Full Text of HB2154 101st General Assembly
HB2154enr 101ST GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. References to Act; intent; purposes. This Act | 5 | | may be referred to as the Children and Young Adult Mental | 6 | | Health Crisis Act. It is intended to fill in significant gaps | 7 | | in Illinois' mental health treatment system for children and | 8 | | young adults given that this is the age group that most mental | 9 | | health conditions begin to manifest. | 10 | | Section 5. Findings. The General Assembly finds as follows: | 11 | | (1) Over 850,000 children and young adults under age 25 in | 12 | | Illinois will experience a mental health condition. Barely | 13 | | one-third will get treatment even though treatment can lead to | 14 | | recovery and wellness. | 15 | | (2) Every year hundreds of Illinois children with treatable | 16 | | serious mental health conditions are forced to remain in | 17 | | psychiatric hospitals far beyond medical necessity because | 18 | | subsequent treatment options are not available. | 19 | | (3) There are many gaps in Illinois' publicly funded mental | 20 | | health system, and private insurance does not cover proven | 21 | | treatment approaches covered by the public sector. | 22 | | (4) Children and young adults must have access to the level | 23 | | of mental health treatment they need at the first signs of a |
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| 1 | | problem to prevent worsening of the condition and the use of | 2 | | substances for purposes of self-medication. | 3 | | (5) Illinois' mental health system for children and young | 4 | | adults must align with system of care principles, which were | 5 | | developed by The Georgetown University Center for Child and | 6 | | Human Development and are the nationally recognized best | 7 | | practices for developing a strong treatment system. | 8 | | (6) This Act contains many of the crucial elements that | 9 | | Illinois requires for building an appropriate service delivery | 10 | | system and for coverage of a comprehensive array of services | 11 | | through private insurance. | 12 | | Section 10. The State Employees Group Insurance Act of 1971 | 13 | | is amended by changing Section 6.11 as follows:
| 14 | | (5 ILCS 375/6.11)
| 15 | | (Text of Section before amendment by P.A. 100-1170 ) | 16 | | Sec. 6.11. Required health benefits; Illinois Insurance | 17 | | Code
requirements. The program of health
benefits shall provide | 18 | | the post-mastectomy care benefits required to be covered
by a | 19 | | policy of accident and health insurance under Section 356t of | 20 | | the Illinois
Insurance Code. The program of health benefits | 21 | | shall provide the coverage
required under Sections 356g, | 22 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 23 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 24 | | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and |
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| 1 | | 356z.29 , 356z.32, and 356z.33 of the
Illinois Insurance Code.
| 2 | | The program of health benefits must comply with Sections | 3 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
| 4 | | Illinois Insurance Code. The Department of Insurance shall | 5 | | enforce the requirements of this Section.
| 6 | | Rulemaking authority to implement Public Act 95-1045, if | 7 | | any, is conditioned on the rules being adopted in accordance | 8 | | with all provisions of the Illinois Administrative Procedure | 9 | | Act and all rules and procedures of the Joint Committee on | 10 | | Administrative Rules; any purported rule not so adopted, for | 11 | | whatever reason, is unauthorized. | 12 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 13 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 14 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 15 | | 1-8-19.) | 16 | | (Text of Section after amendment by P.A. 100-1170 ) | 17 | | Sec. 6.11. Required health benefits; Illinois Insurance | 18 | | Code
requirements. The program of health
benefits shall provide | 19 | | the post-mastectomy care benefits required to be covered
by a | 20 | | policy of accident and health insurance under Section 356t of | 21 | | the Illinois
Insurance Code. The program of health benefits | 22 | | shall provide the coverage
required under Sections 356g, | 23 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 24 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 25 | | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, |
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| 1 | | and 356z.32 , and 356z.33 of the
Illinois Insurance Code.
The | 2 | | program of health benefits must comply with Sections 155.22a, | 3 | | 155.37, 355b, 356z.19, 370c, and 370c.1 of the
Illinois | 4 | | Insurance Code. The Department of Insurance shall enforce the | 5 | | requirements of this Section with respect to Sections 370c and | 6 | | 370c.1 of the Illinois Insurance Code; all other requirements | 7 | | of this Section shall be enforced by the Department of Central | 8 | | Management Services.
| 9 | | Rulemaking authority to implement Public Act 95-1045, if | 10 | | any, is conditioned on the rules being adopted in accordance | 11 | | with all provisions of the Illinois Administrative Procedure | 12 | | Act and all rules and procedures of the Joint Committee on | 13 | | Administrative Rules; any purported rule not so adopted, for | 14 | | whatever reason, is unauthorized. | 15 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 16 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 17 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; | 18 | | 100-1170, eff. 6-1-19.) | 19 | | Section 15. The Counties Code is amended by changing | 20 | | Section 5-1069.3 as follows: | 21 | | (55 ILCS 5/5-1069.3)
| 22 | | Sec. 5-1069.3. Required health benefits. If a county, | 23 | | including a home
rule
county, is a self-insurer for purposes of | 24 | | providing health insurance coverage
for its employees, the |
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| 1 | | coverage shall include coverage for the post-mastectomy
care | 2 | | benefits required to be covered by a policy of accident and | 3 | | health
insurance under Section 356t and the coverage required | 4 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 5 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 6 | | 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29 , | 7 | | 356z.32, and 356z.33 of
the Illinois Insurance Code. The | 8 | | coverage shall comply with Sections 155.22a, 355b, 356z.19, and | 9 | | 370c of
the Illinois Insurance Code. The Department of | 10 | | Insurance shall enforce the requirements of this Section. The | 11 | | requirement that health benefits be covered
as provided in this | 12 | | Section is an
exclusive power and function of the State and is | 13 | | a denial and limitation under
Article VII, Section 6, | 14 | | subsection (h) of the Illinois Constitution. A home
rule county | 15 | | to which this Section applies must comply with every provision | 16 | | of
this Section.
| 17 | | Rulemaking authority to implement Public Act 95-1045, if | 18 | | any, is conditioned on the rules being adopted in accordance | 19 | | with all provisions of the Illinois Administrative Procedure | 20 | | Act and all rules and procedures of the Joint Committee on | 21 | | Administrative Rules; any purported rule not so adopted, for | 22 | | whatever reason, is unauthorized. | 23 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 24 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 25 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 26 | | 10-3-18.) |
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| 1 | | Section 20. The Illinois Municipal Code is amended by | 2 | | changing Section 10-4-2.3 as follows: | 3 | | (65 ILCS 5/10-4-2.3)
| 4 | | Sec. 10-4-2.3. Required health benefits. If a | 5 | | municipality, including a
home rule municipality, is a | 6 | | self-insurer for purposes of providing health
insurance | 7 | | coverage for its employees, the coverage shall include coverage | 8 | | for
the post-mastectomy care benefits required to be covered by | 9 | | a policy of
accident and health insurance under Section 356t | 10 | | and the coverage required
under Sections 356g, 356g.5, | 11 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 12 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | 13 | | and 356z.26, and 356z.29 , 356z.32, and 356z.33 of the Illinois
| 14 | | Insurance
Code. The coverage shall comply with Sections | 15 | | 155.22a, 355b, 356z.19, and 370c of
the Illinois Insurance | 16 | | Code. The Department of Insurance shall enforce the | 17 | | requirements of this Section. The requirement that health
| 18 | | benefits be covered as provided in this is an exclusive power | 19 | | and function of
the State and is a denial and limitation under | 20 | | Article VII, Section 6,
subsection (h) of the Illinois | 21 | | Constitution. A home rule municipality to which
this Section | 22 | | applies must comply with every provision of this Section.
