Bill Text: IL SB1673 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Creates the Mental Health Modernization and Access Improvement Act. Requires the Department of Healthcare and Family Services to apply for a Medicaid waiver or State Plan amendment, or both, within 6 months after the effective date of the Act to develop and implement a regulatory framework that allows, incentivizes, and fosters payment reform models for all Medicaid community mental health services provided by community mental health centers or behavioral health clinics. Requires the regulatory framework to: (i) allow for and incentivize service innovation that is aimed at producing the best health outcomes for Medicaid enrollees with mental health conditions; (ii) reward high-quality care through annual incentive payments to community mental health centers and behavioral health clinics; (iii) require community mental health centers and behavioral health clinics to report on specified quality and outcomes metrics; and other matters. Provides that all documentation and reporting requirements under the regulatory framework must comply with the federal Mental Health Parity and Addiction Equity Act of 2008 and the State mental health parity requirements under the Illinois Insurance Code. Contains provisions concerning quality and outcomes metrics reporting; data sharing; the establishment of a Stakeholder Quality and Outcomes Metrics Development Working Group; statewide in-person trainings to ensure provider readiness for the regulatory framework; quality and patient safety protections; implementation timeline; certification of community mental health centers that opt into the regulatory framework; and other matters. Provides that the Act shall be implemented upon federal approval and only to the extent that federal financial participation is available. Effective immediately.

Spectrum: Partisan Bill (Democrat 12-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB1673 Detail]

Download: Illinois-2019-SB1673-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB1673 Introduced 2/15/2019, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED:
New Act
Creates the Mental Health Modernization and Access Improvement Act. Requires the Department of Healthcare and Family Services to apply for a Medicaid waiver or State Plan amendment, or both, within 6 months after the effective date of the Act to develop and implement a regulatory framework that allows, incentivizes, and fosters payment reform models for all Medicaid community mental health services provided by community mental health centers or behavioral health clinics. Requires the regulatory framework to: (i) allow for and incentivize service innovation that is aimed at producing the best health outcomes for Medicaid enrollees with mental health conditions; (ii) reward high-quality care through annual incentive payments to community mental health centers and behavioral health clinics; (iii) require community mental health centers and behavioral health clinics to report on specified quality and outcomes metrics; and other matters. Provides that all documentation and reporting requirements under the regulatory framework must comply with the federal Mental Health Parity and Addiction Equity Act of 2008 and the State mental health parity requirements under the Illinois Insurance Code. Contains provisions concerning quality and outcomes metrics reporting; data sharing; the establishment of a Stakeholder Quality and Outcomes Metrics Development Working Group; statewide in-person trainings to ensure provider readiness for the regulatory framework; quality and patient safety protections; implementation timeline; certification of community mental health centers that opt into the regulatory framework; and other matters. Provides that the Act shall be implemented upon federal approval and only to the extent that federal financial participation is available. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning mental health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the Mental
Health Modernization and Access Improvement Act.
Section 5. Findings. The General Assembly finds as follows:
(1) Insufficient access to mental health care in
Illinois has led to numerous consent decrees, children
remaining in psychiatric hospitals beyond medical
necessity, custody relinquishment to get treatment, and
growing suicide rates. These major problems are direct
consequences of: (i) a State regulatory structure for
mental health services that does not allow for or align
with payment for outcomes, integration, or care delivery
innovation; and (ii) limited State investment in Medicaid
reimbursement rates for community mental health services.
(2) Illinois must align its regulatory framework for
community mental health services with the modern era of
health care delivery to enable and reward high-quality
health outcomes and to reduce costs, and must also reform
payment rates to allow for service growth and increased
participation of psychiatrists and other mental health
professionals in the State's Medicaid program.

