Public Act 100-1065
 
HB5868 EnrolledLRB100 21705 KTG 39208 b


  
    AN ACT concerning health.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 1. Legislative findings and purpose. Medical 
clinics, emergency rooms, and hospitals across the country are 
overwhelmed by the opioid crisis and have been adversely 
affected by costs and increasing rates of recidivism due to an 
increase in the need for additional comprehensive 
community-based continuum of care services for persons with 
opioid and other substance use disorders. According to the 
Centers for Disease Control and Prevention, there has been a 
600% increase in the incidence of opioid use disorders since 
1999, creating an increased need for treatment and other 
recovery support services. Most persons with substance use 
disorders also face co-existing social and economic challenges 
including poverty, job insecurity, and a lack of safe and sober 
living environments. The current health care system is often 
too expensive, fragmented, and disjointed to sufficiently 
address the needs of persons with substance use disorders. 
Consequently, we are at a pivotal time in history when 
insurance companies are having to become more innovative in 
their approaches to contain costs and improve the outcomes of 
those persons with substance use disorders. Hospitals are also 
contemplating new and innovative ways to reduce their costs and 
rates of recidivism, improve the outcomes of those persons with 
substance use disorders, and monitor these persons with a 
greater level of care in order to achieve the highest level of 
multiple performance outcomes at a time when performance 
metrics matter more than ever. The State of Illinois has the 
opportunity to lead the nation by supporting and amplifying the 
most comprehensive and vertically integrated approach to 
recovery that can effectively address the root causes of 
substance use disorders, while stabilizing other co-existing 
social, economic, and housing conditions that can impair a 
person's long-term recovery. In addition to helping persons 
achieve physical recovery from a substance use disorder, it is 
also important to help them find new meaning in their personal 
lives by rebuilding and strengthening their family 
relationships, community ties, and spiritual development. 
Recovery housing can facilitate this holistic approach to 
recovery and help persons replace their need for substances 
with more meaningful elements of life. Therefore, it is the 
purpose of this Act to provide Illinois citizens with greater 
access to a more robust and holistic continuum of behavioral 
health care services and supports by providing health care 
coverage for recovery housing for persons with substance use 
disorders.
 
    Section 5. The Illinois Insurance Code is amended  by adding 
Section 356z.29 as follows:
 
    (215 ILCS 5/356z.29 new)
    Sec. 356z.29. Recovery housing for persons with substance 
use
disorders.
    (a) Definitions. As used in this Section:
    "Substance use disorder" and "case management" have the 
meanings ascribed to those terms in Section 1-10 of the 
Substance Use Disorder Act. 
    "Hospital" means a facility licensed by the Department of 
Public Health under the Hospital Licensing Act. 
    "Federally qualified health center" means a facility as 
defined in Section 1905(l)(2)(B) of the federal Social Security 
Act. 
    "Recovery housing" means a residential extended care 
treatment facility or a recovery home as defined and licensed 
in 77 Illinois Administrative Code, Part 2060, by the Illinois 
Department of Human Services, Division of Substance Use 
Prevention and Recovery. 
    (b) A group or individual policy of accident and health 
insurance or managed care plan amended, delivered, issued, or 
renewed on or after the effective date of this amendatory Act 
of the 100th General Assembly may provide coverage for 
residential extended care services and supports for persons 
recovery housing for persons with substance use disorders who 
are at risk of a relapse following discharge from a health care 
clinic, federally qualified health center, hospital withdrawal 
management program or any other licensed withdrawal management 
program, or hospital emergency department so long as all of the 
following conditions are met: 
        (1) A health care clinic, federally qualified health 
    center, hospital withdrawal management program or any 
    other licensed withdrawal management program, or hospital 
    emergency department has conducted an individualized 
    assessment, using criteria established by the American 
    Society of Addiction Medicine, of the person's condition 
    prior to discharge and has identified the person as being 
    at risk of a relapse and in need of supportive services, 
    including employment and training and case management, to 
    maintain long-term recovery. A determination of whether a 
    person is in need of supportive services shall also be 
    based on whether the person has a history of poverty, job 
    insecurity, and lack of a safe and sober living 
    environment. 
        (2) The recovery housing is administered by a 
    community-based agency that is licensed by or under 
    contract with the Department of Human Services, Division of 
    Substance Use Prevention and Recovery. 
        (3) The recovery housing is administered by a 
    community-based agency as described in paragraph (2) upon 
    the referral of a health care clinic, federally qualified 
    health center, hospital withdrawal management program or 
    any other licensed withdrawal management program, or 
    hospital emergency department. 
    (c) Based on the individualized needs assessment, any 
coverage provided in accordance with this Section may include, 
but not be limited to, the following: 
        (1) Substance use disorder treatment services that are 
    in accordance with licensure standards promulgated by the 
    Department of Human Services, Division of Substance Use 
    Prevention and Recovery.
        (2) Transitional housing services, including food or 
    meal plans.
        (3) Individualized case management and referral 
    services, including case management and social services 
    for the families of persons who are seeking treatment for a 
    substance use disorder.
        (4)
Job training or placement services. 
    (d) The insurer may rate each community-based agency that 
is licensed by or under contract with the Department of Human 
Services, Division of Substance Use Prevention and Recovery to 
provide recovery housing based on an evaluation of each 
agency's ability to: 
        (1) reduce health care costs; 
        (2) reduce recidivism rates for persons suffering from 
    a substance use disorder; 
        (3) improve outcomes; 
        (4) track persons with substance use disorders; and 
        (5) improve the quality of life of persons with 
    substance use disorders through the utilization of 
    sustainable recovery, education, employment, and housing 
    services. 
    The insurer may publish the results of the ratings on its 
official website and shall, on an annual basis, update the 
posted results. 
    (e) The Department of Insurance may adopt any rules 
necessary to implement the provisions of this Section in 
accordance with the Illinois Administrative Procedure Act and 
all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized.