Illinois General Assembly - Full Text of HB3276
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Full Text of HB3276  102nd General Assembly

HB3276 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3276

 

Introduced 2/19/2021, 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; 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.


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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
5Illinois Certified Community Behavioral Health Clinics Act.
 
6    Section 5. Medicaid Pilot Program; integrated behavioral
7health and primary care; findings.
8    (a) The General Assembly finds and declares that the
9federal Protecting Access to Medicare Act of 2014, which
10requires the establishment of demonstration programs to
11improve community behavioral health services to be funded as
12part of Medicaid, serves as a useful model for the creation of
13a similar program in Illinois to provide and improve upon
14community behavioral health services and treatment.
15    (b) The General Assembly finds and declares that the
16federal Protecting Access to Medicare Act of 2014 identifies
17some of the appropriate criteria for certified community
18behavioral health clinics. These criteria fall into 6 areas:
19        (1) staffing;
20        (2) availability and accessibility of services;
21        (3) care coordination;
22        (4) scope of services;
23        (5) quality and other reporting; and

 

 

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1        (6) organizational authority.
2    (c) The General Assembly finds and declares that certified
3community behavioral health clinics represent an opportunity
4to improve the behavioral health of Illinois citizens by:
5        (1) expanding access to community-based mental health
6    and substance use disorder services;
7        (2) increasing the capacity of the mental health and
8    substance use disorder treatment systems to reduce unmet
9    need for care;
10        (3) advancing integration of behavioral health with
11    physical health care;
12        (4) assimilating and utilizing evidence-based
13    practices on a more consistent basis; and
14        (5) promoting improved access to high quality care.
15    (d) The General Assembly finds and declares that the pilot
16program created in accordance with this Act should focus upon
174 key patient populations that may benefit from the certified
18community behavioral health clinic model, with a special
19emphasis on serving the following individuals living in
20minority communities, communities of color, or underserved
21areas:
22        (1) children with serious emotional disturbances;
23        (2) children with substance use disorders;
24        (3) adults with serious mental illness; and
25        (4) adults with substance use disorders.
 

 

 

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1    Section 10. Definitions. As used in this Act:
2    "Departments" means the Department of Healthcare and
3Family Services and the Department of Human Services, Division
4of Mental Health and Division of Substance Use Prevention and
5Recovery.
6    "PAMA" means the Protecting Access to Medicare Act of
72014.
8    "Pilot program" means the Certified Community Behavioral
9Health Clinic pilot program.
 
10    Section 15. Certified Community Behavioral Health Clinic
11pilot program.
12    (a) The Department of Healthcare and Family Services, in
13partnership with the Department of Human Services, Division of
14Mental Health and Division of Substance Use Prevention and
15Recovery, shall develop, with meaningful input from
16stakeholders, a pilot program based upon, but not necessarily
17identical to, the certified community behavioral health clinic
18criteria and prospective payment system methodology issued by
19the federal Substance Abuse and Mental Health Services
20Administration and the Centers for Medicare and Medicaid
21Services as created under the Protecting Access to Medicare
22Act of 2014, Prospective Payment System Guidance. Input from
23stakeholders shall include and incorporate information
24received from consumers, family members of consumers,
25community mental health centers, mental health providers,

 

 

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1substance use disorder treatment facilities, substance use
2disorder treatment providers, primary care physicians, and
3statewide associations representing the foregoing. Stakeholder
4input shall be gathered from across the State utilizing
5listening sessions including those areas most severely
6impacted by the opioid and suicide crises such as minority
7communities, rural areas, and urban areas.
8    (b) Implementation of the pilot program is subject to
9federal approval. The Departments shall seek federal financial
10assistance for this pilot program and certified community
11behavioral health clinic technical assistance and support
12through all potential federal sources, including, but not
13limited to, the federal Delivery System Reform Incentive
14Payment program. The pilot program shall be implemented under
15the following timeline:
16        (1) The Departments shall submit any necessary
17    applications to the Centers for Medicare and Medicaid
18    Services for a waiver under Section 1115 to implement the
19    pilot program described in this Section no later than
20    December 31, 2021. The Departments shall promptly engage
21    in any additional steps requested or required by the
22    Centers for Medicare and Medicaid Services to obtain
23    approval of the pilot program waiver on a timely basis.
24        (2) The Departments shall conduct the stakeholder
25    listening sessions as described above no later than 3
26    months following federal approval of the pilot program

 

 

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1    waiver.
2        (3) After federal approval of the pilot program waiver
3    has been secured, the Departments may adopt rules to carry
4    out this pilot program and include requirements and
5    specifications separate from those prescribed under the
6    federal Protecting Access to Medicare Act of 2014 by the
7    federal Substance Abuse and Mental Health Services
8    Administration and the Centers for Medicare and Medicaid
9    Services no later than 6 months following federal approval
10    of the pilot program waiver, but shall not draft any rules
11    in contravention of the criteria or specifications for the
12    pilot program development and implementation as set forth
13    in this Act.
14        (4) Upon federal approval of the pilot program waiver,
15    the Department of Healthcare and Family Services shall
16    implement the prospective payment system for certified
17    community behavioral health clinic services under the
18    medical assistance fee-for-service and managed care
19    programs based upon the certified community behavioral
20    health clinic daily (CC PPS-1) or monthly (CC PPS-2)
21    prospective payment system methodology set forth in
22    Appendix III to the Prospective Payment System Guidance.
23    The Department of Healthcare and Family Services shall
24    implement quality bonus and outlier payments, as further
25    detailed under the Prospective Payment System Guidance.
26    The prospective payment system shall be updated and

