Illinois General Assembly - Full Text of HB4238
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Full Text of HB4238  102nd General Assembly

HB4238 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB4238

 

Introduced 1/5/2022, by Rep. Greg Harris - Tom Demmer - Elizabeth Hernandez - Deb Conroy - Kambium Buckner, et al.

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Rebuild Illinois Mental Health Workforce Act. Provides that the purpose of the 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. Establishes add-on payments for the following community mental health services to be paid beginning with State Fiscal Year 2023 and continuing for each State fiscal year thereafter: individual therapy services; community support-individual services; case management services; and assertive community treatment services. Requires monthly directed payments to community mental health providers of community support team services or assertive community treatment services. Provides that such directed payments shall be based on the number of Medicaid users, as defined, who receive services from the provider in the base year. Provides that the add-on payments established under the Act shall apply to Medicaid services provided by a contracted managed care organization or entity and services paid for directly by the Department of Healthcare and Family Services. Provides that 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 under the Act. Requires the Department to apply for federal approval to implement the Act. Provides that implementation of the add-on payments is conditioned on the receipt of federal financial participation for such payments. Effective immediately.


LRB102 21402 KTG 30518 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB4238LRB102 21402 KTG 30518 b

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
5Rebuild Illinois Mental Health Workforce Act.
 
6    Section 5. Purpose. The purpose of this Act is to preserve
7and expand access to Medicaid community mental health care in
8Illinois to prevent unnecessary hospitalizations and avoid the
9criminalization of mental health conditions.
 
10    Section 10. Medicaid funding for community mental health
11services. Medicaid funding for the specific community mental
12health services listed in this Act shall be adjusted and paid
13as set forth in this Act. Such payments shall be paid in
14addition to the base Medicaid reimbursement rate per service
15unit. The payment adjustments shall begin on July 1, 2022 for
16State Fiscal Year 2023 and shall continue for every State
17fiscal year thereafter.
18        (1) Individual Therapy Medicaid Add-on Payment for
19    services provided under the H0004 Code:
20            (A) The Medicaid add-on payment for individual
21        therapy provided by a qualified mental health
22        professional shall be increased by $9 per service

 

 

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1        unit, for a total add-on payment of $15 per service
2        unit.
3            (B) A Medicaid add-on payment of $9 per service
4        unit for individual therapy provided by a mental
5        health professional shall be established.
6        (2) Community Support - Individual Medicaid Add-on
7    Payment for services provided under the H2015 Code: All
8    community support - individual services shall receive a
9    Medicaid add-on payment equal to $15 per service unit.
10        (3) Case Management Medicaid Add-on Payment for
11    services provided under the T1016 code: All case
12    management services shall receive a Medicaid add-on
13    payment equal to $15 per service unit.
14        (4) Assertive Community Treatment Medicaid Add-on
15    Payment for services provided under the H0039 code: The
16    Medicaid add-on payment for assertive community treatment
17    services shall increase by $8 per service unit, for a
18    total add-on payment of $20 per service unit.
19        (5) Medicaid user-based directed payments.
20            (A) For each State fiscal year, a monthly directed
21        payment shall be paid to a community mental health
22        provider of community support team services based on
23        the number of Medicaid users of community support team
24        services documented by Medicaid fee-for-service and
25        managed care encounter claims delivered by that
26        provider in the base year. The Department of

 

 

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1        Healthcare and Family Services shall make the monthly
2        directed payment to each provider entitled to directed
3        payments under this Act by no later than the last day
4        of each month throughout each State fiscal year.
5                (i) The monthly directed payment for a
6            community support team provider shall be
7            calculated as follows: The sum total number of
8            individual Medicaid users of community support
9            team services delivered by that provider
10            throughout the base year, multiplied by $4,200 per
11            Medicaid user, divided into 12 equal monthly
12            payments for the State fiscal year.
13                (ii) As used in this subparagraph, "user"
14            means an individual who received at least 200
15            units of community support team services (H2016)
16            during the base year.
17            (B) For each State fiscal year, a monthly directed
18        payment shall be paid to each community mental health
19        provider of assertive community treatment services
20        based on the number of Medicaid users of assertive
21        community treatment services documented by Medicaid
22        fee-for-service and managed care encounter claims
23        delivered by the provider in the base year.
24                (i) The monthly direct payment for an
25            assertive community treatment provider shall be
26            calculated as follows: The sum total number of

 

 

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1            Medicaid users of assertive community treatment
2            services provided by that provider throughout the
3            base year, multiplied by $6,000 per Medicaid user,
4            divided into 12 equal monthly payments for that
5            State fiscal year.
6                (ii) As used in this subparagraph, "user"
7            means an individual that received at least 300
8            units of assertive community treatment services
9            during the base year.
10            (C) The base year for directed payments under this
11        Section shall be calendar year 2019 for State Fiscal
12        Year 2023 and State Fiscal Year 2024. For the State
13        fiscal year beginning on July 1, 2024, and for every
14        State fiscal year thereafter, the base year shall be
15        the calendar year that ended 18 months prior to the
16        start of the State fiscal year in which payments are
17        made.
 
18    Section 15. Applicable Medicaid services. The payments
19listed in Section 10 shall apply to Medicaid services provided
20through contracts with any Medicaid managed care organization
21or entity and for Medicaid services paid for directly by the
22Department of Healthcare and Family Services.
 
23    Section 20. Base Medicaid rates or add-on payments. No
24base Medicaid rate or Medicaid rate add-on payment or any

 

 

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1other payment for the provision of Medicaid community mental
2health services in place on July 1, 2021 shall be diminished or
3changed to make the reimbursement changes required by this
4Act. Any payments required under this Act that are delayed due
5to implementation challenges or federal approval shall be made
6retroactive to July 1, 2022 for the full amount required by
7this Act regardless of the amount a provider bills Illinois'
8Medical Assistance Program (via a Medicaid managed care
9organization or the Department of Healthcare and Family
10Services directly) for such services.
 
11    Section 25. Federal approval and Medicaid federal
12financial participation. The Department of Healthcare and
13Family Services shall submit any necessary application to the
14federal Centers for Medicare and Medicaid Services immediately
15following the effective date of this Act for purposes of
16implementation of this Act. The payments required under this
17Act shall only be required as long as Illinois receives
18federal financial participation for such payments.
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.