HB4785 104TH GENERAL ASSEMBLY

LRB104 18498 KTG 31940 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4785

Introduced , by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

New Act

Creates the Preventing Crisis Cost Shifting to Medicaid Act. Provides that the General Assembly finds that (i) behavioral health crisis services, including crisis call centers, mobile crisis response, and crisis stabilization and receiving services, function as essential public health infrastructure and must be available statewide without regard to insurance status; and (ii) commercial health insurance policies issued or administered in the State generally do not provide comprehensive coverage for the full continuum of behavioral health crisis services, resulting in the cost of such services being disproportionately borne by Medicaid, local governments, and taxpayers. Requires specified entities (surcharge payors) that are authorized to issue or administer a policy or contract of accident and health insurance or a health maintenance organization contract in the State to pay a behavioral health crisis assessment to the Department of Human Services for deposit into the Statewide 9-8-8 Trust Fund. Exempts Medicaid managed care organizations from paying the behavioral health crisis assessment. Permits the Department to update the total behavioral health crisis assessment amount as necessary to ensure the continued availability, quality, or geographic equity of the statewide behavioral health crisis system. Requires the Department to establish an appropriate mechanism for enforcing a surcharge payor's liability, which may include accrued interest on unpaid liabilities at a rate not to exceed 18% per annum and late fees or penalties at a rate not to exceed 5% per month. Provides that the enforcement mechanism may also include notification to the Department of Healthcare and Family Services to offset payments on the surcharge payor's claims. Provides that the Department of Human Services shall not direct the Department of Healthcare and Family Services to offset claims payments unless the surcharge payor has maintained an outstanding liability to the Statewide 9-8-8 Trust Fund for a period longer than 45 days and has received proper notice of pending enforcement.

A BILL FOR

AN ACT concerning behavioral health.

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

Section 1. Short title. This Act may be cited as the Preventing Crisis Cost Shifting to Medicaid Act.

Section 5. Legislative findings and purpose. The General Assembly finds that:

(1) Individuals experiencing behavioral health emergencies, including mental health and substance use crises, require timely access to crisis services to promote safety, stability, and recovery for themselves, their families, and their communities.

(2) Behavioral health crisis services, including crisis call centers, mobile crisis response, and crisis stabilization and receiving services, function as essential public health infrastructure and must be available statewide without regard to insurance status.

(3) Commercial health insurance policies issued or administered in this State generally do not provide comprehensive coverage for the full continuum of behavioral health crisis services, resulting in the cost of such services being disproportionately borne by Medicaid, local governments, and taxpayers.

(4) A predictable, multi-payer financing mechanism is necessary to prevent cost-shifting from commercial payors to Medicaid and other publicly financed systems and to ensure the long-term availability and geographic equity of a statewide behavioral health crisis system.

Section 10. Behavioral health crisis assessment.

(a) As used in this Section:

"Surcharge payor" means an entity that is authorized to issue or administer a policy or contract of accident and health insurance or a health maintenance organization contract in this State and that made payments subject to assessment, as determined by the Department of Human Services, in an amount of $1,000,000 or more during the most recent fiscal year for which data are available.

"Total behavioral health crisis assessment amount" means $100,000,000, or, 2 years or later after the effective date of this Act, the most recently updated total behavioral assessment amount as designated by the Department of Human Services by rule.

(b) Each surcharge payor shall pay a behavioral health crisis assessment to the Department of Human Services for deposit into the Statewide 9-8-8 Trust Fund.

(c) Each surcharge payor shall pay a portion of the total behavioral health crisis assessment amount proportional to the surcharge payor's payments subject to assessment during the most recent fiscal year for which data are available, as determined by the Department by rule.

(d) In the event of a merger, acquisition, or other transfer of ownership, liability for the assessment shall be assumed by the successor entity.

(e) The assessment imposed under this Section shall not apply to Medicaid managed care organizations.

Section 15. Deposit of assessment revenues. All revenues collected in accordance with this Act shall be deposited into the Statewide 9-8-8 Trust Fund created under Section 6z-134 of the State Finance Act and shall be expended in accordance with the purposes of that Fund.

Section 20. Adjustment of total assessment amount. Beginning no earlier than 2 years after the effective date of this Act, the Department of Human Services may update the total behavioral health crisis assessment amount as necessary to ensure the continued availability, quality, or geographic equity of the statewide behavioral health crisis system.

Any updated amount shall apply prospectively and preserve proportional allocation among surcharge payors. The Department shall update the amount by rule, provide public notice of any update, and report any such update to the General Assembly.

Section 25. Enforcement.

(a) The Department of Human Services shall establish an appropriate mechanism for enforcing a surcharge payor's liability under this Act if a surcharge payor fails to make a required payment to the Statewide 9-8-8 Trust Fund; however, the Department may establish threshold liability amounts below which enforcement may be modified or waived.

(b) The enforcement mechanism may include assessment of interest on unpaid liabilities at a rate not to exceed 18% per annum and late fees or penalties at a rate not to exceed 5% per month.

(c) The enforcement mechanism may also include notification to the Department of Healthcare and Family Services requiring an offset of payments on claims of the surcharge payor, any entity under common ownership with the surcharge payor, or any successor in interest to the surcharge payor in an amount equal to the payment owed to the Statewide 9-8-8 Trust Fund, including any interest and penalties, and transfer of the withheld amounts into the Fund.

(d) If the Department of Healthcare and Family Services offsets claims payments in accordance with a notice under subsection (c), the Department of Healthcare and Family Services shall not be considered to be in breach of contract or any other obligation for payment of non-contracted services, and a surcharge payor whose payments are offset under this Section shall continue to serve all Medicaid enrollees under any contract then in effect with the Department of Healthcare and Family Services.

(e) The Department of Human Services shall not direct the Department of Healthcare and Family Services to offset claims payments unless the surcharge payor has maintained an outstanding liability to the Statewide 9-8-8 Trust Fund for a period longer than 45 days and has received proper notice that the Department of Human Services intends to initiate enforcement actions under this Section.