Bill Amendment: IL SB3316 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: CHILDREN-MENTAL HEALTH
Status: 2024-05-03 - Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments [SB3316 Detail]
Download: Illinois-2023-SB3316-Senate_Amendment_001.html
Bill Title: CHILDREN-MENTAL HEALTH
Status: 2024-05-03 - Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments [SB3316 Detail]
Download: Illinois-2023-SB3316-Senate_Amendment_001.html
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1 | AMENDMENT TO SENATE BILL 3316 | ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 3316 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The School Code is amended by changing and | ||||||
5 | renumbering Section 2-3.196, as added by Public Act 103-546, | ||||||
6 | as follows:
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7 | (105 ILCS 5/2-3.203) | ||||||
8 | Sec. 2-3.203 2-3.196 . Mental health screenings. | ||||||
9 | (a) On or before December 15, 2023, the State Board of | ||||||
10 | Education, in consultation with the Children's Behavioral | ||||||
11 | Health Transformation Officer, Children's Behavioral Health | ||||||
12 | Transformation Team, and the Office of the Governor, shall | ||||||
13 | file a report with the Governor and the General Assembly that | ||||||
14 | includes recommendations for implementation of mental health | ||||||
15 | screenings in schools for students enrolled in kindergarten | ||||||
16 | through grade 12. This report must include a landscape scan of |
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1 | current district-wide screenings, recommendations for | ||||||
2 | screening tools, training for staff, and linkage and referral | ||||||
3 | for identified students. | ||||||
4 | (b) On or before October 1, 2024, the State Board of | ||||||
5 | Education, in consultation with the Children's Behavioral | ||||||
6 | Health Transformation Team, the Office of the Governor, and | ||||||
7 | relevant stakeholders as needed shall release a strategy that | ||||||
8 | includes a tool for measuring capacity and readiness to | ||||||
9 | implement universal mental health screening of students. The | ||||||
10 | strategy shall build upon existing efforts to understand | ||||||
11 | district needs for resources, technology, training, and | ||||||
12 | infrastructure supports. The strategy shall include a | ||||||
13 | framework for supporting districts in a phased approach to | ||||||
14 | implement universal mental health screenings. The State Board | ||||||
15 | of Education shall issue a report to the Governor and the | ||||||
16 | General Assembly on school district readiness and plan for | ||||||
17 | phased approach to universal mental health screening of | ||||||
18 | students on or before April 1, 2025. | ||||||
19 | (Source: P.A. 103-546, eff. 8-11-23; revised 9-25-23.)
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20 | (105 ILCS 155/Act rep.) | ||||||
21 | Section 10. The Wellness Checks in Schools Program Act is | ||||||
22 | repealed.
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23 | Section 15. The Illinois Public Aid Code is amended by | ||||||
24 | changing Section 5-30.1 as follows:
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1 | (305 ILCS 5/5-30.1) | ||||||
2 | Sec. 5-30.1. Managed care protections. | ||||||
3 | (a) As used in this Section: | ||||||
4 | "Managed care organization" or "MCO" means any entity | ||||||
5 | which contracts with the Department to provide services where | ||||||
6 | payment for medical services is made on a capitated basis. | ||||||
7 | "Emergency services" include: | ||||||
8 | (1) emergency services, as defined by Section 10 of | ||||||
9 | the Managed Care Reform and Patient Rights Act; | ||||||
10 | (2) emergency medical screening examinations, as | ||||||
11 | defined by Section 10 of the Managed Care Reform and | ||||||
12 | Patient Rights Act; | ||||||
13 | (3) post-stabilization medical services, as defined by | ||||||
14 | Section 10 of the Managed Care Reform and Patient Rights | ||||||
15 | Act; and | ||||||
16 | (4) emergency medical conditions, as defined by | ||||||
17 | Section 10 of the Managed Care Reform and Patient Rights | ||||||
18 | Act. | ||||||
19 | (b) As provided by Section 5-16.12, managed care | ||||||
20 | organizations are subject to the provisions of the Managed | ||||||
21 | Care Reform and Patient Rights Act. | ||||||
22 | (c) An MCO shall pay any provider of emergency services | ||||||
23 | that does not have in effect a contract with the contracted | ||||||
24 | Medicaid MCO. The default rate of reimbursement shall be the | ||||||
25 | rate paid under Illinois Medicaid fee-for-service program |
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1 | methodology, including all policy adjusters, including but not | ||||||
2 | limited to Medicaid High Volume Adjustments, Medicaid | ||||||
3 | Percentage Adjustments, Outpatient High Volume Adjustments, | ||||||
4 | and all outlier add-on adjustments to the extent such | ||||||
5 | adjustments are incorporated in the development of the | ||||||
6 | applicable MCO capitated rates. | ||||||
7 | (d) An MCO shall pay for all post-stabilization services | ||||||
8 | as a covered service in any of the following situations: | ||||||
9 | (1) the MCO authorized such services; | ||||||
10 | (2) such services were administered to maintain the | ||||||
11 | enrollee's stabilized condition within one hour after a | ||||||
12 | request to the MCO for authorization of further | ||||||
13 | post-stabilization services; | ||||||
14 | (3) the MCO did not respond to a request to authorize | ||||||
15 | such services within one hour; | ||||||
16 | (4) the MCO could not be contacted; or | ||||||
17 | (5) the MCO and the treating provider, if the treating | ||||||
18 | provider is a non-affiliated provider, could not reach an | ||||||
