Bill Text: IL SB2951 | 2017-2018 | 100th General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Creates the Early Mental Health and Addictions Treatment Act. Requires the Department of Healthcare and Family Services, and other specified agencies and entities, to develop a pilot program under which a qualifying adolescent or young adult may receive community-based mental health treatment from a youth-focused community support team for early treatment that is specifically tailored to the needs of youth and young adults in the early stages of a serious emotional disturbance or serious mental illness. Requires the Department to apply, no later than September 30, 2019, for any necessary federal waiver or State Plan amendment to implement the pilot program. Requires the Department to implement the pilot program no later than December 31, 2019 if federal approval is not necessary. Contains provisions concerning the creation of a community-based treatment model under the pilot program; the development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Requires the Department to develop an Assertive Engagement and Community-Based Clinical Treatment Pilot Program for individuals with opioid and other drug addictions. Contains provisions on in-office, in-home, and in-community services provided under the pilot program; application for a federal waiver or State Plan amendment to implement the pilot program; development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Effective immediately.

Spectrum: Moderate Partisan Bill (Democrat 31-10)

Status: (Passed) 2018-08-21 - Public Act . . . . . . . . . 100-1016 [SB2951 Detail]

Download: Illinois-2017-SB2951-Enrolled.html

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AN ACT concerning public aid.
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 Early
Mental Health and Addictions Treatment Act.
Section 5. Medicaid Pilot Program; early treatment for
youth and young adults.
(a) The General Assembly finds as follows:
(1) Most mental health conditions begin in adolescence
and young adulthood, yet it can take an average of 10 years
before the right diagnosis and treatment are received.
(2) Over 850,000 Illinois youth under age 25 will
experience a mental health condition.
(3) Early treatment of significant mental health
conditions can enable wellness and recovery and prevent a
life of disability or early death from suicide.
(4) Early treatment leads to higher rates of school
completion and employment.
(5) Illinois' mental health system is aimed at adults
with advanced mental illnesses who have become disabled,
rather than focusing on youth in the early stages of a
mental health condition to prevent progression.
(6) Many states are implementing programs and services

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for the early treatment of significant mental health
conditions in youth.
(7) The cost of early community-based treatment is a
fraction of the cost of a life of multiple
hospitalizations, disability, criminal justice
involvement, and homelessness, the common trajectory for
someone with a serious mental health condition.
(8) Early treatment for adolescents and young adults
with mental health conditions will save lives and State
dollars.
(b) As the sole Medicaid State agency, the Department of
Healthcare and Family Services, in partnership with the
Department of Human Services' Division of Mental Health and
with meaningful input from stakeholders, shall develop a pilot
program under which a qualifying adolescent or young adult, as
defined in subsection (d), may receive community-based mental
health treatment from a youth-focused community support team
for early treatment, as provided in subsection (e), that is
specifically tailored to the needs of youth and young adults in
the early stages of a serious emotional disturbance or serious
mental illness for purposes of stabilizing the youth's
condition and symptoms and preventing the worsening of the
illness and debilitating or disabling symptoms. The pilot
program shall be implemented across a broad spectrum of
geographic regions across the State.
(c) Federal waiver or State Plan amendment; implementation

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timeline.
(1) Federal approval. The Department of Healthcare and
Family Services shall submit any necessary application to
the federal Centers for Medicare and Medicaid Services for
a waiver or State Plan amendment to implement the pilot
program described in this Section no later than September
30, 2019. If the Department determines the pilot program
can be implemented without federal approval, the
Department shall implement the program no later than
December 31, 2019. The Department shall not draft any rules
in contravention of this timetable for pilot program
development and implementation. This pilot program shall
be implemented only to the extent that federal financial
participation is available.
(2) Implementation. After federal approval is secured,
if federal approval is required, the Department of
Healthcare and Family Services shall implement the pilot
program within 6 months after the date of federal approval.
(d) Qualifying adolescent or young adult. As used in this
Section, "qualifying adolescent or young adult" means a person
age 16 through 26 who is enrolled in the Medical Assistance
Program under Article V of the Illinois Public Aid Code and has
a diagnosis of a serious emotional disturbance as interpreted
by the federal Substance Abuse and Mental Health Services
Administration or a serious mental illness listed in the most
recent edition of the Diagnostic and Statistical Manual of

