HB5333 102ND GENERAL ASSEMBLY

LRB102 25421 KTG 34706 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5333

Introduced 1/31/2022, by Rep. Kelly M. Cassidy

SYNOPSIS AS INTRODUCED:

New Act
5 ILCS 100/5-45.21 new

Creates the Mental Health Assessment Reform Act. Provides that the purpose of the Act is to remove barriers to care in the Medicaid mental health assessment and treatment planning process. Provides that, within 3 months after the effective date of the Act, the Department of Healthcare and Family Services shall clearly identify the minimum information necessary to establish and document medical necessity in an individual's medical record for each community mental health general rehabilitation option service through the use of the Department's standardized assessment and treatment planning tool required in the integrated assessment and treatment planning process. Requires minimum medical necessity documentation requirements to be publicly available to all community mental health centers and behavioral health clinics. Provides that an individual is immediately eligible to receive any community mental health service upon documentation of the specified medical necessity criteria in his or her medical record, and the provider shall be reimbursed for such delivered services. Provides that the integrated assessment and treatment planning process shall be required no more frequently than annually for specified community mental health services. Contains provisions requiring the Department to establish a workgroup to resolve certain issues identified by the Department with the assessment tool and the integrated assessment and treatment planning process. Requires the Department to submit a report to the General Assembly that outlines the issues and recommendations discussed by the workgroup. Contains provisions concerning the Department's development of a billing code, modifier, or other mechanism to reimburse providers for the full time spent on the integrated assessment and treatment planning process; assessment tool training; and other matters. Requires the Department to seek federal approval, if required to implement the Act. Permits the Department, with input from the Department's workgroup, to adopt emergency rules in accordance with the Illinois Administrative Procedure Act. Effective immediately.

A BILL FOR

AN ACT concerning mental 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 Mental Health Assessment Reform Act.

Section 3. Purpose. The purpose of this Act is to remove major barriers to care in the Medicaid mental health assessment and treatment planning process.

Section 5. Clear delineation of eligibility criteria for Medicaid community mental health services. Within 3 months after the effective date of this Act and in accordance with this Section, the Department of Healthcare and Family Services shall clearly identify the minimum information necessary to establish and document medical necessity in an individual's medical record for each community mental health general rehabilitation option service through the use of the Department's standardized assessment and treatment planning tool (assessment tool) required in the integrated assessment and treatment planning process. Such minimum medical necessity documentation requirements through the use of the assessment tool shall be publicly available to all community mental health centers and behavioral health clinics.

(1) Documenting medical necessity. The information required to be gathered and documented through the assessment tool to establish medical necessity for a mental health service shall be no broader than what is required to establish eligibility, duration, and frequency for such service:

(A) Mental health symptoms or functional impairment.

(B) A mental health diagnosis listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Health Disorders or the International Classification of Diseases.

(C) Any other information necessary solely for purposes of determining eligibility, duration, and frequency for a community-based mental health service.

(D) A recommendation for such service by an appropriate mental health or medical professional for the treatment of a mental health condition or symptoms or to improve functional impairment.

(2) Improved access to care. An individual shall immediately be eligible to receive any community mental health service or services upon documentation of the specified medical necessity criteria in his or her medical record and the provider shall be reimbursed for such delivered services. An individual's background, experiences, health, or other information that is not necessary to a medical necessity determination for a community mental health service shall be left to the clinical discretion of the provider as to the relevance for developing a treatment plan in the integrated assessment and treatment planning process. The absence of discretional information in an individual's integrated assessment and treatment planning or medical record that is unrelated to medical necessity shall not be used by the Department or any contracted third party to delay or deny a community mental health service. The integrated assessment and treatment planning process shall remain open for no less than 90 days to allow providers to gather the relevant and appropriate information from an individual to complete the integrated assessment and treatment planning process.

(3) No further assessment or treatment planning documentation shall be required if services are terminated or completed within 90 days. If an individual terminates or completes his or her community mental health services within 90 days from the date of his or her first treatment contact with his or her provider, the integrated assessment and treatment planning process also terminates, and no further documentation shall be required using the Department's assessment tool or in the individual's medical record. A provider shall be fully reimbursed for any services delivered for which medical necessity is established during these 90 days, and such services shall not be delayed or denied by the Department or a managed care organization.

Section 10. Preventing re-traumatization and unnecessary re-assessments. Beginning on the effective date of this Act, the integrated assessment and treatment planning process shall be required no more frequently than annually for any community mental health service covered under 89 Ill. Adm. Code 140.453, 140.455, and 140.TABLE N (c) and (e).

