Bill Text: IL HB2154 | 2019-2020 | 101st General Assembly | Chaptered


Bill Title: Amends the Illinois Public Aid Code. Provides that, for recipients of public aid who are required to comply with the terms of a service plan developed by the Department of Children and Family Services, participation in substance abuse treatment, drug testing, parenting classes, anger management, domestic violence counseling, evaluations, or any other activities specified in the service plan shall count as an approvable job search activity under TANF employment, education, and training programs; the SNAP Employment and Training Program; and any job search, training, and work programs authorized under Article IX of the Code. Requires the Department of Human Services to apply for any federal waivers or approvals necessary to implement the job search exemption.

Spectrum: Strong Partisan Bill (Democrat 21-2)

Status: (Passed) 2019-08-26 - Public Act . . . . . . . . . 101-0461 [HB2154 Detail]

Download: Illinois-2019-HB2154-Chaptered.html



Public Act 101-0461
HB2154 EnrolledLRB101 04633 KTG 49642 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. References to Act; intent; purposes. This Act
may be referred to as the Children and Young Adult Mental
Health Crisis Act. It is intended to fill in significant gaps
in Illinois' mental health treatment system for children and
young adults given that this is the age group that most mental
health conditions begin to manifest.
Section 5. Findings. The General Assembly finds as follows:
(1) Over 850,000 children and young adults under age 25 in
Illinois will experience a mental health condition. Barely
one-third will get treatment even though treatment can lead to
recovery and wellness.
(2) Every year hundreds of Illinois children with treatable
serious mental health conditions are forced to remain in
psychiatric hospitals far beyond medical necessity because
subsequent treatment options are not available.
(3) There are many gaps in Illinois' publicly funded mental
health system, and private insurance does not cover proven
treatment approaches covered by the public sector.
(4) Children and young adults must have access to the level
of mental health treatment they need at the first signs of a
problem to prevent worsening of the condition and the use of
substances for purposes of self-medication.
(5) Illinois' mental health system for children and young
adults must align with system of care principles, which were
developed by The Georgetown University Center for Child and
Human Development and are the nationally recognized best
practices for developing a strong treatment system.
(6) This Act contains many of the crucial elements that
Illinois requires for building an appropriate service delivery
system and for coverage of a comprehensive array of services
through private insurance.
Section 10. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
(Text of Section before amendment by P.A. 100-1170)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
The program of health benefits must comply with Sections
155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
Illinois Insurance Code. The Department of Insurance shall
enforce the requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1-8-19.)
(Text of Section after amendment by P.A. 100-1170)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
and 356z.32, and 356z.33 of the Illinois Insurance Code. The
program of health benefits must comply with Sections 155.22a,
155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section with respect to Sections 370c and
370c.1 of the Illinois Insurance Code; all other requirements
of this Section shall be enforced by the Department of Central
Management Services.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
100-1170, eff. 6-1-19.)
Section 15. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes of
providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
356z.32, and 356z.33 of the Illinois Insurance Code. The
coverage shall comply with Sections 155.22a, 355b, 356z.19, and
370c of the Illinois Insurance Code. The Department of
Insurance shall enforce the requirements of this Section. The
requirement that health benefits be covered as provided in this
Section is an exclusive power and function of the State and is
a denial and limitation under Article VII, Section 6,
subsection (h) of the Illinois Constitution. A home rule county
to which this Section applies must comply with every provision
of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
10-3-18.)
Section 20. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include coverage
for the post-mastectomy care benefits required to be covered by
a policy of accident and health insurance under Section 356t
and the coverage required under Sections 356g, 356g.5,
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
Insurance Code. The coverage shall comply with Sections
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health
benefits be covered as provided in this is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
10-4-18.)
Section 25. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
Insurance policies shall comply with Section 356z.19 of the
Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, and 370c of the Illinois Insurance
Code. The Department of Insurance shall enforce the
requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
1-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
Section 30. The Illinois Insurance Code is amended by
adding Section 356z.33 as follows:
(215 ILCS 5/356z.33 new)
Sec. 356z.33. Coverage of treatment models for early
treatment of serious mental illnesses.