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(3) The existing regulatory framework for Medicaid
mental health services is fee-for-service, even under
managed care. Nearly all Medicaid managed care contracts
with mental health providers are fee-for-service
contracts, rather than value-based contracts. This is due
largely to the fee-for-service regulatory framework for
mental health and an encounter-based Medicaid system that
stymies payment reform.
(4) The existing mental health fee-for-service
framework: (i) impedes delivery of care that produces the
best health outcomes and reduces unnecessary costs; (ii)
allows for no innovation; (iii) disincentivizes care
coordination and integration; and (iv) prevents the growth
of psychiatry and team-based treatment models that could
improve access to care.
(5) Pay-for-performance and value-based payment models
that provide financial incentives to providers for
achieving defined quality and outcomes metrics have shown
early evidence of producing better health outcomes and
reduced Medicaid costs.
(6) A value-based payment model for community mental
health care delivery will dovetail and further the
value-based payment model for care coordination and
integration being implemented through integrated health
homes.
(7) To modernize mental health service delivery,

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Illinois must develop a regulatory framework for mental
health services that allows for and encourages payment
reform consistent with the framework established by the
U.S. Department of Health and Human Services' Health Care
Payment Learning and Action Network (LAN) Alternative
Payment Model (such as incentive payments linked to quality
and outcomes metrics, shared savings, and bundled payment
models) combined with reimbursement rates that enable
service growth to meet Illinois' mental health treatment
needs. The payment reform models developed shall work with
both managed and unmanaged Medicaid.
Section 10. Community mental health payment reform model.
(a) Regulatory framework for community mental health
providers. To move away from the antiquated fee-for-service
payment model for community mental health services and to
foster increased access to high-quality care, particularly for
services for individuals with serious mental health
conditions, the Department of Healthcare and Family Services,
as the sole Medicaid State agency, in partnership with the
Department of Human Services' Division of Mental Health, and
with meaningful stakeholder involvement, shall apply for a
Medicaid waiver or State Plan amendment, or both, within 6
months after the effective date of this Act to develop and
implement a regulatory framework that allows, incentivizes,
and fosters payment reform models for all community mental

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health services provided by community mental health centers
licensed or certified by the Division of Mental Health and for
behavioral health clinics established under 89 Ill. Adm. Code
140. Such payment reform models shall be consistent with the
Health Care Payment Learning and Action Network Alternative
Payment Model framework developed by the U.S. Department of
Health and Human Services. Upon federal approval, and the
adoption of rules to implement this Act, all community mental
health services provided by community mental health centers or
behavioral health clinics shall be subject to the regulatory
framework for providers that opt in. Providers that do not opt
in shall be governed by the existing administrative rules for
community mental health services. Community mental health
centers and behavioral health clinics that opt into the
regulatory framework shall be given the opportunity to opt out
every 2 years. Community mental health centers and behavioral
health clinics that do not opt in shall be given the
opportunity to opt in annually. This Act shall be implemented
only to the extent that federal approval is granted and federal
financial participation is available.
(b) Incentivizing service innovation. The regulatory
framework established under this Act shall allow for and
incentivize service innovation, enabled through service and
workforce flexibility, consistent with all scope of practice
laws for all mental health professionals, that is aimed at
producing the best health outcomes for Medicaid enrollees with

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mental health conditions and combined with reporting quality
and outcomes metrics. The regulatory framework shall reward
high-quality care through annual incentive payments to
community mental health centers and behavioral health clinics
participating in the regulatory framework.
(c) Mental health professionals; practice. To address
Illinois' mental health workforce challenges, the regulatory
framework shall allow mental health professionals to practice
at the top of their qualifications and the regulatory framework
shall not restrict this ability (such as maximum use of advance
practice nurses with a psychiatric specialty, maximum use of
mental health professionals with a bachelor's degree, maximum
use of licensed clinicians, and maximum use of persons with
lived experience) enabling staffing flexibility that reflects
the local workforce, particularly for team-based treatment
models. All workforce requirements established pursuant to
this regulatory framework shall comply with and be consistent
with all scope of practice laws for all mental health
professionals. In developing minimum staffing requirements
within the regulatory framework, the Department of Healthcare
and Family Services shall take into account the inability of
community mental health centers and behavioral health clinics
to hire and retain certain mental health professionals in
workforce shortage areas across the State and the effect this
has on restricting access to care, while recognizing the full
value of mental health professionals not currently relied upon

