Illinois General Assembly - Full Text of SB3935
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Full Text of SB3935  102nd General Assembly

SB3935sam001 102ND GENERAL ASSEMBLY

Sen. Elgie R. Sims, Jr.

Filed: 2/7/2022

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3935

2    AMENDMENT NO. ______. Amend Senate Bill 3935 by replacing
3everything after the enacting clause with the following:
 
4
"Article 5.

 
5    Section 5-1. Short title. This Article may be cited as the
6Rebuild Illinois Mental Health Workforce Act. References in
7this Article to "this Act" mean this Article.
 
8    Section 5-5. Purpose. The purpose of this Act is to
9preserve and expand access to Medicaid community mental health
10care in Illinois to prevent unnecessary hospitalizations and
11avoid the criminalization of mental health conditions.
 
12    Section 5-10. Medicaid funding for community mental health
13services. Medicaid funding for the specific community mental
14health services listed in this Act shall be adjusted and paid

 

 

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1as set forth in this Act. Such payments shall be paid in
2addition to the base Medicaid reimbursement rate per service
3unit. The payment adjustments shall begin on July 1, 2022 for
4State Fiscal Year 2023 and shall continue for every State
5fiscal year thereafter.
6        (1) Individual Therapy Medicaid Add-on Payment for
7    services provided under the H0004 Code:
8            (A) The Medicaid add-on payment for individual
9        therapy provided by a qualified mental health
10        professional shall be increased by $9 per service
11        unit, for a total add-on payment of $15 per service
12        unit.
13            (B) A Medicaid add-on payment of $9 per service
14        unit for individual therapy provided by a mental
15        health professional shall be established.
16        (2) Community Support - Individual Medicaid Add-on
17    Payment for services provided under the H2015 Code: All
18    community support - individual services shall receive a
19    Medicaid add-on payment equal to $15 per service unit.
20        (3) Case Management Medicaid Add-on Payment for
21    services provided under the T1016 code: All case
22    management services shall receive a Medicaid add-on
23    payment equal to $15 per service unit.
24        (4) Assertive Community Treatment Medicaid Add-on
25    Payment for services provided under the H0039 code: The
26    Medicaid add-on payment for assertive community treatment

 

 

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

 

 

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1            (B) For each State fiscal year, a monthly directed
2        payment shall be paid to each community mental health
3        provider of assertive community treatment services
4        based on the number of Medicaid users of assertive
5        community treatment services documented by Medicaid
6        fee-for-service and managed care encounter claims
7        delivered by the provider in the base year.
8                (i) The monthly direct payment for an
9            assertive community treatment provider shall be
10            calculated as follows: The sum total number of
11            Medicaid users of assertive community treatment
12            services provided by that provider throughout the
13            base year, multiplied by $6,000 per Medicaid user,
14            divided into 12 equal monthly payments for that
15            State fiscal year.
16                (ii) As used in this subparagraph, "user"
17            means an individual that received at least 300
18            units of assertive community treatment services
19            during the base year.
20            (C) The base year for directed payments under this
21        Section shall be calendar year 2019 for State Fiscal
22        Year 2023 and State Fiscal Year 2024. For the State
23        fiscal year beginning on July 1, 2024, and for every
24        State fiscal year thereafter, the base year shall be
25        the calendar year that ended 18 months prior to the
26        start of the State fiscal year in which payments are

 

 

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1        made.
 
2    Section 5-15. Applicable Medicaid services. The payments
3listed in Section 5-10 shall apply to Medicaid services
4provided through contracts with any Medicaid managed care
5organization or entity and for Medicaid services paid for
6directly by the Department of Healthcare and Family Services.
 
7    Section 5-20. Base Medicaid rates or add-on payments. No
8base Medicaid rate or Medicaid rate add-on payment or any
9other payment for the provision of Medicaid community mental
10health services in place on July 1, 2021 shall be diminished or
11changed to make the reimbursement changes required by this
12Act. Any payments required under this Act that are delayed due
13to implementation challenges or federal approval shall be made
14retroactive to July 1, 2022 for the full amount required by
15this Act regardless of the amount a provider bills Illinois'
16Medical Assistance Program (via a Medicaid managed care
17organization or the Department of Healthcare and Family
18Services directly) for such services.
 