| 23 | | Rulemaking authority to implement Public Act 95-1045, if | 24 | | any, is conditioned on the rules being adopted in accordance |
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| 1 | | with all provisions of the Illinois Administrative Procedure | 2 | | Act and all rules and procedures of the Joint Committee on | 3 | | Administrative Rules; any purported rule not so adopted, for | 4 | | whatever reason, is unauthorized. | 5 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 6 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 7 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 8 | | 10-4-18.) | 9 | | Section 25. The School Code is amended by changing Section | 10 | | 10-22.3f as follows: | 11 | | (105 ILCS 5/10-22.3f)
| 12 | | Sec. 10-22.3f. Required health benefits. Insurance | 13 | | protection and
benefits
for employees shall provide the | 14 | | post-mastectomy care benefits required to be
covered by a | 15 | | policy of accident and health insurance under Section 356t and | 16 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 17 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 18 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and | 19 | | 356z.29 , 356z.32, and 356z.33 of
the
Illinois Insurance Code.
| 20 | | Insurance policies shall comply with Section 356z.19 of the | 21 | | Illinois Insurance Code. The coverage shall comply with | 22 | | Sections 155.22a, 355b, and 370c of
the Illinois Insurance | 23 | | Code. The Department of Insurance shall enforce the | 24 | | requirements of this Section.
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| 1 | | Rulemaking authority to implement Public Act 95-1045, if | 2 | | any, is conditioned on the rules being adopted in accordance | 3 | | with all provisions of the Illinois Administrative Procedure | 4 | | Act and all rules and procedures of the Joint Committee on | 5 | | Administrative Rules; any purported rule not so adopted, for | 6 | | whatever reason, is unauthorized. | 7 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 8 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 9 | | 1-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.) | 10 | | Section 30. The Illinois Insurance Code is amended by | 11 | | adding Section 356z.33 as follows: | 12 | | (215 ILCS 5/356z.33 new) | 13 | | Sec. 356z.33. Coverage of treatment models for early | 14 | | treatment of serious mental illnesses. | 15 | | (a) For purposes of early treatment of a serious mental | 16 | | illness in a child or young adult under age 26, a group or | 17 | | individual policy of accident and health insurance, or managed | 18 | | care plan, that is amended, delivered, issued, or renewed after | 19 | | December 31, 2020 shall provide coverage of the following | 20 | | bundled, evidence-based treatment: | 21 | | (1) Coordinated specialty care for first episode | 22 | | psychosis treatment, covering the elements of the | 23 | | treatment model included in the most recent national | 24 | | research trials conducted by the National Institute of |
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| 1 | | Mental Health in the Recovery After an Initial | 2 | | Schizophrenia Episode (RAISE) trials for psychosis | 3 | | resulting from a serious mental illness, but excluding the | 4 | | components of the treatment model related to education and | 5 | | employment support. | 6 | | (2) Assertive community treatment (ACT) and community | 7 | | support team (CST) treatment. The elements of ACT and CST | 8 | | to be covered shall include those covered under Article V | 9 | | of the Illinois Public Aid Code, through 89 Ill. Adm. Code | 10 | | 140.453(d)(4). | 11 | | (b) Adherence to the clinical models. For purposes of | 12 | | ensuring adherence to the coordinated specialty care for first | 13 | | episode psychosis treatment model, only providers contracted | 14 | | with the Department of Human Services' Division of Mental | 15 | | Health to be FIRST.IL providers to deliver coordinated | 16 | | specialty care for first episode psychosis treatment shall be | 17 | | permitted to provide such treatment in accordance with this | 18 | | Section and such providers must adhere to the fidelity of the | 19 | | treatment model. For purposes of ensuring fidelity to ACT and | 20 | | CST, only providers certified to provide ACT and CST by the | 21 | | Department of Human Services' Division of Mental Health and | 22 | | approved to provide ACT and CST by the Department of Healthcare | 23 | | and Family Services, or its designee, in accordance with 89 | 24 | | Ill. Adm. Code 140, shall be permitted to provide such services | 25 | | under this Section and such providers shall be required to | 26 | | adhere to the fidelity of the models. |
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| 1 | | (c) Development of medical necessity criteria for | 2 | | coverage. Within 6 months after the effective date of this | 3 | | amendatory Act of the 101st General Assembly, the Department of | 4 | | Insurance shall lead and convene a workgroup that includes the | 5 | | Department of Human Services' Division of Mental Health, the | 6 | | Department of Healthcare and Family Services, providers of the | 7 | | treatment models listed in this Section, and insurers operating | 8 | | in Illinois to develop medical necessity criteria for such | 9 | | treatment models for purposes of coverage under this Section. | 10 | | The workgroup shall use the medical necessity criteria the | 11 | | State and other states use as guidance for establishing medical | 12 | | necessity for insurance coverage. The Department of Insurance | 13 | | shall adopt a rule that defines medical necessity for each of | 14 | | the 3 treatment models listed in this Section by no later than | 15 | | June 30, 2020 based on the workgroup's recommendations. | 16 | | (d) For purposes of credentialing the mental health | 17 | | professionals and other medical professionals that are part of | 18 | | a coordinated specialty care for first episode psychosis | 19 | | treatment team, an ACT team, or a CST team, the credentialing | 20 | | of the psychiatrist or the licensed clinical leader of the | 21 | | treatment team shall qualify all members of the treatment team | 22 | | to be credentialed with the insurer. | 23 | | (e) Payment for the services performed under the treatment | 24 | | models listed in this Section shall be based on a bundled | 25 | | treatment model or payment, rather than payment for each | 26 | | separate service delivered by a treatment team member. By no |
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| 1 | | later than 6 months after the effective date of this amendatory | 2 | | Act of the 101st General Assembly, the Department of Insurance | 3 | | shall convene a workgroup of Illinois insurance companies and | 4 | | Illinois mental health treatment providers that deliver the | 5 | | bundled treatment approaches listed in this Section to | 6 | | determine a coding solution that allows for these bundled | 7 | | treatment models to be coded and paid for as a bundle of | 8 | | services, similar to intensive outpatient treatment where | 9 | | multiple services are covered under one billing code or a | 10 | | bundled set of billing codes. The coding solution shall ensure | 11 | | that services delivered using coordinated specialty care for | 12 | | first episode psychosis treatment, ACT, or CST are provided and | 13 | | billed as a bundled service, rather than for each individual | 14 | | service provided by a treatment team member, which would | 15 | | deconstruct the evidence-based practice. The coding solution | 16 | | shall be reached prior to coverage, which shall begin for plans | 17 | | amended, delivered, issued, or renewed after December 31, 2020, | 18 | | to ensure coverage of the treatment team approaches as intended | 19 | | by this Section. | 20 | | (f) If, at any time, the Secretary of the United States | 21 | | Department of Health and Human Services, or its successor | 22 | | agency, adopts rules or regulations to be published in the | 23 | | Federal Register or publishes a comment in the Federal Register | 24 | | or issues an opinion, guidance, or other action that would | 25 | | require the State, under any provision of the Patient | 26 | | Protection and Affordable Care Act (P.L. 111-148), including, |
