Rep. Camille Y. Lilly

Filed: 1/13/2021

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 558

2    AMENDMENT NO. ______. Amend Senate Bill 558, AS AMENDED,
3with reference to page and line numbers of House Amendment No.
44, as follows:
 
5on page 12, line 25, by inserting ", subject to funding
6availability," after "program"; and
 
7on page 13, lines 8 and 9, by replacing "Certification shall
8not be required for reimbursement." with "For reimbursement
9under the medical assistance program, a community health worker
10must work under the supervision of an enrolled medical program
11provider, as specified by the Department, and certification
12shall be required for reimbursement. The supervision of
13enrolled medical program providers and certification are not
14required for community health workers who receive
15reimbursement through managed care administrative dollars.
16Non-certified community health workers are reimbursable at the

 

 

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1discretion of managed care entities up to 18 months following
2availability of community health worker certification."; and
 
3on page 13, by inserting after line 14 the following:
 
4    "Section 5-22. Certification. Certification shall not be
5required for employment of community health workers.
6Non-certified community health workers may be employed through
7funding sources outside of the medical assistance program.";
8and
 
9by deleting lines 9 through 24 on page 43 and lines 1 through 6
10on page 44; and
 
11on page 71, by inserting after line 16 the following:
 
12
"Article 65.

 
13    Section 65-1. Short title. This Article may be cited as the
14Behavioral Health Workforce Education Center of Illinois Act.
15References in this Article to "this Act" mean this Article.
 
16    Section 65-5. Findings. The General Assembly finds as
17follows:
18        (1) There are insufficient behavioral health
19    professionals in this State's behavioral health workforce

 

 

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1    and further that there are insufficient behavioral health
2    professionals trained in evidence-based practices.
3        (2) The Illinois behavioral health workforce situation
4    is at a crisis state and the lack of a behavioral health
5    strategy is exacerbating the problem.
6        (3) In 2019, the Journal of Community Health found that
7    suicide rates are disproportionately higher among African
8    American adolescents. From 2001 to 2017, the rate for
9    African American teen boys rose 60%, according to the
10    study. Among African American teen girls, rates nearly
11    tripled, rising by an astounding 182%. Illinois was among
12    the 10 states with the greatest number of African American
13    adolescent suicides (2015-2017).
14        (4) Workforce shortages are evident in all behavioral
15    health professions, including, but not limited to,
16    psychiatry, psychiatric nursing, psychiatric physician
17    assistant, social work (licensed social work, licensed
18    clinical social work), counseling (licensed professional
19    counseling, licensed clinical professional counseling),
20    marriage and family therapy, licensed clinical psychology,
21    occupational therapy, prevention, substance use disorder
22    counseling, and peer support.
23        (5) The shortage of behavioral health practitioners
24    affects every Illinois county, every group of people with
25    behavioral health needs, including children and
26    adolescents, justice-involved populations, working adults,

 

 

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1    people experiencing homelessness, veterans, and older
2    adults, and every health care and social service setting,
3    from residential facilities and hospitals to
4    community-based organizations and primary care clinics.
5        (6) Estimates of unmet needs consistently highlight
6    the dire situation in Illinois. Mental Health America ranks
7    Illinois 29th in the country in mental health workforce
8    availability based on its 480-to-1 ratio of population to
9    mental health professionals, and the Kaiser Family
10    Foundation estimates that only 23.3% of Illinoisans'
11    mental health needs can be met with its current workforce.
12        (7) Shortages are especially acute in rural areas and
13    among low-income and under-insured individuals and
14    families. 30.3% of Illinois' rural hospitals are in
15    designated primary care shortage areas and 93.7% are in
16    designated mental health shortage areas. Nationally, 40%
17    of psychiatrists work in cash-only practices, limiting
18    access for those who cannot afford high out-of-pocket
19    costs, especially Medicaid eligible individuals and
20    families.
21        (8) Spanish-speaking therapists in suburban Cook
22    County, as well as in immigrant new growth communities
23    throughout the State, for example, and master's-prepared
24    social workers in rural communities are especially
25    difficult to recruit and retain.
26        (9) Illinois' shortage of psychiatrists specializing

 

 