19 | agreement concerning the enrollee's care and an affiliated | ||||||
20 | provider was unavailable for a consultation, in which case | ||||||
21 | the MCO must pay for such services rendered by the | ||||||
22 | treating non-affiliated provider until an affiliated | ||||||
23 | provider was reached and either concurred with the | ||||||
24 | treating non-affiliated provider's plan of care or assumed | ||||||
25 | responsibility for the enrollee's care. Such payment shall | ||||||
26 | be made at the default rate of reimbursement paid under |
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1 | Illinois Medicaid fee-for-service program methodology, | ||||||
2 | including all policy adjusters, including but not limited | ||||||
3 | to Medicaid High Volume Adjustments, Medicaid Percentage | ||||||
4 | Adjustments, Outpatient High Volume Adjustments and all | ||||||
5 | outlier add-on adjustments to the extent that such | ||||||
6 | adjustments are incorporated in the development of the | ||||||
7 | applicable MCO capitated rates. | ||||||
8 | (e) The following requirements apply to MCOs in | ||||||
9 | determining payment for all emergency services: | ||||||
10 | (1) MCOs shall not impose any requirements for prior | ||||||
11 | approval of emergency services. | ||||||
12 | (2) The MCO shall cover emergency services provided to | ||||||
13 | enrollees who are temporarily away from their residence | ||||||
14 | and outside the contracting area to the extent that the | ||||||
15 | enrollees would be entitled to the emergency services if | ||||||
16 | they still were within the contracting area. | ||||||
17 | (3) The MCO shall have no obligation to cover medical | ||||||
18 | services provided on an emergency basis that are not | ||||||
19 | covered services under the contract. | ||||||
20 | (4) The MCO shall not condition coverage for emergency | ||||||
21 | services on the treating provider notifying the MCO of the | ||||||
22 | enrollee's screening and treatment within 10 days after | ||||||
23 | presentation for emergency services. | ||||||
24 | (5) The determination of the attending emergency | ||||||
25 | physician, or the provider actually treating the enrollee, | ||||||
26 | of whether an enrollee is sufficiently stabilized for |
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1 | discharge or transfer to another facility, shall be | ||||||
2 | binding on the MCO. The MCO shall cover emergency services | ||||||
3 | for all enrollees whether the emergency services are | ||||||
4 | provided by an affiliated or non-affiliated provider. | ||||||
5 | (6) The MCO's financial responsibility for | ||||||
6 | post-stabilization care services it has not pre-approved | ||||||
7 | ends when: | ||||||
8 | (A) a plan physician with privileges at the | ||||||
9 | treating hospital assumes responsibility for the | ||||||
10 | enrollee's care; | ||||||
11 | (B) a plan physician assumes responsibility for | ||||||
12 | the enrollee's care through transfer; | ||||||
13 | (C) a contracting entity representative and the | ||||||
14 | treating physician reach an agreement concerning the | ||||||
15 | enrollee's care; or | ||||||
16 | (D) the enrollee is discharged. | ||||||
17 | (f) Network adequacy and transparency. | ||||||
18 | (1) The Department shall: | ||||||
19 | (A) ensure that an adequate provider network is in | ||||||
20 | place, taking into consideration health professional | ||||||
21 | shortage areas and medically underserved areas; | ||||||
22 | (B) publicly release an explanation of its process | ||||||
23 | for analyzing network adequacy; | ||||||
24 | (C) periodically ensure that an MCO continues to | ||||||
25 | have an adequate network in place; | ||||||
26 | (D) require MCOs, including Medicaid Managed Care |
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1 | Entities as defined in Section 5-30.2, to meet | ||||||
2 | provider directory requirements under Section 5-30.3; | ||||||
3 | (E) require MCOs to ensure that any | ||||||
4 | Medicaid-certified provider under contract with an MCO | ||||||
5 | and previously submitted on a roster on the date of | ||||||
6 | service is paid for any medically necessary, | ||||||
7 | Medicaid-covered, and authorized service rendered to | ||||||
8 | any of the MCO's enrollees, regardless of inclusion on | ||||||
9 | the MCO's published and publicly available directory | ||||||
10 | of available providers; and | ||||||
11 | (F) require MCOs, including Medicaid Managed Care | ||||||
12 | Entities as defined in Section 5-30.2, to meet each of | ||||||
13 | the requirements under subsection (d-5) of Section 10 | ||||||
14 | of the Network Adequacy and Transparency Act; with | ||||||
15 | necessary exceptions to the MCO's network to ensure | ||||||
16 | that admission and treatment with a provider or at a | ||||||
17 | treatment facility in accordance with the network | ||||||
18 | adequacy standards in paragraph (3) of subsection | ||||||
19 | (d-5) of Section 10 of the Network Adequacy and | ||||||
20 | Transparency Act is limited to providers or facilities | ||||||
21 | that are Medicaid certified. | ||||||
22 | (2) Each MCO shall confirm its receipt of information | ||||||
23 | submitted specific to physician or dentist additions or | ||||||
24 | physician or dentist deletions from the MCO's provider | ||||||
25 | network within 3 days after receiving all required | ||||||
26 | information from contracted physicians or dentists, and |
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1 | electronic physician and dental directories must be | ||||||
2 | updated consistent with current rules as published by the | ||||||
3 | Centers for Medicare and Medicaid Services or its | ||||||
4 | successor agency. | ||||||
5 | (g) Timely payment of claims. | ||||||
6 | (1) The MCO shall pay a claim within 30 days of | ||||||
7 | receiving a claim that contains all the essential | ||||||