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| 1 | | but not limited to, 42 U.S.C. 18031(d)(3)(b), or any successor | 2 | | provision, to defray the cost of any coverage for serious | 3 | | mental illnesses or serious emotional disturbances outlined in | 4 | | this Section, then the requirement that a group or individual | 5 | | policy of accident and health insurance or managed care plan | 6 | | cover the bundled treatment approaches listed in this Section | 7 | | is inoperative other than any such coverage authorized under | 8 | | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and | 9 | | the State shall not assume any obligation for the cost of the | 10 | | coverage. | 11 | | (g) After 5 years following full implementation of this | 12 | | Section, if requested by an insurer, the Department of | 13 | | Insurance shall contract with an independent third party with | 14 | | expertise in analyzing health insurance premiums and costs to | 15 | | perform an independent analysis of the impact coverage of the | 16 | | team-based treatment models listed in this Section has had on | 17 | | insurance premiums in Illinois. If premiums increased by more | 18 | | than 1% annually solely due to coverage of these treatment | 19 | | models, coverage of these models shall no longer be required. | 20 | | (h) The Department of Insurance shall adopt any rules | 21 | | necessary to implement the provisions of this Section by no | 22 | | later than June 30, 2020. | 23 | | Section 35. The Health Maintenance Organization Act is | 24 | | amended by changing Section 5-3 as follows:
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| 1 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 2 | | Sec. 5-3. Insurance Code provisions.
| 3 | | (a) Health Maintenance Organizations
shall be subject to | 4 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 5 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 6 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 7 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 8 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 9 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 10 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, | 11 | | 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, | 12 | | 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, | 13 | | 409, 412, 444,
and
444.1,
paragraph (c) of subsection (2) of | 14 | | Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, | 15 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 16 | | (b) For purposes of the Illinois Insurance Code, except for | 17 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 18 | | Maintenance Organizations in
the following categories are | 19 | | deemed to be "domestic companies":
| 20 | | (1) a corporation authorized under the
Dental Service | 21 | | Plan Act or the Voluntary Health Services Plans Act;
| 22 | | (2) a corporation organized under the laws of this | 23 | | State; or
| 24 | | (3) a corporation organized under the laws of another | 25 | | state, 30% or more
of the enrollees of which are residents | 26 | | of this State, except a
corporation subject to |
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| 1 | | substantially the same requirements in its state of
| 2 | | organization as is a "domestic company" under Article VIII | 3 | | 1/2 of the
Illinois Insurance Code.
| 4 | | (c) In considering the merger, consolidation, or other | 5 | | acquisition of
control of a Health Maintenance Organization | 6 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 7 | | (1) the Director shall give primary consideration to | 8 | | the continuation of
benefits to enrollees and the financial | 9 | | conditions of the acquired Health
Maintenance Organization | 10 | | after the merger, consolidation, or other
acquisition of | 11 | | control takes effect;
| 12 | | (2)(i) the criteria specified in subsection (1)(b) of | 13 | | Section 131.8 of
the Illinois Insurance Code shall not | 14 | | apply and (ii) the Director, in making
his determination | 15 | | with respect to the merger, consolidation, or other
| 16 | | acquisition of control, need not take into account the | 17 | | effect on
competition of the merger, consolidation, or | 18 | | other acquisition of control;
| 19 | | (3) the Director shall have the power to require the | 20 | | following
information:
| 21 | | (A) certification by an independent actuary of the | 22 | | adequacy
of the reserves of the Health Maintenance | 23 | | Organization sought to be acquired;
| 24 | | (B) pro forma financial statements reflecting the | 25 | | combined balance
sheets of the acquiring company and | 26 | | the Health Maintenance Organization sought
to be |
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| 1 | | acquired as of the end of the preceding year and as of | 2 | | a date 90 days
prior to the acquisition, as well as pro | 3 | | forma financial statements
reflecting projected | 4 | | combined operation for a period of 2 years;
| 5 | | (C) a pro forma business plan detailing an | 6 | | acquiring party's plans with
respect to the operation | 7 | | of the Health Maintenance Organization sought to
be | 8 | | acquired for a period of not less than 3 years; and
| 9 | | (D) such other information as the Director shall | 10 | | require.
| 11 | | (d) The provisions of Article VIII 1/2 of the Illinois | 12 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 13 | | any health maintenance
organization of greater than 10% of its
| 14 | | enrollee population (including without limitation the health | 15 | | maintenance
organization's right, title, and interest in and to | 16 | | its health care
certificates).
| 17 | | (e) In considering any management contract or service | 18 | | agreement subject
to Section 141.1 of the Illinois Insurance | 19 | | Code, the Director (i) shall, in
addition to the criteria | 20 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 21 | | into account the effect of the management contract or
service | 22 | | agreement on the continuation of benefits to enrollees and the
| 23 | | financial condition of the health maintenance organization to | 24 | | be managed or
serviced, and (ii) need not take into account the | 25 | | effect of the management
contract or service agreement on | 26 | | competition.
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| 1 | | (f) Except for small employer groups as defined in the | 2 | | Small Employer
Rating, Renewability and Portability Health | 3 | | Insurance Act and except for
medicare supplement policies as | 4 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 5 | | Maintenance Organization may by contract agree with a
group or | 6 | | other enrollment unit to effect refunds or charge additional | 7 | | premiums
under the following terms and conditions:
| 8 | | (i) the amount of, and other terms and conditions with | 9 | | respect to, the
refund or additional premium are set forth | 10 | | in the group or enrollment unit
contract agreed in advance | 11 | | of the period for which a refund is to be paid or
| 12 | | additional premium is to be charged (which period shall not | 13 | | be less than one
year); and
| 14 | | (ii) the amount of the refund or additional premium | 15 | | shall not exceed 20%
of the Health Maintenance | 16 | | Organization's profitable or unprofitable experience
with | 17 | | respect to the group or other enrollment unit for the | 18 | | period (and, for
purposes of a refund or additional | 19 | | premium, the profitable or unprofitable
experience shall | 20 | | be calculated taking into account a pro rata share of the
| 21 | | Health Maintenance Organization's administrative and | 22 | | marketing expenses, but
shall not include any refund to be | 23 | | made or additional premium to be paid
pursuant to this | 24 | | subsection (f)). The Health Maintenance Organization and | 25 | | the
group or enrollment unit may agree that the profitable | 26 | | or unprofitable
experience may be calculated taking into |
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| 1 | | account the refund period and the
immediately preceding 2 | 2 | | plan years.
