HB4970 101ST GENERAL ASSEMBLY

LRB101 17927 KTG 70084 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4970

Introduced 2/18/2020, by Rep. Deb Conroy

SYNOPSIS AS INTRODUCED:

New Act

Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services and the Department of Human Services (Departments) to develop a pilot program based upon the certified community behavioral health clinic criteria and the prospective payment system methodology issued by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services as created under the federal Protecting Access to Medicare Act of 2014. Provides that implementation of the pilot program is subject to federal approval. Requires the Departments to seek federal financial assistance for the pilot program and certified community behavioral health clinic technical assistance and support through all potential federal sources, including, but not limited to, the federal Delivery System Reform Incentive Payment program. Contains provisions concerning the timeline for implementing the pilot program; the Departments applications for a federal Section 1115 waiver to implement the pilot program; the adoption of rules to implement the pilot program; implementation of the pilot program for certified community behavioral health clinic services under the medical assistance fee-for-service and managed care programs; payments to community behavioral health clinics under the certified community behavioral health clinic prospective payment system methodology for each qualifying visit; staffing requirements for certified community behavioral health clinics; reporting requirements; and other matters. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Illinois Certified Community Behavioral Health Clinics Act.

Section 5. Medicaid Pilot Program; integrated behavioral health and primary care; findings.

(a) The General Assembly finds and declares that the federal Protecting Access to Medicare Act of 2014, which requires the establishment of demonstration programs to improve community behavioral health services to be funded as part of Medicaid, serves as a useful model for the creation of a similar program in Illinois to provide and improve upon community behavioral health services and treatment.

(b) The General Assembly finds and declares that the federal Protecting Access to Medicare Act of 2014 identifies appropriate criteria for certified community behavioral health clinics. These criteria fall into 6 areas:

(1) staffing;

(2) availability and accessibility of services;

(3) care coordination;

(4) scope of services;

(5) quality and other reporting; and

(6) organizational authority.

(c) The General Assembly finds and declares that certified community behavioral health clinics represent an opportunity to improve the behavioral health of Illinois citizens by:

(1) expanding access to community-based mental health and substance use disorder services;

(2) increasing the capacity of the mental health and substance use disorder treatment systems to reduce unmet need for care;

(3) advancing integration of behavioral health with physical health care;

(4) assimilating and utilizing evidence-based practices on a more consistent basis; and

(5) promoting improved access to high quality care.

(d) The General Assembly finds and declares that the pilot program created in accordance with this Act should focus upon 4 key patient populations that may benefit from the certified community behavioral health clinic model:

(1) children with serious emotional disturbances;

(2) children with substance use disorders;

(3) adults with serious mental illness; and

(4) adults with substance use disorders.

Section 10. Definitions. As used in this Act:

"Departments" means the Department of Healthcare and Family Services and the Department of Human Services, Division of Mental Health and Division of Substance Use Prevention and Recovery.

"PAMA" means the Protecting Access to Medicare Act of 2014.

"Pilot program" means the Certified Community Behavioral Health Clinic pilot program.

Section 15. Certified Community Behavioral Health Clinic pilot program.

(a) The Department of Healthcare and Family Services, in partnership with the Department of Human Services, Division of Mental Health and Division of Substance Use Prevention and Recovery, shall develop, with meaningful input from stakeholders, a pilot program based upon the certified community behavioral health clinic criteria and prospective payment system methodology issued by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services as created under the Protecting Access to Medicare Act of 2014, Prospective Payment System Guidance. Input from stakeholders shall include and incorporate information received from consumers, family members of consumers, community mental health centers, mental health providers, substance use disorder treatment facilities, substance use disorder treatment providers, primary care physicians, federally qualified health centers, and statewide associations representing the foregoing. Stakeholder input shall be gathered from across the State utilizing listening sessions including those areas most severely impacted by the opioid and suicide crises such as minority communities, rural areas, and urban areas.

(b) Implementation of the pilot program is subject to federal approval. The Departments shall seek federal financial assistance for this pilot program and certified community behavioral health clinic technical assistance and support through all potential federal sources, including, but not limited to, the federal Delivery System Reform Incentive Payment program. The pilot program shall be implemented under the following timeline:

(1) The Departments shall submit any necessary applications to the Centers for Medicare and Medicaid Services for a waiver under Section 1115 to implement the pilot program described in this Section no later than December 31, 2020. The Departments shall promptly engage in any additional steps requested or required by the Centers for Medicare and Medicaid Services to obtain approval of the pilot program waiver on a timely basis.

(2) The Departments shall conduct the stakeholder listening sessions as described above no later than 3 months following federal approval of the pilot program waiver.

