Rep. Robyn Gabel

Filed: 3/10/2017

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 498

2    AMENDMENT NO. ______. Amend House Bill 498 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-35 as follows:
 
6    (305 ILCS 5/5-35 new)
7    Sec. 5-35. Wrap-around service components of first episode
8psychosis treatment.
9    (a) Subject to subsection (d), the Department of Healthcare
10and Family Services shall provide adolescents and young adults
11who are experiencing an initial episode of psychosis or
12pre-psychosis medical assistance coverage for the wrap-around
13service components of the bundled first episode psychosis
14treatment that are not covered by their primary health
15insurance plan. The purpose of this medical assistance coverage
16is to prevent disability and a permanent shift from private

 

 

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1insurance coverage to medical assistance coverage for
2adolescents and young adults experiencing psychosis.
3Eligibility requirements for adolescents and young adults with
4private insurance who apply for medical assistance coverage for
5the wrap-around service components of first episode psychosis
6treatment shall be the same as those requirements applicable to
7all other persons applying for medical assistance coverage
8under this Article. The Department shall maximize individual
9and family-cost sharing and any federal matching funds for
10coverage of the wrap-around service components of first episode
11psychosis treatment for adolescents and young adults with
12private insurance.
13    (b) Individuals and families with private insurance who are
14eligible under this Section for medical assistance coverage for
15the wrap-around service components of first episode psychosis
16treatment shall be required to contribute to the cost of the
17wrap-around service components based on their income level and
18ability to pay and on the following cost-sharing requirements.
19For children under age 21, parental income is not included for
20purposes of cost-sharing:
21        (1) An individual or family with private insurance and
22    with earned income of less than 200% of the federal poverty
23    level shall not be required to pay more than 2.5% of their
24    earned income toward the annual cost of the wrap-around
25    service components.
26        (2) An individual or family with private insurance and

 

 

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1    with earned income of at least 200% but less than 400% of
2    the federal poverty level shall not be required to pay more
3    than 5% of their earned income toward the annual cost of
4    the wrap-around service components.
5        (3) An individual or family with private insurance and
6    with earned income of at least 400% but less than 500% of
7    the federal poverty level shall not be required to pay more
8    than 8% of their earned income toward the annual cost of
9    the wrap-around service components.
10        (4) An individual or family with private insurance and
11    with earned income of 500% or greater of the federal
12    poverty level shall not be required to pay more than 10% of
13    their earned income toward the annual cost of the
14    wrap-around service components.
15    (c) The Division of Mental Health of the Department of
16Human Services, in cooperation with the Department of
17Healthcare and Family Services, shall establish, by rule,
18policies and procedures for cost-sharing within 6 months of
19receiving federal approval of the medical assistance coverage
20for wrap-around service components of first episode psychosis
21treatment as described in this Section.
22    (d) The Department of Healthcare and Family Services shall
23submit the necessary application to the federal Centers for
24Medicare and Medicaid Services for a waiver or State Plan
25amendment to implement medical assistance coverage for the
26wrap-around service components of first episode psychosis

 

 

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1treatment as described in this Section. Implementation of this
2Section is contingent upon federal approval. The Department
3shall implement the medical assistance coverage described in
4this Section within 6 months of receiving federal approval.
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.".