| 3 | | The Health Maintenance Organization shall include a | 4 | | statement in the
evidence of coverage issued to each enrollee | 5 | | describing the possibility of a
refund or additional premium, | 6 | | and upon request of any group or enrollment unit,
provide to | 7 | | the group or enrollment unit a description of the method used | 8 | | to
calculate (1) the Health Maintenance Organization's | 9 | | profitable experience with
respect to the group or enrollment | 10 | | unit and the resulting refund to the group
or enrollment unit | 11 | | or (2) the Health Maintenance Organization's unprofitable
| 12 | | experience with respect to the group or enrollment unit and the | 13 | | resulting
additional premium to be paid by the group or | 14 | | enrollment unit.
| 15 | | In no event shall the Illinois Health Maintenance | 16 | | Organization
Guaranty Association be liable to pay any | 17 | | contractual obligation of an
insolvent organization to pay any | 18 | | refund authorized under this Section.
| 19 | | (g) Rulemaking authority to implement Public Act 95-1045, | 20 | | if any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for | 24 | | whatever reason, is unauthorized. | 25 | | (Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; | 26 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff. |
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| 1 | | 8-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 2 | | 10-4-18.) | 3 | | Section 40. The Illinois Public Aid Code is amended by | 4 | | changing Section 5-5.23 and by adding Sections 5-36, 5-37, and | 5 | | 5-38 as follows:
| 6 | | (305 ILCS 5/5-5.23)
| 7 | | Sec. 5-5.23. Children's mental health services.
| 8 | | (a) The Department of Healthcare and Family Services, by | 9 | | rule, shall require the screening and
assessment of
a child | 10 | | prior to any Medicaid-funded admission to an inpatient hospital | 11 | | for
psychiatric
services to be funded by Medicaid. The | 12 | | screening and assessment shall include a
determination of the | 13 | | appropriateness and availability of out-patient support
| 14 | | services
for necessary treatment. The Department, by rule, | 15 | | shall establish methods and
standards of payment for the | 16 | | screening, assessment, and necessary alternative
support
| 17 | | services.
| 18 | | (b) The Department of Healthcare and Family Services, to | 19 | | the extent allowable under federal law,
shall secure federal | 20 | | financial participation for Individual Care Grant
expenditures | 21 | | made
by the Department of Healthcare and Family Services for | 22 | | the Medicaid optional service
authorized under
Section 1905(h) | 23 | | of the federal Social Security Act, pursuant to the provisions
| 24 | | of Section
7.1 of the Mental Health and Developmental |
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| 1 | | Disabilities Administrative Act. The
Department of Healthcare | 2 | | and Family Services may exercise the
authority under this | 3 | | Section as is necessary to administer
Individual Care Grants as | 4 | | authorized under Section 7.1 of the
Mental Health and | 5 | | Developmental Disabilities Administrative
Act.
| 6 | | (c) The Department of Healthcare and Family Services shall | 7 | | work collaboratively with the Department of Children and Family
| 8 | | Services and the Division of Mental Health of the Department of
| 9 | | Human Services to implement subsections (a) and (b).
| 10 | | (d) On and after July 1, 2012, the Department shall reduce | 11 | | any rate of reimbursement for services or other payments or | 12 | | alter any methodologies authorized by this Code to reduce any | 13 | | rate of reimbursement for services or other payments in | 14 | | accordance with Section 5-5e. | 15 | | (e) All rights, powers, duties, and responsibilities | 16 | | currently exercised by the Department of Human Services related | 17 | | to the Individual Care Grant program are transferred to the | 18 | | Department of Healthcare and Family Services with the transfer | 19 | | and transition of the Individual Care Grant program to the | 20 | | Department of Healthcare and Family Services to be completed | 21 | | and implemented within 6 months after the effective date of | 22 | | this amendatory Act of the 99th General Assembly. For the | 23 | | purposes of the Successor Agency Act, the Department of | 24 | | Healthcare and Family Services is declared to be the successor | 25 | | agency of the Department of Human Services, but only with | 26 | | respect to the functions of the Department of Human Services |
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| 1 | | that are transferred to the Department of Healthcare and Family | 2 | | Services under this amendatory Act of the 99th General | 3 | | Assembly. | 4 | | (1) Each act done by the Department of Healthcare and | 5 | | Family Services in exercise of the transferred powers, | 6 | | duties, rights, and responsibilities shall have the same | 7 | | legal effect as if done by the Department of Human Services | 8 | | or its offices. | 9 | | (2) Any rules of the Department of Human Services that | 10 | | relate to the functions and programs transferred by this | 11 | | amendatory Act of the 99th General Assembly that are in | 12 | | full force on the effective date of this amendatory Act of | 13 | | the 99th General Assembly shall become the rules of the | 14 | | Department of Healthcare and Family Services. All rules | 15 | | transferred under this amendatory Act of the 99th General | 16 | | Assembly are hereby amended such that the term "Department" | 17 | | shall be defined as the Department of Healthcare and Family | 18 | | Services and all references to the "Secretary" shall be | 19 | | changed to the "Director of Healthcare and Family Services | 20 | | or his or her designee". As soon as practicable hereafter, | 21 | | the Department of Healthcare and Family Services shall | 22 | | revise and clarify the rules to reflect the transfer of | 23 | | rights, powers, duties, and responsibilities affected by | 24 | | this amendatory Act of the 99th General Assembly, using the | 25 | | procedures for recodification of rules available under the | 26 | | Illinois Administrative Procedure Act, except that |
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| 1 | | existing title, part, and section numbering for the | 2 | | affected rules may be retained. The Department of | 3 | | Healthcare and Family Services, consistent with its | 4 | | authority to do so as granted by this amendatory Act of the | 5 | | 99th General Assembly, shall propose and adopt any other | 6 | | rules under the Illinois Administrative Procedure Act as | 7 | | necessary to administer the Individual Care Grant program. | 8 | | These rules may include, but are not limited to, the | 9 | | application process and eligibility requirements for | 10 | | recipients. | 11 | | (3) All unexpended appropriations and balances and | 12 | | other funds available for use in connection with any | 13 | | functions of the Individual Care Grant program shall be | 14 | | transferred for the use of the Department of Healthcare and | 15 | | Family Services to operate the Individual Care Grant | 16 | | program. Unexpended balances shall be expended only for the | 17 | | purpose for which the appropriation was originally made. | 18 | | The Department of Healthcare and Family Services shall | 19 | | exercise all rights, powers, duties, and responsibilities | 20 | | for operation of the Individual Care Grant program. | 21 | | (4) Existing personnel and positions of the Department | 22 | | of Human Services pertaining to the administration of the | 23 | | Individual Care Grant program shall be transferred to the | 24 | | Department of Healthcare and Family Services with the | 25 | | transfer and transition of the Individual Care Grant | 26 | | program to the Department of Healthcare and Family |