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1    in serving children and adolescents is also severe.
2    Eighty-one out of 102 Illinois counties have no child and
3    adolescent psychiatrists, and the remaining 21 counties
4    have only 310 child and adolescent psychiatrists for a
5    population of 2,450,000 children.
6        (10) Only 38.9% of the 121,000 Illinois youth aged 12
7    through 17 who experienced a major depressive episode
8    received care.
9        (11) An annual average of 799,000 people in Illinois
10    aged 12 and older need but do not receive substance use
11    disorder treatment at specialty facilities.
12        (12) According to the Statewide Semiannual Opioid
13    Report, Illinois Department of Public Health, September
14    2020, the number of opioid deaths in Illinois has increased
15    3% from 2,167 deaths in 2018 to 2,233 deaths in 2019.
16        (13) Behavioral health workforce shortages have led to
17    well-documented problems of long wait times for
18    appointments with psychiatrists (4 to 6 months in some
19    cases), high turnover, and unfilled vacancies for social
20    workers and other behavioral health professionals that
21    have eroded the gains in insurance coverage for mental
22    illness and substance use disorder under the federal
23    Affordable Care Act and parity laws.
24        (14) As a result, individuals with mental illness or
25    substance use disorders end up in hospital emergency rooms,
26    which are the most expensive level of care, or are

 

 

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1    incarcerated and do not receive adequate care, if any.
2        (15) There are many organizations and institutions
3    that are affected by behavioral health workforce
4    shortages, but no one entity is responsible for monitoring
5    the workforce supply and intervening to ensure it can
6    effectively meet behavioral health needs throughout the
7    State.
8        (16) Workforce shortages are more complex than simple
9    numerical shortfalls. Identifying the optimal number,
10    type, and location of behavioral health professionals to
11    meet the differing needs of Illinois' diverse regions and
12    populations across the lifespan is a difficult logistical
13    problem at the system and practice level that requires
14    coordinated efforts in research, education, service
15    delivery, and policy.
16        (17) This State has a compelling and substantial
17    interest in building a pipeline for behavioral health
18    professionals and to anchor research and education for
19    behavioral health workforce development. Beginning with
20    the proposed Behavioral Health Workforce Education Center
21    of Illinois, Illinois has the chance to develop a blueprint
22    to be a national leader in behavioral health workforce
23    development.
24        (18) The State must act now to improve the ability of
25    its residents to achieve their human potential and to live
26    healthy, productive lives by reducing the misery and

 

 

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1    suffering with unmet behavioral health needs.
 
2    Section 65-10. Behavioral Health Workforce Education
3Center of Illinois.
4    (a) The Behavioral Health Workforce Education Center of
5Illinois is created and shall be administered by a teaching,
6research, or both teaching and research public institution of
7higher education in this State. Subject to appropriation, the
8Center shall be operational on or before July 1, 2022.
9    (b) The Behavioral Health Workforce Education Center of
10Illinois shall leverage workforce and behavioral health
11resources, including, but not limited to, State, federal, and
12foundation grant funding, federal Workforce Investment Act of
131998 programs, the National Health Service Corps and other
14nongraduate medical education physician workforce training
15programs, and existing behavioral health partnerships, and
16align with reforms in Illinois.
 
17    Section 65-15. Structure.
18    (a) The Behavioral Health Workforce Education Center of
19Illinois shall be structured as a multisite model, and the
20administering public institution of higher education shall
21serve as the hub institution, complemented by secondary
22regional hubs, namely academic institutions, that serve rural
23and small urban areas and at least one academic institution
24serving a densely urban municipality with more than 1,000,000

 

 

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1inhabitants.
2    (b) The Behavioral Health Workforce Education Center of
3Illinois shall be located within one academic institution and
4shall be tasked with a convening and coordinating role for
5workforce research and planning, including monitoring progress
6toward Center goals.
7    (c) The Behavioral Health Workforce Education Center of
8Illinois shall also coordinate with key State agencies involved
9in behavioral health, workforce development, and higher
10education in order to leverage disparate resources from health
11care, workforce, and economic development programs in Illinois
12government.
 
13    Section 65-20. Duties. The Behavioral Health Workforce
14Education Center of Illinois shall perform the following
15duties:
16        (1) Organize a consortium of universities in
17    partnerships with providers, school districts, law
18    enforcement, consumers and their families, State agencies,
19    and other stakeholders to implement workforce development
20    concepts and strategies in every region of this State.
21        (2) Be responsible for developing and implementing a
22    strategic plan for the recruitment, education, and
23    retention of a qualified, diverse, and evolving behavioral
24    health workforce in this State. Its planning and activities
25    shall include:

 

 

