305 ILCS 66/20-1
(305 ILCS 66/20-1) Sec. 20-1. Short title. This Article may be cited as the Rebuild Illinois Mental Health Workforce Act. References in this Article to "this Act" mean this Article. (Source: P.A. 102-699, eff. 4-19-22.)
305 ILCS 66
305 ILCS 66
in effect305 ILCS 66/20-5 Purpose
(305 ILCS 66/20-5) Sec. 20-5. Purpose. The purpose of this Act is to preserve and expand access to Medicaid community mental health care in Illinois to prevent unnecessary hospitalizations and avoid the criminalization of mental health conditions. (Source: P.A. 102-699, eff. 4-19-22.)
305 ILCS 66/20-10
(305 ILCS 66/20-10) Sec. 20-10. Medicaid funding for community mental health services. Medicaid funding for the specific community mental health services listed in this Act shall be adjusted and paid as set forth in this Act. Such payments shall be paid in addition to the base Medicaid reimbursement rate and add-on payment rates per service unit. (a) The following payment adjustments shall begin on July 1, 2022 for State Fiscal Year 2023 and shall continue for every State fiscal year thereafter. (1) Individual Therapy Medicaid Payment rate for services provided under the H0004 Code: (A) The Medicaid total payment rate for individual therapy provided by a qualified mental health professional shall be increased by no less than $9 per service unit. (B) The Medicaid total payment rate for individual therapy provided by a mental health professional shall be increased by no less than $9 per service unit. (2) Community Support - Individual Medicaid Payment rate for services provided under the H2015 Code: All community support - individual services shall be increased by no less than $15 per service unit. (3) Case Management Medicaid Add-on Payment for services provided under the T1016 code: All case management services rates shall be increased by no less than $15 per service unit. (4) Assertive Community Treatment Medicaid Add-on Payment for services provided under the H0039 code: The Medicaid total payment rate for assertive community treatment services shall increase by no less than $8 per service unit. (b) Medicaid user-based directed payments. The following directed payments shall be paid to qualifying providers for State Fiscal Year 2023 through State Fiscal Year 2026. This subsection does not prevent the Department from making payments in future State fiscal years to correct errors or omissions made in State Fiscal Year 2023 through State Fiscal Year 2026 payments. (1) For each State fiscal year, a monthly directed payment shall be paid to a community mental health provider of community support team services based on the number of Medicaid users of community support team services documented by Medicaid fee-for-service and managed care encounter claims delivered by that provider in the base year. The Department of Healthcare and Family Services shall make the monthly directed payment to each provider entitled to directed payments under this Act by no later than the last day of each month throughout each State fiscal year. (A) The monthly directed payment for a community support team provider shall be calculated as follows: The sum total number of individual Medicaid users of community support team services delivered by that provider throughout the base year, multiplied by $4,200 per Medicaid user, divided into 12 equal monthly payments for the State fiscal year. (B) As used in this subparagraph, "user" means an individual who received at least 200 units of community support team services (H2016) during the base year. (2) For each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of assertive community treatment services based on the number of Medicaid users of assertive community treatment services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. (A) The monthly direct payment for an assertive community treatment provider shall be calculated as follows: The sum total number of Medicaid users of assertive community treatment services provided by that provider throughout the base year, multiplied by $6,000 per Medicaid user, divided into 12 equal monthly payments for that State fiscal year. (B) As used in this subparagraph, "user" means an individual that received at least 300 units of assertive community treatment services during the base year. (3) The base year for directed payments under this Section shall be calendar year 2019 for State Fiscal Year 2023 and State Fiscal Year 2024. For the State fiscal year beginning on July 1, 2024, and for every State fiscal year thereafter, the base year shall be the calendar year that ended 18 months prior to the start of the State fiscal year in which payments are made. (b-5) Subject to federal approval, a one-time directed payment must be made in calendar year 2023 for community mental health services provided by community mental health providers. The one-time directed payment shall be for an amount appropriated for these purposes. The one-time directed payment shall be for services for Integrated Assessment and Treatment Planning and other intensive services, including, but not limited to, services for Mobile Crisis Response, crisis intervention, and medication monitoring. The amounts and services used for designing and distributing these one-time directed payments shall not be construed to require any future rate or funding increases for the same or other mental health services. (b-6) Subject to federal approval, for dates of service on and after July 1, 2026, the Medicaid reimbursement rates for Assertive Community Treatment and Community Support Team services shall be increased by an amount no less than the following targeted pools. The Department must use service units delivered under the fee-for-service and managed care programs by community mental health centers during State Fiscal Year 2024 for distributing the targeted pools and setting rates. (1) Assertive Community Treatment, $10,600,000; and (2) Community Support Team services, $17,500,000. (c) The following payment adjustments shall be made: (1) Subject to federal approval, beginning on January 1, 2024, the Department shall introduce rate increases to behavioral health services no less than by the following targeted pool for the specified services provided by community mental health centers: (A) Mobile Crisis Response, $6,800,000; (B) Crisis Intervention, $4,000,000; (C) Integrative Assessment and Treatment Planning services, $10,500,000; (D) Group Therapy, $1,200,000; (E) Family Therapy, $500,000; (F) Community Support Group, $4,000,000; and (G) Medication Monitoring, $3,000,000. (2) Rate increases shall be determined with significant input from Illinois behavioral health trade associations and advocates. The Department must use service units delivered under the fee-for-service and managed care programs by community mental health centers during State Fiscal Year 2022. These services are used for distributing the targeted pools and setting rates but do not prohibit the Department from paying providers not enrolled as community mental health centers the same rate if providing the same services. (d) Rate simplification for team-based services. (1) The Department shall work with stakeholders to redesign reimbursement rates for behavioral health team-based services established under the Rehabilitation Option of the Illinois Medicaid State Plan supporting individuals with chronic or complex behavioral health conditions and crisis services. Subject to federal approval, the redesigned rates shall seek to introduce bundled payment systems that minimize provider claiming activities while transitioning the focus of treatment towards metrics and outcomes. Federally approved rate models shall seek to ensure reimbursement levels are no less than the State's total reimbursement for similar services in calendar year 2023, including all service level payments, add-ons, and all other payments specified in this Section. (2) In State Fiscal Year 2024, the Department shall identify an existing, or establish a new, Behavioral Health Outcomes Stakeholder Workgroup to help inform the identification of metrics and outcomes for team-based services. (3) In State Fiscal Year 2025, subject to federal approval, the Department shall introduce a pay-for-performance model for team-based services to be informed by the Behavioral Health Outcomes Stakeholder Workgroup. (Source: P.A. 103-102, eff. 7-1-23; 103-154, eff. 6-30-23; 104-470, eff. 7-1-26.)