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or permitted in certain roles or to fulfill certain functions
(such as mental health professionals with a bachelor's degree,
advanced practice registered nurses with a psychiatric
specialty, licensed clinicians, and persons with lived
experience who are not certified recovery support specialists)
and shall maximize the use of telehealth and telepsychiatry.
(d) Provider outreach and engagement. To address the need
to encourage Medicaid enrollees with the most serious mental
illnesses to participate in treatment, the regulatory
framework shall allow for and incentivize significant provider
outreach and engagement for individuals with serious mental
illnesses who are often homeless, difficult to reach, and the
hardest to connect to treatment. The regulatory framework shall
also take into account the significant distances providers
employing team-based treatment models must travel to
effectively engage and treat such individuals.
(e) Quality and outcomes metrics. To ensure high-quality
care, patient satisfaction, and patient safety, the regulatory
framework shall require community mental health centers and
behavioral health clinics opting into the regulatory framework
to report on specified quality and outcomes metrics that shall
be used to determine eligibility for an annual incentive
payment. The quality and outcomes metrics established by the
Department of Healthcare and Family Services shall be done in
accordance with Section 15. Eligibility for an incentive
payment is addressed in Section 25. Section 30 sets out the

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consequences for community mental health centers and
behavioral health clinics participating in the framework that
do not meet a minimum level of quality and outcomes metrics.
(f) Mental health parity compliance. Provider utilization
management processes, prior authorizations, assessment and
treatment plan reviews and updates, and all related
documentation and reporting required through the regulatory
framework shall be in compliance with the federal Mental Health
Parity and Addiction Equity Act of 2008 and the State mental
health parity requirements set forth in Section 370c of the
Illinois Insurance Code. The Department of Healthcare and
Family Services shall not require more onerous processes for
mental health treatment, treatment plans, assessments, or the
frequency of provider reviews or updates of assessments and
treatment plans, and related reporting or documentation than
the processes the State imposes on treatment providers of other
similar chronic medical conditions (such as providers treating
diabetes or heart disease). More onerous requirements for
access to treatment, treatment plan reviews and updates,
utilization management processes, prior authorization
requirements or documentation, and reporting requirements for
mental health conditions compared to those requirements for
other similar chronic medical conditions can be construed as
non-quantitative treatment limitations, which would be a
violation of the federal Mental Health Parity and Addiction
Equity Act of 2008 and Section 370c of the Illinois Insurance

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Code. To ensure and demonstrate to the General Assembly that
the regulatory framework complies with the federal Mental
Health Parity and Addiction Equity Act of 2008 and Section 370c
of the Illinois Insurance Code, upon the date the Department of
Healthcare and Family Services submits to the Joint Committee
on Administrative Rules its proposed rule to implement this
Act, as provided in Section 40, the Department shall also
submit to the Joint Committee on Administrative Rules a
detailed analysis demonstrating that the provider utilization
management requirements, assessment or treatment planning
frequency, and related documentation and reporting
requirements imposed under the regulatory framework are no more
onerous for mental health treatment than the requirements the
State imposes on treatment providers of other comparable
chronic medical conditions.
(g) Managed care contracts. The regulatory framework shall
align with the ability of community mental health centers and
behavioral health clinics to provide services through managed
care contracts linked to (i) quality and performance metrics
(LAN Category 2) or (ii) a shared savings or shared risk model
or bundled or episode-based payments with managed care
organizations (LAN Category 3), all of which require service
and workforce flexibility to achieve quality and outcomes
metrics. The documentation required by the State from community
mental health centers and behavioral health clinics for
services provided through these payment reform models through