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| 1 | | Services. The status and rights of Department of Human | 2 | | Services employees engaged in the performance of the | 3 | | functions of the Individual Care Grant program shall not be | 4 | | affected by this amendatory Act of the 99th General | 5 | | Assembly. The rights of the employees, the State of | 6 | | Illinois, and its agencies under the Personnel Code and | 7 | | applicable collective bargaining agreements or under any | 8 | | pension, retirement, or annuity plan shall not be affected | 9 | | by this amendatory Act of the 99th General Assembly. All | 10 | | transferred employees who are members of collective | 11 | | bargaining units shall retain their seniority, continuous | 12 | | service, salary, and accrued benefits. | 13 | | (5) All books, records, papers, documents, property | 14 | | (real and personal), contracts, and pending business | 15 | | pertaining to the powers, duties, rights, and | 16 | | responsibilities related to the functions of the | 17 | | Individual Care Grant program, including, but not limited | 18 | | to, material in electronic or magnetic format and necessary | 19 | | computer hardware and software, shall be delivered to the | 20 | | Department of Healthcare and Family Services; provided, | 21 | | however, that the delivery of this information shall not | 22 | | violate any applicable confidentiality constraints. | 23 | | (6) Whenever reports or notices are now required to be
| 24 | | made or given or papers or documents furnished or served by | 25 | | any person to or upon the Department of Human Services in | 26 | | connection with any of the functions transferred by this |
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| 1 | | amendatory Act of the 99th General Assembly, the same shall | 2 | | be made, given, furnished, or served in the same manner to | 3 | | or upon the Department of Healthcare and Family Services. | 4 | | (7) This amendatory Act of the 99th General Assembly | 5 | | shall not affect any act done, ratified, or canceled or any | 6 | | right occurring or established or any action or proceeding | 7 | | had or commenced in an administrative, civil, or criminal | 8 | | cause regarding the Department of Human Services before the | 9 | | effective date of this amendatory Act of the 99th General | 10 | | Assembly; and those actions or proceedings may be defended, | 11 | | prosecuted, and continued by the Department of Human | 12 | | Services. | 13 | | (f) (Blank). The Individual Care Grant program shall be | 14 | | inoperative during the calendar year in which implementation | 15 | | begins of any remedies in response to litigation against the | 16 | | Department of Healthcare and Family Services related to | 17 | | children's behavioral health and the general status of | 18 | | children's behavioral health in this State. Individual Care | 19 | | Grant recipients in the program the year it becomes inoperative | 20 | | shall continue to remain in the program until it is clinically | 21 | | appropriate for them to step down in level of care. | 22 | | (g) Family Support Program. The Department of Healthcare | 23 | | and Family Services shall restructure the Family Support | 24 | | Program, formerly known as the Individual Care Grant program, | 25 | | to enable early treatment of youth, emerging adults, and | 26 | | transition-age adults with a serious mental illness or serious |
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| 1 | | emotional disturbance. | 2 | | (1) As used in this subsection and in subsections (h) | 3 | | through (s): | 4 | | (A) "Youth" means a person under the age of 18. | 5 | | (B) "Emerging adult" means a person who is 18 | 6 | | through 20 years of age. | 7 | | (C) "Transition-age adult" means a person who is 21 | 8 | | through 25 years of age. | 9 | | (2) The Department shall amend 89 Ill.
Adm. Code 139 in | 10 | | accordance with this Section and consistent with the | 11 | | timelines outlined in this Section. | 12 | | (3) Implementation of any amended requirements shall | 13 | | be completed within 8 months of the adoption of any | 14 | | amendment to 89 Ill.
Adm. Code 139 that is consistent with | 15 | | the provisions of this Section. | 16 | | (4) To align the Family Support Program with the | 17 | | Medicaid system of care, the services available to a youth, | 18 | | emerging adult, or transition-age adult through the Family | 19 | | Support Program shall include all Medicaid community-based | 20 | | mental health treatment services and all Family Support | 21 | | Program services included under 89 Ill.
Adm. Code 139. No | 22 | | person receiving services through the Family Support | 23 | | Program or the Specialized Family Support Program shall | 24 | | become a Medicaid enrollee unless Medicaid eligibility | 25 | | criteria are met and the person is enrolled in Medicaid. No | 26 | | part of this Section creates an entitlement to services |
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| 1 | | through the Family Support Program, the Specialized Family | 2 | | Support Program, or the Medicaid program. | 3 | | (5) The Family Support Program shall align with the | 4 | | following system of care principles: | 5 | | (A) Treatment and support services shall be based | 6 | | on the results of an integrated behavioral health | 7 | | assessment and treatment plan using an instrument | 8 | | approved by the Department of Healthcare and Family | 9 | | Services. | 10 | | (B)
Strong interagency collaboration between all | 11 | | State agencies the parent or legal guardian is involved | 12 | | with for services, including the Department of | 13 | | Healthcare and Family Services, the Department of | 14 | | Human Services, the Department of Children and Family | 15 | | Services, the Department of Juvenile Justice, and the | 16 | | Illinois State Board of Education. | 17 | | (C)
Individualized, strengths-based practices and | 18 | | trauma-informed treatment approaches. | 19 | | (D)
For a youth, full participation of the parent | 20 | | or legal guardian at all levels of treatment through a | 21 | | process that is family-centered and youth-focused. The | 22 | | process shall include consideration of the services | 23 | | and supports the parent, legal guardian, or caregiver | 24 | | requires for family stabilization, and shall connect | 25 | | such person or persons to services based on available | 26 | | insurance coverage. |
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| 1 | | (h) Eligibility for the Family Support Program. | 2 | | Eligibility criteria established under 89 Ill.