(a) For purposes of early treatment of a serious mental
illness in a child or young adult under age 26, a group or
individual policy of accident and health insurance, or managed
care plan, that is amended, delivered, issued, or renewed after
December 31, 2020 shall provide coverage of the following
bundled, evidence-based treatment:
(1) Coordinated specialty care for first episode
psychosis treatment, covering the elements of the
treatment model included in the most recent national
research trials conducted by the National Institute of
Mental Health in the Recovery After an Initial
Schizophrenia Episode (RAISE) trials for psychosis
resulting from a serious mental illness, but excluding the
components of the treatment model related to education and
employment support.
(2) Assertive community treatment (ACT) and community
support team (CST) treatment. The elements of ACT and CST
to be covered shall include those covered under Article V
of the Illinois Public Aid Code, through 89 Ill. Adm. Code
140.453(d)(4).
(b) Adherence to the clinical models. For purposes of
ensuring adherence to the coordinated specialty care for first
episode psychosis treatment model, only providers contracted
with the Department of Human Services' Division of Mental
Health to be FIRST.IL providers to deliver coordinated
specialty care for first episode psychosis treatment shall be
permitted to provide such treatment in accordance with this
Section and such providers must adhere to the fidelity of the
treatment model. For purposes of ensuring fidelity to ACT and
CST, only providers certified to provide ACT and CST by the
Department of Human Services' Division of Mental Health and
approved to provide ACT and CST by the Department of Healthcare
and Family Services, or its designee, in accordance with 89
Ill. Adm. Code 140, shall be permitted to provide such services
under this Section and such providers shall be required to
adhere to the fidelity of the models.
(c) Development of medical necessity criteria for
coverage. Within 6 months after the effective date of this
amendatory Act of the 101st General Assembly, the Department of
Insurance shall lead and convene a workgroup that includes the
Department of Human Services' Division of Mental Health, the
Department of Healthcare and Family Services, providers of the
treatment models listed in this Section, and insurers operating
in Illinois to develop medical necessity criteria for such
treatment models for purposes of coverage under this Section.
The workgroup shall use the medical necessity criteria the
State and other states use as guidance for establishing medical
necessity for insurance coverage. The Department of Insurance
shall adopt a rule that defines medical necessity for each of
the 3 treatment models listed in this Section by no later than
June 30, 2020 based on the workgroup's recommendations.
(d) For purposes of credentialing the mental health
professionals and other medical professionals that are part of
a coordinated specialty care for first episode psychosis
treatment team, an ACT team, or a CST team, the credentialing
of the psychiatrist or the licensed clinical leader of the
treatment team shall qualify all members of the treatment team
to be credentialed with the insurer.
(e) Payment for the services performed under the treatment
models listed in this Section shall be based on a bundled
treatment model or payment, rather than payment for each
separate service delivered by a treatment team member. By no
later than 6 months after the effective date of this amendatory
Act of the 101st General Assembly, the Department of Insurance
shall convene a workgroup of Illinois insurance companies and
Illinois mental health treatment providers that deliver the
bundled treatment approaches listed in this Section to
determine a coding solution that allows for these bundled
treatment models to be coded and paid for as a bundle of
services, similar to intensive outpatient treatment where
multiple services are covered under one billing code or a
bundled set of billing codes. The coding solution shall ensure
that services delivered using coordinated specialty care for
first episode psychosis treatment, ACT, or CST are provided and
billed as a bundled service, rather than for each individual
service provided by a treatment team member, which would
deconstruct the evidence-based practice. The coding solution
shall be reached prior to coverage, which shall begin for plans
amended, delivered, issued, or renewed after December 31, 2020,
to ensure coverage of the treatment team approaches as intended
by this Section.
(f) If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, adopts rules or regulations to be published in the
Federal Register or publishes a comment in the Federal Register
or issues an opinion, guidance, or other action that would
require the State, under any provision of the Patient
Protection and Affordable Care Act (P.L. 111-148), including,
but not limited to, 42 U.S.C. 18031(d)(3)(b), or any successor
provision, to defray the cost of any coverage for serious
mental illnesses or serious emotional disturbances outlined in
this Section, then the requirement that a group or individual
policy of accident and health insurance or managed care plan
cover the bundled treatment approaches listed in this Section
is inoperative other than any such coverage authorized under
Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
the State shall not assume any obligation for the cost of the
coverage.
(g) After 5 years following full implementation of this
Section, if requested by an insurer, the Department of
Insurance shall contract with an independent third party with
expertise in analyzing health insurance premiums and costs to
perform an independent analysis of the impact coverage of the
team-based treatment models listed in this Section has had on
insurance premiums in Illinois. If premiums increased by more
than 1% annually solely due to coverage of these treatment
models, coverage of these models shall no longer be required.
