103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1831

 

Introduced 2/9/2023, by Sen. Elgie R. Sims, Jr.

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 66/20-10
305 ILCS 66/20-20

    Amends the Rebuild Illinois Mental Health Workforce Act. In a provision concerning Medicaid funding for community mental health services, sets forth rate increases, to begin on and after January 1, 2024, for the following rates and services: the Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code; the Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code; the Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code; the Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code; the Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code; the Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code; and the Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code for medication monitoring provided by a physician, an advanced practice registered nurse, and all other levels of provider. Provides that no base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by the amendatory Act. Provides that any payments required under the amendatory Act that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by the amendatory Act.


LRB103 27179 KTG 53549 b

 

 

A BILL FOR

 

SB1831LRB103 27179 KTG 53549 b

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 5. The Rebuild Illinois Mental Health Workforce
5Act is amended by changing Sections 20-10 and 20-20 as
6follows:
 
7    (305 ILCS 66/20-10)
8    Sec. 20-10. Medicaid funding for community mental health
9services. Medicaid funding for the specific community mental
10health services listed in this Act shall be adjusted and paid
11as set forth in this Act. Such payments shall be paid in
12addition to the base Medicaid reimbursement rate and add-on
13payment rates per service unit.
14    (a) The payment adjustments shall begin on July 1, 2022
15for State Fiscal Year 2023 and shall continue for every State
16fiscal year thereafter.
17        (1) Individual Therapy Medicaid Payment rate for
18    services provided under the H0004 Code:
19            (A) The Medicaid total payment rate for individual
20        therapy provided by a qualified mental health
21        professional shall be increased by no less than $9 per
22        service unit.
23            (B) The Medicaid total payment rate for individual

 

 

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1        therapy provided by a mental health professional shall
2        be increased by no less then $9 per service unit.
3        (2) Community Support - Individual Medicaid Payment
4    rate for services provided under the H2015 Code: All
5    community support - individual services shall be increased
6    by no less than $15 per service unit.
7        (3) Case Management Medicaid Add-on Payment for
8    services provided under the T1016 code: All case
9    management services rates shall be increased by no less
10    than $15 per service unit.
11        (4) Assertive Community Treatment Medicaid Add-on
12    Payment for services provided under the H0039 code: The
13    Medicaid total payment rate for assertive community
14    treatment services shall increase by no less than $8 per
15    service unit.
16        (5) Medicaid user-based directed payments.
17            (A) For each State fiscal year, a monthly directed
18        payment shall be paid to a community mental health
19        provider of community support team services based on
20        the number of Medicaid users of community support team
21        services documented by Medicaid fee-for-service and
22        managed care encounter claims delivered by that
23        provider in the base year. The Department of
24        Healthcare and Family Services shall make the monthly
25        directed payment to each provider entitled to directed
26        payments under this Act by no later than the last day

 

 

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1        of each month throughout each State fiscal year.
2                (i) The monthly directed payment for a
3            community support team provider shall be
4            calculated as follows: The sum total number of
5            individual Medicaid users of community support
6            team services delivered by that provider
7            throughout the base year, multiplied by $4,200 per
8            Medicaid user, divided into 12 equal monthly
9            payments for the State fiscal year.
10                (ii) As used in this subparagraph, "user"
11            means an individual who received at least 200
12            units of community support team services (H2016)
13            during the base year.
14            (B) For each State fiscal year, a monthly directed
15        payment shall be paid to each community mental health
16        provider of assertive community treatment services
17        based on the number of Medicaid users of assertive
18        community treatment services documented by Medicaid
19        fee-for-service and managed care encounter claims
20        delivered by the provider in the base year.
21                (i) The monthly direct payment for an
22            assertive community treatment provider shall be
23            calculated as follows: The sum total number of
24            Medicaid users of assertive community treatment
25            services provided by that provider throughout the
26            base year, multiplied by $6,000 per Medicaid user,

 

 

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1            divided into 12 equal monthly payments for that
2            State fiscal year.
3                (ii) As used in this subparagraph, "user"
4            means an individual that received at least 300
5            units of assertive community treatment services
6            during the base year.
7            (C) The base year for directed payments under this
8        Section shall be calendar year 2019 for State Fiscal
9        Year 2023 and State Fiscal Year 2024. For the State
10        fiscal year beginning on July 1, 2024, and for every
11        State fiscal year thereafter, the base year shall be
12        the calendar year that ended 18 months prior to the
13        start of the State fiscal year in which payments are
14        made.
15    (b) Subject to federal approval, a one-time directed
16payment must be made in calendar year 2023 for community
17mental health services provided by community mental health
18providers. The one-time directed payment shall be for an
19amount appropriated for these purposes. The one-time directed
20payment shall be for services for Integrated Assessment and
21Treatment Planning and other intensive services, including,
22but not limited to, services for Mobile Crisis Response,
23crisis intervention, and medication monitoring. The amounts
24and services used for designing and distributing these
25one-time directed payments shall not be construed to require
26any future rate or funding increases for the same or other

 

 

