100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5868

Introduced , by Rep. La Shawn K. Ford

SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.29 new
305 ILCS 5/5-36 new

Amends the Illinois Insurance Code. Permits a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act to provide coverage for residential extended care services and supports for persons suffering from alcoholism or other drug addiction so long as: (1) a health care clinic or any other specified entity has conducted an individualized assessment of the person's condition prior to discharge and has identified the person as being at risk of a drug or alcohol relapse and in need of supportive services to maintain long-term recovery; (2) the residential extended care services and supports are administered by a community-based agency that is licensed by or under contract with the Department of Human Services; and (3) the residential extended care services and supports are administered upon the referral of a health care clinic or any other specified entity. Sets forth the services available for coverage. Requires the Department of Insurance to rate each community-based agency that is licensed by or under contract with the Department of Human Services to provide residential extended care services and supports and to publish the results on its official website. Amends the Illinois Public Aid Code. Permits the fee-for-service and managed care medical assistance programs established under the Code to provide coverage for residential extended care services and supports for any person suffering from alcoholism or other drug addiction who is at risk of a drug or alcohol relapse following discharge from a health care clinic or any other specified entity. Sets forth the conditions that must be met to qualify for coverage and makes other changes.
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FISCAL NOTE ACT MAY APPLY

A BILL FOR

HB5868LRB100 21705 KTG 39208 b
1 AN ACT concerning health.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 1. Legislative findings and purpose. Medical
5clinics, emergency rooms, and hospitals across the country are
6overwhelmed by the opioid crisis and have been adversely
7affected by costs and increasing rates of recidivism due to a
8lack of comprehensive community-based continuum of care
9services available for persons suffering from drug addiction.
10According to the Centers for Disease Control and Prevention,
11there has been a 600% increase in the incidence of opioid
12addictions since 1999, yet only one in 10 people afflicted with
13the disease of addiction have access to treatment. Most
14patients are not only affected by the issues of addiction, but
15are also facing co-existing social and economic challenges
16associated with the disease of addiction including poverty, job
17insecurity, and homelessness. The current health care system is
18too expensive, fragmented, and disjointed to sufficiently
19address the needs of persons afflicted with drug addiction.
20Consequently, we are at a pivotal time in history when
21insurance companies are having to become more innovative in
22their approaches to contain costs and improve patient outcomes.
23Hospitals are also contemplating new and innovative ways to
24reduce their costs and rates of recidivism, improve patient

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1outcomes, and monitor patients with a greater level of care in
2order to achieve the highest level of multiple performance
3outcomes at a time when performance metrics matter more than
4ever. The State of Illinois has the opportunity to lead the
5nation by supporting and amplifying the most comprehensive and
6vertically integrated approach to recovery that can
7effectively address the root causes of drug addiction,
8including alcoholism, while stabilizing other co-existing
9social, economic, and housing conditions that can impair a
10person's long-term recovery from addiction. In addition to
11helping persons achieve physical recovery from a drug or
12alcohol addiction, it is also important to help them find new
13meaning in their personal lives by rebuilding and strengthening
14their family relationships, community ties, and spiritual
15development. Residential recovery services and supports can
16facilitate this holistic approach to recovery and help persons
17replace their need for addictive substances with more
18meaningful elements of life. Therefore, it is the purpose of
19this Act to provide Illinois citizens with greater access to a
20more robust and holistic continuum of behavioral health care
21services and supports by providing health care coverage for
22residential recovery services and supports for persons
23suffering from alcoholism or other drug addiction.
24 Section 5. The Illinois Insurance Code is amended by adding
25Section 356z.29 as follows:

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1 (215 ILCS 5/356z.29 new)
2 Sec. 356z.29. Residential extended care services and
3supports for drug addicted persons.
4 (a) Definitions. As used in this Section:
5 "Addiction", "alcoholism", "case management", and
6"relapse" have the meanings ascribed to those terms in Section
71-10 of the Alcoholism and Other Drug Abuse and Dependency Act.
8 "Hospital" means a facility licensed by the Department of
9Public Health under the Hospital Licensing Act.
10 "Federally qualified health center" means a facility as
11defined in Section 1905(l)(2)(B) of the federal Social Security
12Act.
13 (b) A group or individual policy of accident and health
14insurance or managed care plan amended, delivered, issued, or
15renewed on or after the effective date of this amendatory Act
16of the 100th General Assembly may provide coverage for
17residential extended care services and supports for persons
18suffering from alcoholism or other drug addiction who are at
19risk of a drug or alcohol relapse following discharge from a
20health care clinic, federally qualified health center,
21hospital detoxification program or any other licensed
22detoxification program, or hospital emergency department so
23long as all of the following conditions are met:
24 (1) A health care clinic, federally qualified health
25 center, hospital detoxification program or any other

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1 licensed detoxification program, or hospital emergency
2 department has conducted an individualized assessment of
3 the person's condition prior to discharge and has
4 identified the person as being at risk of a drug or alcohol
5 relapse and in need of aftercare treatment and supportive
6 services to maintain long-term recovery. A determination
7 of whether a person is in need of supportive services shall
8 be based on whether the person has a history of
9 unemployment, homelessness, or housing instability.
10 (2) The residential extended care services and
11 supports are administered by a community-based agency that
12 is licensed by or under contract with the Department of
13 Human Services' Division of Alcoholism and Substance
14 Abuse, which may include a halfway house, recovery home, or
15 sanctuary.
16 (3) The residential extended care services and
17 supports are administered by a community-based agency as
18 described in paragraph (2) upon the referral of a health
19 care clinic, federally qualified health center, hospital
20 detoxification program or any other licensed
21 detoxification program, or hospital emergency department.
22 (c) Any coverage provided in accordance with this Section
23shall include, but not be limited to, the following:
24 (1) Drug or alcohol treatment services that are in
25 accordance with industry standards.
26 (2) Transitional housing services, including food or

