SB3525 101ST GENERAL ASSEMBLY

LRB101 17365 KTG 66770 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3525

Introduced 2/14/2020, by Sen. Sara Feigenholtz

SYNOPSIS AS INTRODUCED:

New Act

Creates the Community Mental Health Reform Act. Requires the Department of Healthcare and Family Services, in partnership with the Department of Human Services, to revise administrative rules and other Department policies and practices concerning certification and service requirements for community mental health centers and behavioral health clinics. Provides that the primary goal of revising the administrative rules and Department policies is to develop a modernized regulatory framework that: (1) fosters the provision of services that results in the best mental health and health outcomes and is consistent with a Medicaid managed care environment; (2) enables innovation and integrated mental and physical health care; (3) harnesses the modern mental health workforce; and (4) reduces unnecessary process barriers that do not offer meaningful clinical value and that act as a barrier to treatment. Requires the Department of Human Services to revise administrative rules concerning the Medicaid Community Mental Health Services Program to be consistent with changes made to administrative rules concerning certification and service requirements for community mental health centers and behavioral health clinics. Contains provisions concerning reducing client mental health assessments; enabling workforce expertise for certain roles on multidisciplinary, team-based treatment models; streamlining fee-for-service documentation requirements to enable increased time for client care; the establishment of a working group of community mental health centers and behavioral health clinics; and other matters. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning mental health.

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 Community Mental Health Reform Act.

Section 5. Purpose. Community mental health centers certified in accordance with 59 Ill. Adm. Code 132 and behavioral health clinics eligible to provide community mental health services in accordance with 89 Ill. Adm. Code 140.452 through 140.456 are the backbone of Illinois' mental health safety net. As health care and mental health care systems have changed under the Affordable Care Act and Medicaid managed care, moving toward care integration, stronger care coordination, and payment for outcomes rather than volume, the regulations governing community mental health services need to be modernized to align with these advances.

Section 10. Community mental health centers and behavioral health clinics; administrative rules. The Department of Healthcare and Family Services, in partnership with the Department of Human Services' Division of Mental Health, and with meaningful stakeholder input, shall revise 89 Ill. Adm. Code 140.452 through 140.456 and supporting Department policies and practices consistent with this Act, with the primary goals of developing a modernized regulatory framework that:

(1) fosters the provision of services that results in the best mental health and health outcomes and is consistent with a Medicaid managed care environment;

(2) enables innovation and integrated mental and physical health care;

(3) harnesses the modern mental health workforce; and

(4) reduces unnecessary process barriers that do not offer meaningful clinical value and that act as a barrier to treatment.

The Department of Human Services shall revise 59 Ill. Adm. Code 132 to be consistent with the changes made to 89 Ill. Adm. Code 140.452 through 140.456 in accordance with this Act.

Section 15. Mental health assessments. Excessive, lengthy, and duplicative mental health assessments and reassessments that are a precondition to care or treatment that go beyond a reasonable length of time for an average client visit act as a serious barrier to care and take valuable time away from treatment.

(1) Streamlining the number, length, and frequency of mental health assessments that are required before care or treatment can begin or continue. The Department of Healthcare and Family Services, with meaningful stakeholder input, shall revise 89 Ill. Adm. Code 140.452 through 140.456, and supporting Department policies and practices, to streamline the number, length, and frequency of mental health assessments and reassessments in fee-for-service Medicaid or through a Medicaid managed care plan, including the completion of an integrated assessment and treatment plan, that are required before an individual can begin receiving mental health services in accordance with 89 Ill. Adm. Code 140.452 through 140.456. A required mental health assessment must have clinical value for purposes of assisting the provider with what services are needed to address the individual's mental health needs and must also be of reasonable length to administer within the average length of one client visit. To ensure that an integrated assessment and treatment plan does not act as a barrier to beginning mental health care or treatment, a Medicaid enrollee shall be able to begin receiving medically necessary services under 89 Ill. Adm. Code 140.452 through 140.456 immediately after the initiation of an integrated assessment and treatment plan or other assessment, and the community mental health center or behavioral health clinic shall have 45 days from the date of initiation of the integrated assessment and treatment plan to complete the plan and related documentation. The performance of an integrated assessment and treatment plan for a Medicaid enrollee by a provider shall be required no more frequently than annually.

(2) Streamlining the frequency of treatment plan updates and reviews that do not meaningfully assist the treating professional in evaluating treatment progress. The Department of Healthcare and Family Services shall revise 89 Ill. Adm. Code 140.452 through 140.456 to reduce the frequency of mental health treatment plan reviews and updates that do not provide meaningful clinical value in monitoring the individual's progress or guide what services continue to be needed to address the individual's mental health needs or when discharge is appropriate. The frequency of treatment plan updates and reviews must take into account that serious mental illnesses are chronic, rather than acute, medical conditions, and typically do not change radically over a short period of time, but are managed over significant lengths of time. Treatment plan reviews or updates for services provided in accordance with 89 Ill. Adm. Code 140.452 through 140.456, including assertive community treatment or community support team services, shall not be required more frequently than quarterly.

Section 20. Assertive community treatment and community support teams. The prescriptive requirements of 89 Ill. Adm. Code 140.452 through 140.456 for staffing assertive community treatment and community support team treatment models do not reflect the modern workforce, are more restrictive than the fidelity scale, and must be modernized in the following manner:

(1) Consistent with all Illinois scope of practice laws, a mental health professional as defined in 89 Ill. Adm. Code 140.453(b)(5)(A)(i) or in the first 2 items in 89 Ill. Adm. Code 140.453(b)(5)(A)(ii) shall be permitted to lead an assertive community treatment or community support team.

(2) Consistent with all Illinois scope of practice laws, a psychiatric advanced practice registered nurse shall be permitted to be the full-time psychiatric resource for an assertive community treatment team, and be permitted to sign off on treatment plans, treatment plan reviews, and treatment plan updates.

(3) Consistent with all Illinois scope of practice laws, a community mental health center that has a formal, written agreement with a federally qualified health clinic or hospital for psychiatry services for psychiatrists or psychiatric advanced practice registered nurses employed by or on contract with the federally qualified health clinic or hospital, or a formal written agreement with an independent psychiatrist or psychiatric advanced practice registered nurse, shall be permitted to use such psychiatry services as the full-time psychiatric resource for assertive community treatment teams.

(4) To enable development of more assertive community treatment and community support teams to grow service capacity to meet Illinois' treatment needs for people with serious mental illnesses, the establishment of new assertive community treatment or community support teams shall be permitted as long as the team staffing requirements are met within 6 months of the establishment of the team. This provision is intended to allow for hiring team members as client volume ramps up rather than hiring all the required team members prior to establishing a new team when there is not enough volume to support the new hires, as long as the community mental health center or behavioral health clinic is using the appropriate mental health professionals to be temporary members of the new team for the first 6 months.

Section 25. Billing documentation requirements; community mental health services. The Department of Healthcare and Family Services, with meaningful stakeholder input, shall streamline the 15-minute billing documentation requirements for community mental health services, which are required for both fee-for-service enrollees and those enrolled in a Medicaid managed care plan. Among other things, the Department of Healthcare and Family Services shall consider:

(1) eliminating unnecessary and duplicative documentation in provider service notes, such as when a service or billing code is self-explanatory;

(2) allowing for weekly or monthly batch service notes for services that need additional explanation;

(3) whether the integrated assessment and treatment plan required by the Department of Healthcare and Family Services can serve as the documentation necessary to support the services delivered; and

(4) whether a bundled payment for team-based services will enable more innovative service delivery aimed at getting the best health outcomes.

The Department of Healthcare and Family Services shall take into account that documenting in the service notes for every 15-minute service increment is excessive documentation and takes significant time away from client care, and that such requirements are a major administrative barrier to moving toward outcomes-based care.

Section 30. Working group. The Department of Healthcare and Family Services, in partnership with the Department of Human Services' Division of Mental Health, shall establish a working group of community mental health centers and behavioral health clinics from across the State, and other interested stakeholders, that shall meet for meaningful stakeholder input for purposes of revising 89 Ill. Adm. Code 140.452 through 140.456 consistent with this Act. The working group shall meet at least monthly over a 9-month period prior to the development of revised administrative rules implementing this Act.

Section 35. Revisions to rules. The Department of Healthcare and Family Services shall file revisions to 89 Ill. Adm. Code 140.452 through 140.456 within 12 months after the effective date of this Act. The Department of Human Services' Division of Mental Health shall file revisions to 59 Ill. Adm. Code 132 consistent with the changes made to 89 Ill. Adm. Code 140.452 through 140.456 in accordance with this Act simultaneously with the Department of Healthcare and Family Services' filing of revisions to 89 Ill. Adm. Code 140.452 through 140.456.

Section 40. Application for federal approval. The Department of Healthcare and Family Services, as the State's sole Medicaid agency, shall apply for any necessary federal approval with the Centers for Medicare and Medicaid Services for purposes of implementing this Act within 6 months after the effective date of this Act.

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