Illinois General Assembly - Full Text of HB1152
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Full Text of HB1152  97th General Assembly




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1    AN ACT concerning State government.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Mental Health and Developmental
5Disabilities Administrative Act is amended by adding Section
671a as follows:
7    (20 ILCS 1705/71a new)
8    Sec. 71a. Community Behavioral Health Care.
9    (a) The Department shall strive to guarantee that persons,
10including children, suffering from mental illness, substance
11abuse, and other behavioral disorders have access to locally
12accessible behavioral health care providers who have the
13ability to treat the person's conditions in a cost effective,
14outcome-based manner. To ensure continuity and quality of care
15that is integrated with the person's overall medical care, the
16Department shall:
17        (1) Designate as essential community behavioral health
18    care providers organizations that meet the qualifications
19    set forth in subsection (b) of this Section.
20        (2) Promote the co-location of primary and behavioral
21    health care services centers.
22        (3) Promote access to necessary behavioral health care
23    services in the State's Health Insurance Exchange



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1    policies.
2        (4) Promote continuity of care for persons moving
3    between Medicaid, SCHIP, and programs administered by the
4    Department that provide behavioral health care services.
5        (5) Promote continuity of care for persons not yet
6    eligible for Medicaid or who are without insurance coverage
7    for their conditions.
8        (6) Work toward improving access in Illinois'
9    underserved and health professional shortage areas.
10    (b) The Department shall designate certain community
11behavioral health care providers as essential community
12behavioral health care providers. To qualify for the
13designation an organization must be a not-for-profit
14organization under the Internal Revenue Code or a governmental
15entity that:
16        (1) Demonstrates a commitment to serving low-income
17    and underserved populations.
18        (2) Provides outcome-based community behavioral health
19    care treatment or services.
20        (3) Does not restrict access or services because of a
21    client's financial limitation.
22        (4) Is a community behavioral health care provider
23    certified by the Department, or a licensed community
24    behavioral health care provider holding a purchase of care
25    contract with the State under the State's Medicaid program.
26    An organization that is licensed or certified by the



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1Department may apply to the Department for designation as an
2essential community behavioral health care provider. The
3Department, through administrative rule, shall describe the
4standards and process of designating an essential community
5behavioral health care provider, establishing the community to
6be served, other criteria for selection, and grounds for
8    (c) An organization designated as an essential community
9behavioral health care provider under subsection (b) and all
10members of the care treatment and service staff of the
11essential community behavioral health care provider shall
12agree to serve enrollees of all health insurers or health care
13service contractors operating in the area that the designated
14essential community behavioral health care provider serves.
15Health insurers shall include State programs funded under Title
16XIX and Title XXI of the federal Social Security Act, including
17the State's Medicaid program and the Covering ALL KIDS Health
18Insurance Program; other programs funded by the Department of
19Healthcare and Family Services for non-public employees; and
20programs for both the insured and uninsured funded by the
21Department of Human Services.
22    (d) An essential community behavioral health care provider
23shall be compensated on a fee-for-service basis within a global
24budget or within a risk-based incentive contract in accordance
25with the contracts and standards of the respective payors.
26Staff members and other health care providers in the service



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1area of the designated essential community behavioral health
2care provider shall not be restricted from providing care,
3treatment, or services through affiliation with any other
4health insurer or health care service contractor.
5    (e) A designation of a community behavioral health care
6provider as an essential community behavioral health care
7provider shall end 5 years after the date the designation is
8granted. The Department, however, may terminate the
9designation for cause before the end of the 5-year period if
10the essential community behavioral health care provider fails
11to comply with the eligibility standards set forth in
12subsection (b).
13    A designated essential community behavioral health care
14provider may reapply for designation 6 months prior to the
15designation ending and shall provide documented evidence that
16the provider continues to meet all criteria for designation.
17    If the essential community behavioral health care provider
18continues to meet all criteria for designation, the Department
19shall continue the designation for an additional 5-year period.
20    Section 99. Effective date. This Act takes effect upon
21becoming law.