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| Public Act 097-0166 | ||||
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AN ACT concerning State government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Mental Health and Developmental | ||||
Disabilities Administrative Act is amended by adding Section | ||||
71a as follows: | ||||
(20 ILCS 1705/71a new) | ||||
Sec. 71a. Community Behavioral Health Care. | ||||
(a) The Department shall strive to guarantee that persons, | ||||
including children, suffering from mental illness, substance | ||||
abuse, and other behavioral disorders have access to locally | ||||
accessible behavioral health care providers who have the | ||||
ability to treat the person's conditions in a cost effective, | ||||
outcome-based manner. To ensure continuity and quality of care | ||||
that is integrated with the person's overall medical care, the | ||||
Department shall: | ||||
(1) Designate as essential community behavioral health | ||||
care providers organizations that meet the qualifications | ||||
set forth in subsection (b) of this Section. | ||||
(2) Promote the co-location of primary and behavioral | ||||
health care services centers. | ||||
(3) Promote access to necessary behavioral health care | ||||
services in the State's Health Insurance Exchange | ||||
policies. | ||
(4) Promote continuity of care for persons moving | ||
between Medicaid, SCHIP, and programs administered by the | ||
Department that provide behavioral health care services. | ||
(5) Promote continuity of care for persons not yet | ||
eligible for Medicaid or who are without insurance coverage | ||
for their conditions. | ||
(6) Work toward improving access in Illinois' | ||
underserved and health professional shortage areas. | ||
(b) The Department shall designate certain community | ||
behavioral health care providers as essential community | ||
behavioral health care providers. To qualify for the | ||
designation an organization must be a not-for-profit | ||
organization under the Internal Revenue Code or a governmental | ||
entity that: | ||
(1) Demonstrates a commitment to serving low-income | ||
and underserved populations. | ||
(2) Provides outcome-based community behavioral health | ||
care treatment or services. | ||
(3) Does not restrict access or services because of a | ||
client's financial limitation. | ||
(4) Is a community behavioral health care provider | ||
certified by the Department, or a licensed community | ||
behavioral health care provider holding a purchase of care | ||
contract with the State under the State's Medicaid program. | ||
An organization that is licensed or certified by the | ||
Department may apply to the Department for designation as an | ||
essential community behavioral health care provider. The | ||
Department, through administrative rule, shall describe the | ||
standards and process of designating an essential community | ||
behavioral health care provider, establishing the community to | ||
be served, other criteria for selection, and grounds for | ||
termination. | ||
(c) An organization designated as an essential community | ||
behavioral health care provider under subsection (b) and all | ||
members of the care treatment and service staff of the | ||
essential community behavioral health care provider shall | ||
agree to serve enrollees of all health insurers or health care | ||
service contractors operating in the area that the designated | ||
essential community behavioral health care provider serves. | ||
Health insurers shall include State programs funded under Title | ||
XIX and Title XXI of the federal Social Security Act, including | ||
the State's Medicaid program and the Covering ALL KIDS Health | ||
Insurance Program; other programs funded by the Department of | ||
Healthcare and Family Services for non-public employees; and | ||
programs for both the insured and uninsured funded by the | ||
Department of Human Services. | ||
(d) An essential community behavioral health care provider | ||
shall be compensated on a fee-for-service basis within a global | ||
budget or within a risk-based incentive contract in accordance | ||
with the contracts and standards of the respective payors. | ||
Staff members and other health care providers in the service | ||
area of the designated essential community behavioral health | ||
care provider shall not be restricted from providing care, | ||
treatment, or services through affiliation with any other | ||
health insurer or health care service contractor. | ||
(e) A designation of a community behavioral health care | ||
provider as an essential community behavioral health care | ||
provider shall end 5 years after the date the designation is | ||
granted. The Department, however, may terminate the | ||
designation for cause before the end of the 5-year period if | ||
the essential community behavioral health care provider fails | ||
to comply with the eligibility standards set forth in | ||
subsection (b). | ||
A designated essential community behavioral health care | ||
provider may reapply for designation 6 months prior to the | ||
designation ending and shall provide documented evidence that | ||
the provider continues to meet all criteria for designation. | ||
If the essential community behavioral health care provider | ||
continues to meet all criteria for designation, the Department | ||
shall continue the designation for an additional 5-year period.
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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