HB5868 100TH GENERAL ASSEMBLY

LRB100 21705 KTG 39208 b

100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5868

Introduced , by Rep. La Shawn K. Ford

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.29 new
305 ILCS 5/5-36 new

Amends the Illinois Insurance Code. Permits 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 the amendatory Act to provide coverage for residential extended care services and supports for persons suffering from alcoholism or other drug addiction so long as: (1) a health care clinic or any other specified entity has conducted an individualized assessment of the person's condition prior to discharge and has identified the person as being at risk of a drug or alcohol relapse and in need of supportive services to maintain long-term recovery; (2) the residential extended care services and supports are administered by a community-based agency that is licensed by or under contract with the Department of Human Services; and (3) the residential extended care services and supports are administered upon the referral of a health care clinic or any other specified entity. Sets forth the services available for coverage. Requires the Department of Insurance to rate each community-based agency that is licensed by or under contract with the Department of Human Services to provide residential extended care services and supports and to publish the results on its official website. Amends the Illinois Public Aid Code. Permits the fee-for-service and managed care medical assistance programs established under the Code to provide coverage for residential extended care services and supports for any person suffering from alcoholism or other drug addiction who is at risk of a drug or alcohol relapse following discharge from a health care clinic or any other specified entity. Sets forth the conditions that must be met to qualify for coverage and makes other changes.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

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 a lack of comprehensive community-based continuum of care services available for persons suffering from drug addiction. According to the Centers for Disease Control and Prevention, there has been a 600% increase in the incidence of opioid addictions since 1999, yet only one in 10 people afflicted with the disease of addiction have access to treatment. Most patients are not only affected by the issues of addiction, but are also facing co-existing social and economic challenges associated with the disease of addiction including poverty, job insecurity, and homelessness. The current health care system is too expensive, fragmented, and disjointed to sufficiently address the needs of persons afflicted with drug addiction. 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 patient outcomes. Hospitals are also contemplating new and innovative ways to reduce their costs and rates of recidivism, improve patient outcomes, and monitor patients 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 drug addiction, including alcoholism, while stabilizing other co-existing social, economic, and housing conditions that can impair a person's long-term recovery from addiction. In addition to helping persons achieve physical recovery from a drug or alcohol addiction, 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. Residential recovery services and supports can facilitate this holistic approach to recovery and help persons replace their need for addictive 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 residential recovery services and supports for persons suffering from alcoholism or other drug addiction.

Section 5. The Illinois Insurance Code is amended by adding Section 356z.29 as follows:

(215 ILCS 5/356z.29 new)

Sec. 356z.29. Residential extended care services and supports for drug addicted persons.

(a) Definitions. As used in this Section:

"Addiction", "alcoholism", "case management", and "relapse" have the meanings ascribed to those terms in Section 1-10 of the Alcoholism and Other Drug Abuse and Dependency 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.

(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 suffering from alcoholism or other drug addiction who are at risk of a drug or alcohol relapse following discharge from a health care clinic, federally qualified health center, hospital detoxification program or any other licensed detoxification 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 detoxification program or any other licensed detoxification program, or hospital emergency department has conducted an individualized assessment of the person's condition prior to discharge and has identified the person as being at risk of a drug or alcohol relapse and in need of aftercare treatment and supportive services to maintain long-term recovery. A determination of whether a person is in need of supportive services shall be based on whether the person has a history of unemployment, homelessness, or housing instability.

(2) The residential extended care services and supports are administered by a community-based agency that is licensed by or under contract with the Department of Human Services' Division of Alcoholism and Substance Abuse, which may include a halfway house, recovery home, or sanctuary.

(3) The residential extended care services and supports are administered by a community-based agency as described in paragraph (2) upon the referral of a health care clinic, federally qualified health center, hospital detoxification program or any other licensed detoxification program, or hospital emergency department.

(c) Any coverage provided in accordance with this Section shall include, but not be limited to, the following:

(1) Drug or alcohol treatment services that are in accordance with industry standards.

(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 alcoholism or other drug addiction.

(4) Job training or placement services.

(d) The Department of Insurance, in collaboration with the Department of Human Services, the Department of Public Health, and the Department of Healthcare and Family Services, shall rate each community-based agency that is licensed by or under contract with the Department of Human Services to provide residential extended care services and supports based on an assessment and evaluation of each agency's ability to:

(1) reduce health care costs;

(2) reduce recidivism rates for persons suffering from alcoholism or other drug addiction;

(3) improve outcomes;

(4) track patients; and

(5) improve patients' quality of life through the utilization of sustainable recovery, education, employment, and housing services.

The Department of Insurance, the Department of Human Services, the Department of Public Health, and the Department of Healthcare and Family Services shall publish the results of the assessments and ratings on their official websites 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.

Section 15. The Illinois Public Aid Code is amended by adding Section 5-36 as follows:

(305 ILCS 5/5-36 new)

Sec. 5-36. Residential extended care services and supports for drug addicted persons.

(a) Definitions. As used in this Section:

"Addiction", "alcoholism", "case management", and "relapse" have the meanings ascribed to those terms in Section 1-10 of the Alcoholism and Other Drug Abuse and Dependency 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.

(b) On and after the effective date of this amendatory Act of the 100th General Assembly, the fee-for-service and managed care medical assistance programs established under this Article may provide coverage for residential extended care services and supports for any person suffering from alcoholism or other drug addiction who is at risk of a drug or alcohol relapse following discharge from a health care clinic, federally qualified health center, hospital detoxification program or any other licensed detoxification program, or hospital emergency department so long as all of the following conditions are met:

(1) The person is otherwise eligible for medical assistance under this Article.

(2) A health care clinic, federally qualified health center, hospital detoxification program or any other licensed detoxification program, or hospital emergency department has conducted an individualized assessment of the person's condition prior to discharge and has identified the person as being at risk of a drug or alcohol relapse and in need of aftercare treatment and supportive services to maintain long-term recovery. A determination of whether a person is in need of supportive services shall be based on whether the person has a history of unemployment, homelessness, or housing instability.

(3) The residential extended care services and supports are administered by a community-based agency that is licensed by or under contract with the Department of Human Services' Division of Alcoholism and Substance Abuse, which may include a halfway house, recovery home, or sanctuary.

(4) The residential extended care services and supports are administered by a community-based agency as described in paragraph (3) upon the referral of a health care clinic, federally qualified health center, hospital detoxification program or any other licensed detoxification program, or hospital emergency department.

(c) Any coverage provided in accordance with this Section shall include, but not be limited to, the following:

(1) Drug or alcohol treatment services that are in accordance with industry standards.

(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 alcoholism or other drug addiction.

(4) Job training or placement services.

(d) The Department of Healthcare and Family Services, in collaboration with the Department of Human Services, the Department of Public Health, and the Department of Insurance, shall rate each community-based agency that is licensed by or under contract with the Department of Human Services to provide residential extended care services and supports based on an assessment and evaluation of each agency's ability to:

(1) reduce health care costs;

(2) reduce recidivism rates for persons suffering from alcoholism or other drug addiction;

(3) improve outcomes;

(4) track patients; and

(5) improve patients' quality of life through the utilization of sustainable recovery, education, employment, and housing services.

The Department of Healthcare and Family Services, the Department of Human Services, the Department of Public Health, and the Department of Insurance shall publish the results of the assessments and ratings on their official websites and shall, on an annual basis, update the posted results.

(e) The Department 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.