Adm. Code 139 | 3 | | for the Family Support Program shall include the following: | 4 | | (1) Individuals applying to the program must be under | 5 | | the age of 26. | 6 | | (2) Requirements for parental or legal guardian | 7 | | involvement are applicable to youth and to emerging adults | 8 | | or transition-age adults who have a guardian appointed | 9 | | under Article XIa of the Probate Act. | 10 | | (3)
Youth, emerging adults, and transition-age adults | 11 | | are eligible for services under the Family Support Program | 12 | | upon their third inpatient admission to a hospital or | 13 | | similar treatment facility for the primary purpose of | 14 | | psychiatric treatment within the most recent 12 months and | 15 | | are hospitalized for the purpose of psychiatric treatment. | 16 | | (4)
School participation for emerging adults applying | 17 | | for services under the Family Support Program may be waived | 18 | | by request of the individual at the sole discretion of the | 19 | | Department of Healthcare and Family Services. | 20 | | (5) School participation is not applicable to | 21 | | transition-age adults. | 22 | | (i) Notification of Family Support Program and Specialized | 23 | | Family Support Program services. | 24 | | (1) Within 12 months after the effective date of this | 25 | | amendatory Act of the 101st General Assembly, the | 26 | | Department of Healthcare and Family Services, with |
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| 1 | | meaningful stakeholder input through a working group of | 2 | | psychiatric hospitals, Family Support Program providers, | 3 | | family support organizations, the Community and | 4 | | Residential Services Authority, a statewide association | 5 | | representing a majority of hospitals, and foster care | 6 | | alumni advocates, shall establish a clear process by which | 7 | | a youth's or emerging adult's parents, guardian, or | 8 | | caregiver, or the emerging adult or transition-age adult, | 9 | | is identified, notified, and educated about the Family | 10 | | Support Program and the Specialized Family Support Program | 11 | | upon a first psychiatric inpatient hospital admission, and | 12 | | any following psychiatric inpatient admissions. | 13 | | Notification and education may take place through a Family | 14 | | Support Program coordinator, a mobile crisis response | 15 | | provider, a Comprehensive Community Based Youth Services | 16 | | provider, the Community and Residential Services | 17 | | Authority, or any other designated provider or coordinator | 18 | | identified by the Department of Healthcare and Family | 19 | | Services. In developing this process, the Department of | 20 | | Healthcare and Family Services and the working group shall | 21 | | take into account the unique needs of emerging adults and | 22 | | transition-age adults without parental involvement who are | 23 | | eligible for services under the Family Support Program. The | 24 | | Department of Healthcare and Family Services and the | 25 | | working group shall ensure the appropriate provider or | 26 | | coordinator is required to assist individuals and their |
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| 1 | | parents, guardians, or caregivers, as applicable, in the | 2 | | completion of the application or referral process for the | 3 | | Family Support Program or the Specialized Family Support | 4 | | Program. | 5 | | (2) Upon a youth's, emerging adult's or transition-age | 6 | | adult's second psychiatric inpatient hospital admission, | 7 | | the hospital must ensure that the youth's parents, | 8 | | guardian, or caregiver, or the emerging adult or | 9 | | transition-age adult, have been notified of the Family | 10 | | Support Program and the Specialized Family Support Program | 11 | | prior to hospital discharge. | 12 | | (3) Psychiatric lockout as last resort. | 13 | | (A) Prior to referring any youth to the Department | 14 | | of Children and Family Services for the filing of a | 15 | | petition in accordance with subparagraph (c) of | 16 | | paragraph (1) of Section 2-4 of the Juvenile Court Act | 17 | | of 1987 alleging that the youth is dependent because | 18 | | the youth was left in a psychiatric hospital beyond | 19 | | medical necessity, the hospital shall educate the | 20 | | youth and the youth's parents, guardian, or caregiver | 21 | | about the Family Support Program and the Specialized | 22 | | Family Support Program and shall assist with | 23 | | connections to the designated Family Support Program | 24 | | coordinator in the service area. Once this process has | 25 | | begun, any such youth shall be considered a youth for | 26 | | whom an application for the Family Support Program is |
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| 1 | | pending with the Department of Healthcare and Family | 2 | | Services or an active application for the Family | 3 | | Support Program was being reviewed by the Department | 4 | | for the purposes of subparagraph (b) of paragraph (1) | 5 | | of Section 2-4 of the Juvenile Court Act of 1987. | 6 | | (B) No state agency or hospital shall coach a | 7 | | parent or guardian of a youth in a psychiatric hospital | 8 | | inpatient unit to lock out or otherwise relinquish | 9 | | custody of a youth to the Department of Children and | 10 | | Family Services for the sole purpose of obtaining | 11 | | necessary mental health treatment for the youth. In the | 12 | | absence of abuse or neglect, a psychiatric lockout or | 13 | | custody relinquishment to the Department of Children | 14 | | and Family Services shall only be considered as the | 15 | | option of last resort. | 16 | | (4) Development of new Family Support Program | 17 | | services. | 18 | | (A) Development of specialized therapeutic | 19 | | residential treatment for youth and emerging adults | 20 | | with high-acuity mental health conditions. Through a | 21 | | working group led by the Department of Healthcare and | 22 | | Family Services that includes the Department of | 23 | | Children and Family Services and residential treatment | 24 | | providers for youth and emerging adults, the | 25 | | Department of Healthcare and Family Services, within | 26 | | 12 months after the effective date of this amendatory |
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| 1 | | Act of the 101st General Assembly, shall develop a plan | 2 | | for the development of specialized therapeutic | 3 | | residential treatment beds similar to a qualified | 4 | | residential treatment program, as defined in the | 5 | | federal Family First Prevention Services Act, for | 6 | | youth in the Family Support Program with high-acuity | 7 | | mental health needs. The Department of Healthcare and | 8 | | Family Services and the Department of Children and | 9 | | Family Services shall work together to maximize | 10 | | federal funding through Medicaid and Title IV-E of the | 11 | | Social Security Act in the development and | 12 | | implementation of this plan. | 13 | | (B) Using the Department of Children and Family | 14 | | Services' beyond medical necessity data over the last 5 | 15 | | years and any other relevant, available data, the | 16 | | Department of Healthcare and Family Services shall | 17 | | assess the estimated number of these specialized | 18 | | high-acuity residential treatment beds that are needed | 19 | | in each region of the State based on the number of | 20 | | youth remaining in psychiatric hospitals beyond | 21 | | medical necessity and the number of youth placed | 22 | | out-of-state who need this level of care. The | 23 | | Department of Healthcare and Family Services shall | 24 | | report the results of this assessment to the General | 25 | | Assembly by no later than December 31, 2020. | 26 | | (C) Development of an age-appropriate therapeutic |
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| 1 | | residential treatment model for emerging adults and | 2 | | transition-age adults. Within 30 months after the | 3 | | effective date of this amendatory Act of the 101st | 4 | | General Assembly, the Department of Healthcare and | 5 | | Family Services, in partnership with the Department of | 6 | | Human Services' Division of Mental Health and with | 7 | | significant and meaningful stakeholder input through a | 8 | | working group of providers and other stakeholders, | 9 | | shall develop a supportive housing model for emerging | 10 | | adults and transition-age adults receiving services | 11 | | through the Family Support Program who need | 12 | | residential treatment and support to enable recovery. | 13 | | Such a model shall be age-appropriate and shall allow | 14 | | the residential component of the model to be in a | 15 | | community-based setting combined with intensive | 16 | | community-based mental health services. | 17 | | (j) Workgroup to develop a plan for improving access to | 18 | | substance use treatment. The Department of Healthcare and | 19 | | Family Services and the Department of Human Services' Division | 20 | | of Substance Use Prevention and Recovery shall co-lead a | 21 | | working group that includes Family Support Program providers, | 22 | | family support organizations, and other stakeholders over a | 23 | | 12-month period beginning in the first quarter of calendar year | 24 | | 2020 to develop a plan for increasing access to substance use | 25 | | treatment services for youth, emerging adults, and | 26 | | transition-age adults who are eligible for Family Support |
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| 1 | | Program services. | 2 | | (k) Appropriation. Implementation of this Section shall be | 3 | | limited by the State's annual appropriation to the Family | 4 | | Support Program. Spending within the Family Support Program | 5 | | appropriation shall be further limited for the new Family | 6 | | Support Program services to be developed accordingly: | 7 | | (1) Targeted use of specialized therapeutic | 8 | | residential treatment for youth and emerging adults with | 9 | | high-acuity mental health conditions through appropriation | 10 | | limitation. No more than 12% of all annual Family Support | 11 | | Program funds shall be spent on this level of care in any | 12 | | given state fiscal year. | 13 | | (2) Targeted use of residential treatment model | 14 | | established for emerging adults and transition-age adults | 15 | | through appropriation limitation. No more than one-quarter | 16 | | of all annual Family Support Program funds shall be spent | 17 | | on this level of care in any given state fiscal year. | 18 | | (l) Exhausting third party insurance coverage first. | 19 | | (A) A parent, legal guardian, emerging adult, or | 20 | | transition-age adult with private insurance coverage shall | 21 | | work with the Department of Healthcare and Family Services, | 22 | | or its designee, to identify insurance coverage for any and | 23 | | all benefits covered by their plan. If insurance | 24 | | cost-sharing by any method for treatment is | 25 | | cost-prohibitive for the parent, legal guardian, emerging | 26 | | adult, or transition-age adult, Family Support Program |
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| 1 | | funds may be applied as a payer of last resort toward | 2 | | insurance cost-sharing for purposes of using private | 3 | | insurance coverage to the fullest extent for the | 4 | | recommended treatment. If the Department, or its agent, has | 5 | | a concern relating to the parent's, legal guardian's, | 6 | | emerging adult's, or transition-age adult's insurer's | 7 | | compliance with Illinois or federal insurance requirements | 8 | | relating to the coverage of mental health or substance use | 9 | | disorders, it shall refer all relevant information to the | 10 | | applicable regulatory authority. | 11 | | (B) The Department of Healthcare and Family Services | 12 | | shall use Medicaid funds first for an individual who has | 13 | | Medicaid coverage if the treatment or service recommended | 14 | | using an integrated behavioral health assessment and | 15 | | treatment plan (using the instrument approved by the | 16 | | Department of Healthcare and Family Services) is covered by | 17 | | Medicaid. | 18 | | (C) If private or public insurance coverage does not | 19 | | cover the needed treatment or service, Family Support | 20 | | Program funds shall be used to cover the services offered | 21 | | through the Family Support Program. | 22 | | (m) Service authorization. A youth, emerging adult, or | 23 | | transition-age adult enrolled in the Family Support Program or | 24 | | the Specialized Family Support Program shall be eligible to | 25 | | receive a mental health treatment service covered by the | 26 | | applicable program if the medical necessity criteria |
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| 1 | | established by the Department of Healthcare and Family Services | 2 | | are met. | 3 | | (n) Streamlined application. The Department of Healthcare | 4 | | and Family Services shall revise the Family Support Program | 5 | | applications and the application process to reflect the changes | 6 | | made to this Section by this amendatory Act of the 101st | 7 | | General Assembly within 8 months after the adoption of any | 8 | | amendments to 89 Ill.
Adm. Code 139. | 9 | | (o) Study of reimbursement policies during planned and | 10 | | unplanned absences of youth and emerging adults in Family | 11 | | Support Program residential treatment settings. The Department | 12 | | of Healthcare and Family Services shall undertake a study of | 13 | | those standards of the Department of Children and Family | 14 | | Services and other states for reimbursement of residential | 15 | | treatment during planned and unplanned absences to determine if | 16 | | reimbursing residential providers for such unplanned absences | 17 | | positively impacts the availability of residential treatment | 18 | | for youth and emerging adults. The Department of Healthcare and | 19 | | Family Services shall begin the study on July 1, 2019 and shall | 20 | | report its findings and the results of the study to the General | 21 | | Assembly, along with any recommendations for or against | 22 | | adopting a similar policy, by December 31, 2020. | 23 | | (p) Public awareness and educational campaign for all | 24 | | relevant providers. The Department of Healthcare and Family | 25 | | Services shall engage in a public awareness campaign to educate | 26 | | hospitals with psychiatric units, crisis response providers |
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| 1 | | such as Screening, Assessment and Support Services providers | 2 | | and Comprehensive Community Based Youth Services agencies, | 3 | | schools, and other community institutions and providers across | 4 | | Illinois on the changes made by this amendatory Act of the | 5 | | 101st General Assembly to the Family Support Program. The | 6 | | Department of Healthcare and Family Services shall produce | 7 | | written materials geared for the appropriate target audience, | 8 | | develop webinars, and conduct outreach visits over a 12-month | 9 | | period beginning after implementation of the changes made to | 10 | | this Section by this amendatory Act of the 101st General | 11 | | Assembly. | 12 | | (q) Maximizing federal matching funds for the Family | 13 | | Support Program and the Specialized Family Support Program. The | 14 | | Department of Healthcare and Family Services, as the sole | 15 | | Medicaid State agency, shall seek approval from the federal | 16 | | Centers for Medicare and Medicaid Services within 12 months | 17 | | after the effective date of this amendatory Act of the 101st | 18 | | General Assembly to draw additional federal Medicaid matching | 19 | | funds for individuals served under the Family Support Program | 20 | | or the Specialized Family Support Program who are not covered | 21 | | by the Department's medical assistance programs. The | 22 | | Department of Children and Family Services, as the State agency | 23 | | responsible for administering federal funds pursuant to Title | 24 | | IV-E of the Social Security Act, shall submit a State Plan to | 25 | | the federal government within 12 months after the effective | 26 | | date of this amendatory Act of the 101st General Assembly to |
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| 1 | | maximize the use of federal Title IV-E prevention funds through | 2 | | the federal Family First Prevention Services Act, to provide | 3 | | mental health and substance use disorder treatment services and | 4 | | supports, including, but not limited to, the provision of | 5 | | short-term crisis and transition beds post-hospitalization for | 6 | | youth who are at imminent risk of entering Illinois' youth | 7 | | welfare system solely due to the inability to access mental | 8 | | health or substance use treatment services. | 9 | | (r) Outcomes and data reported annually to the General | 10 | | Assembly. Beginning in 2021, the Department of Healthcare and | 11 | | Family Services shall submit an annual report to the General | 12 | | Assembly that includes the following information with respect | 13 | | to the time period covered by the report: | 14 | | (1) The number and ages of youth, emerging adults, and | 15 | | transition-age adults who requested services under the | 16 | | Family Support Program and the Specialized Family Support | 17 | | Program and the services received. | 18 | | (2) The number and ages of youth, emerging adults, and | 19 | | transition-age adults who requested services under the | 20 | | Specialized Family Support Program who were eligible for | 21 | | services based on the number of hospitalizations. | 22 | | (3) The number and ages of youth, emerging adults, and | 23 | | transition-age adults who applied for Family Support | 24 | | Program or Specialized Family Support Program services but | 25 | | did not receive any services. | 26 | | (s) Rulemaking authority. Unless a timeline is otherwise |
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| 1 | | specified in a subsection, if amendments to 89 Ill. Adm. Code | 2 | | 139 are needed for implementation of this Section, such | 3 | | amendments shall be filed by the Department of Healthcare and | 4 | | Family Services within one year after the effective date of | 5 | | this amendatory Act of the 101st General Assembly. | 6 | | (Source: P.A. 99-479, eff. 9-10-15.)