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1            (A) convening and organizing vested stakeholders
2        spanning government agencies, clinics, behavioral
3        health facilities, prevention programs, hospitals,
4        schools, jails, prisons and juvenile justice, police
5        and emergency medical services, consumers and their
6        families, and other stakeholders;
7            (B) collecting and analyzing data on the
8        behavioral health workforce in Illinois, with detailed
9        information on specialties, credentials, additional
10        qualifications (such as training or experience in
11        particular models of care), location of practice, and
12        demographic characteristics, including age, gender,
13        race and ethnicity, and languages spoken;
14            (C) building partnerships with school districts,
15        public institutions of higher education, and workforce
16        investment agencies to create pipelines to behavioral
17        health careers from high schools and colleges,
18        pathways to behavioral health specialization among
19        health professional students, and expanded behavioral
20        health residency and internship opportunities for
21        graduates;
22            (D) evaluating and disseminating information about
23        evidence-based practices emerging from research
24        regarding promising modalities of treatment, care
25        coordination models, and medications;
26            (E) developing systems for tracking the

 

 

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1        utilization of evidence-based practices that most
2        effectively meet behavioral health needs; and
3            (F) providing technical assistance to support
4        professional training and continuing education
5        programs that provide effective training in
6        evidence-based behavioral health practices.
7        (3) Coordinate data collection and analysis, including
8    systematic tracking of the behavioral health workforce and
9    datasets that support workforce planning for an
10    accessible, high-quality behavioral health system. In the
11    medium to long-term, the Center shall develop Illinois
12    behavioral workforce data capacity by:
13            (A) filling gaps in workforce data by collecting
14        information on specialty, training, and qualifications
15        for specific models of care, demographic
16        characteristics, including gender, race, ethnicity,
17        and languages spoken, and participation in public and
18        private insurance networks;
19            (B) identifying the highest priority geographies,
20        populations, and occupations for recruitment and
21        training;
22            (C) monitoring the incidence of behavioral health
23        conditions to improve estimates of unmet need; and
24            (D) compiling up-to-date, evidence-based
25        practices, monitoring utilization, and aligning
26        training resources to improve the uptake of the most

 

 

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1        effective practices.
2        (4) Work to grow and advance peer and parent-peer
3    workforce development by:
4            (A) assessing the credentialing and reimbursement
5        processes and recommending reforms;
6            (B) evaluating available peer-parent training
7        models, choosing a model that meets Illinois' needs,
8        and working with partners to implement it universally
9        in child-serving programs throughout this State; and
10            (C) including peer recovery specialists and
11        parent-peer support professionals in interdisciplinary
12        training programs.
13        (5) Focus on the training of behavioral health
14    professionals in telehealth techniques, including taking
15    advantage of a telehealth network that exists, and other
16    innovative means of care delivery in order to increase
17    access to behavioral health services for all persons within
18    this State.
19        (6) No later than December 1 of every odd-numbered
20    year, prepare a report of its activities under this Act.
21    The report shall be filed electronically with the General
22    Assembly, as provided under Section 3.1 of the General
23    Assembly Organization Act, and shall be provided
24    electronically to any member of the General Assembly upon
25    request.
 

 

 

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1    Section 65-25. Selection process.
2    (a) No later than 90 days after the effective date of this
3Act, the Board of Higher Education shall select a public
4institution of higher education, with input and assistance from
5the Division of Mental Health of the Department of Human
6Services, to administer the Behavioral Health Workforce
7Education Center of Illinois.
8    (b) The selection process shall articulate the principles
9of the Behavioral Health Workforce Education Center of
10Illinois, not inconsistent with this Act.
11    (c) The Board of Higher Education, with input and
12assistance from the Division of Mental Health of the Department
13of Human Services, shall make its selection of a public
14institution of higher education based on its ability and
15willingness to execute the following tasks:
16        (1) Convening academic institutions providing
17    behavioral health education to:
18            (A) develop curricula to train future behavioral
19        health professionals in evidence-based practices that
20        meet the most urgent needs of Illinois' residents;
21            (B) build capacity to provide clinical training
22        and supervision; and
23            (C) facilitate telehealth services to every region
24        of the State.
25        (2) Functioning as a clearinghouse for research,
26    education, and training efforts to identify and

 

 

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1    disseminate evidence-based practices across the State.
2        (3) Leveraging financial support from grants and
3    social impact loan funds.
4        (4) Providing infrastructure to organize regional
5    behavioral health education and outreach. As budgets
6    allow, this shall include conference and training space,
7    research and faculty staff time, telehealth, and distance
8    learning equipment.
9        (5) Working with regional hubs that assess and serve
10    the workforce needs of specific, well-defined regions and
11    specialize in specific research and training areas, such as
12    telehealth or mental health-criminal justice partnerships,
13    for which the regional hub can serve as a statewide leader.
14    (d) The Board of Higher Education may adopt such rules as
15may be necessary to implement and administer this Section.";
16and
 
