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1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Legislative findings and purpose. Medical
5clinics, emergency rooms, and hospitals across the country are
6overwhelmed by the opioid crisis and have been adversely
7affected by costs and increasing rates of recidivism due to an
8increase in the need for additional comprehensive
9community-based continuum of care services for persons with
10opioid and other substance use disorders. According to the
11Centers for Disease Control and Prevention, there has been a
12600% increase in the incidence of opioid use disorders since
131999, creating an increased need for treatment and other
14recovery support services. Most persons with substance use
15disorders also face co-existing social and economic challenges
16including poverty, job insecurity, and a lack of safe and sober
17living environments. The current health care system is often
18too expensive, fragmented, and disjointed to sufficiently
19address the needs of persons with substance use disorders.
20Consequently, we are at a pivotal time in history when
21insurance companies are having to become more innovative in
22their approaches to contain costs and improve the outcomes of
23those persons with substance use disorders. Hospitals are also
24contemplating new and innovative ways to reduce their costs and



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1rates of recidivism, improve the outcomes of those persons with
2substance use disorders, and monitor these persons with a
3greater level of care in order to achieve the highest level of
4multiple performance outcomes at a time when performance
5metrics matter more than ever. The State of Illinois has the
6opportunity to lead the nation by supporting and amplifying the
7most comprehensive and vertically integrated approach to
8recovery that can effectively address the root causes of
9substance use disorders, while stabilizing other co-existing
10social, economic, and housing conditions that can impair a
11person's long-term recovery. In addition to helping persons
12achieve physical recovery from a substance use disorder, it is
13also important to help them find new meaning in their personal
14lives by rebuilding and strengthening their family
15relationships, community ties, and spiritual development.
16Recovery housing can facilitate this holistic approach to
17recovery and help persons replace their need for substances
18with more meaningful elements of life. Therefore, it is the
19purpose of this Act to provide Illinois citizens with greater
20access to a more robust and holistic continuum of behavioral
21health care services and supports by providing health care
22coverage for recovery housing for persons with substance use
24    Section 5. The Illinois Insurance Code is amended by adding
25Section 356z.29 as follows:



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1    (215 ILCS 5/356z.29 new)
2    Sec. 356z.29. Recovery housing for persons with substance
3use disorders.
4    (a) Definitions. As used in this Section:
5    "Substance use disorder" and "case management" have the
6meanings ascribed to those terms in Section 1-10 of the
7Substance Use Disorder Act.
8    "Hospital" means a facility licensed by the Department of
9Public Health under the Hospital Licensing Act.
10    "Federally qualified health center" means a facility as
11defined in Section 1905(l)(2)(B) of the federal Social Security
13    "Recovery housing" means a residential extended care
14treatment facility or a recovery home as defined and licensed
15in 77 Illinois Administrative Code, Part 2060, by the Illinois
16Department of Human Services, Division of Substance Use
17Prevention and Recovery.
18    (b) A group or individual policy of accident and health
19insurance or managed care plan amended, delivered, issued, or
20renewed on or after the effective date of this amendatory Act
21of the 100th General Assembly may provide coverage for
22residential extended care services and supports for persons
23recovery housing for persons with substance use disorders who
24are at risk of a relapse following discharge from a health care
25clinic, federally qualified health center, hospital withdrawal



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1management program or any other licensed withdrawal management
2program, or hospital emergency department so long as all of the
3following conditions are met:
4        (1) A health care clinic, federally qualified health
5    center, hospital withdrawal management program or any
6    other licensed withdrawal management program, or hospital
7    emergency department has conducted an individualized
8    assessment, using criteria established by the American
9    Society of Addiction Medicine, of the person's condition
10    prior to discharge and has identified the person as being
11    at risk of a relapse and in need of supportive services,
12    including employment and training and case management, to
13    maintain long-term recovery. A determination of whether a
14    person is in need of supportive services shall also be
15    based on whether the person has a history of poverty, job
16    insecurity, and lack of a safe and sober living
17    environment.
18        (2) The recovery housing is administered by a
19    community-based agency that is licensed by or under
20    contract with the Department of Human Services, Division of
21    Substance Use Prevention and Recovery.
22        (3) The recovery housing is administered by a
23    community-based agency as described in paragraph (2) upon
24    the referral of a health care clinic, federally qualified
25    health center, hospital withdrawal management program or
26    any other licensed withdrawal management program, or



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1    hospital emergency department.
2    (c) Based on the individualized needs assessment, any
3coverage provided in accordance with this Section may include,
4but not be limited to, the following:
5        (1) Substance use disorder treatment services that are
6    in accordance with licensure standards promulgated by the
7    Department of Human Services, Division of Substance Use
8    Prevention and Recovery.
9        (2) Transitional housing services, including food or
10    meal plans.
11        (3) Individualized case management and referral
12    services, including case management and social services
13    for the families of persons who are seeking treatment for a
14    substance use disorder.
15        (4) Job training or placement services.
16    (d) The insurer may rate each community-based agency that
17is licensed by or under contract with the Department of Human
18Services, Division of Substance Use Prevention and Recovery to
19provide recovery housing based on an evaluation of each
20agency's ability to:
21        (1) reduce health care costs;
22        (2) reduce recidivism rates for persons suffering from
23    a substance use disorder;
24        (3) improve outcomes;
25        (4) track persons with substance use disorders; and
26        (5) improve the quality of life of persons with



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1    substance use disorders through the utilization of
2    sustainable recovery, education, employment, and housing
3    services.
4    The insurer may publish the results of the ratings on its
5official website and shall, on an annual basis, update the
6posted results.
7    (e) The Department of Insurance may adopt any rules
8necessary to implement the provisions of this Section in
9accordance with the Illinois Administrative Procedure Act and
10all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.