HB0158ham003 102ND GENERAL ASSEMBLY

Rep. Camille Y. Lilly

Filed: 3/18/2021

10200HB0158ham003 LRB102 10244 CPF 23956 a

AMENDMENT TO HOUSE BILL 158

AMENDMENT NO. ______. Amend House Bill 158, AS AMENDED, with reference to page and line numbers of House Amendment No. 1, by deleting line 20 on page 64 through line 18 on page 70; and

by replacing line 22 on page 70 through line 21 on page 72 with the following:

"(320 ILCS 20/3.1 new)

Sec. 3.1. Adult protective services dementia training.

(a) This Section shall apply to any person who is employed by the Department in the Adult Protective Services division, or is contracted with the Department, and works on the development or implementation of social services to respond to and prevent adult abuse, neglect, or exploitation.

(b) The Department shall implement a dementia training program that must include instruction on the identification of people with dementia, risks such as wandering, communication impairments, and elder abuse, and the best practices for interacting with people with dementia.

(c) Training of at least 2 hours shall be completed at the start of employment with the Adult Protective Services division. Persons who are employees of the Adult Protective Services division on the effective date of this amendatory Act of the 102nd General Assembly shall complete this training within 6 months after the effective date of this amendatory Act of the 102nd General Assembly. The training shall cover the following subjects:

(1) Alzheimer's disease and dementia.

(2) Safety risks.

(3) Communication and behavior.

(d) Annual continuing education shall include at least 2 hours of dementia training covering the subjects described in subsection (c).

(e) This Section is designed to address gaps in current dementia training requirements for Adult Protective Services officials and improve the quality of training. If laws or rules existing on the effective date of this amendatory Act of the 102nd General Assembly contain more rigorous training requirements for Adult Protective Service officials, those laws or rules shall apply. Where there is overlap between this Section and other laws and rules, the Department shall interpret this Section to avoid duplication of requirements while ensuring that the minimum requirements set in this Section are met.

(f) The Department may adopt rules for the administration of this Section."; and

on page 147, by replacing lines 1 through 21 with the following:

"Sec. 14-14. Increasing access to primary care in hospitals. The Department of Healthcare and Family Services shall develop a program to facilitate coordination between Federally Qualified Health Centers (FQHCs) and safety net hospitals, with the goal of increasing care coordination, managing chronic diseases, and addressing the social determinants of health on or before December 31, 2021. Coordination between FQHCs and safety hospitals may include, but is not limited to, embedding FQHC staff in hospitals, utilizing health information technology for care coordination, and enabling FQHCs to connect hospital patients to community-based resources when needed to provide whole-person care. In addition, the Department shall develop a payment methodology to allow FQHCs to provide care coordination services, including, but not limited to, chronic disease management and behavioral health services. The Department of Healthcare and Family Services shall develop a payment methodology to allow for FQHC care coordination services by no later than December 31, 2021."; and

on page 180, line 5, after the period, by inserting "Expenditures from the Fund shall be subject to appropriation."; and

by replacing line 15 on page 222 through line 18 on page 226 with the following:

"Section 185-1. Short title. This Article may be cited as the Medicaid Technical Assistance Act. References in this Article to "this Act" mean this Article.

Section 185-3. Findings. The General Assembly finds as follows:

(1) This Act seeks to remedy a fraction of a much larger broken system by addressing access to health care, managed care organization reform, mental and substance abuse treatment services, and services to address the social determinants of health.

(2) Illinois transitioned Medicaid services to managed care with the goals of achieving better health outcomes for the Medicaid population and reducing the per capita costs of health care.

(3) Illinois benefits when people have support constructing the sturdy foundation of health and well-being that we all need to reach our potential. Medicaid managed care can be a vital tool in ensuring that people have the full range of supports that form this foundation, including services from community providers that address behavioral health needs, as well as related services that help people access food, housing, and employment.

(4) However, there are barriers that prevent Illinois from fully realizing the benefits of Medicaid managed care. The 2 devastating years of the State budget impasse resulted in 2 years of lost opportunity for community providers to invest in the people, systems, and technology that are necessary for them to participate in Medicaid managed care. A recent survey by the Illinois Collaboration on Youth of more than 130 community providers revealed that the majority do not have contracts with managed care organizations, and most do not have adequate billing and technology infrastructure sufficient for Medicaid billing now or in the future. The survey also revealed that community-based providers primarily serving people of color are the least prepared to participate in Medicaid managed care.

(5) The disparity in readiness between providers primarily serving people of color and those who serve a more mixed or white clientele is especially urgent because 62% of Illinois' Medicaid recipients are people of color. Racial disparities in behavioral health care result in significant human and financial costs to both the individual and to the State.

(6) The COVID-19 pandemic has further exacerbated the health disparities experienced by communities of color. COVID-19 has increased both the Medicaid-eligible population in Illinois, and increased the demand for behavioral health services, as Illinois residents grapple with trauma, death, job loss, depression, suicide, addiction, and exposure to violence. In addition, COVID-19 threatens the stability and viability of community-based providers, further straining the health care safety net for people who depend on Medicaid for these essential services.

(7) Lack of support for a diversity of providers reduces choice for Medicaid recipients and may incentivize managed care organizations to focus on a narrow selection of community partners. Having some choice in which providers people see for these essential services and having access to providers who understand their community, culture, and language has been demonstrated to reduce disparities in health outcomes and improve health and well-being across the life span.