17by replacing lines 20 through 22 of page 141 and lines 1 and 2
18of page 142 with the following:
 
19    "Section 115-5. The Illinois Public Aid Code is amended by
20adding Section 14-14 as follows:
 
21    (305 ILCS 5/14-14 new)
22    Sec. 14-14. Increasing access to primary care in"; and
 

 

 

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1on page 177, lines 3 and 4, by replacing "4 and 5.4 and by
2adding Section 5.5" with "4, 5.4, and 8.7"; and
 
3on page 177, line 20, by changing "10" to "11"; and
 
4on page 185, by replacing lines 1 through 9 with the following:
 
5    "(20 ILCS 3960/8.7)
6    (Section scheduled to be repealed on December 31, 2029)
7    Sec. 8.7. Application for permit for discontinuation of a
8health care facility or category of service; public notice and
9public hearing.
10    (a) Upon a finding that an application to close a health
11care facility or discontinue a category of service is complete,
12the State Board shall publish a legal notice on 3 consecutive
13days in a newspaper of general circulation in the area or
14community to be affected and afford the public an opportunity
15to request a hearing. If the application is for a facility
16located in a Metropolitan Statistical Area, an additional legal
17notice shall be published in a newspaper of limited
18circulation, if one exists, in the area in which the facility
19is located. If the newspaper of limited circulation is
20published on a daily basis, the additional legal notice shall
21be published on 3 consecutive days. The legal notice shall also
22be posted on the Health Facilities and Services Review Board's
23website and sent to the State Representative and State Senator

 

 

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1of the district in which the health care facility is located.
2In addition, the health care facility shall provide notice of
3closure to the local media that the health care facility would
4routinely notify about facility events.
5    An application to close a health care facility shall only
6be deemed complete if it includes evidence that the health care
7facility provided written notice at least 30 days prior to
8filing the application of its intent to do so to the
9municipality in which it is located, the State Representative
10and State Senator of the district in which the health care
11facility is located, the State Board, the Director of Public
12Health, and the Director of Healthcare and Family Services. The
13changes made to this subsection by this amendatory Act of the
14101st General Assembly shall apply to all applications
15submitted after the effective date of this amendatory Act of
16the 101st General Assembly.
17    (b) No later than 30 days after issuance of a permit to
18close a health care facility or discontinue a category of
19service, the permit holder shall give written notice of the
20closure or discontinuation to the State Senator and State
21Representative serving the legislative district in which the
22health care facility is located.
23    (c)(1) If there is a pending lawsuit that challenges an
24application to discontinue a health care facility that either
25names the Board as a party or alleges fraud in the filing of
26the application, the Board may defer action on the application

 

 

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1for up to 6 months after the date of the initial deferral of
2the application.
3    (2) The Board may defer action on an application to
4discontinue a hospital that is pending before the Board as of
5the effective date of this amendatory Act of the 101st General
6Assembly for up to 60 days from the effective date of this
7amendatory Act of the 101st General Assembly.
8    (3) The Board may defer taking final action on an
9application to discontinue a hospital that is filed on or after
10January 12, 2021 until the earlier to occur of: (i) the
11expiration of the statewide disaster declaration proclaimed by
12the Governor of the State of Illinois due to the COVID-19
13pandemic that is in effect on January 12, 2021, or any
14extension thereof, or July 1, 2021, whichever occurs later; or
15(ii) the expiration of the declaration of a public health
16emergency due to the COVID-19 pandemic as declared by the
17Secretary of the U.S. Department of Health and Human Services
18that is in effect on January 12, 2021, or any extension
19thereof, or July 1, 2021, whichever occurs later. This
20paragraph (3) is inoperative as of the date of the expiration
21of the statewide disaster declaration proclaimed by the
22Governor of the State of Illinois due to the COVID-19 pandemic
23that is in effect on January 12, 2021, or any extension
24thereof, or July 1, 2021, whichever occurs later.
25    (d) The changes made to this Section by this amendatory Act
26of the 101st General Assembly shall apply to all applications

 

 

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1submitted after the effective date of this amendatory Act of
2the 101st General Assembly.
3(Source: P.A. 101-83, eff. 7-15-19; 101-650, eff. 7-7-20.)";
4and
 
5on page 200, line 19, by inserting "a majority of" after
6"representing"; and
 
7on page 202, line 11, by inserting "a majority of" after
8"representing"; and
 
9on page 202, line 23, by changing "association, and" to
10"association, a dental association, and".