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Mental Disorders. Because the purpose of the pilot program is
treatment in the early stages of a significant mental health
condition or emotional disturbance for purposes of preventing
progression of the illness, debilitating symptoms and
disability, a qualifying adolescent or young adult shall not be
required to demonstrate disability due to the mental health
condition, show a reduction in functioning as a result of the
condition, or have a reality impairment (psychosis) to be
eligible for services through the pilot program. A qualifying
adolescent or young adult who is determined to be eligible for
pilot program services before the age of 21 shall continue to
be eligible for such services without interruption through age
26 as long as he or she remains enrolled in the Medical
Assistance Program.
(e) Community-based treatment model. The pilot program
shall create youth-focused community support teams for early
treatment. The community-based treatment model shall be a
multidisciplinary, team-based model specifically tailored for
adolescents and young adults and their needs for wellness,
symptom management, and recovery. The model shall take into
consideration area workforce, community uniqueness, and
cultural diversity. All services shall be evidence-based or
evidence-informed as applicable, and the services shall be
flexibly provided in-office, in-home, and in-community with an
emphasis on in-home and in-community services. The model shall
allow for and include each of the following:

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(1) Community-based, outreach treatment, and
wrap-around services that begin in the early stages of a
serious mental illness or serious emotional disturbance
(functional impairment shall not be required for service
eligibility under the pilot program).
(2) Youth specific engagement strategies to encourage
participation and retention in services.
(3) Same-age or similar-age peer services to foster
resiliency.
(4) Family psycho-education and family involvement.
(5) Expertise or knowledge in school and university
systems, special education and work, volunteer and social
life for youth.
(6) Evidence-informed and young person-specific
psychotherapies.
(7) Care coordination for primary care.
(8) Medication management.
(9) Case management for problem solving to address
practicable problems, including criminal justice
involvement and housing challenges; and assisting the
young person or family in organizing all treatment and
goals.
(10) Supported education and employment to keep the
young person engaged in school and work to attain
self-sufficiency.
(11) Trauma-informed expertise for youth.

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(12) Substance use treatment expertise.
(f) Pay-for-performance payment model. The Department of
Healthcare and Family Services, with meaningful input from
stakeholders, shall develop a pay-for-performance payment
model aimed at achieving high-quality mental health and overall
health and quality of life outcomes for the youth, rather than
a fee-for-service payment model. The payment model shall allow
for service flexibility to achieve such outcomes, shall cover
actual provider costs of delivering the pilot program services
to enable sustainability, and shall include all provider costs
associated with the data collection for purposes of the
analytics and outcomes reporting required under subsection
(h). The Department shall ensure that the payment model works
as intended by this Section within managed care.
(g) Rulemaking. The Department of Healthcare and Family
Services, in partnership with the Department of Human Services'
Division of Mental Health and with meaningful input from
stakeholders, shall develop rules for purposes of
implementation of the pilot program contemplated in this
Section within 6 months of federal approval of the pilot
program. If the Department determines federal approval is not
required for implementation, the Department shall develop
rules with meaningful stakeholder input no later than December
31, 2019.
(h) Pilot program analytics and outcomes reports. The
Department of Healthcare and Family Services shall engage a

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third party partner with expertise in program evaluation,
analysis, and research at the end of 5 years of implementation
to review the outcomes of the pilot program in stabilizing
youth with significant mental health conditions early on in
their condition to prevent debilitating symptoms and
disability and enable youth to reach their full potential. For
purposes of evaluating the outcomes of the pilot program, the
Department shall require providers of the pilot program
services to track the following annual data:
(1) days of inpatient hospital stays of service
recipients;
(2) periods of homelessness of service recipients and
periods of housing stability;
(3) periods of criminal justice involvement of service
recipients;
(4) avoidance of disability and the need for
Supplemental Security Income;
(5) rates of high school, college, or vocational school
engagement and graduation for service recipients;
(6) rates of employment annually of service
recipients;
(7) average length of stay in pilot program services;
(8) symptom management over time; and
(9) youth satisfaction with their quality of life,
pre-pilot and post-pilot program services.
(i) The Department of Healthcare and Family Services shall

