Bill Text: IL HB3276 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services and the Department of Human Services (Departments) to develop a pilot program based upon the certified community behavioral health clinic criteria and the prospective payment system methodology issued by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services as created under the federal Protecting Access to Medicare Act of 2014. Provides that implementation of the pilot program is subject to federal approval. Requires the Departments to seek federal financial assistance for the pilot program and certified community behavioral health clinic technical assistance and support through all potential federal sources, including, but not limited to, the federal Delivery System Reform Incentive Payment program. Contains provisions concerning the timeline for implementing the pilot program; applications for a federal Section 1115 waiver to implement the pilot program; the adoption of rules to implement the pilot program; implementation of the pilot program for certified community behavioral health clinic services under the medical assistance fee-for-service and managed care programs; payments to community behavioral health clinics under the certified community behavioral health clinic prospective payment system methodology for each qualifying visit; staffing requirements for certified community behavioral health clinics; reporting requirements; and other matters. Effective immediately.

Sponsorship: Partisan Bill (Democrat 3)

Status: (Introduced - Dead) 2021-04-19 - Added Chief Co-Sponsor Rep. Jay Hoffman [HB3276 Detail]

Download: Illinois-2021-HB3276-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB3276 Introduced , by Rep. Deb Conroy SYNOPSIS AS INTRODUCED:
New Act
Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services and the Department of Human Services (Departments) to develop a pilot program based upon the certified community behavioral health clinic criteria and the prospective payment system methodology issued by the federal Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services as created under the federal Protecting Access to Medicare Act of 2014. Provides that implementation of the pilot program is subject to federal approval. Requires the Departments to seek federal financial assistance for the pilot program and certified community behavioral health clinic technical assistance and support through all potential federal sources, including, but not limited to, the federal Delivery System Reform Incentive Payment program. Contains provisions concerning the timeline for implementing the pilot program; applications for a federal Section 1115 waiver to implement the pilot program; the adoption of rules to implement the pilot program; implementation of the pilot program for certified community behavioral health clinic services under the medical assistance fee-for-service and managed care programs; payments to community behavioral health clinics under the certified community behavioral health clinic prospective payment system methodology for each qualifying visit; staffing requirements for certified community behavioral health clinics; reporting requirements; and other matters. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
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
Illinois Certified Community Behavioral Health Clinics Act.
Section 5. Medicaid Pilot Program; integrated behavioral
health and primary care; findings.
(a) The General Assembly finds and declares that the
federal Protecting Access to Medicare Act of 2014, which
requires the establishment of demonstration programs to
improve community behavioral health services to be funded as
part of Medicaid, serves as a useful model for the creation of
a similar program in Illinois to provide and improve upon
community behavioral health services and treatment.
(b) The General Assembly finds and declares that the
federal Protecting Access to Medicare Act of 2014 identifies
some of the appropriate criteria for certified community
behavioral health clinics. These criteria fall into 6 areas:
(1) staffing;
(2) availability and accessibility of services;
(3) care coordination;
(4) scope of services;
(5) quality and other reporting; and

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(6) organizational authority.
(c) The General Assembly finds and declares that certified
community behavioral health clinics represent an opportunity
to improve the behavioral health of Illinois citizens by:
(1) expanding access to community-based mental health
and substance use disorder services;
(2) increasing the capacity of the mental health and
substance use disorder treatment systems to reduce unmet
need for care;
(3) advancing integration of behavioral health with
physical health care;
(4) assimilating and utilizing evidence-based
practices on a more consistent basis; and
(5) promoting improved access to high quality care.
(d) The General Assembly finds and declares that the pilot
program created in accordance with this Act should focus upon
4 key patient populations that may benefit from the certified
community behavioral health clinic model, with a special
emphasis on serving the following individuals living in
minority communities, communities of color, or underserved
areas:
(1) children with serious emotional disturbances;
(2) children with substance use disorders;
(3) adults with serious mental illness; and
(4) adults with substance use disorders.