(3) After federal approval of the pilot program waiver has been secured, the Departments may adopt rules to carry out this pilot program and include requirements and specifications separate from those prescribed under the federal Protecting Access to Medicare Act of 2014 by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services no later than 6 months following federal approval of the pilot program waiver, but shall not draft any rules in contravention of the criteria or specifications for the pilot program development and implementation as set forth in this Act.

(4) Upon federal approval of the pilot program waiver, the Department of Healthcare and Family Services shall implement the prospective payment system for certified community behavioral health clinic services under the medical assistance fee-for-service and managed care programs based upon the certified community behavioral health clinic daily (CC PPS-1) or monthly (CC PPS-2) prospective payment system methodology set forth in Appendix III to the Prospective Payment System Guidance. The Department of Healthcare and Family Services shall implement quality bonus and outlier payments, as further detailed under the Prospective Payment System Guidance. The prospective payment system shall be updated and subject to rebasing in accordance with Appendix III to the Prospective Payment System Guidance. For services rendered by a certified community behavioral health clinic to an individual enrolled in a Medicaid managed care organization, the Department of Healthcare and Family Services shall implement a supplemental payment system at the same time as the prospective payment system to ensure that the community behavioral health clinic receives full payment under the certified community behavioral health clinic prospective payment system methodology for each qualifying visit. Specifically, the Department of Healthcare and Family Services shall provide for payment to the community behavioral health clinic by the Department of Healthcare and Family Services of a supplemental payment equal to the amount (if any) by which payment under the certified community behavioral health clinic prospective payment system methodology would exceed payments by the managed care organization to the certified community behavioral health clinic for services rendered to the entity's enrollee. The supplemental payments shall be made by the Department of Healthcare and Family Services according to a schedule agreed to between the State and the certified community behavioral health clinic, but in no case shall payment be made less frequently than every 3 months. The prospective payment system methodology shall remain in effect so long as the Departments continue to offer the pilot program and regardless of the status of the PAMA-authorized Certified Community Behavioral Health Clinic demonstration program, including the Prospective Payment System Guidance.

(5) The Departments shall fully implement the pilot program so that certified community behavioral health clinic services may begin operations within 9 months following federal approval of the pilot program waiver.

(c) The General Assembly shall appropriate such funds to support the Departments in planning, obtaining stakeholder input, and implementing and carrying out the pilot program as well as other related duties specified in this Act, in addition to funding that the Departments shall seek from the Centers for Medicare and Medicaid Services and the federal Substance Abuse and Mental Health Services Administration to support these efforts.

(d) Certification of certified community behavioral health clinics by the Department of Healthcare and Family Services shall be based upon the following criteria. Where applicable, the State shall use federal certified community behavioral health clinic criteria established by the federal Substance Abuse and Mental Health Services Administration as a guide. The Department of Healthcare and Family Services shall impose the certification criteria on all initial certified community behavioral health clinic applications and shall require recertification on a regular basis, no less frequently than every 2 years.

(1) Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required licensure or certification and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.

(2) Availability and accessibility of services, including crisis management services that are available and accessible 24 hours a day, the use of a sliding scale for payment, and no rejection for services or limiting of services on the basis of a patient's ability to pay or place of residence.

(3) Care coordination, including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services, including acute, chronic, and behavioral health needs.

(4) Provision (in a manner reflecting person-centered care) of the following services which, if not available directly through the certified community behavioral health clinic, are provided or referred through formal relationships with other providers:

(A) crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization;

(B) screening, assessment, and diagnosis, including risk assessment;

(C) patient-centered treatment planning or similar processes, including risk assessment and crisis planning;

(D) outpatient mental health and substance use disorder services;

(E) outpatient clinic primary care screening and monitoring of key health indicators and health risk;

(F) targeted case management;

(G) psychiatric rehabilitation services;

(H) peer support and counselor services and family supports; and

(I) intensive, community-based mental health care for members of the armed forces and veterans.

(5) Reporting of encounter data, clinical outcomes data, quality data in accordance with federal certified community behavioral health clinic criteria, and such other data as the Departments deem necessary.

(6) Certified community behavioral health clinics may only be formed and organized by community mental health centers and substance use disorder treatment facilities or licensed or certified mental health or substance use disorder treatment providers.

(e) The Departments shall deliver a report to the General Assembly during the regular session on the outcomes of the pilot program after 2 years of full implementation and again after 4 years of full implementation providing information on performance of the pilot program along with plans for future sustainability, including, but not limited to, the quality measures and certification criteria set forth above and under the guidance issued by the Centers for Medicare and Medicaid Services and the federal Substance Abuse and Mental Health Services Administration for the Protecting Access to Medicare Act of 2014.

Section 99. Effective date. This Act takes effect upon becoming law.