101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4970

 

Introduced 2/18/2020, by Rep. Deb Conroy

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services and the Department of Human Services (Departments) to develop a pilot program based upon the certified community behavioral health clinic criteria and the prospective payment system methodology issued by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services as created under the federal Protecting Access to Medicare Act of 2014. Provides that implementation of the pilot program is subject to federal approval. Requires the Departments to seek federal financial assistance for the pilot program and certified community behavioral health clinic technical assistance and support through all potential federal sources, including, but not limited to, the federal Delivery System Reform Incentive Payment program. Contains provisions concerning the timeline for implementing the pilot program; the Departments applications for a federal Section 1115 waiver to implement the pilot program; the adoption of rules to implement the pilot program; implementation of the pilot program for certified community behavioral health clinic services under the medical assistance fee-for-service and managed care programs; payments to community behavioral health clinics under the certified community behavioral health clinic prospective payment system methodology for each qualifying visit; staffing requirements for certified community behavioral health clinics; reporting requirements; and other matters. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
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
5Illinois Certified Community Behavioral Health Clinics Act.
 
6    Section 5. Medicaid Pilot Program; integrated behavioral
7health and primary care; findings.
8    (a) The General Assembly finds and declares that the
9federal Protecting Access to Medicare Act of 2014, which
10requires the establishment of demonstration programs to
11improve community behavioral health services to be funded as
12part of Medicaid, serves as a useful model for the creation of
13a similar program in Illinois to provide and improve upon
14community behavioral health services and treatment.
15    (b) The General Assembly finds and declares that the
16federal Protecting Access to Medicare Act of 2014 identifies
17appropriate criteria for certified community behavioral health
18clinics. These criteria fall into 6 areas:
19        (1) staffing;
20        (2) availability and accessibility of services;
21        (3) care coordination;
22        (4) scope of services;
23        (5) quality and other reporting; and

 

 

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1        (6) organizational authority.
2    (c) The General Assembly finds and declares that certified
3community behavioral health clinics represent an opportunity
4to improve the behavioral health of Illinois citizens by:
5        (1) expanding access to community-based mental health
6    and substance use disorder services;
7        (2) increasing the capacity of the mental health and
8    substance use disorder treatment systems to reduce unmet
9    need for care;
10        (3) advancing integration of behavioral health with
11    physical health care;
12        (4) assimilating and utilizing evidence-based
13    practices on a more consistent basis; and
14        (5) promoting improved access to high quality care.
15    (d) The General Assembly finds and declares that the pilot
16program created in accordance with this Act should focus upon 4
17key patient populations that may benefit from the certified
18community behavioral health clinic model:
19        (1) children with serious emotional disturbances;
20        (2) children with substance use disorders;
21        (3) adults with serious mental illness; and
22        (4) adults with substance use disorders.
 
23    Section 10. Definitions. As used in this Act:
24    "Departments" means the Department of Healthcare and
25Family Services and the Department of Human Services, Division

 

 

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1of Mental Health and Division of Substance Use Prevention and
2Recovery.
3    "PAMA" means the Protecting Access to Medicare Act of 2014.
4    "Pilot program" means the Certified Community Behavioral
5Health Clinic pilot program.
 
6    Section 15. Certified Community Behavioral Health Clinic
7pilot program.
8    (a) The Department of Healthcare and Family Services, in
9partnership with the Department of Human Services, Division of
10Mental Health and Division of Substance Use Prevention and
11Recovery, shall develop, with meaningful input from
12stakeholders, a pilot program based upon the certified
13community behavioral health clinic criteria and prospective
14payment system methodology issued by the federal Substance
15Abuse and Mental Health Services Administration and the Centers
16for Medicare and Medicaid Services as created under the
17Protecting Access to Medicare Act of 2014, Prospective Payment
18System Guidance. Input from stakeholders shall include and
19incorporate information received from consumers, family
20members of consumers, community mental health centers, mental
21health providers, substance use disorder treatment facilities,
22substance use disorder treatment providers, primary care
23physicians, federally qualified health centers, and statewide
24associations representing the foregoing. Stakeholder input
25shall be gathered from across the State utilizing listening

 

 

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1sessions including those areas most severely impacted by the
2opioid and suicide crises such as minority communities, rural
3areas, and urban areas.
4    (b) Implementation of the pilot program is subject to
5federal approval. The Departments shall seek federal financial
6assistance for this pilot program and certified community
7behavioral health clinic technical assistance and support
8through all potential federal sources, including, but not
9limited to, the federal Delivery System Reform Incentive
10Payment program. The pilot program shall be implemented under
11the following timeline:
12        (1) The Departments shall submit any necessary
13    applications to the Centers for Medicare and Medicaid
14    Services for a waiver under Section 1115 to implement the
15    pilot program described in this Section no later than
16    December 31, 2020. The Departments shall promptly engage in
17    any additional steps requested or required by the Centers
18    for Medicare and Medicaid Services to obtain approval of
19    the pilot program waiver on a timely basis.
20        (2) The Departments shall conduct the stakeholder
21    listening sessions as described above no later than 3
22    months following federal approval of the pilot program
23    waiver.
24        (3) After federal approval of the pilot program waiver
25    has been secured, the Departments may adopt rules to carry
26    out this pilot program and include requirements and

 

 