8 | information needed to adjudicate the claim. | ||||||
9 | (2) The MCO shall notify the billing party of its | ||||||
10 | inability to adjudicate a claim within 30 days of | ||||||
11 | receiving that claim. | ||||||
12 | (3) The MCO shall pay a penalty that is at least equal | ||||||
13 | to the timely payment interest penalty imposed under | ||||||
14 | Section 368a of the Illinois Insurance Code for any claims | ||||||
15 | not timely paid. | ||||||
16 | (A) When an MCO is required to pay a timely payment | ||||||
17 | interest penalty to a provider, the MCO must calculate | ||||||
18 | and pay the timely payment interest penalty that is | ||||||
19 | due to the provider within 30 days after the payment of | ||||||
20 | the claim. In no event shall a provider be required to | ||||||
21 | request or apply for payment of any owed timely | ||||||
22 | payment interest penalties. | ||||||
23 | (B) Such payments shall be reported separately | ||||||
24 | from the claim payment for services rendered to the | ||||||
25 | MCO's enrollee and clearly identified as interest | ||||||
26 | payments. |
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1 | (4)(A) The Department shall require MCOs to expedite | ||||||
2 | payments to providers identified on the Department's | ||||||
3 | expedited provider list, determined in accordance with 89 | ||||||
4 | Ill. Adm. Code 140.71(b), on a schedule at least as | ||||||
5 | frequently as the providers are paid under the | ||||||
6 | Department's fee-for-service expedited provider schedule. | ||||||
7 | (B) Compliance with the expedited provider requirement | ||||||
8 | may be satisfied by an MCO through the use of a Periodic | ||||||
9 | Interim Payment (PIP) program that has been mutually | ||||||
10 | agreed to and documented between the MCO and the provider, | ||||||
11 | if the PIP program ensures that any expedited provider | ||||||
12 | receives regular and periodic payments based on prior | ||||||
13 | period payment experience from that MCO. Total payments | ||||||
14 | under the PIP program may be reconciled against future PIP | ||||||
15 | payments on a schedule mutually agreed to between the MCO | ||||||
16 | and the provider. | ||||||
17 | (C) The Department shall share at least monthly its | ||||||
18 | expedited provider list and the frequency with which it | ||||||
19 | pays providers on the expedited list. | ||||||
20 | (g-5) Recognizing that the rapid transformation of the | ||||||
21 | Illinois Medicaid program may have unintended operational | ||||||
22 | challenges for both payers and providers: | ||||||
23 | (1) in no instance shall a medically necessary covered | ||||||
24 | service rendered in good faith, based upon eligibility | ||||||
25 | information documented by the provider, be denied coverage | ||||||
26 | or diminished in payment amount if the eligibility or |
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1 | coverage information available at the time the service was | ||||||
2 | rendered is later found to be inaccurate in the assignment | ||||||
3 | of coverage responsibility between MCOs or the | ||||||
4 | fee-for-service system, except for instances when an | ||||||
5 | individual is deemed to have not been eligible for | ||||||
6 | coverage under the Illinois Medicaid program; and | ||||||
7 | (2) the Department shall, by December 31, 2016, adopt | ||||||
8 | rules establishing policies that shall be included in the | ||||||
9 | Medicaid managed care policy and procedures manual | ||||||
10 | addressing payment resolutions in situations in which a | ||||||
11 | provider renders services based upon information obtained | ||||||
12 | after verifying a patient's eligibility and coverage plan | ||||||
13 | through either the Department's current enrollment system | ||||||
14 | or a system operated by the coverage plan identified by | ||||||
15 | the patient presenting for services: | ||||||
16 | (A) such medically necessary covered services | ||||||
17 | shall be considered rendered in good faith; | ||||||
18 | (B) such policies and procedures shall be | ||||||
19 | developed in consultation with industry | ||||||
20 | representatives of the Medicaid managed care health | ||||||
21 | plans and representatives of provider associations | ||||||
22 | representing the majority of providers within the | ||||||
23 | identified provider industry; and | ||||||
24 | (C) such rules shall be published for a review and | ||||||
25 | comment period of no less than 30 days on the | ||||||
26 | Department's website with final rules remaining |
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1 | available on the Department's website. | ||||||
2 | The rules on payment resolutions shall include, but | ||||||
3 | not be limited to: | ||||||
4 | (A) the extension of the timely filing period; | ||||||
5 | (B) retroactive prior authorizations; and | ||||||
6 | (C) guaranteed minimum payment rate of no less | ||||||
7 | than the current, as of the date of service, | ||||||
8 | fee-for-service rate, plus all applicable add-ons, | ||||||
9 | when the resulting service relationship is out of | ||||||
10 | network. | ||||||
11 | The rules shall be applicable for both MCO coverage | ||||||
12 | and fee-for-service coverage. | ||||||
13 | If the fee-for-service system is ultimately determined to | ||||||
14 | have been responsible for coverage on the date of service, the | ||||||
15 | Department shall provide for an extended period for claims | ||||||
16 | submission outside the standard timely filing requirements. | ||||||
17 | (g-6) MCO Performance Metrics Report. | ||||||
18 | (1) The Department shall publish, on at least a | ||||||
19 | quarterly basis, each MCO's operational performance, | ||||||
20 | including, but not limited to, the following categories of | ||||||
21 | metrics: | ||||||
22 | (A) claims payment, including timeliness and | ||||||
23 | accuracy; | ||||||
