentation shall be required if services are terminated
18    or completed within 90 days. If an individual terminates
19    or completes his or her community mental health services
20    within 90 days from the date of his or her first treatment
21    contact with his or her provider, the integrated
22    assessment and treatment planning process also terminates,
23    and no further documentation shall be required using the
24    Department's assessment tool or in the individual's
25    medical record. A provider shall be fully reimbursed for
26    any services delivered for which medical necessity is

 

 

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1    established during these 90 days, and such services shall
2    not be delayed or denied by the Department or a managed
3    care organization.
 
4    Section 10. Preventing re-traumatization and unnecessary
5re-assessments. Beginning on the effective date of this Act,
6the integrated assessment and treatment planning process shall
7be required no more frequently than annually for any community
8mental health service covered under 89 Ill. Adm. Code 140.453,
9140.455, and 140.TABLE N (c) and (e).
 
10    Section 15. Assessment and treatment planning process
11centered on motivational interviewing. Within 3 months after
12the effective date of this Act, through a workgroup
13established by the Department of Healthcare and Family
14Services to review the practical challenges of the
15Department's standardized assessment and treatment planning
16tool, the Department and stakeholders, including people with
17lived experience, shall work to resolve the issues listed
18below with the assessment tool and the integrated assessment
19and treatment planning process. Within 6 months after the
20effective date of this Act, the Department of Healthcare and
21Family Services shall deliver a report to the General
22Assembly, with a copy delivered to the Chairs of the Senate
23Behavioral and Mental Health Committee and the House Mental
24Health and Addiction Committee, that outlines in plain

 

 

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1language the issues and recommendations discussed by the
2workgroup, what stakeholder recommendations the Department
3agreed with and will implement and the timeline for
4implementation, and which recommendations the Department
5declined to address and the reason for such decline.
6        (1) Reforming the Department's standardized assessment
7    and treatment planning tool to enable the integrated
8    assessment and treatment planning process to be centered
9    on motivational interviewing.
10        (2) Avoiding requesting information in the integrated
11    assessment and treatment planning process that can
12    re-traumatize individuals by continuing to ask about past
13    traumatic personal experiences that are better addressed
14    through the clinical relationship.
15        (3) Examine the assessment tool for any potential
16    racial or cultural biases.
17        (4) Ensure the confidentiality protections afforded
18    individuals under Section 4 of the Mental Health and
19    Developmental Disabilities Confidentiality Act are fully
20    respected throughout the integrated assessment and
21    treatment planning processes, in particular as it relates
22    to the rights of minors between the age of 12 and 17 to
23    limit their parents' access to mental health information.
24        (5) Ensure that individuals' mental health and
25    substance use parity rights afforded under Section 370c.1
26    of the Illinois Insurance Code are fully recognized and

 

 

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1    protected in the integrated assessment and treatment
2    planning process.
3        (6) Streamline the documentation process to ensure
4    that clinician time is not wasted on unnecessary and
5    duplicative paperwork and process.
6        (7) Ensure that managed care organizations do not deny
7    a service for which medical necessity has been established
8    and documented in the individual's medical record.
 
9    Section 20. Payment for the full assessment process. The
10Department of Healthcare and Family Services shall develop a
11billing code, modifier, or other mechanism to reimburse
12providers for the full time spent on the integrated assessment
13and treatment planning process, including Department-required
14documentation and submission of the integrated assessment and
15treatment planning without the client present, including
16transferring information onto the Department-required form;
17collateral interviews to collect client information; review of
18documentation received by hospitals, schools, and other health
19care entities; and uploading the information into the
20Department of Healthcare and Family Services' portal since
21this is a core part of the assessment and treatment planning
22process mandated by the Department. The reimbursement rate for
23documentation and submission shall be equal to the rate and
24rate add-on payment paid for the related specific integrated
25assessment and treatment planning service delivered. Provider

 

 

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1payment for such services shall begin no later than July 1,
22022. If the Department of Healthcare and Family Services
3experiences any delays in implementation of this Section for
4any reason, including seeking federal approval, payment shall
5be retroactive to July 1, 2022.
 
6    Section 25. Improving training for mental health
7assessments with on-the-ground, experienced clinicians. By no
8later than the effective date of this Act, to enable more
9consistency and effective use of the Department's standardized
10assessment and treatment planning tool used in the integrated
11assessment and treatment planning process, the Department of
12Healthcare and Family Services shall provide a
13train-the-trainer model as an alternative to the
14State-sponsored trainings, so providers can elect to train
15their own staff in the use and application of the assessment
16tool. This train-the-trainer model allows providers to
17maintain fidelity to the tool while providing practical
18knowledge of how the tool is implemented within the provider's
19unique service delivery environment, and allows for more
20timely training of new staff. All assessment tool trainings
21sponsored by the State shall be available in in-person and
22video modalities, including recorded trainings that can be
23accessed anytime, to ensure the timely training of provider
24staff.
 

 

 

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1    Section 30. Federal approval and State administrative
2rulemaking. If federal approval is required for any provision
3of this Act, the Department of Healthcare and Family Services
4shall seek approval from the Centers for Medicare and Medicaid
5Services within 30 days after the effective date of this Act.
6Within 3 months after the Department receives federal
7approval, the Department may, with prior input from the
8Department's workgroup referenced in Section 15, adopt
9emergency rules to implement any provision of this Act in
10accordance with the Illinois Administrative Procedure Act.
 
11    Section 35. The Illinois Administrative Procedure Act is
12amended by adding Section 5-45.21 as follows:
 
13    (5 ILCS 100/5-45.21 new)
14    Sec. 5-45.21. Emergency rulemaking; Department of
15Healthcare and Family Services. To provide for the expeditious
16and timely implementation of the Mental Health Assessment
17Reform Act, emergency rules implementing any provision of the
18Mental Health Assessment Reform Act may be adopted in
19accordance with Section 5-45 by the Department of Healthcare
20and Family Services. The adoption of emergency rules
21authorized by Section 5-45 and this Section is deemed to be
22necessary for the public interest, safety, and welfare.
23    This Section is repealed one year after the effective date
24of this amendatory Act of the 102nd General Assembly.
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.