(305 ILCS 75/185-3)
Sec. 185-3. Findings. The General Assembly finds as follows: (1) This Act seeks to remedy a fraction of a much |
| larger broken system by addressing access to health care, managed care organization reform, mental and substance abuse treatment services, and services to address the social determinants of health.
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(2) Illinois transitioned Medicaid services to
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| managed care with the goals of achieving better health outcomes for the Medicaid population and reducing the per capita costs of health care.
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(3) Illinois benefits when people have support
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| constructing the sturdy foundation of health and well-being that we all need to reach our potential. Medicaid managed care can be a vital tool in ensuring that people have the full range of supports that form this foundation, including services from community providers that address behavioral health needs, as well as related services that help people access food, housing, and employment.
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(4) However, there are barriers that prevent Illinois
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| from fully realizing the benefits of Medicaid managed care. The 2 devastating years of the State budget impasse resulted in 2 years of lost opportunity for community providers to invest in the people, systems, and technology that are necessary for them to participate in Medicaid managed care. A recent survey by the Illinois Collaboration on Youth of more than 130 community providers revealed that the majority do not have contracts with managed care organizations, and most do not have adequate billing and technology infrastructure sufficient for Medicaid billing now or in the future. The survey also revealed that community-based providers primarily serving people of color are the least prepared to participate in Medicaid managed care.
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(5) The disparity in readiness between providers
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| primarily serving people of color and those who serve a more mixed or white clientele is especially urgent because 62% of Illinois' Medicaid recipients are people of color. Racial disparities in behavioral health care result in significant human and financial costs to both the individual and to the State.
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(6) The COVID-19 pandemic has further exacerbated the
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| health disparities experienced by communities of color. COVID-19 has increased both the Medicaid-eligible population in Illinois, and increased the demand for behavioral health services, as Illinois residents grapple with trauma, death, job loss, depression, suicide, addiction, and exposure to violence. In addition, COVID-19 threatens the stability and viability of community-based providers, further straining the health care safety net for people who depend on Medicaid for these essential services.
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(7) Lack of support for a diversity of providers
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| reduces choice for Medicaid recipients and may incentivize managed care organizations to focus on a narrow selection of community partners. Having some choice in which providers people see for these essential services and having access to providers who understand their community, culture, and language has been demonstrated to reduce disparities in health outcomes and improve health and well-being across the life span.
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(8) The Medicaid managed care system lacks
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| consistent, statewide support for community providers, creating inefficiency and duplication. Providers need targeted trainings focused on their levels of readiness, learning collaboratives to provide group-level support for those experiencing similar challenges, and a mechanism to identify problems that need systemic solutions. Illinois could receive up to 70% in Medicaid matching funds from the federal government to supplement the costs of operating a Medicaid Technical Assistance Center.
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(9) When community-based health care providers are
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| able to contract with managed care organizations to deliver Medicaid services, people can access the care they need, in their communities, from providers they trust.
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(Source: P.A. 102-4, eff. 4-27-21.)
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(305 ILCS 75/185-5)
Sec. 185-5. Definitions. As used in this Act: "Behavioral health providers" means mental health and substance use disorder providers. "Department" means the Department of Healthcare and Family Services. "Health care providers" means organizations who provide physical, mental, substance use disorder, or social determinant of health services. "Health equity" means providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
"Network adequacy" means a Medicaid beneficiaries' ability to access all necessary provider types within time and distance standards as defined in the Managed Care Organization model contract. "Service deserts" means geographic areas of the State with no or limited Medicaid providers that accept Medicaid. "Social determinants of health" means any conditions that impact an individual's health, including, but not limited to, access to healthy food, safety, education, and housing stability. "Stakeholders" means, but are not limited to, health care providers, advocacy organizations, managed care organizations, Medicaid beneficiaries, and State and city partners.
(Source: P.A. 102-4, eff. 4-27-21.) |
(305 ILCS 75/185-15)
Sec. 185-15. Collaboration. The Medicaid Technical Assistance Center shall collaborate with public and private partners throughout the State to identify, establish, and maintain best practices necessary for health providers to ensure their capacity to participate in HealthChoice Illinois or YouthCare. The Medicaid Technical Assistance Center shall administer the following: (1) Outreach and engagement: The Medicaid Technical |
| Assistance Center shall undertake efforts to identify and engage community-based providers offering behavioral health services or services addressing the social determinants of health, especially those predominantly serving communities of color or those operating within or near service deserts, for the purpose of offering training and technical assistance to them through the Medicaid Technical Assistance Center. Outreach and engagement services may be subcontracted.
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(2) Trainings: The Medicaid Technical Assistance
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| Center shall create and administer ongoing trainings for health care providers. Trainings may be subcontracted. The Medicaid Technical Assistance Center shall provide in-person and web-based trainings. In-person training shall be conducted throughout the State. All trainings must be free of charge. The Medicaid Technical Assistance Center shall administer post-training surveys and incorporate feedback. Training content and delivery must be reflective of Illinois providers' varying levels of readiness, resources, and client populations.
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(3) Web-based resources: The Medicaid Technical
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| Assistance Center shall maintain an independent, easy to navigate, and up-to-date website that includes, but is not limited to: recorded training archives, a training calendar, provider resources and tools, up-to-date explanations of Department and managed care organization guidance, a running database of frequently asked questions and contact information for key staff members of the Department, managed care organizations, and the Medicaid Technical Assistance Center.
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(4) Learning collaboratives: The Medicaid Technical
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| Assistance Center shall host regional learning collaboratives that will supplement the Medicaid Technical Assistance Center training curriculum to bring together groups of stakeholders to share issues and best practices, and to escalate issues. Leadership of the Department and managed care organizations shall attend learning collaboratives on a quarterly basis.
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(5) Network adequacy reports: The Medicaid Technical
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| Assistance Center shall publicly release a report on Medicaid provider network adequacy within the first 3 years of implementation and annually thereafter. The reports shall identify provider service deserts and health care disparities by race and ethnicity.
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(6) Equitable delivery system: The Medicaid Technical
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| Assistance Center is committed to the principle that all Medicaid recipients have accessible and equitable physical and mental health care services. All providers served through the Medicaid Technical Assistance Center shall deliver services notwithstanding the patient's race, color, gender, gender identity, age, ancestry, marital status, military status, religion, national origin, disability status, sexual orientation, order of protection status, as defined under Section 1-103 of the Illinois Human Rights Act, or immigration status.
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(Source: P.A. 102-4, eff. 4-27-21.)
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