19    Section 5-25. Federal approval and Medicaid federal
20financial participation. The Department of Healthcare and
21Family Services shall submit any necessary application to the
22federal Centers for Medicare and Medicaid Services immediately
23following the effective date of this Act for purposes of

 

 

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1implementation of this Act. The payments required under this
2Act shall only be required as long as Illinois receives
3federal financial participation for such payments.
 
4
Article 10.

 
5    Section 10-1. Short title. This Article may be cited as
6the Substance Use Disorder Rate Equity Act.
 
7    Section 10-5. Funding for licensed or certified
8community-based substance use disorder treatment providers and
9services. Beginning in State Fiscal Year 2023, and every State
10fiscal year thereafter, the General Assembly shall appropriate
11sufficient funds to the Department of Human Services for
12reimbursement rates for licensed or certified community-based
13substance use disorder treatment providers and services under
14community service grant programs for persons with substance
15use disorders, including, but not limited to, all of the
16following services:
17        (1) Admission and Discharge Assessment.
18        (2) Level 1 (Individual).
19        (3) Level 1 (Group).
20        (4) Level 2 (Individual).
21        (5) Level 2 (Group).
22        (6) Case Management.
23        (7) Psychiatric Evaluation.

 

 

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1        (8) Medication Assisted Recovery.
2        (9) Community Intervention.
3        (10) Early Intervention (Individual).
4        (11) Early Intervention (Group).
5    Reimbursement rates for such services shall be adjusted
6upward by an amount equal to the Consumer Price Index-U from
7the previous year, not to exceed 2% in any State fiscal year.
8If there is a decrease in the Consumer Price Index-U, rates
9shall remain unchanged for that State fiscal year. The
10Department shall adopt rules, including emergency rules in
11accordance with the Illinois Administrative Procedure Act, to
12implement the provisions of this Section.
13    As used in this Section, "consumer price index-u" means
14the index published by the Bureau of Labor Statistics of the
15United States Department of Labor that measures the average
16change in prices of goods and services purchased by all urban
17consumers, United States city average, all items, 1982-84 =
18100.
 
19
Article 15.

 
20    Section 15-5. The Illinois Administrative Procedure Act is
21amended by adding Section 5-45.21 as follows:
 
22    (5 ILCS 100/5-45.21 new)
23    Sec. 5-45.21. Emergency rulemaking; Departments of

 

 

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1Healthcare and Family Services and Human Services. To provide
2for the expeditious and timely implementation of the Substance
3Use Disorder Rate Equity Act, Section 55-30 of the Substance
4Use Disorder Act, and Section 5-5.05a of the Illinois Public
5Aid Code, emergency rules implementing the Substance Use
6Disorder Rate Equity Act and changes made to Section 55-30 of
7the Substance Use Disorder Act and Section 5-5.05a of the
8Illinois Public Aid Code may be adopted in accordance with
9Section 5-45 by the respective Department. The adoption of
10emergency rules authorized by Section 5-45 and this Section is
11deemed to be necessary for the public interest, safety, and
12welfare.
13    This Section is repealed one year after the effective date
14of this amendatory Act of the 102nd General Assembly.
 
15    Section 15-10. The Substance Use Disorder Act is amended
16by changing Section 55-30 as follows:
 
17    (20 ILCS 301/55-30)
18    Sec. 55-30. Rate increase.
19    (a) The Department shall by rule develop the increased
20rate methodology and annualize the increased rate beginning
21with State fiscal year 2018 contracts to licensed providers of
22community-based substance use disorder intervention or
23treatment, based on the additional amounts appropriated for
24the purpose of providing a rate increase to licensed

 

 