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1 meal plans.
2 (3) Individualized case management and referral
3 services, including case management and social services
4 for the families of persons who are seeking treatment for
5 alcoholism or other drug addiction.
6 (4) Job training or placement services.
7 (d) The Department of Insurance, in collaboration with the
8Department of Human Services, the Department of Public Health,
9and the Department of Healthcare and Family Services, shall
10rate each community-based agency that is licensed by or under
11contract with the Department of Human Services to provide
12residential extended care services and supports based on an
13assessment and evaluation of each agency's ability to:
14 (1) reduce health care costs;
15 (2) reduce recidivism rates for persons suffering from
16 alcoholism or other drug addiction;
17 (3) improve outcomes;
18 (4) track patients; and
19 (5) improve patients' quality of life through the
20 utilization of sustainable recovery, education,
21 employment, and housing services.
22 The Department of Insurance, the Department of Human
23Services, the Department of Public Health, and the Department
24of Healthcare and Family Services shall publish the results of
25the assessments and ratings on their official websites and
26shall, on an annual basis, update the posted results.

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1 (e) The Department of Insurance may adopt any rules
2necessary to implement the provisions of this Section in
3accordance with the Illinois Administrative Procedure Act and
4all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7 Section 15. The Illinois Public Aid Code is amended by
8adding Section 5-36 as follows:
9 (305 ILCS 5/5-36 new)
10 Sec. 5-36. Residential extended care services and supports
11for drug addicted persons.
12 (a) Definitions. As used in this Section:
13 "Addiction", "alcoholism", "case management", and
14"relapse" have the meanings ascribed to those terms in Section
151-10 of the Alcoholism and Other Drug Abuse and Dependency Act.
16 "Hospital" means a facility licensed by the Department of
17Public Health under the Hospital Licensing Act.
18 "Federally qualified health center" means a facility as
19defined in Section 1905(l)(2)(B) of the federal Social Security
20Act.
21 (b) On and after the effective date of this amendatory Act
22of the 100th General Assembly, the fee-for-service and managed
23care medical assistance programs established under this
24Article may provide coverage for residential extended care

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1services and supports for any person suffering from alcoholism
2or other drug addiction who is at risk of a drug or alcohol
3relapse following discharge from a health care clinic,
4federally qualified health center, hospital detoxification
5program or any other licensed detoxification program, or
6hospital emergency department so long as all of the following
7conditions are met:
8 (1) The person is otherwise eligible for medical
9 assistance under this Article.
10 (2) A health care clinic, federally qualified health
11 center, hospital detoxification program or any other
12 licensed detoxification program, or hospital emergency
13 department has conducted an individualized assessment of
14 the person's condition prior to discharge and has
15 identified the person as being at risk of a drug or alcohol
16 relapse and in need of aftercare treatment and supportive
17 services to maintain long-term recovery. A determination
18 of whether a person is in need of supportive services shall
19 be based on whether the person has a history of
20 unemployment, homelessness, or housing instability.
21 (3) The residential extended care services and
22 supports are administered by a community-based agency that
23 is licensed by or under contract with the Department of
24 Human Services' Division of Alcoholism and Substance
25 Abuse, which may include a halfway house, recovery home, or
26 sanctuary.

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1 (4) The residential extended care services and
2 supports are administered by a community-based agency as
3 described in paragraph (3) upon the referral of a health
4 care clinic, federally qualified health center, hospital
5 detoxification program or any other licensed
6 detoxification program, or hospital emergency department.
7 (c) Any coverage provided in accordance with this Section
8shall include, but not be limited to, the following:
9 (1) Drug or alcohol treatment services that are in
10 accordance with industry standards.
11 (2) Transitional housing services, including food or
12 meal plans.
13 (3) Individualized case management and referral
14 services, including case management and social services
15 for the families of persons who are seeking treatment for
16 alcoholism or other drug addiction.
17 (4) Job training or placement services.
18 (d) The Department of Healthcare and Family Services, in
19collaboration with the Department of Human Services, the
20Department of Public Health, and the Department of Insurance,
21shall rate each community-based agency that is licensed by or
22under contract with the Department of Human Services to provide
23residential extended care services and supports based on an
24assessment and evaluation of each agency's ability to:
25 (1) reduce health care costs;
26 (2) reduce recidivism rates for persons suffering from

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1 alcoholism or other drug addiction;
2 (3) improve outcomes;
3 (4) track patients; and
4 (5) improve patients' quality of life through the
5 utilization of sustainable recovery, education,
6 employment, and housing services.
7 The Department of Healthcare and Family Services, the
8Department of Human Services, the Department of Public Health,
9and the Department of Insurance shall publish the results of
10the assessments and ratings on their official websites and
11shall, on an annual basis, update the posted results.
12 (e) The Department may adopt any rules necessary to
13implement the provisions of this Section in accordance with the
14Illinois Administrative Procedure Act and all rules and
15procedures of the Joint Committee on Administrative Rules; any
16purported rule not so adopted, for whatever reason, is
17unauthorized.