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deliver a final report to the General Assembly on the outcomes
of the pilot program within one year after 4 years of full
implementation, and after 7 years of full implementation,
compared to typical treatment available to other youth with
significant mental health conditions, as well as the cost
savings associated with the pilot program taking into account
all public systems used when an individual with a significant
mental health condition does not have access to the right
treatment and supports in the early stages of his or her
illness.
The reports to the General Assembly shall be filed with the
Clerk of the House of Representatives and the Secretary of the
Senate in electronic form only, in the manner that the Clerk
and the Secretary shall direct.
Post-pilot program discharge outcomes shall be collected
for all service recipients who exit the pilot program for up to
3 years after exit. This includes youth who exit the program
with planned or unplanned discharges. The post-exit data
collected shall include the annual data listed in paragraphs
(1) through (9) of subsection (h). Data collection shall be
done in a manner that does not violate individual privacy laws.
Outcomes for enrollees in the pilot and post-exit outcomes
shall be included in the final report to the General Assembly
under this subsection (i) within one year of 4 full years of
implementation, and in an additional report within one year of
7 full years of implementation in order to provide more

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information about post-exit outcomes on a greater number of
youth who enroll in pilot program services in the final years
of the pilot program.
Section 10. Medicaid pilot program for opioid and other
drug addictions.
(a) Legislative findings. The General Assembly finds as
follows:
(1) Illinois continues to face a serious and ongoing
opioid epidemic.
(2) Opioid-related overdose deaths rose 76% between
2013 and 2016.
(3) Opioid and other drug addictions are life-long
diseases that require a disease management approach and not
just episodic treatment.
(4) There is an urgent need to create a treatment
approach that proactively engages and encourages
individuals with opioid and other drug addictions into
treatment to help prevent chronic use and a worsening
addiction and to significantly curb the rate of overdose
deaths.
(b) With the goal of early initial engagement of
individuals who have an opioid or other drug addiction in
addiction treatment and for keeping individuals engaged in
treatment following detoxification, a residential treatment
stay, or hospitalization to prevent chronic recurrent drug use,

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the Department of Healthcare and Family Services, in
partnership with the Department of Human Services' Division of
Alcoholism and Substance Abuse and with meaningful input from
stakeholders, shall develop an Assertive Engagement and
Community-Based Clinical Treatment Pilot Program for early
treatment of an opioid or other drug addiction. The pilot
program shall be implemented across a broad spectrum of
geographic regions across the State.
(c) Assertive engagement and community-based clinical
treatment services. All services included in the pilot program
established under this Section shall be evidence-based or
evidence-informed as applicable and the services shall be
flexibly provided in-office, in-home, and in-community with an
emphasis on in-home and in-community services. The model shall
take into consideration area workforce, community uniqueness,
and cultural diversity. The model shall, at a minimum, allow
for and include each of the following:
(1) Assertive community outreach, engagement, and
continuing care strategies to encourage participation and
retention in addiction treatment services for both initial
engagement into addiction treatment services, and for
post-hospitalization, post-detoxification, and
post-residential treatment.
(2) Case management for purposes of linking
individuals to treatment, ongoing monitoring, problem
solving, and assisting individuals in organizing their