24 | (B) prior authorizations; | ||||||
25 | (C) grievance and appeals; | ||||||
26 | (D) utilization statistics; |
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1 | (E) provider disputes; | ||||||
2 | (F) provider credentialing; and | ||||||
3 | (G) member and provider customer service. | ||||||
4 | (2) The Department shall ensure that the metrics | ||||||
5 | report is accessible to providers online by January 1, | ||||||
6 | 2017. | ||||||
7 | (3) The metrics shall be developed in consultation | ||||||
8 | with industry representatives of the Medicaid managed care | ||||||
9 | health plans and representatives of associations | ||||||
10 | representing the majority of providers within the | ||||||
11 | identified industry. | ||||||
12 | (4) Metrics shall be defined and incorporated into the | ||||||
13 | applicable Managed Care Policy Manual issued by the | ||||||
14 | Department. | ||||||
15 | (g-7) MCO claims processing and performance analysis. In | ||||||
16 | order to monitor MCO payments to hospital providers, pursuant | ||||||
17 | to Public Act 100-580, the Department shall post an analysis | ||||||
18 | of MCO claims processing and payment performance on its | ||||||
19 | website every 6 months. Such analysis shall include a review | ||||||
20 | and evaluation of a representative sample of hospital claims | ||||||
21 | that are rejected and denied for clean and unclean claims and | ||||||
22 | the top 5 reasons for such actions and timeliness of claims | ||||||
23 | adjudication, which identifies the percentage of claims | ||||||
24 | adjudicated within 30, 60, 90, and over 90 days, and the dollar | ||||||
25 | amounts associated with those claims. | ||||||
26 | (g-8) Dispute resolution process. The Department shall |
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1 | maintain a provider complaint portal through which a provider | ||||||
2 | can submit to the Department unresolved disputes with an MCO. | ||||||
3 | An unresolved dispute means an MCO's decision that denies in | ||||||
4 | whole or in part a claim for reimbursement to a provider for | ||||||
5 | health care services rendered by the provider to an enrollee | ||||||
6 | of the MCO with which the provider disagrees. Disputes shall | ||||||
7 | not be submitted to the portal until the provider has availed | ||||||
8 | itself of the MCO's internal dispute resolution process. | ||||||
9 | Disputes that are submitted to the MCO internal dispute | ||||||
10 | resolution process may be submitted to the Department of | ||||||
11 | Healthcare and Family Services' complaint portal no sooner | ||||||
12 | than 30 days after submitting to the MCO's internal process | ||||||
13 | and not later than 30 days after the unsatisfactory resolution | ||||||
14 | of the internal MCO process or 60 days after submitting the | ||||||
15 | dispute to the MCO internal process. Multiple claim disputes | ||||||
16 | involving the same MCO may be submitted in one complaint, | ||||||
17 | regardless of whether the claims are for different enrollees, | ||||||
18 | when the specific reason for non-payment of the claims | ||||||
19 | involves a common question of fact or policy. Within 10 | ||||||
20 | business days of receipt of a complaint, the Department shall | ||||||
21 | present such disputes to the appropriate MCO, which shall then | ||||||
22 | have 30 days to issue its written proposal to resolve the | ||||||
23 | dispute. The Department may grant one 30-day extension of this | ||||||
24 | time frame to one of the parties to resolve the dispute. If the | ||||||
25 | dispute remains unresolved at the end of this time frame or the | ||||||
26 | provider is not satisfied with the MCO's written proposal to |
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1 | resolve the dispute, the provider may, within 30 days, request | ||||||
2 | the Department to review the dispute and make a final | ||||||
3 | determination. Within 30 days of the request for Department | ||||||
4 | review of the dispute, both the provider and the MCO shall | ||||||
5 | present all relevant information to the Department for | ||||||
6 | resolution and make individuals with knowledge of the issues | ||||||
7 | available to the Department for further inquiry if needed. | ||||||
8 | Within 30 days of receiving the relevant information on the | ||||||
9 | dispute, or the lapse of the period for submitting such | ||||||
10 | information, the Department shall issue a written decision on | ||||||
11 | the dispute based on contractual terms between the provider | ||||||
12 | and the MCO, contractual terms between the MCO and the | ||||||
13 | Department of Healthcare and Family Services and applicable | ||||||
14 | Medicaid policy. The decision of the Department shall be | ||||||
15 | final. By January 1, 2020, the Department shall establish by | ||||||
16 | rule further details of this dispute resolution process. | ||||||
17 | Disputes between MCOs and providers presented to the | ||||||
18 | Department for resolution are not contested cases, as defined | ||||||
19 | in Section 1-30 of the Illinois Administrative Procedure Act, | ||||||
20 | conferring any right to an administrative hearing. | ||||||
21 | (g-9)(1) The Department shall publish annually on its | ||||||
22 | website a report on the calculation of each managed care | ||||||
23 | organization's medical loss ratio showing the following: | ||||||
24 | (A) Premium revenue, with appropriate adjustments. | ||||||
25 | (B) Benefit expense, setting forth the aggregate | ||||||
26 | amount spent for the following: |
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1 | (i) Direct paid claims. | ||||||
2 | (ii) Subcapitation payments. | ||||||
3 | (iii) Other claim payments. | ||||||
4 | (iv) Direct reserves. | ||||||
5 | (v) Gross recoveries. | ||||||
6 | (vi) Expenses for activities that improve health | ||||||
7 | care quality as allowed by the Department. | ||||||
