|Public Act 097-0166|
|HB1152 Enrolled||LRB097 05474 KTG 45533 b|
AN ACT concerning State government.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
The Mental Health and Developmental
Disabilities Administrative Act is amended by adding Section
71a as follows:
(20 ILCS 1705/71a new)
Community Behavioral Health Care.
(a) The Department shall strive to guarantee that persons,
including children, suffering from mental illness, substance
abuse, and other behavioral disorders have access to locally
accessible behavioral health care providers who have the
ability to treat the person's conditions in a cost effective,
outcome-based manner. To ensure continuity and quality of care
that is integrated with the person's overall medical care, the
(1) Designate as essential community behavioral health
care providers organizations that meet the qualifications
set forth in subsection (b) of this Section.
(2) Promote the co-location of primary and behavioral
health care services centers.
(3) Promote access to necessary behavioral health care
services in the State's Health Insurance Exchange
(4) Promote continuity of care for persons moving
between Medicaid, SCHIP, and programs administered by the
Department that provide behavioral health care services.
(5) Promote continuity of care for persons not yet
eligible for Medicaid or who are without insurance coverage
for their conditions.
(6) Work toward improving access in Illinois'
underserved and health professional shortage areas.
(b) The Department shall designate certain community
behavioral health care providers as essential community
behavioral health care providers. To qualify for the
designation an organization must be a not-for-profit
organization under the Internal Revenue Code or a governmental
(1) Demonstrates a commitment to serving low-income
and underserved populations.
(2) Provides outcome-based community behavioral health
care treatment or services.
(3) Does not restrict access or services because of a
client's financial limitation.
(4) Is a community behavioral health care provider
certified by the Department, or a licensed community
behavioral health care provider holding a purchase of care
contract with the State under the State's Medicaid program.
An organization that is licensed or certified by the
Department may apply to the Department for designation as an
essential community behavioral health care provider. The
Department, through administrative rule, shall describe the
standards and process of designating an essential community
behavioral health care provider, establishing the community to
be served, other criteria for selection, and grounds for
(c) An organization designated as an essential community
behavioral health care provider under subsection (b) and all
members of the care treatment and service staff of the
essential community behavioral health care provider shall
agree to serve enrollees of all health insurers or health care
service contractors operating in the area that the designated
essential community behavioral health care provider serves.
Health insurers shall include State programs funded under Title
XIX and Title XXI of the federal Social Security Act, including
the State's Medicaid program and the Covering ALL KIDS Health
Insurance Program; other programs funded by the Department of
Healthcare and Family Services for non-public employees; and
programs for both the insured and uninsured funded by the
Department of Human Services.
(d) An essential community behavioral health care provider
shall be compensated on a fee-for-service basis within a global
budget or within a risk-based incentive contract in accordance
with the contracts and standards of the respective payors.
Staff members and other health care providers in the service
area of the designated essential community behavioral health
care provider shall not be restricted from providing care,
treatment, or services through affiliation with any other
health insurer or health care service contractor.
(e) A designation of a community behavioral health care
provider as an essential community behavioral health care
provider shall end 5 years after the date the designation is
granted. The Department, however, may terminate the
designation for cause before the end of the 5-year period if
the essential community behavioral health care provider fails
to comply with the eligibility standards set forth in
A designated essential community behavioral health care
provider may reapply for designation 6 months prior to the
designation ending and shall provide documented evidence that
the provider continues to meet all criteria for designation.
If the essential community behavioral health care provider
continues to meet all criteria for designation, the Department
shall continue the designation for an additional 5-year period.
This Act takes effect upon