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managed care organization contracts shall not be duplicative or
inconsistent with these payment reform models, meaning that
State reporting and documentation requirements must align with
what is required through managed care so duplicative processes
or reporting are not required to the State and to managed care
organizations. The Department of Healthcare and Family
Services shall pay an annual incentive payment to community
mental health centers and behavioral health clinics that
achieve the State specified quality and mental health or health
outcomes metrics for enrollees in Medicaid managed care. The
incentive payment shall be in addition to the base Medicaid
reimbursement rate and any Medicaid rate add-on payments for
the specific service.
(h) Non-managed Medicaid services; community mental health
centers and behavioral health clinics. Because a large
percentage of Medicaid enrollees with serious mental health
conditions are dually eligible for Medicare and Medicaid and
therefore cannot be required to be in managed Medicaid under
federal law, the regulatory framework shall also apply to
non-managed Medicaid services delivered by community mental
health centers and behavioral health clinics. For the
non-managed Medicaid population, the payment model shall
reward services with an annual incentive payment paid by the
Department of Healthcare and Family Services to community
mental health centers and behavioral health clinics that
achieve specified quality and outcomes metrics. The incentive

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payment shall be in addition to the base Medicaid reimbursement
rate and any Medicaid add-on payments for the specific service.
Shared risk or penalties shall not be a part of the regulatory
framework for non-managed Medicaid services.
Section 15. Quality and outcomes metrics reporting.
(a) Quality and outcomes metrics. The Department of
Healthcare and Family Services, in partnership with the
Department of Human Services' Division of Mental Health and
with meaningful stakeholder participation through the
establishment of a Stakeholder Quality and Outcomes Metrics
Development Working Group, shall establish or select (i)
metrics that community mental health centers and behavioral
health clinics opting into the regulatory framework must report
on annually to the Department of Healthcare and Family Services
upon implementation of this Act and (ii) metrics that determine
eligibility for an annual incentive payment.
(1) For guidance in adoption of the most appropriate
and feasible quality and outcomes metrics, the Department
of Healthcare and Family Services shall use the relevant
metrics it uses for Illinois Medicaid managed care
organizations and integrated health homes, as well as those
established or used by the National Committee for Quality
Assurance or the federal Certified Community Behavioral
Health Clinic pilot program. The Department of Healthcare
and Family Services shall establish 4 categories of

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metrics:
(A) Quality metrics. Quality metrics are
claims-based and intended to be used to measure
business processes that lead to and support
high-quality care. The Department of Healthcare and
Family Services shall establish quality metrics, which
must include some of the relevant quality metrics the
Department of Healthcare and Family Services uses to
measure the performance of Medicaid managed care
organizations, by which to measure the quality of care
delivered by community mental health centers and
behavioral health clinics participating in the
regulatory framework. Annual reporting on quality
metrics shall begin in the first year after
implementation of this Act.
(B) Health outcomes metrics. Health outcomes
metrics are intended to measure improvement in health
outcomes across populations. These metrics must be
clinically relevant, feasible, and reliable. Any
health outcomes metrics established or used for
measuring mental and behavioral health outcomes for
community mental health centers and behavioral health
clinics participating in the regulatory framework
shall be claims-based, standard health outcome
measures. Annual reporting on claims-based standard
health outcomes metrics shall begin in the second full

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calendar year after the implementation of this Act.
(C) Patient experience and patient satisfaction
metrics. The Department of Healthcare and Family
Services shall develop quality of life and patient
experience measures. Reporting on these metrics shall
begin in the second full calendar year after
implementation of this Act.
(D) Social determinants of health metrics. Social
determinants of health metrics take into account a
person's social factors and the physical condition of
the environment in which the person lives, works,
learns, plays, and ages. Measuring the social
determinants of health may include evaluating improved
housing status, reduced justice involvement, and
school, work, civic, or volunteer participation that
are a result of mental health treatment. The Department
of Healthcare and Family Services shall include at
least 2 social determinants of health metrics that are
reported to the State for purposes of this Act.
Reporting on these metrics shall begin in the third
full calendar year after implementation of this Act.
(E) Payment-for-performance metrics. The
Department of Healthcare and Family Services, with
meaningful stakeholder input through the Stakeholder
Quality and Outcomes Metrics Development Working
Group, shall select clinically relevant, feasible, and