8 | (2) The medical loss ratio shall be calculated consistent | ||||||
9 | with federal law and regulation following a claims runout | ||||||
10 | period determined by the Department. | ||||||
11 | (g-10)(1) "Liability effective date" means the date on | ||||||
12 | which an MCO becomes responsible for payment for medically | ||||||
13 | necessary and covered services rendered by a provider to one | ||||||
14 | of its enrollees in accordance with the contract terms between | ||||||
15 | the MCO and the provider. The liability effective date shall | ||||||
16 | be the later of: | ||||||
17 | (A) The execution date of a network participation | ||||||
18 | contract agreement. | ||||||
19 | (B) The date the provider or its representative | ||||||
20 | submits to the MCO the complete and accurate standardized | ||||||
21 | roster form for the provider in the format approved by the | ||||||
22 | Department. | ||||||
23 | (C) The provider effective date contained within the | ||||||
24 | Department's provider enrollment subsystem within the | ||||||
25 | Illinois Medicaid Program Advanced Cloud Technology | ||||||
26 | (IMPACT) System. |
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1 | (2) The standardized roster form may be submitted to the | ||||||
2 | MCO at the same time that the provider submits an enrollment | ||||||
3 | application to the Department through IMPACT. | ||||||
4 | (3) By October 1, 2019, the Department shall require all | ||||||
5 | MCOs to update their provider directory with information for | ||||||
6 | new practitioners of existing contracted providers within 30 | ||||||
7 | days of receipt of a complete and accurate standardized roster | ||||||
8 | template in the format approved by the Department provided | ||||||
9 | that the provider is effective in the Department's provider | ||||||
10 | enrollment subsystem within the IMPACT system. Such provider | ||||||
11 | directory shall be readily accessible for purposes of | ||||||
12 | selecting an approved health care provider and comply with all | ||||||
13 | other federal and State requirements. | ||||||
14 | (g-11) The Department shall work with relevant | ||||||
15 | stakeholders on the development of operational guidelines to | ||||||
16 | enhance and improve operational performance of Illinois' | ||||||
17 | Medicaid managed care program, including, but not limited to, | ||||||
18 | improving provider billing practices, reducing claim | ||||||
19 | rejections and inappropriate payment denials, and | ||||||
20 | standardizing processes, procedures, definitions, and response | ||||||
21 | timelines, with the goal of reducing provider and MCO | ||||||
22 | administrative burdens and conflict. The Department shall | ||||||
23 | include a report on the progress of these program improvements | ||||||
24 | and other topics in its Fiscal Year 2020 annual report to the | ||||||
25 | General Assembly. | ||||||
26 | (g-12) Notwithstanding any other provision of law, if the |
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1 | Department or an MCO requires submission of a claim for | ||||||
2 | payment in a non-electronic format, a provider shall always be | ||||||
3 | afforded a period of no less than 90 business days, as a | ||||||
4 | correction period, following any notification of rejection by | ||||||
5 | either the Department or the MCO to correct errors or | ||||||
6 | omissions in the original submission. | ||||||
7 | Under no circumstances, either by an MCO or under the | ||||||
8 | State's fee-for-service system, shall a provider be denied | ||||||
9 | payment for failure to comply with any timely submission | ||||||
10 | requirements under this Code or under any existing contract, | ||||||
11 | unless the non-electronic format claim submission occurs after | ||||||
12 | the initial 180 days following the latest date of service on | ||||||
13 | the claim, or after the 90 business days correction period | ||||||
14 | following notification to the provider of rejection or denial | ||||||
15 | of payment. | ||||||
16 | (h) The Department shall not expand mandatory MCO | ||||||
17 | enrollment into new counties beyond those counties already | ||||||
18 | designated by the Department as of June 1, 2014 for the | ||||||
19 | individuals whose eligibility for medical assistance is not | ||||||
20 | the seniors or people with disabilities population until the | ||||||
21 | Department provides an opportunity for accountable care | ||||||
22 | entities and MCOs to participate in such newly designated | ||||||
23 | counties. | ||||||
24 | (h-5) Leading indicator data sharing. By January 1, 2024, | ||||||
25 | the Department shall obtain input from the Department of Human | ||||||
26 | Services, the Department of Juvenile Justice, the Department |
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1 | of Children and Family Services, the State Board of Education, | ||||||
2 | managed care organizations, providers, and clinical experts to | ||||||
3 | identify and analyze key indicators and data elements that can | ||||||
4 | be used in an analysis of lead indicators from assessments and | ||||||
5 | data sets available to the Department that can be shared with | ||||||
6 | managed care organizations and similar care coordination | ||||||
7 | entities contracted with the Department as leading indicators | ||||||
8 | for elevated behavioral health crisis risk for children , | ||||||
9 | including data sets such as the Illinois Medicaid | ||||||
10 | Comprehensive Assessment of Needs and Strengths (IM-CANS), | ||||||
11 | calls made to the State's Crisis and Referral Entry Services | ||||||
12 | (CARES) hotline, health services information from Health and | ||||||
13 | Human Services Innovators, or other data sets that may include | ||||||
14 | key indicators . The workgroup shall complete its | ||||||