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1providers. The Department shall adopt rules, including
2emergency rules under subsection (y) of Section 5-45 of the
3Illinois Administrative Procedure Act, to implement the
4provisions of this Section.
5    (b) (Blank). Within 30 days after June 4, 2018 (the
6effective date of Public Act 100-587), the Division of
7Substance Use Prevention and Recovery shall apply an increase
8in rates of 3% above the rate paid on June 30, 2017 to all
9Medicaid and non-Medicaid reimbursable service rates. The
10Department shall adopt rules, including emergency rules under
11subsection (bb) of Section 5-45 of the Illinois Administrative
12Procedure Act, to implement the provisions of this subsection
13(b).
14    (c) Beginning on July 1, 2022, the Division of Substance
15Use Prevention and Recovery shall increase reimbursement rates
16for all community-based substance use disorder treatment and
17intervention services by 47%, including, but not limited to,
18all of the following:
19        (1) Admission and Discharge Assessment.
20        (2) Level 1 (Individual).
21        (3) Level 1 (Group).
22        (4) Level 2 (Individual).
23        (5) Level 2 (Group).
24        (6) Case Management.
25        (7) Psychiatric Evaluation.
26        (8) Medication Assisted Recovery.

 

 

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1        (9) Community Intervention.
2        (10) Early Intervention (Individual).
3        (11) Early Intervention (Group).
4    Beginning in State Fiscal Year 2023, and every State
5fiscal year thereafter, reimbursement rates for those
6community-based substance use disorder treatment and
7intervention services shall be adjusted upward by an amount
8equal to the Consumer Price Index-U from the previous year,
9not to exceed 2% in any State fiscal year. If there is a
10decrease in the Consumer Price Index-U, rates shall remain
11unchanged for that State fiscal year. The Department shall
12adopt rules, including emergency rules in accordance with the
13Illinois Administrative Procedure Act, to implement the
14provisions of this Section.
15    As used in this subsection, "consumer price index-u" means
16the index published by the Bureau of Labor Statistics of the
17United States Department of Labor that measures the average
18change in prices of goods and services purchased by all urban
19consumers, United States city average, all items, 1982-84 =
20100.
21(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
22100-759, eff. 1-1-19; 101-81, eff. 7-12-19.)
 
23    Section 15-15. Illinois Public Aid Code is amended by
24adding Section 5-45 as follows:
 

 

 

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1    (305 ILCS 5/5-45 new)
2    Sec. 5-45. Reimbursement rates; substance use disorder
3treatment providers and facilities. Beginning on July 1, 2022,
4the Department of Human Services' Division of Substance Use
5Prevention and Recovery in conjunction with the Department of
6Healthcare and Family Services, shall provide for an increase
7in reimbursement rates by way of an increase to existing rates
8of 47% for all community-based substance use disorder
9treatment services, including, but not limited to, all of the
10following:
11        (1) Admission and Discharge Assessment.
12        (2) Level 1 (Individual).
13        (3) Level 1 (Group).
14        (4) Level 2 (Individual).
15        (5) Level 2 (Group).
16        (6) Psychiatric/Diagnostic.
17        (7) Medication Monitoring (Individual).
18        (8) Methadone as an Adjunct to Treatment.
19    No existing or future reimbursement rates or add-ons shall
20be reduced or changed to address the rate increase proposed
21under this Section. The Department of Healthcare and Family
22Services shall immediately, no later than 3 months following
23the effective date of this amendatory Act of the 102nd General
24Assembly, submit any necessary application to the federal
25Centers for Medicare and Medicaid Services for a waiver or
26State Plan amendment to implement the requirements of this

 

 

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1Section. Beginning in State Fiscal year 2023, and every State
2fiscal year thereafter, reimbursement rates for those
3community-based substance use disorder treatment services
4shall be adjusted upward by an amount equal to the Consumer
5Price Index-U from the previous year, not to exceed 2% in any
6State fiscal year. If there is a decrease in the Consumer Price
7Index-U, rates shall remain unchanged for that State fiscal
8year. The Department of Human Services shall adopt rules,
9including emergency rules under Section 5-45.1 of the Illinois
10Administrative Procedure Act, to implement the provisions of
11this Section.
12    As used in this Section, "consumer price index-u" means
13the index published by the Bureau of Labor Statistics of the
14United States Department of Labor that measures the average
15change in prices of goods and services purchased by all urban
16consumers, United States city average, all items, 1982-84 =
17100.
 
18
Article 99.

 
19    Section 99-999. Effective date. This Act takes effect upon
20becoming law.".