305 ILCS 66/20-15 Applicable Medicaid services
(305 ILCS 66/20-15) Sec. 20-15. Applicable Medicaid services. The payments listed in Section 20-10 shall apply to Medicaid services provided through contracts with any Medicaid managed care organization or entity and for Medicaid services paid for directly by the Department of Healthcare and Family Services. (Source: P.A. 102-699, eff. 4-19-22.)
305 ILCS 66/20-20
(305 ILCS 66/20-20) Sec. 20-20. Base Medicaid rates or add-on payments. (a) For services under subsection (a) of Section 20-10: No base Medicaid rate or Medicaid rate add-on payment or any other payment for the provision of Medicaid community mental health services in place on July 1, 2021 shall be diminished or changed to make the reimbursement changes required by this Act. Any payments required under this Act that are delayed due to implementation challenges or federal approval shall be made retroactive to July 1, 2022 for the full amount required by this Act. (b) For directed payments under subsection (b) of Section 20-10: No base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by this Act. The Department of Healthcare and Family Services must pay the directed payment in one installment within 60 days of receiving federal approval. (c) For directed payments under subsection (c) of Section 20-10: No base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by this amendatory Act of the 103rd General Assembly. Any payments required under this amendatory Act of the 103rd General Assembly that are delayed due to implementation challenges or federal approval shall be made retroactive to no later than January 1, 2024 for the full amount required by this amendatory Act of the 103rd General Assembly. (Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23; 103-102, eff. 7-1-23.)
305 ILCS 66/20-22
(305 ILCS 66/20-22) Sec. 20-22. Implementation plan for cost reporting. (a) For the purpose of understanding behavioral health services cost structures and their impact on the Illinois Medical Assistance Program, the Department shall engage stakeholders to develop a plan for the regular collection of cost reporting for all entity-based providers of behavioral health services reimbursed under the Rehabilitation or Prevention authorities of the Illinois Medicaid State Plan. Data shall be used to inform on the effectiveness and efficiency of Illinois Medicaid rates. The plan at minimum should consider the following: (1) alignment with certified community behavioral health clinic requirements, standards, policies, and procedures; (2) inclusion of prospective costs to measure what is needed to increase services and capacity; (3) consideration of differences in collection and policies based on the size of providers; (4) consideration of additional administrative time and costs; (5) goals, purposes, and usage of data collected from cost reports; (6) inclusion of qualitative data in addition to quantitative data; (7) technical assistance for providers for completing cost reports including initial training by the Department for providers; and (8) an implementation timeline that allows an initial grace period for providers to adjust internal procedures and data collection. Details from collected cost reports shall be made publicly available on the Department's website and costs shall be used to ensure the effectiveness and efficiency of Illinois Medicaid rates. (b) The Department and stakeholders shall develop a plan by April 1, 2024. The Department shall engage stakeholders on implementation of the plan. (Source: P.A. 103-102, eff. 7-1-23.)
305 ILCS 66/20-25
(305 ILCS 66/20-25) Sec. 20-25. Federal approval and Medicaid federal financial participation. The Department of Healthcare and Family Services shall submit any necessary application to the federal Centers for Medicare and Medicaid Services immediately following the effective date of this Act for purposes of implementation of this Act. The payments required under this Act shall only be required as long as Illinois receives federal financial participation for such payments. (Source: P.A. 102-699, eff. 4-19-22.)
305 ILCS 66/99-99
(305 ILCS 66/99-99) Sec. 99-99. Effective date. This Act takes effect upon becoming law, except that Article 15 takes effect on July 1, 2022, and Article 35 takes effect upon becoming law or on the date Senate Bill 3023 of the 102nd General Assembly takes effect, whichever is later. (Source: P.A. 102-699, eff. 4-19-22.)
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://www.ilga.gov/legislation/ilcs/ilcs.aspFetched: 10/17/2026