(h) The Department of Insurance shall adopt any rules
necessary to implement the provisions of this Section by no
later than June 30, 2020.
Section 35. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except for
Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
Maintenance Organizations in the following categories are
deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the financial
conditions of the acquired Health Maintenance Organization
after the merger, consolidation, or other acquisition of
control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and to
its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code, take
into account the effect of the management contract or service
agreement on the continuation of benefits to enrollees and the
financial condition of the health maintenance organization to
be managed or serviced, and (ii) need not take into account the
effect of the management contract or service agreement on
competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a Health
Maintenance Organization may by contract agree with a group or
other enrollment unit to effect refunds or charge additional
premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall not
be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and the
resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
8-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
10-4-18.)
Section 40. The Illinois Public Aid Code is amended by
changing Section 5-5.23 and by adding Sections 5-36, 5-37, and
5-38 as follows:
(305 ILCS 5/5-5.23)
Sec. 5-5.23. Children's mental health services.
(a) The Department of Healthcare and Family Services, by
rule, shall require the screening and assessment of a child
prior to any Medicaid-funded admission to an inpatient hospital
for psychiatric services to be funded by Medicaid. The
screening and assessment shall include a determination of the
appropriateness and availability of out-patient support
services for necessary treatment. The Department, by rule,
shall establish methods and standards of payment for the
screening, assessment, and necessary alternative support
services.
(b) The Department of Healthcare and Family Services, to
the extent allowable under federal law, shall secure federal
financial participation for Individual Care Grant expenditures
made by the Department of Healthcare and Family Services for
the Medicaid optional service authorized under Section 1905(h)
of the federal Social Security Act, pursuant to the provisions
of Section 7.1 of the Mental Health and Developmental
Disabilities Administrative Act. The Department of Healthcare
and Family Services may exercise the authority under this
Section as is necessary to administer Individual Care Grants as
authorized under Section 7.1 of the Mental Health and
Developmental Disabilities Administrative Act.
(c) The Department of Healthcare and Family Services shall
work collaboratively with the Department of Children and Family
Services and the Division of Mental Health of the Department of
Human Services to implement subsections (a) and (b).
(d) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(e) All rights, powers, duties, and responsibilities
currently exercised by the Department of Human Services related
to the Individual Care Grant program are transferred to the
Department of Healthcare and Family Services with the transfer
and transition of the Individual Care Grant program to the
Department of Healthcare and Family Services to be completed
and implemented within 6 months after the effective date of
this amendatory Act of the 99th General Assembly. For the
purposes of the Successor Agency Act, the Department of
Healthcare and Family Services is declared to be the successor
agency of the Department of Human Services, but only with
respect to the functions of the Department of Human Services
that are transferred to the Department of Healthcare and Family
Services under this amendatory Act of the 99th General
Assembly.
(1) Each act done by the Department of Healthcare and
Family Services in exercise of the transferred powers,
duties, rights, and responsibilities shall have the same
legal effect as if done by the Department of Human Services
or its offices.
(2) Any rules of the Department of Human Services that
relate to the functions and programs transferred by this
amendatory Act of the 99th General Assembly that are in
full force on the effective date of this amendatory Act of
the 99th General Assembly shall become the rules of the
Department of Healthcare and Family Services. All rules
transferred under this amendatory Act of the 99th General
Assembly are hereby amended such that the term "Department"
shall be defined as the Department of Healthcare and Family
Services and all references to the "Secretary" shall be
changed to the "Director of Healthcare and Family Services
or his or her designee". As soon as practicable hereafter,
the Department of Healthcare and Family Services shall
revise and clarify the rules to reflect the transfer of
rights, powers, duties, and responsibilities affected by
this amendatory Act of the 99th General Assembly, using the
procedures for recodification of rules available under the
Illinois Administrative Procedure Act, except that
existing title, part, and section numbering for the
affected rules may be retained. The Department of
Healthcare and Family Services, consistent with its
authority to do so as granted by this amendatory Act of the
99th General Assembly, shall propose and adopt any other
rules under the Illinois Administrative Procedure Act as
necessary to administer the Individual Care Grant program.
These rules may include, but are not limited to, the
application process and eligibility requirements for
recipients.
(3) All unexpended appropriations and balances and
other funds available for use in connection with any
functions of the Individual Care Grant program shall be
transferred for the use of the Department of Healthcare and
Family Services to operate the Individual Care Grant
program. Unexpended balances shall be expended only for the
purpose for which the appropriation was originally made.
The Department of Healthcare and Family Services shall
exercise all rights, powers, duties, and responsibilities
for operation of the Individual Care Grant program.
(4) Existing personnel and positions of the Department
of Human Services pertaining to the administration of the
Individual Care Grant program shall be transferred to the
Department of Healthcare and Family Services with the
transfer and transition of the Individual Care Grant
program to the Department of Healthcare and Family
Services. The status and rights of Department of Human
Services employees engaged in the performance of the
functions of the Individual Care Grant program shall not be
affected by this amendatory Act of the 99th General
Assembly. The rights of the employees, the State of
Illinois, and its agencies under the Personnel Code and
applicable collective bargaining agreements or under any
pension, retirement, or annuity plan shall not be affected
by this amendatory Act of the 99th General Assembly. All
transferred employees who are members of collective
bargaining units shall retain their seniority, continuous
service, salary, and accrued benefits.
(5) All books, records, papers, documents, property
(real and personal), contracts, and pending business
pertaining to the powers, duties, rights, and
responsibilities related to the functions of the
Individual Care Grant program, including, but not limited
to, material in electronic or magnetic format and necessary
computer hardware and software, shall be delivered to the
Department of Healthcare and Family Services; provided,
however, that the delivery of this information shall not
violate any applicable confidentiality constraints.
(6) Whenever reports or notices are now required to be
made or given or papers or documents furnished or served by
any person to or upon the Department of Human Services in
connection with any of the functions transferred by this
amendatory Act of the 99th General Assembly, the same shall
be made, given, furnished, or served in the same manner to
or upon the Department of Healthcare and Family Services.
(7) This amendatory Act of the 99th General Assembly
shall not affect any act done, ratified, or canceled or any
right occurring or established or any action or proceeding
had or commenced in an administrative, civil, or criminal
cause regarding the Department of Human Services before the
effective date of this amendatory Act of the 99th General
Assembly; and those actions or proceedings may be defended,
prosecuted, and continued by the Department of Human
Services.
(f) (Blank). The Individual Care Grant program shall be
inoperative during the calendar year in which implementation
begins of any remedies in response to litigation against the
Department of Healthcare and Family Services related to
children's behavioral health and the general status of
children's behavioral health in this State. Individual Care
Grant recipients in the program the year it becomes inoperative
shall continue to remain in the program until it is clinically
appropriate for them to step down in level of care.
(g) Family Support Program. The Department of Healthcare
and Family Services shall restructure the Family Support
Program, formerly known as the Individual Care Grant program,
to enable early treatment of youth, emerging adults, and
transition-age adults with a serious mental illness or serious
emotional disturbance.
(1) As used in this subsection and in subsections (h)
through (s):
(A) "Youth" means a person under the age of 18.
(B) "Emerging adult" means a person who is 18
through 20 years of age.
(C) "Transition-age adult" means a person who is 21
through 25 years of age.
(2) The Department shall amend 89 Ill. Adm. Code 139 in
accordance with this Section and consistent with the
timelines outlined in this Section.
(3) Implementation of any amended requirements shall
be completed within 8 months of the adoption of any
amendment to 89 Ill. Adm. Code 139 that is consistent with
the provisions of this Section.
(4) To align the Family Support Program with the
Medicaid system of care, the services available to a youth,
emerging adult, or transition-age adult through the Family
Support Program shall include all Medicaid community-based
mental health treatment services and all Family Support
Program services included under 89 Ill. Adm. Code 139. No
person receiving services through the Family Support
Program or the Specialized Family Support Program shall
become a Medicaid enrollee unless Medicaid eligibility
criteria are met and the person is enrolled in Medicaid. No
part of this Section creates an entitlement to services
through the Family Support Program, the Specialized Family
Support Program, or the Medicaid program.
(5) The Family Support Program shall align with the
following system of care principles:
(A) Treatment and support services shall be based
on the results of an integrated behavioral health
assessment and treatment plan using an instrument
approved by the Department of Healthcare and Family
Services.
(B) Strong interagency collaboration between all
State agencies the parent or legal guardian is involved
with for services, including the Department of
Healthcare and Family Services, the Department of
Human Services, the Department of Children and Family
Services, the Department of Juvenile Justice, and the
Illinois State Board of Education.