15 | recommendations for leading indicator data elements on or | ||||||
16 | before September 1, 2024. To the extent permitted by State and | ||||||
17 | federal law, the identified leading indicators shall be shared | ||||||
18 | with managed care organizations and similar care coordination | ||||||
19 | entities contracted with the Department on or before December | ||||||
20 | 1, 2024 within 6 months of identification for the purpose of | ||||||
21 | improving care coordination with the early detection of | ||||||
22 | elevated risk. Leading indicators shall be reassessed annually | ||||||
23 | with stakeholder input. The Department shall implement | ||||||
24 | guidance to managed care organizations and similar care | ||||||
25 | coordination entities contracted with the Department, so that | ||||||
26 | the managed care organizations and care coordination entities |
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1 | respond to lead indicators with services and interventions | ||||||
2 | that are designed to help stabilize the child. | ||||||
3 | (i) The requirements of this Section apply to contracts | ||||||
4 | with accountable care entities and MCOs entered into, amended, | ||||||
5 | or renewed after June 16, 2014 (the effective date of Public | ||||||
6 | Act 98-651). | ||||||
7 | (j) Health care information released to managed care | ||||||
8 | organizations. A health care provider shall release to a | ||||||
9 | Medicaid managed care organization, upon request, and subject | ||||||
10 | to the Health Insurance Portability and Accountability Act of | ||||||
11 | 1996 and any other law applicable to the release of health | ||||||
12 | information, the health care information of the MCO's | ||||||
13 | enrollee, if the enrollee has completed and signed a general | ||||||
14 | release form that grants to the health care provider | ||||||
15 | permission to release the recipient's health care information | ||||||
16 | to the recipient's insurance carrier. | ||||||
17 | (k) The Department of Healthcare and Family Services, | ||||||
18 | managed care organizations, a statewide organization | ||||||
19 | representing hospitals, and a statewide organization | ||||||
20 | representing safety-net hospitals shall explore ways to | ||||||
21 | support billing departments in safety-net hospitals. | ||||||
22 | (l) The requirements of this Section added by Public Act | ||||||
23 | 102-4 shall apply to services provided on or after the first | ||||||
24 | day of the month that begins 60 days after April 27, 2021 (the | ||||||
25 | effective date of Public Act 102-4). | ||||||
26 | (Source: P.A. 102-4, eff. 4-27-21; 102-43, eff. 7-6-21; |
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1 | 102-144, eff. 1-1-22; 102-454, eff. 8-20-21; 102-813, eff. | ||||||
2 | 5-13-22; 103-546, eff. 8-11-23.)
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3 | Section 20. The Children's Mental Health Act is amended by | ||||||
4 | changing Section 5 as follows:
| ||||||
5 | (405 ILCS 49/5) | ||||||
6 | Sec. 5. Children's Mental Health Partnership; Children's | ||||||
7 | Mental Health Plan. | ||||||
8 | (a) The Children's Mental Health Partnership (hereafter | ||||||
9 | referred to as "the Partnership") created under Public Act | ||||||
10 | 93-495 and continued under Public Act 102-899 shall advise | ||||||
11 | State agencies and the Children's Behavioral Health | ||||||
12 | Transformation Initiative on designing and implementing | ||||||
13 | short-term and long-term strategies to provide comprehensive | ||||||
14 | and coordinated services for children from birth to age 25 and | ||||||
15 | their families with the goal of addressing children's mental | ||||||
16 | health needs across a full continuum of care, including social | ||||||
17 | determinants of health, prevention, early identification, and | ||||||
18 | treatment. The recommended strategies shall build upon the | ||||||
19 | recommendations in the Children's Mental Health Plan of 2022 | ||||||
20 | and may include, but are not limited to, recommendations | ||||||
21 | regarding the following: | ||||||
22 | (1) Increasing public awareness on issues connected to | ||||||
23 | children's mental health and wellness to decrease stigma, | ||||||
24 | promote acceptance, and strengthen the ability of |
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1 | children, families, and communities to access supports. | ||||||
2 | (2) Coordination of programs, services, and policies | ||||||
3 | across child-serving State agencies to best monitor and | ||||||
4 | assess spending, as well as foster innovation of adaptive | ||||||
5 | or new practices. | ||||||
6 | (3) Funding and resources for children's mental health | ||||||
7 | prevention, early identification, and treatment across | ||||||
8 | child-serving State agencies. | ||||||
9 | (4) Facilitation of research on best practices and | ||||||
10 | model programs and dissemination of this information to | ||||||
11 | State policymakers, practitioners, and the general public. | ||||||
12 | (5) Monitoring programs, services, and policies | ||||||
13 | addressing children's mental health and wellness. | ||||||
14 | (6) Growing, retaining, diversifying, and supporting | ||||||
15 | the child-serving workforce, with special emphasis on | ||||||
16 | professional development around child and family mental | ||||||
17 | health and wellness services. | ||||||
18 | (7) Supporting the design, implementation, and | ||||||
19 | evaluation of a quality-driven children's mental health | ||||||
20 | system of care across all child services that prevents | ||||||
21 | mental health concerns and mitigates trauma. | ||||||
22 | (8) Improving the system to more effectively meet the | ||||||
23 | emergency and residential placement needs for all children | ||||||
24 | with severe mental and behavioral challenges. | ||||||
25 | (b) The Partnership shall have the responsibility of | ||||||