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Section 10. Definitions. As used in this Act:
"Departments" means the Department of Healthcare and
Family Services and the Department of Human Services, Division
of Mental Health and Division of Substance Use Prevention and
Recovery.
"PAMA" means the Protecting Access to Medicare Act of
2014.
"Pilot program" means the Certified Community Behavioral
Health Clinic pilot program.
Section 15. Certified Community Behavioral Health Clinic
pilot program.
(a) The Department of Healthcare and Family Services, in
partnership with the Department of Human Services, Division of
Mental Health and Division of Substance Use Prevention and
Recovery, shall develop, with meaningful input from
stakeholders, a pilot program based upon, but not necessarily
identical to, the certified community behavioral health clinic
criteria and prospective payment system methodology issued by
the federal Substance Abuse and Mental Health Services
Administration and the Centers for Medicare and Medicaid
Services as created under the Protecting Access to Medicare
Act of 2014, Prospective Payment System Guidance. Input from
stakeholders shall include and incorporate information
received from consumers, family members of consumers,
community mental health centers, mental health providers,

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substance use disorder treatment facilities, substance use
disorder treatment providers, primary care physicians, and
statewide associations representing the foregoing. Stakeholder
input shall be gathered from across the State utilizing
listening sessions including those areas most severely
impacted by the opioid and suicide crises such as minority
communities, rural areas, and urban areas.
(b) Implementation of the pilot program is subject to
federal approval. The Departments shall seek federal financial
assistance for this pilot program and certified community
behavioral health clinic technical assistance and support
through all potential federal sources, including, but not
limited to, the federal Delivery System Reform Incentive
Payment program. The pilot program shall be implemented under
the following timeline:
(1) The Departments shall submit any necessary
applications to the Centers for Medicare and Medicaid
Services for a waiver under Section 1115 to implement the
pilot program described in this Section no later than
December 31, 2021. The Departments shall promptly engage
in any additional steps requested or required by the
Centers for Medicare and Medicaid Services to obtain
approval of the pilot program waiver on a timely basis.
(2) The Departments shall conduct the stakeholder
listening sessions as described above no later than 3
months following federal approval of the pilot program

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waiver.
(3) After federal approval of the pilot program waiver
has been secured, the Departments may adopt rules to carry
out this pilot program and include requirements and
specifications separate from those prescribed under the
federal Protecting Access to Medicare Act of 2014 by the
federal Substance Abuse and Mental Health Services
Administration and the Centers for Medicare and Medicaid
Services no later than 6 months following federal approval
of the pilot program waiver, but shall not draft any rules
in contravention of the criteria or specifications for the
pilot program development and implementation as set forth
in this Act.
(4) Upon federal approval of the pilot program waiver,
the Department of Healthcare and Family Services shall
implement the prospective payment system for certified
community behavioral health clinic services under the
medical assistance fee-for-service and managed care
programs based upon the certified community behavioral
health clinic daily (CC PPS-1) or monthly (CC PPS-2)
prospective payment system methodology set forth in
Appendix III to the Prospective Payment System Guidance.
The Department of Healthcare and Family Services shall
implement quality bonus and outlier payments, as further
detailed under the Prospective Payment System Guidance.
The prospective payment system shall be updated and

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subject to rebasing in accordance with Appendix III to the
Prospective Payment System Guidance. For services rendered
by a certified community behavioral health clinic to an
individual enrolled in a Medicaid managed care
organization, the Department of Healthcare and Family
Services shall implement a supplemental payment system at
the same time as the prospective payment system to ensure
that the community behavioral health clinic receives full
payment under the certified community behavioral health
clinic prospective payment system methodology for each
qualifying visit. Specifically, the Department of
Healthcare and Family Services shall provide for payment
to the community behavioral health clinic by the
Department of Healthcare and Family Services of a
supplemental payment equal to the amount (if any) by which
payment under the certified community behavioral health
clinic prospective payment system methodology would exceed
payments by the managed care organization to the certified
community behavioral health clinic for services rendered
to the entity's enrollee. The supplemental payments shall
be made by the Department of Healthcare and Family
Services according to a schedule agreed to between the
State and the certified community behavioral health
clinic, but in no case shall payment be made less
frequently than every 3 months. The prospective payment
system methodology shall remain in effect so long as the