(C) Individualized, strengths-based practices and
trauma-informed treatment approaches.
(D) For a youth, full participation of the parent
or legal guardian at all levels of treatment through a
process that is family-centered and youth-focused. The
process shall include consideration of the services
and supports the parent, legal guardian, or caregiver
requires for family stabilization, and shall connect
such person or persons to services based on available
insurance coverage.
(h) Eligibility for the Family Support Program.
Eligibility criteria established under 89 Ill. Adm. Code 139
for the Family Support Program shall include the following:
(1) Individuals applying to the program must be under
the age of 26.
(2) Requirements for parental or legal guardian
involvement are applicable to youth and to emerging adults
or transition-age adults who have a guardian appointed
under Article XIa of the Probate Act.
(3) Youth, emerging adults, and transition-age adults
are eligible for services under the Family Support Program
upon their third inpatient admission to a hospital or
similar treatment facility for the primary purpose of
psychiatric treatment within the most recent 12 months and
are hospitalized for the purpose of psychiatric treatment.
(4) School participation for emerging adults applying
for services under the Family Support Program may be waived
by request of the individual at the sole discretion of the
Department of Healthcare and Family Services.
(5) School participation is not applicable to
transition-age adults.
(i) Notification of Family Support Program and Specialized
Family Support Program services.
(1) Within 12 months after the effective date of this
amendatory Act of the 101st General Assembly, the
Department of Healthcare and Family Services, with
meaningful stakeholder input through a working group of
psychiatric hospitals, Family Support Program providers,
family support organizations, the Community and
Residential Services Authority, a statewide association
representing a majority of hospitals, and foster care
alumni advocates, shall establish a clear process by which
a youth's or emerging adult's parents, guardian, or
caregiver, or the emerging adult or transition-age adult,
is identified, notified, and educated about the Family
Support Program and the Specialized Family Support Program
upon a first psychiatric inpatient hospital admission, and
any following psychiatric inpatient admissions.
Notification and education may take place through a Family
Support Program coordinator, a mobile crisis response
provider, a Comprehensive Community Based Youth Services
provider, the Community and Residential Services
Authority, or any other designated provider or coordinator
identified by the Department of Healthcare and Family
Services. In developing this process, the Department of
Healthcare and Family Services and the working group shall
take into account the unique needs of emerging adults and
transition-age adults without parental involvement who are
eligible for services under the Family Support Program. The
Department of Healthcare and Family Services and the
working group shall ensure the appropriate provider or
coordinator is required to assist individuals and their
parents, guardians, or caregivers, as applicable, in the
completion of the application or referral process for the
Family Support Program or the Specialized Family Support
Program.
(2) Upon a youth's, emerging adult's or transition-age
adult's second psychiatric inpatient hospital admission,
the hospital must ensure that the youth's parents,
guardian, or caregiver, or the emerging adult or
transition-age adult, have been notified of the Family
Support Program and the Specialized Family Support Program
prior to hospital discharge.
(3) Psychiatric lockout as last resort.
(A) Prior to referring any youth to the Department
of Children and Family Services for the filing of a
petition in accordance with subparagraph (c) of
paragraph (1) of Section 2-4 of the Juvenile Court Act
of 1987 alleging that the youth is dependent because
the youth was left in a psychiatric hospital beyond
medical necessity, the hospital shall educate the
youth and the youth's parents, guardian, or caregiver
about the Family Support Program and the Specialized
Family Support Program and shall assist with
connections to the designated Family Support Program
coordinator in the service area. Once this process has
begun, any such youth shall be considered a youth for
whom an application for the Family Support Program is
pending with the Department of Healthcare and Family
Services or an active application for the Family
Support Program was being reviewed by the Department
for the purposes of subparagraph (b) of paragraph (1)
of Section 2-4 of the Juvenile Court Act of 1987.
(B) No state agency or hospital shall coach a
parent or guardian of a youth in a psychiatric hospital
inpatient unit to lock out or otherwise relinquish
custody of a youth to the Department of Children and
Family Services for the sole purpose of obtaining
necessary mental health treatment for the youth. In the
absence of abuse or neglect, a psychiatric lockout or
custody relinquishment to the Department of Children
and Family Services shall only be considered as the
option of last resort.
(4) Development of new Family Support Program
services.