(8) The Medicaid managed care system lacks consistent, statewide support for community providers, creating inefficiency and duplication. Providers need targeted trainings focused on their levels of readiness, learning collaboratives to provide group-level support for those experiencing similar challenges, and a mechanism to identify problems that need systemic solutions. Illinois could receive up to 70% in Medicaid matching funds from the federal government to supplement the costs of operating a Medicaid Technical Assistance Center.

(9) When community-based health care providers are able to contract with managed care organizations to deliver Medicaid services, people can access the care they need, in their communities, from providers they trust.

Section 185-5. Definitions. As used in this Act:

"Behavioral health providers" means mental health and substance use disorder providers.

"Department" means the Department of Healthcare and Family Services.

"Health care providers" means organizations who provide physical, mental, substance use disorder, or social determinant of health services.

"Health equity" means providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

"Network adequacy" means a Medicaid beneficiaries' ability to access all necessary provider types within time and distance standards as defined in the Managed Care Organization model contract.

"Service deserts" means geographic areas of the State with no or limited Medicaid providers that accept Medicaid.

"Social determinants of health" means any conditions that impact an individual's health, including, but not limited to, access to healthy food, safety, education, and housing stability.

"Stakeholders" means, but are not limited to, health care providers, advocacy organizations, managed care organizations, Medicaid beneficiaries, and State and city partners.

Section 185-10. Medicaid Technical Assistance Center. The Department of Healthcare and Family Services shall establish a Medicaid Technical Assistance Center. The Medicaid Technical Assistance Center shall operate as a cross-system educational resource to strengthen the business infrastructure of health care provider organizations in Illinois to ultimately increase the capacity, access, health equity, and quality of Illinois' Medicaid managed care program, HealthChoice Illinois, and YouthCare, the Medicaid managed care program for children and youth who receive Medicaid health services through the Department of Children and Family Services. The Medicaid Technical Assistance Center shall be established within the Department's Office of Medicaid Innovation.

Section 185-15. Collaboration. The Medicaid Technical Assistance Center shall collaborate with public and private partners throughout the State to identify, establish, and maintain best practices necessary for health providers to ensure their capacity to participate in HealthChoice Illinois or YouthCare. The Medicaid Technical Assistance Center shall administer the following:

(1) Outreach and engagement: The Medicaid Technical Assistance Center shall undertake efforts to identify and engage community-based providers offering behavioral health services or services addressing the social determinants of health, especially those predominantly serving communities of color or those operating within or near service deserts, for the purpose of offering training and technical assistance to them through the Medicaid Technical Assistance Center. Outreach and engagement services may be subcontracted.

(2) Trainings: The Medicaid Technical Assistance Center shall create and administer ongoing trainings for health care providers. Trainings may be subcontracted. The Medicaid Technical Assistance Center shall provide in-person and web-based trainings. In-person training shall be conducted throughout the State. All trainings must be free of charge. The Medicaid Technical Assistance Center shall administer post-training surveys and incorporate feedback. Training content and delivery must be reflective of Illinois providers' varying levels of readiness, resources, and client populations.

(3) Web-based resources: The Medicaid Technical Assistance Center shall maintain an independent, easy to navigate, and up-to-date website that includes, but is not limited to: recorded training archives, a training calendar, provider resources and tools, up-to-date explanations of Department and managed care organization guidance, a running database of frequently asked questions and contact information for key staff members of the Department, managed care organizations, and the Medicaid Technical Assistance Center.

(4) Learning collaboratives: The Medicaid Technical Assistance Center shall host regional learning collaboratives that will supplement the Medicaid Technical Assistance Center training curriculum to bring together groups of stakeholders to share issues and best practices, and to escalate issues. Leadership of the Department and managed care organizations shall attend learning collaboratives on a quarterly basis.

(5) Network adequacy reports: The Medicaid Technical Assistance Center shall publicly release a report on Medicaid provider network adequacy within the first 3 years of implementation and annually thereafter. The reports shall identify provider service deserts and health care disparities by race and ethnicity.

(6) Equitable delivery system: The Medicaid Technical Assistance Center is committed to the principle that all Medicaid recipients have accessible and equitable physical and mental health care services. All providers served through the Medicaid Technical Assistance Center shall deliver services notwithstanding the patient's race, color, gender, gender identity, age, ancestry, marital status, military status, religion, national origin, disability status, sexual orientation, order of protection status, as defined under Section 1-103 of the Illinois Human Rights Act, or immigration status.

Section 185-20. Federal financial participation. The Department of Healthcare and Family Services, to the extent allowable under federal law, shall maximize federal financial participation for any moneys appropriated to the Department for the Medicaid Technical Assistance Center. Any federal financial participation funds obtained in accordance with this Section shall be used for the further development and expansion of the Medicaid Technical Assistance Center. All federal financial participation funds obtained under this subsection shall be deposited into the Medicaid Technical Assistance Center Fund created under Section 25.

Section 185-25. Medicaid Technical Assistance Center Fund. The Medicaid Technical Assistance Center Fund is created as a special fund in the State treasury. The Fund shall consist of any moneys appropriated to the Department of Healthcare and Family Services for the purposes of this Act and any federal financial participation funds obtained as provided under Section 20. Subject to appropriation, moneys in the Fund shall be used for carrying out the purposes of this Act and for no other purpose. All interest earned on the moneys in the Fund shall be deposited into the Fund.

Section 185-90. The State Finance Act is amended by adding Section 5.935 as follows:

(30 ILCS 105/5.935 new)

Sec. 5.935. The Medicaid Technical Assistance Center Fund.".