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treatment and goals. Case management shall be covered for
individuals not yet engaged in treatment for purposes of
reaching such individuals early on in their addiction and
for individuals in treatment.
(3) Clinical treatment that is delivered in an
individual's natural environment, including in-home or
in-community treatment, to better equip the individual
with coping mechanisms that may trigger re-use.
(4) Coverage of provider transportation costs in
delivering in-home and in-community services in both rural
and urban settings. For rural communities, the model shall
take into account the wider geographic areas providers are
required to travel for in-home and in-community pilot
services for purposes of reimbursement.
(5) Recovery support services.
(6) For individuals who receive services through the
pilot program but disengage for a short duration (a period
of no longer than 9 months), allow seamless treatment
re-engagement in the pilot program.
(7) Supported education and employment.
(8) Working with the individual's family, school, and
other community support systems.
(9) Service flexibility to enable recovery and
positive health outcomes.
(d) Federal waiver or State Plan amendment; implementation
timeline. The Department shall follow the timeline for

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application for federal approval and implementation outlined
in subsection (c) of Section 5. The pilot program contemplated
in this Section shall be implemented only to the extent that
federal financial participation is available.
(e) Pay-for-performance payment model. The Department of
Healthcare and Family Services, in partnership with the
Department of Human Services' Division of Alcoholism and
Substance Abuse and with meaningful input from stakeholders,
shall develop a pay-for-performance payment model aimed at
achieving high quality treatment and overall health and quality
of life outcomes, rather than a fee-for-service payment model.
The payment model shall allow for service flexibility to
achieve such outcomes, shall cover actual provider costs of
delivering the pilot program services to enable
sustainability, and shall include all provider costs
associated with the data collection for purposes of the
analytics and outcomes reporting required in subsection (g).
The Department shall ensure that the payment model works as
intended by this Section within managed care.
(f) Rulemaking. The Department of Healthcare and Family
Services, in partnership with the Department of Human Services'
Division of Alcoholism and Substance Abuse and with meaningful
input from stakeholders, shall develop rules for purposes of
implementation of the pilot program within 6 months after
federal approval of the pilot program. If the Department
determines federal approval is not required for

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implementation, the Department shall develop rules with
meaningful stakeholder input no later than December 31, 2019.
(g) Pilot program analytics and outcomes reports. The
Department of Healthcare and Family Services shall engage a
third party partner with expertise in program evaluation,
analysis, and research at the end of 5 years of implementation
to review the outcomes of the pilot program in treating
addiction and preventing periods of symptom exacerbation and
recurrence. For purposes of evaluating the outcomes of the
pilot program, the Department shall require providers of the
pilot program services to track all of the following annual
data:
(1) Length of engagement and retention in pilot program
services.
(2) Recurrence of drug use.
(3) Symptom management (the ability or inability to
control drug use).
(4) Days of hospitalizations related to substance use
or residential treatment stays.
(5) Periods of homelessness and periods of housing
stability.
(6) Periods of criminal justice involvement.
(7) Educational and employment attainment during
following pilot program services.
(8) Enrollee satisfaction with his or her quality of
life and level of social connectedness, pre-pilot and

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post-pilot services.
(h) The Department of Healthcare and Family Services shall
deliver a final report to the General Assembly on the outcomes
of the pilot program within one year after 4 years of full
implementation, and after 7 years of full implementation,
compared to typical treatment available to other youth with
significant mental health conditions, as well as the cost
savings associated with the pilot program taking into account
all public systems used when an individual with a significant
mental health condition does not have access to the right
treatment and supports in the early stages of his or her
illness.
The reports to the General Assembly shall be filed with the
Clerk of the House of Representatives and the Secretary of the
Senate in electronic form only, in the manner that the Clerk
and the Secretary shall direct.
Post-pilot program discharge outcomes shall be collected
for all service recipients who exit the pilot program for up to
3 years after exit. This includes youth who exit the program
with planned or unplanned discharges. The post-exit data
collected shall include the annual data listed in paragraphs
(1) through (8) of subsection (g). Data collection shall be
done in a manner that does not violate individual privacy laws.
Outcomes for enrollees in the pilot and post-exit outcomes
shall be included in the final report to the General Assembly
under this subsection (h) within one year of 4 full years of

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implementation, and in an additional report within one year of
7 full years of implementation in order to provide more
information about post-exit outcomes on a greater number of
youth who enroll in pilot program services in the final years
of the pilot program.
Section 99. Effective date. This Act takes effect upon
becoming law.