(A) Development of specialized therapeutic
residential treatment for youth and emerging adults
with high-acuity mental health conditions. Through a
working group led by the Department of Healthcare and
Family Services that includes the Department of
Children and Family Services and residential treatment
providers for youth and emerging adults, the
Department of Healthcare and Family Services, within
12 months after the effective date of this amendatory
Act of the 101st General Assembly, shall develop a plan
for the development of specialized therapeutic
residential treatment beds similar to a qualified
residential treatment program, as defined in the
federal Family First Prevention Services Act, for
youth in the Family Support Program with high-acuity
mental health needs. The Department of Healthcare and
Family Services and the Department of Children and
Family Services shall work together to maximize
federal funding through Medicaid and Title IV-E of the
Social Security Act in the development and
implementation of this plan.
(B) Using the Department of Children and Family
Services' beyond medical necessity data over the last 5
years and any other relevant, available data, the
Department of Healthcare and Family Services shall
assess the estimated number of these specialized
high-acuity residential treatment beds that are needed
in each region of the State based on the number of
youth remaining in psychiatric hospitals beyond
medical necessity and the number of youth placed
out-of-state who need this level of care. The
Department of Healthcare and Family Services shall
report the results of this assessment to the General
Assembly by no later than December 31, 2020.
(C) Development of an age-appropriate therapeutic
residential treatment model for emerging adults and
transition-age adults. Within 30 months after the
effective date of this amendatory Act of the 101st
General Assembly, the Department of Healthcare and
Family Services, in partnership with the Department of
Human Services' Division of Mental Health and with
significant and meaningful stakeholder input through a
working group of providers and other stakeholders,
shall develop a supportive housing model for emerging
adults and transition-age adults receiving services
through the Family Support Program who need
residential treatment and support to enable recovery.
Such a model shall be age-appropriate and shall allow
the residential component of the model to be in a
community-based setting combined with intensive
community-based mental health services.
(j) Workgroup to develop a plan for improving access to
substance use treatment. The Department of Healthcare and
Family Services and the Department of Human Services' Division
of Substance Use Prevention and Recovery shall co-lead a
working group that includes Family Support Program providers,
family support organizations, and other stakeholders over a
12-month period beginning in the first quarter of calendar year
2020 to develop a plan for increasing access to substance use
treatment services for youth, emerging adults, and
transition-age adults who are eligible for Family Support
Program services.
(k) Appropriation. Implementation of this Section shall be
limited by the State's annual appropriation to the Family
Support Program. Spending within the Family Support Program
appropriation shall be further limited for the new Family
Support Program services to be developed accordingly:
(1) Targeted use of specialized therapeutic
residential treatment for youth and emerging adults with
high-acuity mental health conditions through appropriation
limitation. No more than 12% of all annual Family Support
Program funds shall be spent on this level of care in any
given state fiscal year.
(2) Targeted use of residential treatment model
established for emerging adults and transition-age adults
through appropriation limitation. No more than one-quarter
of all annual Family Support Program funds shall be spent
on this level of care in any given state fiscal year.
(l) Exhausting third party insurance coverage first.
(A) A parent, legal guardian, emerging adult, or
transition-age adult with private insurance coverage shall
work with the Department of Healthcare and Family Services,
or its designee, to identify insurance coverage for any and
all benefits covered by their plan. If insurance
cost-sharing by any method for treatment is
cost-prohibitive for the parent, legal guardian, emerging
adult, or transition-age adult, Family Support Program
funds may be applied as a payer of last resort toward
insurance cost-sharing for purposes of using private
insurance coverage to the fullest extent for the
recommended treatment. If the Department, or its agent, has
a concern relating to the parent's, legal guardian's,
emerging adult's, or transition-age adult's insurer's
compliance with Illinois or federal insurance requirements
relating to the coverage of mental health or substance use
disorders, it shall refer all relevant information to the
applicable regulatory authority.
(B) The Department of Healthcare and Family Services
shall use Medicaid funds first for an individual who has
Medicaid coverage if the treatment or service recommended
using an integrated behavioral health assessment and
treatment plan (using the instrument approved by the
Department of Healthcare and Family Services) is covered by
Medicaid.
(C) If private or public insurance coverage does not
cover the needed treatment or service, Family Support
Program funds shall be used to cover the services offered
through the Family Support Program.
(m) Service authorization. A youth, emerging adult, or
transition-age adult enrolled in the Family Support Program or
the Specialized Family Support Program shall be eligible to
receive a mental health treatment service covered by the
applicable program if the medical necessity criteria
established by the Department of Healthcare and Family Services
are met.
(n) Streamlined application. The Department of Healthcare
and Family Services shall revise the Family Support Program
applications and the application process to reflect the changes
made to this Section by this amendatory Act of the 101st
General Assembly within 8 months after the adoption of any
amendments to 89 Ill. Adm. Code 139.
(o) Study of reimbursement policies during planned and
unplanned absences of youth and emerging adults in Family
Support Program residential treatment settings. The Department
of Healthcare and Family Services shall undertake a study of
those standards of the Department of Children and Family
Services and other states for reimbursement of residential
treatment during planned and unplanned absences to determine if
reimbursing residential providers for such unplanned absences
positively impacts the availability of residential treatment
for youth and emerging adults. The Department of Healthcare and
Family Services shall begin the study on July 1, 2019 and shall
report its findings and the results of the study to the General
Assembly, along with any recommendations for or against
adopting a similar policy, by December 31, 2020.
(p) Public awareness and educational campaign for all
relevant providers. The Department of Healthcare and Family
Services shall engage in a public awareness campaign to educate
hospitals with psychiatric units, crisis response providers
such as Screening, Assessment and Support Services providers
and Comprehensive Community Based Youth Services agencies,
schools, and other community institutions and providers across
Illinois on the changes made by this amendatory Act of the
101st General Assembly to the Family Support Program. The
Department of Healthcare and Family Services shall produce
written materials geared for the appropriate target audience,
develop webinars, and conduct outreach visits over a 12-month
period beginning after implementation of the changes made to
this Section by this amendatory Act of the 101st General
Assembly.
(q) Maximizing federal matching funds for the Family
Support Program and the Specialized Family Support Program. The
Department of Healthcare and Family Services, as the sole
Medicaid State agency, shall seek approval from the federal
Centers for Medicare and Medicaid Services within 12 months
after the effective date of this amendatory Act of the 101st
General Assembly to draw additional federal Medicaid matching
funds for individuals served under the Family Support Program
or the Specialized Family Support Program who are not covered
by the Department's medical assistance programs. The
Department of Children and Family Services, as the State agency
responsible for administering federal funds pursuant to Title
IV-E of the Social Security Act, shall submit a State Plan to
the federal government within 12 months after the effective
date of this amendatory Act of the 101st General Assembly to
maximize the use of federal Title IV-E prevention funds through
the federal Family First Prevention Services Act, to provide
mental health and substance use disorder treatment services and
supports, including, but not limited to, the provision of
short-term crisis and transition beds post-hospitalization for
youth who are at imminent risk of entering Illinois' youth
welfare system solely due to the inability to access mental
health or substance use treatment services.
(r) Outcomes and data reported annually to the General
Assembly. Beginning in 2021, the Department of Healthcare and
Family Services shall submit an annual report to the General
Assembly that includes the following information with respect
to the time period covered by the report:
(1) The number and ages of youth, emerging adults, and
transition-age adults who requested services under the
Family Support Program and the Specialized Family Support
Program and the services received.
(2) The number and ages of youth, emerging adults, and
transition-age adults who requested services under the
Specialized Family Support Program who were eligible for
services based on the number of hospitalizations.
(3) The number and ages of youth, emerging adults, and
transition-age adults who applied for Family Support
Program or Specialized Family Support Program services but
did not receive any services.
(s) Rulemaking authority. Unless a timeline is otherwise
specified in a subsection, if amendments to 89 Ill. Adm. Code
139 are needed for implementation of this Section, such
amendments shall be filed by the Department of Healthcare and
Family Services within one year after the effective date of
this amendatory Act of the 101st General Assembly.
(Source: P.A. 99-479, eff. 9-10-15.)
(305 ILCS 5/5-36 new)
Sec. 5-36. Education on mental health and substance use
treatment services for children and young adults. The
Department of Healthcare and Family Services shall develop a
layman's guide to the mental health and substance use treatment
services available in Illinois through the Medical Assistance
Program and through the Family Support Program, or other
publicly funded programs, similar to what Massachusetts
developed, to help families understand what services are
available to them when they have a child in need of treatment
or support. The guide shall be in easy-to-understand language,
be prominently available on the Department of Healthcare and
Family Services' website, and be part of a statewide
communications campaign to ensure families are aware of Family
Support Program services. It shall briefly explain the service
and whether it is covered by the Medical Assistance Program,
the Family Support Program, or any other public funding source.
