HB4448 104TH GENERAL ASSEMBLY

LRB104 17345 KTG 30769 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4448

Introduced 1/20/2026, by Rep. Robyn Gabel

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-48.5 new

Provides that the Act may be referred to as the Safe Place to Go Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, in collaboration with the Department of Human Services' Division of Behavioral Health and Recovery, to apply for a Medicaid State Plan amendment or federal waiver within 12 months after the effective date of the amendatory Act to draw federal financial participation for crisis triage and stabilization services provided by behavioral health urgent care centers to support adults or children 5 years of age and older who are in an active mental health crisis and adults 18 years of age and older in a substance use crisis. Sets forth the services provided by behavioral health urgent care centers that shall be covered, including, but not limited to, crisis triage services, crisis stabilization services, and medication monitoring. Contains provisions concerning the use of the Illinois Mental Health Crisis Assessment Tool to determine an individual's eligibility or medical need for crisis stabilization services; telehealth and on-site services; safe sobering services; linkages to enable rapid transition to next level of care; length of stay; the development of a single bundle rate for crisis triage services and 2 separate per diem reimbursement rates for crisis stabilization services and safe sobering services; no prior authorization requirements; and the establishment of a working group to provide meaningful input on the establishment, operations, staffing, and financing of behavioral health urgent care centers. Requires the Department to adopt rules within 6 months after federal approval of its State Plan amendment or federal waiver application, if granted. Effective immediately.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Reference to Act. This Act may be referred to as the Safe Place to Go Act.

Section 5. The Illinois Public Aid Code is amended by adding Section 5-48.5 as follows:

(305 ILCS 5/5-48.5 new)

Sec. 5-48.5. Behavioral health urgent care center services; coverage for services.

(a) Findings. The General Assembly finds the following:

(1) Studies show that one in 3 high school students and half of female students report persistent feelings of hopelessness, and over 365,000 Illinois children and adolescents have a current diagnosis of anxiety or depression or another behavioral health diagnosis. Over 50,000,000 Americans - one in 5 adults - have a mental health condition.

(2) Behavioral health crises require effective specialized care, yet hospital emergency rooms remain the primary place to go for a person experiencing a mental health or substance use crisis even though hospital emergency rooms are generally not equipped or staffed to effectively treat a behavioral crisis.

(3) Hospitals are designed to treat acute medical emergencies rather than address specialized behavioral health needs during a crisis.

(4) Studies show that hospital emergency room boarding times are 3 times longer for someone in a behavioral health crisis than in other medical crises, forcing behavioral health patients to wait hours, days, and even weeks in a hospital emergency room without receiving the appropriate treatment to stabilize their symptoms.

(5) Long hospital emergency room wait times leave behavioral patients decompensating in waiting rooms and hallways, tie up critical emergency room resources and staff, and increase unnecessary healthcare costs.

(6) According to the Department of Public Health, Illinois youth between the ages of 3 and 17 experienced over 17,000 emergency room visits annually for a mental health or substance use crisis between 2018 and 2022.

(7) Nationally, it is estimated that an average of 13,200,000 adults turn to hospital emergency rooms for a behavioral health crisis.

(8) Approximately two-thirds of youth hospitalized in Illinois for mental health or substance use crises are covered by public insurance, primarily Medicaid, according to the Department of Public Health.

(9) Illinois must develop an alternative place to go - behavioral health urgent care centers - for people in a behavioral crisis, rather than relegating them to hospital emergency rooms.

(10) While Living Rooms staffed by people with lived expertise are an important part of the behavioral health continuum, Living Rooms are not staffed to provide the full range of crisis services an active crisis may need to avoid an emergency room visit.

(11) As Illinois develops the crisis continuum, including 988 (someone to call) and mobile crisis response (someone to respond), it must also develop safe, healing, specialized places to go (such as behavioral health urgent care centers) during a behavioral health crisis to avoid unnecessary emergency room visits or hospitalizations.

(b) Definitions. As used in this Section, "behavioral health urgent care center" means a community-based facility, or portion of a facility, certified by the Department of Healthcare and Family Services where mental health and substance use crisis services are accessible 24 hours a day, 7 days a week for purposes of addressing the crisis, reducing acute symptoms and connecting individuals to the appropriate level of care and follow-up. Services provided by a behavioral health urgent care center are ones that are voluntary and indicated for a person experiencing an active behavioral health crisis who needs a safe, compassionate place to support acute crisis resolution; connection to appropriate levels of care and follow-up; and does not need a hospital level of care. Services are also trauma-informed and offer both observation and therapeutic support. Behavioral health urgent care center services are intended to be consistent with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care for community-based mental health and substance use crisis services. Hospital-based facilities are not eligible to be certified as a behavioral health urgent care center.

(c) Coverage for behavioral health urgent care center services for people experiencing a behavioral health crisis. In collaboration with the Department of Human Services' Division of Behavioral Health and Recovery, the Department of Healthcare and Family Services, as the sole State Medicaid agency, shall apply to the federal Centers for Medicare and Medicaid Services for a Medicaid State Plan amendment or federal waiver within 12 months after the effective date of this amendatory Act of the 104th General Assembly to draw federal financial participation for crisis triage and stabilization services provided by behavioral health urgent care centers to support adults or children 5 years of age and older who are in an active mental health crisis and adults 18 years of age and older in a substance use crisis.