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reliable metrics that are claims-based metrics for
purposes of the payment-for-performance metrics. The
payment-for-performance metrics shall be used in
determining eligibility for an annual incentive
payment in year 3 of implementation of the regulatory
framework and every year thereafter. The Department of
Healthcare and Family Services shall use no more than 6
payment-for-performance metrics, including
sub-measures. To ensure provider certainty and
provider readiness to meet the payment-for-performance
metrics, payment-for-performance metrics shall be
established and shared with providers at least 6 months
prior to such metrics becoming operative and they shall
remain in effect for at least 2 years. Because the
payment-for-performance metrics will be a main driver
of provider behavior, the Department of Healthcare and
Family Services shall take into consideration what
metrics drive high-performing care that leads to
improved mental health symptom management over the
long term, as well as maintenance of recovery and
wellness for the individual. The Department of
Healthcare and Family Services shall ensure that the
payment-for-performance metrics it selects do not
result in providers serving those with the least severe
mental illnesses. The Department of Healthcare and
Family Services shall ensure that there are

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payment-for-performance metrics that encourage and
reward providers that serve those with the most serious
mental illnesses. The metrics developed must be aimed
at measuring care delivery that leads to positive
mental health and health outcomes for the individual
but must also reflect that mental health recovery can
be a life-long process with periods of stabilization
and wellness, but also may include periods of illness
exacerbation (i.e., serious mental health conditions
are chronic medical conditions and recovery is not
linear or static).
(2) To ensure that providers and the State are not
overburdened by data tracking and reporting, no more than
20 metrics in total, including sub-metrics, shall be
established.
(3) The Department of Healthcare and Family Services,
in partnership with the Department of Human Services'
Division of Mental Health, shall develop a formula for how
the payment-for-performance metrics are weighted for
purposes of determining a community mental health clinic's
or a behavioral health clinic's eligibility for an annual
incentive payment.
(4) Solely for purposes of evaluating provider credit
for achieving the metrics outlined in this Section, the
Department of Healthcare and Family Services, with
meaningful input from the Stakeholder Quality and Outcomes

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Metrics Development Working Group, shall determine a
minimum threshold of service provision any individual must
have received from a community mental health clinic or
behavioral health clinic participating in the regulatory
framework to include that individual's outcomes metrics in
that provider's total outcomes measurement.
(5) Given that the federal government and many states
are updating quality metrics for behavioral health as the
field modernizes, the Department of Healthcare and Family
Services may periodically update the metrics reported to
the State and the payment-for-performance metrics, but
only following meaningful input from stakeholders through
the Stakeholder Quality and Outcomes Metrics Development
Working Group on the value and feasibility of the new
metrics.
(6) Mental health parity compliance. The Department of
Healthcare and Family Services shall ensure that the
metrics established in accordance with this Act: (i) are in
compliance with the federal Mental Health Parity and
Addiction Equity Act and Section 370c of the Illinois
Insurance Code and (ii) do not result in a non-quantitative
treatment limitation.
(b) Data sharing. The State and Medicaid managed care
organizations shall be required to timely share claims and
encounter data with community mental health providers
participating in the regulatory framework for the individuals

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for which the provider is serving to enable the provider to
evaluate and improve its own performance and to be able to
deliver care that results in the best mental health and overall
health outcomes. Data, including claims information,
utilization management data, and health outcomes measures,
shall be shared between the State and the community mental
health clinic or behavioral health clinic assigned to the
individual for purposes of metrics evaluation, and between the
managed care organization and the community mental health
clinic or behavioral health clinic assigned to the individual
for purposes of metrics evaluation in compliance with all
health information privacy laws. Standardized data elements,
reporting methods, and data systems shall be established across
managed care organizations and community mental health clinics
or behavioral health clinics to prevent unnecessary
development of different reporting systems for each managed
care organization.
(c) Stakeholder Quality and Outcomes Metrics Development
Working Group. The Department of Healthcare and Family
Services, in partnership with the Department of Human Services'
Division of Mental Health, shall establish and convene a
Stakeholder Quality and Outcomes Metrics Development Working
Group that includes mental health providers, advocates,
including persons with lived experience of a mental health
condition, and representatives from Medicaid managed care
organizations to (i) assist in the development of the metrics