 

 

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1    subject to rebasing in accordance with Appendix III to the
2    Prospective Payment System Guidance. For services rendered
3    by a certified community behavioral health clinic to an
4    individual enrolled in a Medicaid managed care
5    organization, the Department of Healthcare and Family
6    Services shall implement a supplemental payment system at
7    the same time as the prospective payment system to ensure
8    that the community behavioral health clinic receives full
9    payment under the certified community behavioral health
10    clinic prospective payment system methodology for each
11    qualifying visit. Specifically, the Department of
12    Healthcare and Family Services shall provide for payment
13    to the community behavioral health clinic by the
14    Department of Healthcare and Family Services of a
15    supplemental payment equal to the amount (if any) by which
16    payment under the certified community behavioral health
17    clinic prospective payment system methodology would exceed
18    payments by the managed care organization to the certified
19    community behavioral health clinic for services rendered
20    to the entity's enrollee. The supplemental payments shall
21    be made by the Department of Healthcare and Family
22    Services according to a schedule agreed to between the
23    State and the certified community behavioral health
24    clinic, but in no case shall payment be made less
25    frequently than every 3 months. The prospective payment
26    system methodology shall remain in effect so long as the

 

 

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1    Departments continue to offer the pilot program and
2    regardless of the status of the PAMA-authorized Certified
3    Community Behavioral Health Clinic demonstration program,
4    including the Prospective Payment System Guidance.
5        (5) The Departments shall fully implement the pilot
6    program so that certified community behavioral health
7    clinic services may begin operations within 9 months
8    following federal approval of the pilot program waiver.
9    (c) The General Assembly shall appropriate such funds to
10support the Departments in planning, obtaining stakeholder
11input, and implementing and carrying out the pilot program as
12well as other related duties specified in this Act, in
13addition to funding that the Departments shall seek from the
14Centers for Medicare and Medicaid Services and the federal
15Substance Abuse and Mental Health Services Administration to
16support these efforts.
17    (d) Certification of certified community behavioral health
18clinics by the Department of Healthcare and Family Services
19shall be based upon the following criteria. Where applicable,
20the State shall use federal certified community behavioral
21health clinic criteria established by the federal Substance
22Abuse and Mental Health Services Administration as a guide.
23The Department of Healthcare and Family Services shall impose
24the certification criteria on all initial certified community
25behavioral health clinic applications and shall require
26recertification on a regular basis, no less frequently than

 

 

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1every 2 years.
2        (1) Staffing requirements, including criteria that
3    staff have diverse disciplinary backgrounds, have
4    necessary State required licensure or certification and
5    accreditation, and are culturally and linguistically
6    trained to serve the needs of the clinic's patient
7    population.
8        (2) Availability and accessibility of services,
9    including crisis management services that are available
10    and accessible 24 hours a day, the use of a sliding scale
11    for payment, and no rejection for services or limiting of
12    services on the basis of a patient's ability to pay or
13    place of residence.
14        (3) Care coordination, including requirements to
15    coordinate care across settings and providers to ensure
16    seamless transitions for patients across the full spectrum
17    of health services, including acute, chronic, and
18    behavioral health needs.
19        (4) Provision (in a manner reflecting person-centered
20    care) of the following services which, if not available
21    directly through the certified community behavioral health
22    clinic, are provided or referred through formal
23    relationships with other providers:
24            (A) crisis mental health services, including
25        24-hour mobile crisis teams, emergency crisis
26        intervention services, and crisis stabilization;

 

 

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1            (B) screening, assessment, and diagnosis,
2        including risk assessment;
3            (C) patient-centered treatment planning or similar
4        processes, including risk assessment and crisis
5        planning;
6            (D) outpatient mental health and substance use
7        disorder services;
8            (E) outpatient clinic primary care screening and
9        monitoring of key health indicators and health risk;
10            (F) targeted case management;
11            (G) psychiatric rehabilitation services;
12            (H) peer support and counselor services and family
13        supports; and
14            (I) intensive, community-based mental health care
15        for members of the armed forces and veterans.
16        (5) Reporting of encounter data, clinical outcomes
17    data, quality data in accordance with federal certified
18    community behavioral health clinic criteria, and such
19    other data as the Departments deem necessary.
20        (6) Certified community behavioral health clinics may
21    only be formed and organized by community mental health
22    centers and substance use disorder treatment facilities or
23    mental health or substance use disorder treatment
24    providers licensed or certified by the Departments.
25    (e) The Departments shall deliver a report to the General
26Assembly during the regular session on the outcomes of the

 

 

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1pilot program after 2 years of full implementation and again
2after 4 years of full implementation providing information on
3performance of the pilot program along with plans for future
4sustainability, including, but not limited to, the quality
5measures and certification criteria set forth above and under
6the guidance issued by the Centers for Medicare and Medicaid
7Services and the federal Substance Abuse and Mental Health
8Services Administration for the Protecting Access to Medicare
9Act of 2014.
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.