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1mental health services.
2    (c) The following payment adjustments shall begin on
3January 1, 2024 and shall continue thereafter.
4        (1) The Mobile Crisis Response Medicaid Payment rate
5    for all services provided under the S9484 procedure code
6    shall be increased by no less than $200 per service unit
7    for on-site services. Off-site rates for these services
8    must be increased by an amount which at least maintains
9    the current differential between on-site and off-site
10    services as represented on the July 1, 2022 fee schedule.
11        (2) The Crisis Intervention Medicaid Payment rate for
12    all levels of services provided under the H2011 procedure
13    code shall be increased by no less than $8 per service unit
14    for on-site services. Off-site rates for these services
15    must be increased by an amount which at least maintains
16    the current differential between on-site and off-site
17    services as represented on the July 1, 2022 fee schedule.
18        (3) The Integrated Assessment and Treatment Planning
19    Medicaid Payment rate for all levels of services provided
20    under the H2000 procedure code shall be increased by no
21    less than $7 per service unit for on-site services.
22    Off-site rates for these services must be increased by an
23    amount which at least maintains the current differential
24    between on-site and off-site services as represented on
25    the July 1, 2022 fee schedule.
26        (4) The Group and Family Therapy Medicaid Payment rate

 

 

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1    for all levels of services provided under the H0004
2    procedure code shall be increased by no less than $3 per
3    service unit for on-site services. Off-site rates for
4    these services must be increased by an amount which at
5    least maintains the current differential between on-site
6    and off-site services as represented on the July 1, 2022
7    fee schedule. This increase does not apply to individual
8    therapy services which were increased July 1, 2022 in
9    accordance with paragraph (1) of subsection (a).
10        (5) The Community Support - Group Medicaid Payment
11    rate for all levels of services provided under the H2015
12    procedure code shall be increased by no less than $3 per
13    service unit for on-site services. Off-site rates for
14    these services must be increased by an amount which at
15    least maintains the current differential between on-site
16    and off-site services as represented on the July 1, 2022
17    fee schedule. This increase does not apply to Community
18    Support - Individual services which were increased July 1,
19    2022 in accordance with paragraph (2) of subsection (a).
20        (6) The Telepsychiatry Originating Site Medicaid
21    Payment rate for services provided under the Q3014
22    procedure code shall be increased by no less than $10 per
23    service unit for on-site services. Off-site rates for
24    these services must be increased by an amount which at
25    least maintains the current differential between on-site
26    and off-site services as represented on the July 1, 2022

 

 

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1    fee schedule.
2        (7) Medication Monitoring Medicaid Payment rate for
3    services provided under the H2010 procedure code:
4            (A) The Medicaid total payment rate for medication
5        monitoring provided by a physician shall be increased
6        by no less than $25.11 per service unit for on-site
7        services. Off-site rates for these services must be
8        increased by an amount which at least maintains the
9        current differential between on-site and off-site
10        services as represented on the July 1, 2022 fee
11        schedule.
12            (B) The Medicaid total payment rate for medication
13        monitoring provided by an advanced practice registered
14        nurse shall be increased by no less than $18.07 per
15        service unit for on-site services. Off-site rates for
16        these services must be increased by an amount which at
17        least maintains the current differential between
18        on-site and off-site services as represented on the
19        July 1, 2022 fee schedule.
20            (C) The Medicaid total payment rate for medication
21        monitoring provided by all other levels of provider
22        shall be increased by no less than $15.00 per service
23        unit for on-site services. Off-site rates for these
24        services must be increased by an amount which at least
25        maintains the current differential between on-site and
26        off-site services as represented on the July 1, 2022

 

 

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1        fee schedule.
2(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)
 
3    (305 ILCS 66/20-20)
4    Sec. 20-20. Base Medicaid rates or add-on payments.
5    (a) For services under subsection (a) of Section 20-10: .
6     No base Medicaid rate or Medicaid rate add-on payment or
7any other payment for the provision of Medicaid community
8mental health services in place on July 1, 2021 shall be
9diminished or changed to make the reimbursement changes
10required by this Act. Any payments required under this Act
11that are delayed due to implementation challenges or federal
12approval shall be made retroactive to July 1, 2022 for the full
13amount required by this Act.
14    (b) For directed payments under subsection (b) of Section
1520-10: .
16     No base Medicaid rate payment or any other payment for the
17provision of Medicaid community mental health services in
18place on January 1, 2023 shall be diminished or changed to make
19the reimbursement changes required by this Act. The Department
20of Healthcare and Family Services must pay the directed
21payment in one installment within 60 days of receiving federal
22approval.
23    (c) For directed payments under subsection (c) of Section
2420-10:
25    No base Medicaid rate payment or any other payment for the

 

 

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1provision of Medicaid community mental health services in
2place on January 1, 2023 shall be diminished or changed to make
3the reimbursement changes required by this amendatory Act of
4the 103rd General Assembly. Any payments required under this
5amendatory Act of the 103rd General Assembly that are delayed
6due to implementation challenges or federal approval shall be
7made retroactive to January 1, 2024 for the full amount
8required by this amendatory Act of the 103rd General Assembly.
9(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)