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that will be reported to the State in accordance with this
Section and (ii) assist with selecting the
payment-for-performance metrics. The Stakeholder Quality and
Outcomes Metrics Development Working Group shall be
established and convened at least once prior to the date upon
which the Department of Healthcare and Family Services applies
for a Medicaid waiver or State Plan amendment as provided in
subsection (a) of Section 10. The Stakeholder Quality and
Outcomes Metrics Development Working Group shall meet at least
monthly for no less than 8 months to assist in the development
of the metrics that will be reported to the State and used to
determine eligibility for incentive payments.
Section 20. Provider readiness.
(a) To ensure provider readiness for the implementation of
the payment reform models developed in accordance with this
Act, the Department of Healthcare and Family Services shall
require community mental health centers and behavioral health
clinics choosing to opt into the regulatory framework to submit
an initial self-assessment of readiness, including
demonstrating the delivery of person-centered care or
family-centered care, the ability to track quality and outcomes
data for Medicaid enrollees, and a data-driven quality
improvement process. The Department of Healthcare and Family
Services shall engage in statewide provider education for
implementation of the regulatory framework and process through

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statewide in-person trainings, train-the-trainer models, and
webinars at least 6 months prior to implementation to enable
provider readiness. Such education shall continue throughout
the first year of implementation. The Department of Healthcare
and Family Services shall establish an ongoing statewide
learning collaborative for providers opting into the
regulatory framework to share successes, challenges, lessons
learned, and provider and systemic issues that need to be
addressed to foster these payment reform models. The learning
collaborative shall be convened by the Department of Healthcare
and Family Services, in partnership with the Department of
Human Services' Division of Mental Health, on a quarterly basis
after the initial date of implementation of the regulatory
framework.
(b) Provider infrastructure development for
implementation. A total not to exceed $5,000,000 a year for
each of 3 years shall be available for provider infrastructure
development for implementation of this Act, including, but not
limited to, systems for data tracking of the metrics outlined
in Section 15, or other start-up or infrastructure costs, for
providers opting into the regulatory framework. The Department
of Healthcare and Family Services shall have the authority to
determine the process for application and eligibility for
provider infrastructure development dollars under this
subsection.

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Section 25. Annual incentive payments for community mental
health centers and behavioral health clinics.
(a) Annual incentive payment.
(1) Year one of implementation and the first 2 full
calendar years of implementation. For the first partial
calendar year of implementation (if implementation begins
mid-year) and for the first 2 full calendar years after
implementation of this Act, community mental health
centers and behavioral health clinics participating in the
regulatory framework that score above the median score of
the relevant quality metrics the Department of Healthcare
and Family Services uses for Medicaid managed care
organizations that the Department has selected to measure
the quality of care provided by community mental health
centers and behavioral health clinics as provided under
subparagraph (A) of paragraph (1) of subsection (a) of
Section 15 for at least 80% of such quality metrics for
that calendar year shall receive an incentive payment
related to that calendar year. If implementation begins in
the middle of a calendar year, a provider's incentive
payment for that year shall be prorated based on the date
the regulatory framework went into effect.
(2) Year 3 and every calendar year thereafter. For the
third full calendar year after implementation of this Act,
and every year thereafter, community mental health centers
and behavioral health clinics participating in the