(1) Behavioral health urgent care center; core services. All services provided by a behavioral health urgent care center shall be individualized and voluntary, and shall include, but not be limited to, the following:

(A) Crisis triage services:

(i) Assessment. A mental health crisis assessment utilizing the Illinois Mental Health Crisis Assessment Tool, a substance use level of care assessment, or a nursing assessment if clinically indicated.

(ii) Crisis intervention.

(iii) Peer support.

(B) Crisis stabilization services:

(i) Crisis observation.

(ii) Crisis intervention and safety planning.

(iii) Crisis counseling.

(iv) Care coordination.

(v) Case management.

(vi) Individual and family therapy.

(vii) Peer support.

(viii) Mental health and substance use education.

(ix) Overdose prevention.

(x) Discharge planning to the appropriate level of care or services.

(C) Prescribing, evaluating, or monitoring mental health or substance use treatment medications.

(2) Stabilization services. Eligibility or medical necessity for crisis stabilization services outlined in subparagraph (B) shall be based on the results of the Illinois Mental Health Crisis Assessment Tool or the substance level of care assessment.

(3) On-site services. All crisis triage services and crisis stabilization services provided by the behavioral health urgent care center shall be provided on-site and in-person. Prescribing, evaluating, or monitoring mental health and substance use treatment medications may occur via telehealth.

(4) A safe place to go for someone in a substance use crisis. Behavioral health urgent care centers may provide, but are not required to provide, safe sobering services for up to 24 hours for adults 18 years of age or older who are under the influence of alcohol or drugs to provide monitoring and oversight of adults in a substance use crisis in a supervised and supportive environment. Safe sobering is not meant to achieve abstinence or the full removal of alcohol or other drugs from the system, but to decrease the amount of intoxicating substance in a safe setting with a recovery-oriented framework.

(A) A behavioral health urgent care center that provides safe sobering services must have access to 24-hour on-call emergency medical technicians to ensure the safety of adults who are receiving safe sobering services.

(B) Safe sobering services in a behavioral health urgent care center may be located within the same unit or program of ASAM Level 3.7 Medically Monitored Intensive Inpatient Services for adults to enable a seamless transition to this level of care for adults who choose to engage in medically necessary withdrawal management services.

(5) Linkages to enable rapid transition to the next level of care. Rapid connection to the appropriate levels of care or follow-up services to facilitate post-crisis care, including short-term crisis residential services, services addressing the social determinants of health, and overdose prevention, shall be a primary goal of behavioral health urgent care centers.

(6) Length of stay. An individual may receive mental health stabilization services or safe sobering services for up to, but not longer than, 24 hours in a behavioral health urgent care center to address an active mental health crisis or substance use crisis.

(7) Reimbursement for behavioral health urgent care center services.

(A) Crisis triage services. The Department of Healthcare and Family Services shall develop one bundled rate to cover the full cost of the crisis triage services listed in subparagraph (A) of paragraph (1).

(B) Crisis stabilization services. The Department of Healthcare and Family Services shall develop 2 separate per diem reimbursement rates to cover the full cost of crisis stabilization services listed in subparagraph (B) of paragraph (1) and shall look to how other states, such as New York and Virginia, have developed such rates. A short-term rate shall cover the services provided for up to 4 hours in a behavioral health urgent care center. A full rate shall apply for services delivered for more than 4 hours and up to 24 hours.

(C) Safe sobering services. The Department of Healthcare and Family Services, in partnership with the Department of Human Services' Division of Behavioral Health and Recovery, shall develop 2 separate per diem reimbursement rates to cover the full cost of safe sobering services. A short-term rate shall cover safe sobering services provided for up to 4 hours in a behavioral health urgent care center. A full rate shall apply for safe sobering services delivered for more than 4 hours and up to 24 hours.

(D) Medication prescribing, evaluation, or monitoring. Reimbursement for prescribing, evaluating, or monitoring mental health or substance use treatment medications shall be done utilizing the existing Current Procedural Terminology codes for such services.

(8) No prior authorization. Prior authorization shall not be required or utilized for any of the mental health or substance use services provided by a behavioral health urgent care center.

(d) Stakeholder input. The Department of Healthcare and Family Services, in partnership with the Department of Human Services' Division of Behavioral Health and Recovery, shall establish a workgroup within 6 months after the effective date of this amendatory Act of the 104th General Assembly that includes community-based mental health and substance use providers that have established facilities or units similar to a behavioral health urgent care center, trade associations representing community-based mental health and substance use providers, people with lived expertise, and other stakeholders to provide meaningful input on the establishment, operations, staffing, and financing of behavioral health urgent care centers. The workgroup shall meet at least once a month for at least 8 months prior to the Department of Healthcare and Family Services' application to the Centers for Medicare and Medicaid Services for federal financial participation for services provided by a behavioral health urgent care center.

(e) Rulemaking authority. If federal approval is granted, the Department of Healthcare and Family Services shall file any rules necessary for implementation of this Section within 6 months after federal approval.

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