100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4950

 

Introduced , by Rep. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Early Mental Health and Addictions Treatment Act. Requires the Department of Healthcare and Family Services, and other specified agencies and entities, to develop a pilot program under which a qualifying adolescent or young adult may receive community-based mental health treatment from a youth-focused community support team for early treatment that is specifically tailored to the needs of youth and young adults in the early stages of a serious emotional disturbance or serious mental illness. Requires the Department to apply, no later than September 30, 2019, for any necessary federal waiver or State Plan amendment to implement the pilot program. Requires the Department to implement the pilot program no later than December 31, 2019 if federal approval is not necessary. Contains provisions concerning the creation of a community-based treatment model under the pilot program; the development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Requires the Department to develop an Assertive Engagement and Community-Based Clinical Treatment Pilot Program for individuals with opioid and other drug addictions. Contains provisions on in-office, in-home, and in-community services provided under the pilot program; application for a federal waiver or State Plan amendment to implement the pilot program; development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Early
5Mental Health and Addictions Treatment Act.
 
6    Section 5. Medicaid Pilot Program; early treatment for
7youth and young adults.
8    (a) The General Assembly finds as follows:
9        (1) Most mental health conditions begin in adolescence
10    and young adulthood, yet it can take an average of 10 years
11    before the right diagnosis and treatment are received.
12        (2) Over 850,000 Illinois youth under age 25 will
13    experience a mental health condition.
14        (3) Early treatment of significant mental health
15    conditions can enable wellness and recovery and prevent a
16    life of disability or early death from suicide.
17        (4) Early treatment leads to higher rates of school
18    completion and employment.
19        (5) Illinois' mental health system is aimed at adults
20    with advanced mental illnesses who have become disabled,
21    rather than focusing on youth in the early stages of a
22    mental health condition to prevent progression.
23        (6) Many states are implementing programs and services

 

 

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1    for the early treatment of significant mental health
2    conditions in youth.
3        (7) The cost of early community-based treatment is a
4    fraction of the cost of a life of multiple
5    hospitalizations, disability, criminal justice
6    involvement, and homelessness, the common trajectory for
7    someone with a serious mental health condition.
8        (8) Early treatment for adolescents and young adults
9    with mental health conditions will save lives and State
10    dollars.
11    (b) As the sole Medicaid State agency, the Department of
12Healthcare and Family Services, in partnership with the
13Department of Human Services' Division of Mental Health and
14with meaningful input from stakeholders, shall develop a pilot
15program under which a qualifying adolescent or young adult, as
16defined in subsection (d), may receive community-based mental
17health treatment from a youth-focused community support team
18for early treatment, as provided in subsection (e), that is
19specifically tailored to the needs of youth and young adults in
20the early stages of a serious emotional disturbance or serious
21mental illness for purposes of stabilizing the youth's
22condition and symptoms and preventing the worsening of the
23illness and debilitating or disabling symptoms.
24    (c) Federal waiver or State Plan amendment; implementation
25timeline.
26        (1) Federal approval. The Department of Healthcare and

 

 

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1    Family Services shall submit any necessary application to
2    the federal Centers for Medicare and Medicaid Services for
3    a waiver or State Plan amendment to implement the pilot
4    program described in this Section no later than September
5    30, 2019. If the Department determines the pilot program
6    can be implemented without federal approval, the
7    Department shall implement the program no later than
8    December 31, 2019. The Department shall not draft any rules
9    in contravention of this timetable for pilot program
10    development and implementation. This pilot program shall
11    be implemented only to the extent that federal financial
12    participation is available.
13        (2) Implementation. After federal approval is secured,
14    if federal approval is required, the Department of
15    Healthcare and Family Services shall implement the pilot
16    program within 6 months after the date of federal approval.
17    (d) Qualifying adolescent or young adult. As used in this
18Section, "qualifying adolescent or young adult" means a person
19age 16 through 26 who is enrolled in the Medical Assistance
20Program under Article V of the Illinois Public Aid Code and has
21a diagnosis of a serious emotional disturbance as interpreted
22by the federal Substance Abuse and Mental Health Services
23Administration or a serious mental illness listed in the most
24recent edition of the Diagnostic and Statistical Manual of
25Mental Disorders. Because the purpose of the pilot program is
26treatment in the early stages of a significant mental health

 

 

