|
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 |
|
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 |
|
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: |
|
(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. |
|
(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 |
|
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 |
|
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 |
|
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, |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |