Public Act 097-0166
 
HB1152 EnrolledLRB097 05474 KTG 45533 b


  
    AN ACT concerning State government.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    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. 
 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.