Within one year after the effective date of this amendatory Act
of the 101st General Assembly, the Department of Healthcare and
Family Services shall complete this guide, have it available on
its website, and launch the communications campaign.
(305 ILCS 5/5-37 new)
Sec. 5-37. Billing mechanism for preventive mental health
services delivered to children.
(a) The General Assembly finds:
(1) It is common for children to have mental health
needs but to not have a full-blown diagnosis of a mental
illness. Examples include, but are not limited to, children
who have mild or emerging symptoms of a mental health
condition (such as meeting some but not all the criteria
for a diagnosis, including, but not limited to, symptoms of
depression, attentional deficits, anxiety or prodromal
symptoms of bipolar disorder or schizophrenia); cutting or
engaging in other forms of self-harm; or experiencing
violence or trauma).
(2) The federal requirement that Medicaid-covered
children have access to Early and Periodic Screening,
Diagnostic and Treatment services includes ensuring that
Medicaid-covered children who have a mental health need but
do not have a mental health diagnosis have access to
treatment.
(3) The Department of Healthcare and Family Services'
existing policy acknowledges this federal requirement by
allowing for Medicaid billing for mental health services
for children who have a need for services but who do not
have a mental health diagnosis in Section 207.3.3 of the
Community-Based Behavioral Services Provider Handbook.
However, the current policy of the Department of Healthcare
and Family Services requires clinicians to specify a
diagnosis code and make a notation in the child's medical
record that the service is preventive. This effectively
requires the clinician to associate a diagnosis with the
child and is a major barrier for services because many
clinicians rightly are unwilling to document a mental
health diagnosis in the medical record when a diagnosis is
not medically appropriate.
(b) Consistent with the existing policy of the Department
of Healthcare and Family Services and the federal Early and
Periodic Screening, Diagnostic and Treatment requirement,
within 3 months after the effective date of this amendatory Act
of the 101st General Assembly, the Department of Healthcare and
Family Services shall convene a working group that includes
children's mental health providers to receive input on
recommendations to develop a medically appropriate and
practical solution that enables mental health providers and
professionals to deliver and receive reimbursement for
medically necessary mental health services provided to a
Medicaid-eligible child under age 21 that has a mental health
need but does not have a mental health diagnosis in order to
prevent the development of a serious mental health condition.
The working group shall ensure that the recommended solution
works in practice and does not deter clinicians from delivering
prevention and early treatment to children with mental health
needs but who do not have a diagnosed mental illness. The
Department of Healthcare and Family Services shall meet with
this working group at least 4 times prior to finalizing the
solution to enable and allow for mental health services for a
child without a mental health diagnosis for purposes of
prevention and early treatment when recommended by a licensed
practitioner of the healing arts. If the Department of
Healthcare and Family Services determines that an Illinois
Title XIX State Plan amendment is necessary to implement this
Section, the State Plan amendment shall be filed with the
federal Centers for Medicare and Medicaid Services by no later
than 12 months after the effective date of this amendatory Act
of the 101st General Assembly. If rulemaking is required to
implement this Section, the rule shall be filed by the
Department of Healthcare and Family Services with the Joint
Committee on Administrative Rules by no later than 12 months
after the effective date of this amendatory Act of the 101st
General Assembly, or if federal approval is required, within 6
months after federal approval. If federal approval is required
but not granted, this Section shall become inoperative.
(305 ILCS 5/5-38 new)
Sec. 5-38. Alignment of children's mental health treatment
systems. The Governor's Office shall establish, convene, and
lead a working group that includes the Director of Healthcare
and Family Services, the Secretary of Human Services, the
Director of Public Health, the Director of Children and Family
Services, the Director of Juvenile Justice, the State
Superintendent of Education, and the appropriate agency staff
who will be responsible for implementation or oversight of
reforms to children's behavioral health services. The working
group shall meet at least quarterly to foster interagency
collaboration and work toward the goal of aligning services and
programs to begin to create a coordinated children's behavioral
health system consistent with system of care principles that
spans across State agencies, rather than separate siloed
systems with different requirements, rates, and administrative
processes and standards.
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.
Section 99. Effective date. This Act takes effect January
1, 2020.
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