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Departments continue to offer the pilot program and
regardless of the status of the PAMA-authorized Certified
Community Behavioral Health Clinic demonstration program,
including the Prospective Payment System Guidance.
(5) The Departments shall fully implement the pilot
program so that certified community behavioral health
clinic services may begin operations within 9 months
following federal approval of the pilot program waiver.
(c) The General Assembly shall appropriate such funds to
support the Departments in planning, obtaining stakeholder
input, and implementing and carrying out the pilot program as
well as other related duties specified in this Act, in
addition to funding that the Departments shall seek from the
Centers for Medicare and Medicaid Services and the federal
Substance Abuse and Mental Health Services Administration to
support these efforts.
(d) Certification of certified community behavioral health
clinics by the Department of Healthcare and Family Services
shall be based upon the following criteria. Where applicable,
the State shall use federal certified community behavioral
health clinic criteria established by the federal Substance
Abuse and Mental Health Services Administration as a guide.
The Department of Healthcare and Family Services shall impose
the certification criteria on all initial certified community
behavioral health clinic applications and shall require
recertification on a regular basis, no less frequently than

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every 2 years.
(1) Staffing requirements, including criteria that
staff have diverse disciplinary backgrounds, have
necessary State required licensure or certification and
accreditation, and are culturally and linguistically
trained to serve the needs of the clinic's patient
population.
(2) Availability and accessibility of services,
including crisis management services that are available
and accessible 24 hours a day, the use of a sliding scale
for payment, and no rejection for services or limiting of
services on the basis of a patient's ability to pay or
place of residence.
(3) Care coordination, including requirements to
coordinate care across settings and providers to ensure
seamless transitions for patients across the full spectrum
of health services, including acute, chronic, and
behavioral health needs.
(4) Provision (in a manner reflecting person-centered
care) of the following services which, if not available
directly through the certified community behavioral health
clinic, are provided or referred through formal
relationships with other providers:
(A) crisis mental health services, including
24-hour mobile crisis teams, emergency crisis
intervention services, and crisis stabilization;

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(B) screening, assessment, and diagnosis,
including risk assessment;
(C) patient-centered treatment planning or similar
processes, including risk assessment and crisis
planning;
(D) outpatient mental health and substance use
disorder services;
(E) outpatient clinic primary care screening and
monitoring of key health indicators and health risk;
(F) targeted case management;
(G) psychiatric rehabilitation services;
(H) peer support and counselor services and family
supports; and
(I) intensive, community-based mental health care
for members of the armed forces and veterans.
(5) Reporting of encounter data, clinical outcomes
data, quality data in accordance with federal certified
community behavioral health clinic criteria, and such
other data as the Departments deem necessary.
(6) Certified community behavioral health clinics may
only be formed and organized by community mental health
centers and substance use disorder treatment facilities or
mental health or substance use disorder treatment
providers licensed or certified by the Departments.
(e) The Departments shall deliver a report to the General
Assembly during the regular session on the outcomes of the

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pilot program after 2 years of full implementation and again
after 4 years of full implementation providing information on
performance of the pilot program along with plans for future
sustainability, including, but not limited to, the quality
measures and certification criteria set forth above and under
the guidance issued by the Centers for Medicare and Medicaid
Services and the federal Substance Abuse and Mental Health
Services Administration for the Protecting Access to Medicare
Act of 2014.
Section 99. Effective date. This Act takes effect upon
becoming law.