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1condition or emotional disturbance for purposes of preventing
2progression of the illness, debilitating symptoms and
3disability, a qualifying adolescent or young adult shall not be
4required to demonstrate disability due to the mental health
5condition, show a reduction in functioning as a result of the
6condition, or have a reality impairment (psychosis) to be
7eligible for services through the pilot program. A qualifying
8adolescent or young adult who is determined to be eligible for
9pilot program services before the age of 21 shall continue to
10be eligible for such services without interruption through age
1126 as long as he or she remains enrolled in the Medical
12Assistance Program.
13    (e) Community-based treatment model. The pilot program
14shall create youth-focused community support teams for early
15treatment. The community-based treatment model shall be a
16multidisciplinary, team-based model specifically tailored for
17adolescents and young adults and their needs for wellness,
18symptom management, and recovery. All services shall be
19evidence-based or evidence-informed as applicable, and the
20services shall be flexibly provided in-office, in-home, and
21in-community with an emphasis on in-home and in-community
22services. The model shall allow for and include each of the
23following:
24        (1) Community-based, outreach treatment, and
25    wrap-around services that begin in the early stages of a
26    serious mental illness or serious emotional disturbance

 

 

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1    (functional impairment shall not be required for service
2    eligibility under the pilot program).
3        (2) Youth specific engagement strategies to encourage
4    participation and retention in services.
5        (3) Same-age or similar-age peer services to foster
6    resiliency.
7        (4) Family psycho-education and family involvement.
8        (5) Expertise or knowledge in school and university
9    systems, special education and work, volunteer and social
10    life for youth.
11        (6) Evidence-informed and young person-specific
12    psychotherapies.
13        (7) Care coordination for primary care.
14        (8) Medication management.
15        (9) Case management for problem solving to address
16    practicable problems, including criminal justice
17    involvement and housing challenges; and assisting the
18    young person or family in organizing all treatment and
19    goals.
20        (10) Supported education and employment to keep the
21    young person engaged in school and work to attain
22    self-sufficiency.
23        (11) Trauma-informed expertise for youth.
24        (12) Substance use treatment expertise.
25    (f) Pay-for-performance payment model. The Department of
26Healthcare and Family Services, with meaningful input from

 

 

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1stakeholders, shall develop a pay-for-performance payment
2model aimed at achieving high-quality mental health and overall
3health and quality of life outcomes for the youth, rather than
4a fee-for-service payment model. The payment model shall allow
5for service flexibility to achieve such outcomes and shall
6cover actual provider costs of delivering the pilot program
7services to enable sustainability. The Department shall ensure
8that the payment model works as intended by this Section within
9managed care.
10    (g) Rulemaking. The Department of Healthcare and Family
11Services, in partnership with the Department of Human Services'
12Division of Mental Health and with meaningful input from
13stakeholders, shall develop rules for purposes of
14implementation of the pilot program contemplated in this
15Section within 6 months of federal approval of the pilot
16program. If the Department determines federal approval is not
17required for implementation, the Department shall develop
18rules with meaningful stakeholder input no later than December
1931, 2019.
20    (h) Pilot program analytics and outcomes report. The
21Department of Healthcare and Family Services shall engage a
22third party partner with expertise in program evaluation,
23analysis, and research at the end of 5 years of implementation
24to review the outcomes of the pilot program in stabilizing
25youth with significant mental health conditions early on in
26their condition to prevent debilitating symptoms and

 

 

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1disability and enable youth to reach their full potential. For
2purposes of evaluating the outcomes of the pilot program, the
3Department shall require providers of the pilot program
4services to track the following annual data:
5        (1) days of inpatient hospital stays of service
6    recipients;
7        (2) periods of homelessness of service recipients and
8    periods of housing stability;
9        (3) periods of criminal justice involvement of service
10    recipients;
11        (4) avoidance of disability and the need for
12    Supplemental Security Income;
13        (5) rates of high school, college, or vocational school
14    engagement and graduation for service recipients;
15        (6) rates of employment annually of service
16    recipients;
17        (7) average length of stay in pilot program services;
18        (8) symptom management over time; and
19        (9) youth satisfaction with their quality of life,
20    pre-pilot and post-pilot program services.
21    (i) The Department of Healthcare and Family Services shall
22deliver a final report to the General Assembly on the outcomes
23of the pilot program within one year after 5 years of full
24implementation compared to typical treatment available to
25other youth with significant mental health conditions, as well
26as the cost savings associated with the pilot program taking

 

 

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1into account all public systems used when an individual with a
2significant mental health condition does not have access to the
3right treatment and supports in the early stages of his or her
4illness.
 
5    Section 10. Medicaid pilot program for opioid and other
6drug addictions.
7    (a) Legislative findings. The General Assembly finds as
8follows:
9        (1) Illinois' continues to face a serious and ongoing
10    opioid epidemic.
11        (2) Opioid-related overdose deaths rose 76% between
12    2013 and 2016.
13        (3) Opioid and other drug addictions are life-long
14    diseases that require a disease management approach and not
15    just episodic treatment.
16        (4) There is an urgent need to create a treatment
17    approach that proactively engages and encourages
18    individuals with opioid and other drug addictions into
19    treatment to help prevent chronic use and a worsening
20    addiction and to significantly curb the rate of overdose
21    deaths.
22    (b) With the goal of early initial engagement of
23individuals who have an opioid or other drug addiction in
24addiction treatment and for keeping individuals engaged in
25treatment following detoxification, a residential treatment