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1    specifications separate from those prescribed under the
2    federal Protecting Access to Medicare Act of 2014 by the
3    federal Substance Abuse and Mental Health Services
4    Administration and the Centers for Medicare and Medicaid
5    Services no later than 6 months following federal approval
6    of the pilot program waiver, but shall not draft any rules
7    in contravention of the criteria or specifications for the
8    pilot program development and implementation as set forth
9    in this Act.
10        (4) Upon federal approval of the pilot program waiver,
11    the Department of Healthcare and Family Services shall
12    implement the prospective payment system for certified
13    community behavioral health clinic services under the
14    medical assistance fee-for-service and managed care
15    programs based upon the certified community behavioral
16    health clinic daily (CC PPS-1) or monthly (CC PPS-2)
17    prospective payment system methodology set forth in
18    Appendix III to the Prospective Payment System Guidance.
19    The Department of Healthcare and Family Services shall
20    implement quality bonus and outlier payments, as further
21    detailed under the Prospective Payment System Guidance.
22    The prospective payment system shall be updated and subject
23    to rebasing in accordance with Appendix III to the
24    Prospective Payment System Guidance. For services rendered
25    by a certified community behavioral health clinic to an
26    individual enrolled in a Medicaid managed care

 

 

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1    organization, the Department of Healthcare and Family
2    Services shall implement a supplemental payment system at
3    the same time as the prospective payment system to ensure
4    that the community behavioral health clinic receives full
5    payment under the certified community behavioral health
6    clinic prospective payment system methodology for each
7    qualifying visit. Specifically, the Department of
8    Healthcare and Family Services shall provide for payment to
9    the community behavioral health clinic by the Department of
10    Healthcare and Family Services of a supplemental payment
11    equal to the amount (if any) by which payment under the
12    certified community behavioral health clinic prospective
13    payment system methodology would exceed payments by the
14    managed care organization to the certified community
15    behavioral health clinic for services rendered to the
16    entity's enrollee. The supplemental payments shall be made
17    by the Department of Healthcare and Family Services
18    according to a schedule agreed to between the State and the
19    certified community behavioral health clinic, but in no
20    case shall payment be made less frequently than every 3
21    months. The prospective payment system methodology shall
22    remain in effect so long as the Departments continue to
23    offer the pilot program and regardless of the status of the
24    PAMA-authorized Certified Community Behavioral Health
25    Clinic demonstration program, including the Prospective
26    Payment System Guidance.

 

 

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1        (5) The Departments shall fully implement the pilot
2    program so that certified community behavioral health
3    clinic services may begin operations within 9 months
4    following federal approval of the pilot program waiver.
5    (c) The General Assembly shall appropriate such funds to
6support the Departments in planning, obtaining stakeholder
7input, and implementing and carrying out the pilot program as
8well as other related duties specified in this Act, in addition
9to funding that the Departments shall seek from the Centers for
10Medicare and Medicaid Services and the federal Substance Abuse
11and Mental Health Services Administration to support these
12efforts.
13    (d) Certification of certified community behavioral health
14clinics by the Department of Healthcare and Family Services
15shall be based upon the following criteria. Where applicable,
16the State shall use federal certified community behavioral
17health clinic criteria established by the federal Substance
18Abuse and Mental Health Services Administration as a guide. The
19Department of Healthcare and Family Services shall impose the
20certification criteria on all initial certified community
21behavioral health clinic applications and shall require
22recertification on a regular basis, no less frequently than
23every 2 years.
24        (1) Staffing requirements, including criteria that
25    staff have diverse disciplinary backgrounds, have
26    necessary State required licensure or certification and

 

 

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1    accreditation, and are culturally and linguistically
2    trained to serve the needs of the clinic's patient
3    population.
4        (2) Availability and accessibility of services,
5    including crisis management services that are available
6    and accessible 24 hours a day, the use of a sliding scale
7    for payment, and no rejection for services or limiting of
8    services on the basis of a patient's ability to pay or
9    place of residence.
10        (3) Care coordination, including requirements to
11    coordinate care across settings and providers to ensure
12    seamless transitions for patients across the full spectrum
13    of health services, including acute, chronic, and
14    behavioral health needs.
15        (4) Provision (in a manner reflecting person-centered
16    care) of the following services which, if not available
17    directly through the certified community behavioral health
18    clinic, are provided or referred through formal
19    relationships with other providers:
20            (A) crisis mental health services, including
21        24-hour mobile crisis teams, emergency crisis
22        intervention services, and crisis stabilization;
23            (B) screening, assessment, and diagnosis,
24        including risk assessment;
25            (C) patient-centered treatment planning or similar
26        processes, including risk assessment and crisis

 

 

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1        planning;
2            (D) outpatient mental health and substance use
3        disorder services;
4            (E) outpatient clinic primary care screening and
5        monitoring of key health indicators and health risk;
6            (F) targeted case management;
7            (G) psychiatric rehabilitation services;
8            (H) peer support and counselor services and family
9        supports; and
10            (I) intensive, community-based mental health care
11        for members of the armed forces and veterans.
12        (5) Reporting of encounter data, clinical outcomes
13    data, quality data in accordance with federal certified
14    community behavioral health clinic criteria, and such
15    other data as the Departments deem necessary.
16        (6) Certified community behavioral health clinics may
17    only be formed and organized by community mental health
18    centers and substance use disorder treatment facilities or
19    licensed or certified mental health or substance use
20    disorder treatment providers.
21    (e) The Departments shall deliver a report to the General
22Assembly during the regular session on the outcomes of the
23pilot program after 2 years of full implementation and again
24after 4 years of full implementation providing information on
25performance of the pilot program along with plans for future
26sustainability, including, but not limited to, the quality

 

 

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1measures and certification criteria set forth above and under
2the guidance issued by the Centers for Medicare and Medicaid
3Services and the federal Substance Abuse and Mental Health
4Services Administration for the Protecting Access to Medicare
5Act of 2014.
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.