26 | developing and updating the Children's Mental Health Plan and |
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1 | advising the relevant State agencies on implementation of the | ||||||
2 | Plan. The Children's Mental Health Partnership shall be | ||||||
3 | comprised of the following members: | ||||||
4 | (1) The Governor or his or her designee. | ||||||
5 | (2) The Attorney General or his or her designee. | ||||||
6 | (3) The Secretary of the Department of Human Services | ||||||
7 | or his or her designee. | ||||||
8 | (4) The State Superintendent of Education or his or | ||||||
9 | her designee. | ||||||
10 | (5) The Director of the Department of Children and | ||||||
11 | Family Services or his or her designee. | ||||||
12 | (6) The Director of the Department of Healthcare and | ||||||
13 | Family Services or his or her designee. | ||||||
14 | (7) The Director of the Department of Public Health or | ||||||
15 | his or her designee. | ||||||
16 | (8) The Director of the Department of Juvenile Justice | ||||||
17 | or his or her designee. | ||||||
18 | (9) The Executive Director of the Governor's Office of | ||||||
19 | Early Childhood Development or his or her designee. | ||||||
20 | (10) The Director of the Criminal Justice Information | ||||||
21 | Authority or his or her designee. | ||||||
22 | (11) One member of the General Assembly appointed by | ||||||
23 | the Speaker of the House. | ||||||
24 | (12) One member of the General Assembly appointed by | ||||||
25 | the President of the Senate. | ||||||
26 | (13) One member of the General Assembly appointed by |
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1 | the Minority Leader of the Senate. | ||||||
2 | (14) One member of the General Assembly appointed by | ||||||
3 | the Minority Leader of the House. | ||||||
4 | (15) Up to 25 representatives from the public | ||||||
5 | reflecting a diversity of age, gender identity, race, | ||||||
6 | ethnicity, socioeconomic status, and geographic location, | ||||||
7 | to be appointed by the Governor. Those public members | ||||||
8 | appointed under this paragraph must include, but are not | ||||||
9 | limited to: | ||||||
10 | (A) a family member or individual with lived | ||||||
11 | experience in the children's mental health system; | ||||||
12 | (B) a child advocate; | ||||||
13 | (C) a community mental health expert, | ||||||
14 | practitioner, or provider; | ||||||
15 | (D) a representative of a statewide association | ||||||
16 | representing a majority of hospitals in the State; | ||||||
17 | (E) an early childhood expert or practitioner; | ||||||
18 | (F) a representative from the K-12 school system; | ||||||
19 | (G) a representative from the healthcare sector; | ||||||
20 | (H) a substance use prevention expert or | ||||||
21 | practitioner, or a representative of a statewide | ||||||
22 | association representing community-based mental health | ||||||
23 | substance use disorder treatment providers in the | ||||||
24 | State; | ||||||
25 | (I) a violence prevention expert or practitioner; | ||||||
26 | (J) a representative from the juvenile justice |
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1 | system; | ||||||
2 | (K) a school social worker; and | ||||||
3 | (L) a representative of a statewide organization | ||||||
4 | representing pediatricians. | ||||||
5 | (16) Two co-chairs appointed by the Governor, one | ||||||
6 | being a representative from the public and one being the | ||||||
7 | Director of Public Health a representative from the State . | ||||||
8 | The members appointed by the Governor shall be appointed | ||||||
9 | for 4 years with one opportunity for reappointment, except as | ||||||
10 | otherwise provided for in this subsection. Members who were | ||||||
11 | appointed by the Governor and are serving on January 1, 2023 | ||||||
12 | (the effective date of Public Act 102-899) shall maintain | ||||||
13 | their appointment until the term of their appointment has | ||||||
14 | expired. For new appointments made pursuant to Public Act | ||||||
15 | 102-899, members shall be appointed for one-year, 2-year, or | ||||||
16 | 4-year terms, as determined by the Governor, with no more than | ||||||
17 | 9 of the Governor's new or existing appointees serving the | ||||||
18 | same term. Those new appointments serving a one-year or 2-year | ||||||
19 | term may be appointed to 2 additional 4-year terms. If a | ||||||
20 | vacancy occurs in the Partnership membership, the vacancy | ||||||
21 | shall be filled in the same manner as the original appointment | ||||||
22 | for the remainder of the term. | ||||||
23 | The Partnership shall be convened no later than January | ||||||
24 | 31, 2023 to discuss the changes in Public Act 102-899. | ||||||
25 | The members of the Partnership shall serve without | ||||||
26 | compensation but may be entitled to reimbursement for all |
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1 | necessary expenses incurred in the performance of their | ||||||
2 | official duties as members of the Partnership from funds | ||||||
3 | appropriated for that purpose. | ||||||
4 | The Partnership may convene and appoint special committees | ||||||
5 | or study groups to operate under the direction of the | ||||||
6 | Partnership. Persons appointed to such special committees or | ||||||
7 | study groups shall only receive reimbursement for reasonable | ||||||
8 | expenses. | ||||||
9 | (b-5) The Partnership shall include an adjunct council | ||||||
10 | comprised of no more than 6 youth aged 14 to 25 and 4 | ||||||
11 | representatives of 4 different community-based organizations | ||||||
12 | that focus on youth mental health. Of the community-based | ||||||
13 | organizations that focus on youth mental health, one of the | ||||||
14 | community-based organizations shall be led by an | ||||||
15 | LGBTQ-identified person, one of the community-based | ||||||