 

 

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1stay, or hospitalization to prevent chronic recurrent drug use,
2the Department of Healthcare and Family Services, in
3partnership with the Department of Human Services' Division of
4Alcoholism and Substance Abuse and with meaningful input from
5stakeholders, shall develop an Assertive Engagement and
6Community-Based Clinical Treatment Pilot Program for early
7treatment of an opioid or other drug addiction.
8    (c) Assertive engagement and community-based clinical
9treatment services. All services included in the pilot program
10established under this Section shall be evidence-based or
11evidence-informed as applicable and the services shall be
12flexibly provided in-office, in-home, and in-community with an
13emphasis on in-home and in-community services. The model shall,
14at a minimum, allow for and include each of the following:
15        (1) Assertive community outreach, engagement, and
16    continuing care strategies to encourage participation and
17    retention in addiction treatment services for both initial
18    engagement into addiction treatment services, and for
19    post-hospitalization, post-detoxification, and
20    post-residential treatment.
21        (2) Case management for purposes of linking
22    individuals to treatment, ongoing monitoring, problem
23    solving, and assisting individuals in organizing their
24    treatment and goals. Case management shall be covered for
25    individuals not yet engaged in treatment for purposes of
26    reaching such individuals early on in their addiction and

 

 

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1    for individuals in treatment.
2        (3) Clinical treatment that is delivered in an
3    individual's natural environment, including, in-home or
4    in-community treatment, to better equip the individual
5    with coping mechanisms that may trigger re-use.
6        (4) Coverage of provider transportation costs in
7    delivering in-home and in-community services in both rural
8    and urban settings. For rural communities the model shall
9    take into account the wider geographic areas providers are
10    required to travel for in-home and in-community pilot
11    services for purposes of reimbursement.
12        (5) Recovery support services.
13        (6) For individuals who receive services through the
14    pilot program but disengage for a short duration (a period
15    of no longer than 9 months), allow seamless treatment
16    re-engagement in the pilot program.
17        (7) Supported education and employment.
18        (8) Working with the individual's family, school, and
19    other community support systems.
20        (9) Service flexibility to enable recovery and
21    positive health outcomes.
22    (d) Federal waiver or State Plan amendment; implementation
23timeline. The Department shall follow the timeline for
24application for federal approval and implementation outlined
25in subsection (c) of Section 5. The pilot program contemplated
26in this Section shall be implemented only to the extent that

 

 

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1federal financial participation is available.
2    (e) Pay-for-performance payment model. The Department of
3Healthcare and Family Services, in partnership with the
4Department of Human Services' Division of Alcoholism and
5Substance Abuse and with meaningful input from stakeholders,
6shall develop a pay-for-performance payment model aimed at
7achieving high quality treatment and overall health and quality
8of life outcomes, rather than a fee-for-service payment model.
9The payment model shall allow for service flexibility to
10achieve such outcomes and shall cover actual provider costs of
11delivering the pilot program services to enable
12sustainability. The Department shall ensure that the payment
13model works as intended by this Section within managed care.
14    (f) Rulemaking. The Department of Healthcare and Family
15Services, in partnership with Department of Human Services'
16Division of Alcoholism and Substance Abuse and with meaningful
17input from stakeholders, shall develop rules for purposes of
18implementation of the pilot program within 6 months after
19federal approval of the pilot program. If the Department
20determines federal approval is not required for
21implementation, the Department shall develop rules with
22meaningful stakeholder input no later than December 31, 2019.
23    (g) Pilot program analytics and outcomes report. The
24Department of Healthcare and Family Services shall engage a
25third party partner with expertise in program evaluation,
26analysis, and research at the end of 5 years of implementation

 

 

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1to review the outcomes of the pilot program in treating
2addiction and preventing periods of symptom exacerbation and
3recurrence. For purposes of evaluating the outcomes of the
4pilot program, the Department shall require providers of the
5pilot program services to track all of the following annual
6data:
7        (1) Length of engagement and retention in pilot program
8    services.
9        (2) Recurrence of drug use.
10        (3) Symptom management (the ability or inability to
11    control drug use).
12        (4) Days of hospitalizations related to substance use
13    or residential treatment stays.
14        (5) Periods of homelessness and periods of housing
15    stability.
16        (6) Periods of criminal justice involvement.
17        (7) Educational and employment attainment during
18    following pilot program services.
19        (8) Enrollee satisfaction with his or her quality of
20    life and level of social connectedness, pre-pilot and
21    post-pilot services.
22    (h) The Department of Healthcare and Family Services shall
23deliver a final report to the General Assembly on the outcomes
24of the pilot program within one year after 5 years of full
25implementation. The analysis shall include the cost of the
26pilot program compared to the cost of treatment as usual,

 

 

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1including the use of all other public systems when access to
2addiction treatment is not available.
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.