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regulatory framework shall receive an annual incentive
payment related to that year if:
(A) the provider scores above the median score of
the quality metrics the Department of Healthcare and
Family Services uses for Medicaid managed care
organizations that the Department has selected to
measure the quality of care provided by community
mental health centers and behavioral health clinics as
provided under subparagraph (A) of paragraph (1) of
subsection (a) of Section 15, for at least 80% of such
quality metrics related to that calendar year; and
(B) the provider meets at least 75% of the
payment-for-performance metrics established in
accordance with this Act for that calendar year.
(3) For any calendar year following the first 2 full
calendar years after implementation, the Department of
Healthcare and Family Services shall have the ability to
adjust the benchmark for measuring minimum eligibility for
an incentive payment (the median score of the relevant
quality metrics used to measure Medicaid managed care
organizations that the Department of Healthcare and Family
Services applies to the regulatory framework) by 10% upward
or downward to ensure an appropriate benchmark for
eligibility for an annual incentive payment. The
Department of Healthcare and Family Services shall give
providers participating in the regulatory framework at

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least 6 months notice prior to the benchmark going into
effect for a calendar year.
(4) Number of metrics used to determine annual
incentive payments. No more than 10 metrics (including
sub-metrics), including the payment-for-performance
metrics, shall be used in any given year to determine
eligibility for an annual incentive payment to ensure that
neither the State nor providers are overwhelmed by data
tracking.
(5) Provider preparedness. The Department of
Healthcare and Family Services shall give all community
mental health centers and behavioral health clinics notice
of the metrics that will be used to determine eligibility
for an annual incentive payment at least 6 months prior to
those metrics taking effect for that calendar year.
(6) Amount of annual incentive payment. For community
mental health centers or behavioral health clinics that
meet the requirements set forth in this Act for an
incentive payment for any calendar year, the incentive
payment shall be equal to a 6 percentage point increase in
the base Medicaid reimbursement rates plus any rate add-on
payment, for all Medicaid community mental health services
that the provider delivered during that calendar year. The
incentive payment shall be paid to the community mental
health center or behavioral health clinic within 8 months
following the end of the calendar year.

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Section 30. Eligibility for participation. Community
mental health centers and behavioral health clinics subject to
the regulatory framework that do not meet the median score of
the quality metrics the Department of Healthcare and Family
Services uses for Medicaid managed care organizations and for
which the Department has selected as provided under
subparagraph (A) of paragraph (1) of subsection (a) of Section
15 for at least 50% of such quality metrics for that calendar
year for 3 consecutive calendar years shall be ineligible for
further participation under the regulatory framework for the
following 3 calendar years. A community mental health center or
behavioral health clinic that does not meet the median score of
the quality metrics the Department of Healthcare and Family
Services uses for Medicaid managed care organizations for which
the Department has selected as provided under subparagraph (A)
of paragraph (1) of subsection (a) of Section 15 for at least
30% of such quality metrics for that calendar year shall no
longer be eligible for participation under the regulatory
framework until they are able to demonstrate to the Department,
through a formal plan, that they can achieve at least 75% of
these quality metrics.
Section 35. Community mental health services; rates.
(a) Beginning on July 1, 2019, Medicaid reimbursement rates
for all community-based mental health services provided in

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accordance with 59 Ill. Adm. Code 132 or 89 Ill. Adm. Code
140.452 through 140.455 for which there was an enhanced payment
rate or rate add-on in effect on November 1, 2017 for community
mental health centers, or for behavioral health clinics that
were formerly community mental health centers, shall be
increased by the amount equal to the enhanced payment rate or
rate add-on. The enhanced payment rate or rate add-on shall be
simultaneously reduced by an equal amount. The Department of
Healthcare and Family Services shall hold harmless community
mental health centers, and any relevant behavioral health
clinic that was formerly a community mental health center,
receiving such mental or behavioral health enhanced payment
rates or rate add-on payments. This subsection is intended to
convert the enhanced rate and rate add-on payments into the
Medicaid reimbursement rate for community-based mental health
services.
(b) For State Fiscal Year 2020, Medicaid reimbursement
rates for all community mental and behavioral health services
that can be delivered by a community mental health center or
behavioral health clinic in accordance with 89 Ill. Adm. Code
140.452 through 140.455, for which there is no enhanced payment
rate or rate add-on payment, and for all Medicaid psychiatry
services provided by an advance practice nurse with a
psychiatric specialty delivered through or on behalf of a
community mental health center or a behavioral health clinic,
shall be increased by 7% annually for each state fiscal year