Section 15. Assessment and treatment planning process centered on motivational interviewing. Within 3 months after the effective date of this Act, through a workgroup established by the Department of Healthcare and Family Services to review the practical challenges of the Department's standardized assessment and treatment planning tool, the Department and stakeholders, including people with lived experience, shall work to resolve the issues listed below with the assessment tool and the integrated assessment and treatment planning process. Within 6 months after the effective date of this Act, the Department of Healthcare and Family Services shall deliver a report to the General Assembly, with a copy delivered to the Chairs of the Senate Behavioral and Mental Health Committee and the House Mental Health and Addiction Committee, that outlines in plain language the issues and recommendations discussed by the workgroup, what stakeholder recommendations the Department agreed with and will implement and the timeline for implementation, and which recommendations the Department declined to address and the reason for such decline.

(1) Reforming the Department's standardized assessment and treatment planning tool to enable the integrated assessment and treatment planning process to be centered on motivational interviewing.

(2) Avoiding requesting information in the integrated assessment and treatment planning process that can re-traumatize individuals by continuing to ask about past traumatic personal experiences that are better addressed through the clinical relationship.

(3) Examine the assessment tool for any potential racial or cultural biases.

(4) Ensure the confidentiality protections afforded individuals under Section 4 of the Mental Health and Developmental Disabilities Confidentiality Act are fully respected throughout the integrated assessment and treatment planning processes, in particular as it relates to the rights of minors between the age of 12 and 17 to limit their parents' access to mental health information.

(5) Ensure that individuals' mental health and substance use parity rights afforded under Section 370c.1 of the Illinois Insurance Code are fully recognized and protected in the integrated assessment and treatment planning process.

(6) Streamline the documentation process to ensure that clinician time is not wasted on unnecessary and duplicative paperwork and process.

(7) Ensure that managed care organizations do not deny a service for which medical necessity has been established and documented in the individual's medical record.

Section 20. Payment for the full assessment process. The Department of Healthcare and Family Services shall develop a billing code, modifier, or other mechanism to reimburse providers for the full time spent on the integrated assessment and treatment planning process, including Department-required documentation and submission of the integrated assessment and treatment planning without the client present, including transferring information onto the Department-required form; collateral interviews to collect client information; review of documentation received by hospitals, schools, and other health care entities; and uploading the information into the Department of Healthcare and Family Services' portal since this is a core part of the assessment and treatment planning process mandated by the Department. The reimbursement rate for documentation and submission shall be equal to the rate and rate add-on payment paid for the related specific integrated assessment and treatment planning service delivered. Provider payment for such services shall begin no later than July 1, 2022. If the Department of Healthcare and Family Services experiences any delays in implementation of this Section for any reason, including seeking federal approval, payment shall be retroactive to July 1, 2022.

Section 25. Improving training for mental health assessments with on-the-ground, experienced clinicians. By no later than the effective date of this Act, to enable more consistency and effective use of the Department's standardized assessment and treatment planning tool used in the integrated assessment and treatment planning process, the Department of Healthcare and Family Services shall provide a train-the-trainer model as an alternative to the State-sponsored trainings, so providers can elect to train their own staff in the use and application of the assessment tool. This train-the-trainer model allows providers to maintain fidelity to the tool while providing practical knowledge of how the tool is implemented within the provider's unique service delivery environment, and allows for more timely training of new staff. All assessment tool trainings sponsored by the State shall be available in in-person and video modalities, including recorded trainings that can be accessed anytime, to ensure the timely training of provider staff.

Section 30. Federal approval and State administrative rulemaking. If federal approval is required for any provision of this Act, the Department of Healthcare and Family Services shall seek approval from the Centers for Medicare and Medicaid Services within 30 days after the effective date of this Act. Within 3 months after the Department receives federal approval, the Department may, with prior input from the Department's workgroup referenced in Section 15, adopt emergency rules to implement any provision of this Act in accordance with the Illinois Administrative Procedure Act.

Section 35. The Illinois Administrative Procedure Act is amended by adding Section 5-45.21 as follows:

(5 ILCS 100/5-45.21 new)

Sec. 5-45.21. Emergency rulemaking; Department of Healthcare and Family Services. To provide for the expeditious and timely implementation of the Mental Health Assessment Reform Act, emergency rules implementing any provision of the Mental Health Assessment Reform Act may be adopted in accordance with Section 5-45 by the Department of Healthcare and Family Services. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed one year after the effective date of this amendatory Act of the 102nd General Assembly.

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