16 | organizations shall be led by a person of color, and one of the | ||||||
17 | community-based organizations shall be led by a woman. Of the | ||||||
18 | representatives appointed to the council from the | ||||||
19 | community-based organizations, at least one representative | ||||||
20 | shall be LGBTQ-identified, at least one representative shall | ||||||
21 | be a person of color, and at least one representative shall be | ||||||
22 | a woman. The council members shall be appointed by the Chair of | ||||||
23 | the Partnership and shall reflect the racial, gender identity, | ||||||
24 | sexual orientation, ability, socioeconomic, ethnic, and | ||||||
25 | geographic diversity of the State, including rural, suburban, | ||||||
26 | and urban appointees. The council shall make recommendations |
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1 | to the Partnership regarding youth mental health, including, | ||||||
2 | but not limited to, identifying barriers to youth feeling | ||||||
3 | supported by and empowered by the system of mental health and | ||||||
4 | treatment providers, barriers perceived by youth in accessing | ||||||
5 | mental health services, gaps in the mental health system, | ||||||
6 | available resources in schools, including youth's perceptions | ||||||
7 | and experiences with outreach personnel, agency websites, and | ||||||
8 | informational materials, methods to destigmatize mental health | ||||||
9 | services, and how to improve State policy concerning student | ||||||
10 | mental health. The mental health system may include services | ||||||
11 | for substance use disorders and addiction. The council shall | ||||||
12 | meet at least 4 times annually. | ||||||
13 | (c) (Blank). | ||||||
14 | (d) The Illinois Children's Mental Health Partnership has | ||||||
15 | the following powers and duties: | ||||||
16 | (1) Conducting research assessments to determine the | ||||||
17 | needs and gaps of programs, services, and policies that | ||||||
18 | touch children's mental health. | ||||||
19 | (2) Developing policy statements for interagency | ||||||
20 | cooperation to cover all aspects of mental health | ||||||
21 | delivery, including social determinants of health, | ||||||
22 | prevention, early identification, and treatment. | ||||||
23 | (3) Recommending policies and providing information on | ||||||
24 | effective programs for delivery of mental health services. | ||||||
25 | (4) Using funding from federal, State, or | ||||||
26 | philanthropic partners, to fund pilot programs or research |
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1 | activities to resource innovative practices by | ||||||
2 | organizational partners that will address children's | ||||||
3 | mental health. However, the Partnership may not provide | ||||||
4 | direct services. | ||||||
5 | (4.1) The Partnership shall work with community | ||||||
6 | networks and the Children's Behavioral Health | ||||||
7 | Transformation Initiative team to implement a community | ||||||
8 | needs assessment, that will raise awareness of gaps in | ||||||
9 | existing community-based services for youth. | ||||||
10 | (5) Submitting an annual report, on or before December | ||||||
11 | 30 of each year, to the Governor and the General Assembly | ||||||
12 | on the progress of the Plan, any recommendations regarding | ||||||
13 | State policies, laws, or rules necessary to fulfill the | ||||||
14 | purposes of the Act, and any additional recommendations | ||||||
15 | regarding mental or behavioral health that the Partnership | ||||||
16 | deems necessary. | ||||||
17 | (6) (Blank). Employing an Executive Director and | ||||||
18 | setting the compensation of the Executive Director and | ||||||
19 | other such employees and technical assistance as it deems | ||||||
20 | necessary to carry out its duties under this Section. | ||||||
21 | The Partnership may designate a fiscal and administrative | ||||||
22 | agent that can accept funds to carry out its duties as outlined | ||||||
23 | in this Section. | ||||||
24 | The Department of Public Health Healthcare and Family | ||||||
25 | Services shall provide technical and administrative support | ||||||
26 | for the Partnership. |
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1 | (e) The Partnership may accept monetary gifts or grants | ||||||
2 | from the federal government or any agency thereof, from any | ||||||
3 | charitable foundation or professional association, or from any | ||||||
4 | reputable source for implementation of any program necessary | ||||||
5 | or desirable to carry out the powers and duties as defined | ||||||
6 | under this Section. | ||||||
7 | (f) On or before January 1, 2027, the Partnership shall | ||||||
8 | submit recommendations to the Governor and General Assembly | ||||||
9 | that includes recommended updates to the Act to reflect the | ||||||
10 | current mental health landscape in this State. | ||||||
11 | (Source: P.A. 102-16, eff. 6-17-21; 102-116, eff. 7-23-21; | ||||||
12 | 102-899, eff. 1-1-23; 102-1034, eff. 1-1-23; 103-154, eff. | ||||||
13 | 6-30-23.)
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14 | Section 25. The Interagency Children's Behavioral Health | ||||||
15 | Services Act is amended by adding Section 6 as follows:
| ||||||
16 | (405 ILCS 165/6 new) | ||||||
17 | Sec. 6. Personal support workers. The Children's | ||||||
18 | Behavioral Health Transformation Team in collaboration with | ||||||
19 | the Department of Human Services shall develop a program to | ||||||
20 | provide one-on-one in-home respite behavioral health aids to | ||||||
21 | youth requiring intensive supervision due to behavioral health | ||||||
22 | needs.
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23 | Section 99. Effective date. This Act takes effect upon |
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