HB2173 103RD GENERAL ASSEMBLY

LRB103 29675 KTG 56078 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB2173

Introduced 2/7/2023, by Rep. Robyn Gabel

SYNOPSIS AS INTRODUCED:

305 ILCS 66/20-10
305 ILCS 66/20-20

Amends the Rebuild Illinois Mental Health Workforce Act. In a provision concerning Medicaid funding for community mental health services, sets forth rate increases, to begin on and after January 1, 2024, for the following rates and services: the Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code; the Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code; the Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code; the Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code; the Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code; the Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code; and the Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code for medication monitoring provided by a physician, an advanced practice registered nurse, and all other levels of provider. Provides that no base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by the amendatory Act. Provides that any payments required under the amendatory Act that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by the amendatory Act.

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 5. The Rebuild Illinois Mental Health Workforce Act is amended by changing Sections 20-10 and 20-20 as follows:

(305 ILCS 66/20-10)

Sec. 20-10. Medicaid funding for community mental health services. Medicaid funding for the specific community mental health services listed in this Act shall be adjusted and paid as set forth in this Act. Such payments shall be paid in addition to the base Medicaid reimbursement rate and add-on payment rates per service unit.

(a) The payment adjustments shall begin on July 1, 2022 for State Fiscal Year 2023 and shall continue for every State fiscal year thereafter.

(1) Individual Therapy Medicaid Payment rate for services provided under the H0004 Code:

(A) The Medicaid total payment rate for individual therapy provided by a qualified mental health professional shall be increased by no less than $9 per service unit.

(B) The Medicaid total payment rate for individual therapy provided by a mental health professional shall be increased by no less then $9 per service unit.

(2) Community Support - Individual Medicaid Payment rate for services provided under the H2015 Code: All community support - individual services shall be increased by no less than $15 per service unit.

(3) Case Management Medicaid Add-on Payment for services provided under the T1016 code: All case management services rates shall be increased by no less than $15 per service unit.

(4) Assertive Community Treatment Medicaid Add-on Payment for services provided under the H0039 code: The Medicaid total payment rate for assertive community treatment services shall increase by no less than $8 per service unit.

(5) Medicaid user-based directed payments.

(A) For each State fiscal year, a monthly directed payment shall be paid to a community mental health provider of community support team services based on the number of Medicaid users of community support team services documented by Medicaid fee-for-service and managed care encounter claims delivered by that provider in the base year. The Department of Healthcare and Family Services shall make the monthly directed payment to each provider entitled to directed payments under this Act by no later than the last day of each month throughout each State fiscal year.

(i) The monthly directed payment for a community support team provider shall be calculated as follows: The sum total number of individual Medicaid users of community support team services delivered by that provider throughout the base year, multiplied by $4,200 per Medicaid user, divided into 12 equal monthly payments for the State fiscal year.

(ii) As used in this subparagraph, "user" means an individual who received at least 200 units of community support team services (H2016) during the base year.

(B) For each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of assertive community treatment services based on the number of Medicaid users of assertive community treatment services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year.

(i) The monthly direct payment for an assertive community treatment provider shall be calculated as follows: The sum total number of Medicaid users of assertive community treatment services provided by that provider throughout the base year, multiplied by $6,000 per Medicaid user, divided into 12 equal monthly payments for that State fiscal year.

(ii) As used in this subparagraph, "user" means an individual that received at least 300 units of assertive community treatment services during the base year.

(C) The base year for directed payments under this Section shall be calendar year 2019 for State Fiscal Year 2023 and State Fiscal Year 2024. For the State fiscal year beginning on July 1, 2024, and for every State fiscal year thereafter, the base year shall be the calendar year that ended 18 months prior to the start of the State fiscal year in which payments are made.

(b) Subject to federal approval, a one-time directed payment must be made in calendar year 2023 for community mental health services provided by community mental health providers. The one-time directed payment shall be for an amount appropriated for these purposes. The one-time directed payment shall be for services for Integrated Assessment and Treatment Planning and other intensive services, including, but not limited to, services for Mobile Crisis Response, crisis intervention, and medication monitoring. The amounts and services used for designing and distributing these one-time directed payments shall not be construed to require any future rate or funding increases for the same or other mental health services.

(c) The following payment adjustments shall begin on January 1, 2024 and shall continue thereafter.

(1) The Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code shall be increased by no less than $200 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(2) The Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code shall be increased by no less than $8 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(3) The Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code shall be increased by no less than $7 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(4) The Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code shall be increased by no less than $3 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule. This increase does not apply to individual therapy services which were increased July 1, 2022 in accordance with paragraph (1) of subsection (a).

(5) The Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code shall be increased by no less than $3 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule. This increase does not apply to Community Support - Individual services which were increased July 1, 2022 in accordance with paragraph (2) of subsection (a).

(6) The Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code shall be increased by no less than $10 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(7) Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code:

(A) The Medicaid total payment rate for medication monitoring provided by a physician shall be increased by no less than $25.11 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(B) The Medicaid total payment rate for medication monitoring provided by an advanced practice registered nurse shall be increased by no less than $18.07 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(C) The Medicaid total payment rate for medication monitoring provided by all other levels of provider shall be increased by no less than $15.00 per service unit for on-site services. Off-site rates for these services must be increased by an amount which at least maintains the current differential between on-site and off-site services as represented on the July 1, 2022 fee schedule.

(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)

(305 ILCS 66/20-20)

Sec. 20-20. Base Medicaid rates or add-on payments.

(a) For services under subsection (a) of Section 20-10: .

No base Medicaid rate or Medicaid rate add-on payment or any other payment for the provision of Medicaid community mental health services in place on July 1, 2021 shall be diminished or changed to make the reimbursement changes required by this Act. Any payments required under this Act that are delayed due to implementation challenges or federal approval shall be made retroactive to July 1, 2022 for the full amount required by this Act.

(b) For directed payments under subsection (b) of Section 20-10: .

No base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by this Act. The Department of Healthcare and Family Services must pay the directed payment in one installment within 60 days of receiving federal approval.

(c) For directed payments under subsection (c) of Section 20-10:

No base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by this amendatory Act of the 103rd General Assembly. Any payments required under this amendatory Act of the 103rd General Assembly that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by this amendatory Act of the 103rd General Assembly.

(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)