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for 3 years. Beginning in State Fiscal Year 2023, and every
state fiscal year thereafter, Medicaid reimbursement rates for
those community mental and behavioral health services and those
services covered in subsection (a) provided by community mental
health centers and behavioral health clinics shall be adjusted
upward by an amount equal to the Consumer Price Index from the
previous year, not to exceed 2% in any state fiscal year. If
there is a decrease in the Consumer Price Index, rates shall
remain unchanged for that state fiscal year.
(c) To increase the number of psychiatrists practicing in
Illinois' Medicaid Program that serve individuals with the most
serious mental health conditions, the Department of Healthcare
and Family Services shall develop an encounter-based rate and a
billing and payment mechanism for all Medicaid psychiatry
services delivered by a psychiatrist to be paid at a rate equal
to the average Medicaid reimbursement rate paid to
Illinois-based federally qualified health clinics over the 3
most recent years for such psychiatry services or for the same
or comparable services. This encounter-based Medicaid rate,
and billing and payment mechanism, may be a Medicaid
reimbursement rate adjustment or an enhanced Medicaid payment.
This rate adjustment shall be phased in equally over 4 calendar
years beginning on January 1, 2020. The provisions of this
subsection on psychiatry reimbursement shall not impact other
provider reimbursement rates that may be tied to psychiatry
rates.

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(d) To reduce the rate of children with serious mental
health conditions remaining in psychiatric hospitals beyond
medical necessity because there is a lack of residential
treatment placements available for the child, reimbursement
rates paid to providers for services provided under the Family
Support Program, formerly known as the Individual Care Grant
program, shall be adjusted upward by 7% a year for 3 years
beginning July 1, 2019. Beginning in State Fiscal Year 2023,
and each state fiscal year thereafter, such reimbursement rates
shall be adjusted upward by an amount equal to the Consumer
Price Index from the previous year, not to exceed 2% in any
state fiscal year. If there is a decrease in the Consumer Price
Index, such rates shall remain unchanged for that state fiscal
year.
Section 40. Implementation timeline; rulemaking authority.
(a) The Department of Healthcare and Family Services shall
file a proposed rule implementing this Act no later than 9
months after the date of federal approval of its waiver or
State Plan amendment filed pursuant to this Act.
(b) Stakeholder working group. The Department of
Healthcare and Family Services, in partnership with the
Department of Human Services' Division of Mental Health, shall
establish and convene a stakeholder working group that includes
community mental health providers across the State, advocates,
persons with lived experience, and representatives from

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Medicaid managed care organizations to help guide and assist
the Department of Healthcare and Family Services in the
development of the rule that implements this Act. This
stakeholder working group shall meet at least monthly beginning
immediately after federal approval of the State Plan amendment
or waiver filed pursuant to this Act and shall continue until
the filing of a proposed rule implementing this Act.
Section 45. Rule revision. 59 Ill Adm. Code 132 shall be
revised to align with and match the regulatory framework
developed pursuant to this Act for community mental health
centers participating in the regulatory framework established
by this Act and shall not impose service, staffing,
certification, documentation, or reporting requirements that
are inconsistent with this Act for those community mental
health centers to enable the modernization of the community
mental health regulatory framework. The Department of Human
Services' Division of Mental Health shall file its proposed
amendments to 59 Ill Adm. Code 132 with the Joint Commission on
Administrative Rules simultaneously with the Department of
Healthcare and Family Services' filing of the rule implementing
this Act.
Section 99. Effective date. This Act takes effect upon
becoming law.