| 7 | | (305 ILCS 5/5-36 new) | 8 | | Sec. 5-36. Education on mental health and substance use | 9 | | treatment services for children and young adults. The | 10 | | Department of Healthcare and Family Services shall develop a | 11 | | layman's guide to the mental health and substance use treatment | 12 | | services available in Illinois through the Medical Assistance | 13 | | Program and through the Family Support Program, or other | 14 | | publicly funded programs, similar to what Massachusetts | 15 | | developed, to help families understand what services are | 16 | | available to them when they have a child in need of treatment | 17 | | or support. The guide shall be in easy-to-understand language, | 18 | | be prominently available on the Department of Healthcare and | 19 | | Family Services' website, and be part of a statewide | 20 | | communications campaign to ensure families are aware of Family | 21 | | Support Program services. It shall briefly explain the service | 22 | | and whether it is covered by the Medical Assistance Program, | 23 | | the Family Support Program, or any other public funding source. | 24 | | Within one year after the effective date of this amendatory Act | 25 | | of the 101st General Assembly, the Department of Healthcare and |
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| 1 | | Family Services shall complete this guide, have it available on | 2 | | its website, and launch the communications campaign. | 3 | | (305 ILCS 5/5-37 new) | 4 | | Sec. 5-37. Billing mechanism for preventive mental health | 5 | | services delivered to children. | 6 | | (a) The General Assembly finds: | 7 | | (1) It is common for children to have mental health | 8 | | needs but to not have a full-blown diagnosis of a mental | 9 | | illness. Examples include, but are not limited to, children | 10 | | who have mild or emerging symptoms of a mental health | 11 | | condition (such as meeting some but not all the criteria | 12 | | for a diagnosis, including, but not limited to, symptoms of | 13 | | depression, attentional deficits, anxiety or prodromal | 14 | | symptoms of bipolar disorder or schizophrenia); cutting or | 15 | | engaging in other forms of self-harm; or experiencing | 16 | | violence or trauma). | 17 | | (2) The federal requirement that Medicaid-covered | 18 | | children have access to Early and Periodic Screening, | 19 | | Diagnostic and Treatment services includes ensuring that | 20 | | Medicaid-covered children who have a mental health need but | 21 | | do not have a mental health diagnosis have access to | 22 | | treatment. | 23 | | (3) The Department of Healthcare and Family Services' | 24 | | existing policy acknowledges this federal requirement by | 25 | | allowing for Medicaid billing for mental health services |
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| 1 | | for children who have a need for services but who do not | 2 | | have a mental health diagnosis in Section 207.3.3 of the | 3 | | Community-Based Behavioral Services Provider Handbook. | 4 | | However, the current policy of the Department of Healthcare | 5 | | and Family Services requires clinicians to specify a | 6 | | diagnosis code and make a notation in the child's medical | 7 | | record that the service is preventive. This effectively | 8 | | requires the clinician to associate a diagnosis with the | 9 | | child and is a major barrier for services because many | 10 | | clinicians rightly are unwilling to document a mental | 11 | | health diagnosis in the medical record when a diagnosis is | 12 | | not medically appropriate. | 13 | | (b) Consistent with the existing policy of the Department | 14 | | of Healthcare and Family Services and the federal Early and | 15 | | Periodic Screening, Diagnostic and Treatment requirement, | 16 | | within 3 months after the effective date of this amendatory Act | 17 | | of the 101st General Assembly, the Department of Healthcare and | 18 | | Family Services shall convene a working group that includes | 19 | | children's mental health providers to receive input on | 20 | | recommendations to develop a medically appropriate and | 21 | | practical solution that enables mental health providers and | 22 | | professionals to deliver and receive reimbursement for | 23 | | medically necessary mental health services provided to a | 24 | | Medicaid-eligible child under age 21 that has a mental health | 25 | | need but does not have a mental health diagnosis in order to | 26 | | prevent the development of a serious mental health condition. |
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| 1 | | The working group shall ensure that the recommended solution | 2 | | works in practice and does not deter clinicians from delivering | 3 | | prevention and early treatment to children with mental health | 4 | | needs but who do not have a diagnosed mental illness. The | 5 | | Department of Healthcare and Family Services shall meet with | 6 | | this working group at least 4 times prior to finalizing the | 7 | | solution to enable and allow for mental health services for a | 8 | | child without a mental health diagnosis for purposes of | 9 | | prevention and early treatment when recommended by a licensed | 10 | | practitioner of the healing arts. If the Department of | 11 | | Healthcare and Family Services determines that an Illinois | 12 | | Title XIX State Plan amendment is necessary to implement this | 13 | | Section, the State Plan amendment shall be filed with the | 14 | | federal Centers for Medicare and Medicaid Services by no later | 15 | | than 12 months after the effective date of this amendatory Act | 16 | | of the 101st General Assembly. If rulemaking is required to | 17 | | implement this Section, the rule shall be filed by the | 18 | | Department of Healthcare and Family Services with the Joint | 19 | | Committee on Administrative Rules by no later than 12 months | 20 | | after the effective date of this amendatory Act of the 101st | 21 | | General Assembly, or if federal approval is required, within 6 | 22 | | months after federal approval. If federal approval is required | 23 | | but not granted, this Section shall become inoperative. | 24 | | (305 ILCS 5/5-38 new) | 25 | | Sec. 5-38. Alignment of children's mental health treatment |
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| 1 | | systems. The Governor's Office shall establish, convene, and | 2 | | lead a working group that includes the Director of Healthcare | 3 | | and Family Services, the Secretary of Human Services, the | 4 | | Director of Public Health, the Director of Children and Family | 5 | | Services, the Director of Juvenile Justice, the State | 6 | | Superintendent of Education, and the appropriate agency staff | 7 | | who will be responsible for implementation or oversight of | 8 | | reforms to children's behavioral health services. The working | 9 | | group shall meet at least quarterly to foster interagency | 10 | | collaboration and work toward the goal of aligning services and | 11 | | programs to begin to create a coordinated children's behavioral | 12 | | health system consistent with system of care principles that | 13 | | spans across State agencies, rather than separate siloed | 14 | | systems with different requirements, rates, and administrative | 15 | | processes and standards. | 16 | | Section 95. No acceleration or delay. Where this Act makes | 17 | | changes in a statute that is represented in this Act by text | 18 | | that is not yet or no longer in effect (for example, a Section | 19 | | represented by multiple versions), the use of that text does | 20 | | not accelerate or delay the taking effect of (i) the changes | 21 | | made by this Act or (ii) provisions derived from any other | 22 | | Public Act.
| 23 | | Section 99. Effective date. This Act takes effect January | 24 | | 1, 2020.
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