Rep. Robyn Gabel
Filed: 3/10/2017
 
 

 

 

 
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1
AMENDMENT TO HOUSE BILL 498




2    AMENDMENT NO. ______. Amend House Bill 498 by replacing 
3everything after the enacting clause with the following:

 
4    "Section 5. The Illinois Public Aid Code is amended  by 
5adding Section 5-35 as follows:
 
6    (305 ILCS 5/5-35 new)
7    Sec. 5-35. Wrap-around service components of first episode 
8psychosis treatment.
9    (a) Subject to subsection (d), the Department of Healthcare 
10and Family Services shall provide adolescents and young adults 
11who are experiencing an initial episode of psychosis or 
12pre-psychosis medical assistance coverage for the wrap-around 
13service components of the bundled first episode psychosis 
14treatment that are not covered by their primary health 
15insurance plan. The purpose of this medical assistance coverage 
16is to prevent disability and a permanent shift from private 
 
 
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1insurance coverage to medical assistance coverage for 
2adolescents and young adults experiencing psychosis. 
3Eligibility requirements  for adolescents and young adults with 
4private insurance who apply for medical assistance coverage for 
5the wrap-around service components of first episode psychosis 
6treatment shall be the same as those requirements applicable to 
7all other persons applying for medical assistance coverage 
8under this Article.  The Department shall maximize individual 
9and family-cost sharing and any federal matching funds for 
10coverage of the wrap-around service components of first episode 
11psychosis treatment for adolescents and young adults with 
12private insurance. 
13    (b) Individuals and families with private insurance who are 
14eligible under this Section for medical assistance coverage for 
15the wrap-around service components of first episode psychosis 
16treatment shall be required to contribute to the cost of the 
17wrap-around service components based on their income level and 
18ability to pay and on the following cost-sharing requirements.  
19For children under age 21, parental income is not included for 
20purposes of cost-sharing:
21        (1) An individual or family with private insurance and 
22    with earned income of less than 200% of the federal poverty 
23    level shall not be required to pay more than 2.5% of their 
24    earned income toward the annual cost of the wrap-around 
25    service components. 
26        (2) An individual or family with private insurance and 
 
 
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1    with earned income of at least 200% but less than 400% of 
2    the federal poverty level shall not be required to pay more 
3    than 5% of their earned income toward the annual cost of 
4    the wrap-around service components. 
5        (3) An individual or family with private insurance and 
6    with earned income of at least 400% but less than 500% of 
7    the federal poverty level shall not be required to pay more 
8    than 8% of their earned income toward the annual cost of 
9    the wrap-around service components. 
10        (4) An individual or family with private insurance and 
11    with earned income of 500% or greater of the federal 
12    poverty level shall not be required to pay more than 10% of 
13    their earned income toward the annual cost of the 
14    wrap-around service components. 
15    (c) The Division of Mental Health of the Department of 
16Human Services, in cooperation with the Department of 
17Healthcare and Family Services, shall establish, by rule,  
18policies and procedures for cost-sharing within 6 months of 
19receiving federal approval of the medical assistance coverage 
20for wrap-around service components of first episode psychosis 
21treatment as described in this Section.
22    (d)  The Department of Healthcare and Family Services shall 
23submit the necessary application to the federal Centers for 
24Medicare and Medicaid Services for a waiver or State Plan 
25amendment to implement medical assistance coverage for the 
26wrap-around service components of first episode psychosis 
 
 
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1treatment as described in this Section. Implementation of this 
2Section is contingent upon federal approval. The Department 
3shall implement the medical assistance coverage described  in 
4this Section within 6 months of receiving federal approval.
 

5    Section 99. Effective date. This Act takes effect upon 
6becoming law.".