Bill Text: IL SB1831 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Rebuild Illinois Mental Health Workforce Act. In a provision concerning Medicaid funding for community mental health services, sets forth rate increases, to begin on and after January 1, 2024, for the following rates and services: the Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code; the Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code; the Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code; the Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code; the Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code; the Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code; and the Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code for medication monitoring provided by a physician, an advanced practice registered nurse, and all other levels of provider. Provides that no base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by the amendatory Act. Provides that any payments required under the amendatory Act that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by the amendatory Act.

Spectrum: Partisan Bill (Democrat 12-0)

Status: (Introduced) 2023-03-31 - Added as Co-Sponsor Sen. Sara Feigenholtz [SB1831 Detail]

Download: Illinois-2023-SB1831-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1831 Introduced 2/9/2023, by Sen. Elgie R. Sims, Jr. SYNOPSIS AS INTRODUCED:
305 ILCS 66/20-10
305 ILCS 66/20-20
Amends the Rebuild Illinois Mental Health Workforce Act. In a provision concerning Medicaid funding for community mental health services, sets forth rate increases, to begin on and after January 1, 2024, for the following rates and services: the Mobile Crisis Response Medicaid Payment rate for all services provided under the S9484 procedure code; the Crisis Intervention Medicaid Payment rate for all levels of services provided under the H2011 procedure code; the Integrated Assessment and Treatment Planning Medicaid Payment rate for all levels of services provided under the H2000 procedure code; the Group and Family Therapy Medicaid Payment rate for all levels of services provided under the H0004 procedure code; the Community Support - Group Medicaid Payment rate for all levels of services provided under the H2015 procedure code; the Telepsychiatry Originating Site Medicaid Payment rate for services provided under the Q3014 procedure code; and the Medication Monitoring Medicaid Payment rate for services provided under the H2010 procedure code for medication monitoring provided by a physician, an advanced practice registered nurse, and all other levels of provider. Provides that no base Medicaid rate payment or any other payment for the provision of Medicaid community mental health services in place on January 1, 2023 shall be diminished or changed to make the reimbursement changes required by the amendatory Act. Provides that any payments required under the amendatory Act that are delayed due to implementation challenges or federal approval shall be made retroactive to January 1, 2024 for the full amount required by the amendatory Act.
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A BILL FOR
SB1831 LRB103 27179 KTG 53549 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Rebuild Illinois Mental Health Workforce
Act is amended by changing Sections 20-10 and 20-20 as
follows:
(305 ILCS 66/20-10)
Sec. 20-10. Medicaid funding for community mental health
services. Medicaid funding for the specific community mental
health services listed in this Act shall be adjusted and paid
as set forth in this Act. Such payments shall be paid in
addition to the base Medicaid reimbursement rate and add-on
payment rates per service unit.
(a) The payment adjustments shall begin on July 1, 2022
for State Fiscal Year 2023 and shall continue for every State
fiscal year thereafter.
(1) Individual Therapy Medicaid Payment rate for
services provided under the H0004 Code:
(A) The Medicaid total payment rate for individual
therapy provided by a qualified mental health
professional shall be increased by no less than $9 per
service unit.
(B) The Medicaid total payment rate for individual

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therapy provided by a mental health professional shall
be increased by no less then $9 per service unit.
(2) Community Support - Individual Medicaid Payment
rate for services provided under the H2015 Code: All
community support - individual services shall be increased
by no less than $15 per service unit.
(3) Case Management Medicaid Add-on Payment for
services provided under the T1016 code: All case
management services rates shall be increased by no less
than $15 per service unit.
(4) Assertive Community Treatment Medicaid Add-on
Payment for services provided under the H0039 code: The
Medicaid total payment rate for assertive community
treatment services shall increase by no less than $8 per
service unit.
(5) Medicaid user-based directed payments.
(A) For each State fiscal year, a monthly directed
payment shall be paid to a community mental health
provider of community support team services based on
the number of Medicaid users of community support team
services documented by Medicaid fee-for-service and
managed care encounter claims delivered by that
provider in the base year. The Department of
Healthcare and Family Services shall make the monthly
directed payment to each provider entitled to directed
payments under this Act by no later than the last day

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of each month throughout each State fiscal year.
(i) The monthly directed payment for a
community support team provider shall be
calculated as follows: The sum total number of
individual Medicaid users of community support
team services delivered by that provider
throughout the base year, multiplied by $4,200 per
Medicaid user, divided into 12 equal monthly
payments for the State fiscal year.
(ii) As used in this subparagraph, "user"
means an individual who received at least 200
units of community support team services (H2016)
during the base year.
(B) For each State fiscal year, a monthly directed
payment shall be paid to each community mental health
provider of assertive community treatment services
based on the number of Medicaid users of assertive
community treatment services documented by Medicaid
fee-for-service and managed care encounter claims
delivered by the provider in the base year.
(i) The monthly direct payment for an
assertive community treatment provider shall be
calculated as follows: The sum total number of
Medicaid users of assertive community treatment
services provided by that provider throughout the
base year, multiplied by $6,000 per Medicaid user,

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divided into 12 equal monthly payments for that
State fiscal year.
(ii) As used in this subparagraph, "user"
means an individual that received at least 300
units of assertive community treatment services
during the base year.
(C) The base year for directed payments under this
Section shall be calendar year 2019 for State Fiscal
Year 2023 and State Fiscal Year 2024. For the State
fiscal year beginning on July 1, 2024, and for every
State fiscal year thereafter, the base year shall be
the calendar year that ended 18 months prior to the
start of the State fiscal year in which payments are
made.
(b) Subject to federal approval, a one-time directed
payment must be made in calendar year 2023 for community
mental health services provided by community mental health
providers. The one-time directed payment shall be for an
amount appropriated for these purposes. The one-time directed
payment shall be for services for Integrated Assessment and
Treatment Planning and other intensive services, including,
but not limited to, services for Mobile Crisis Response,
crisis intervention, and medication monitoring. The amounts
and services used for designing and distributing these
one-time directed payments shall not be construed to require
any future rate or funding increases for the same or other

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mental health services.
(c) The following payment adjustments shall begin on
January 1, 2024 and shall continue thereafter.
(1) The Mobile Crisis Response Medicaid Payment rate
for all services provided under the S9484 procedure code
shall be increased by no less than $200 per service unit
for on-site services. Off-site rates for these services
must be increased by an amount which at least maintains
the current differential between on-site and off-site
services as represented on the July 1, 2022 fee schedule.
(2) The Crisis Intervention Medicaid Payment rate for
all levels of services provided under the H2011 procedure
code shall be increased by no less than $8 per service unit
for on-site services. Off-site rates for these services
must be increased by an amount which at least maintains
the current differential between on-site and off-site
services as represented on the July 1, 2022 fee schedule.
(3) The Integrated Assessment and Treatment Planning
Medicaid Payment rate for all levels of services provided
under the H2000 procedure code shall be increased by no
less than $7 per service unit for on-site services.
Off-site rates for these services must be increased by an
amount which at least maintains the current differential
between on-site and off-site services as represented on
the July 1, 2022 fee schedule.
(4) The Group and Family Therapy Medicaid Payment rate

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for all levels of services provided under the H0004
procedure code shall be increased by no less than $3 per
service unit for on-site services. Off-site rates for
these services must be increased by an amount which at
least maintains the current differential between on-site
and off-site services as represented on the July 1, 2022
fee schedule. This increase does not apply to individual
therapy services which were increased July 1, 2022 in
accordance with paragraph (1) of subsection (a).
(5) The Community Support - Group Medicaid Payment
rate for all levels of services provided under the H2015
procedure code shall be increased by no less than $3 per
service unit for on-site services. Off-site rates for
these services must be increased by an amount which at
least maintains the current differential between on-site
and off-site services as represented on the July 1, 2022
fee schedule. This increase does not apply to Community
Support - Individual services which were increased July 1,
2022 in accordance with paragraph (2) of subsection (a).
(6) The Telepsychiatry Originating Site Medicaid
Payment rate for services provided under the Q3014
procedure code shall be increased by no less than $10 per
service unit for on-site services. Off-site rates for
these services must be increased by an amount which at
least maintains the current differential between on-site
and off-site services as represented on the July 1, 2022

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fee schedule.
(7) Medication Monitoring Medicaid Payment rate for
services provided under the H2010 procedure code:
(A) The Medicaid total payment rate for medication
monitoring provided by a physician shall be increased
by no less than $25.11 per service unit for on-site
services. Off-site rates for these services must be
increased by an amount which at least maintains the
current differential between on-site and off-site
services as represented on the July 1, 2022 fee
schedule.
(B) The Medicaid total payment rate for medication
monitoring provided by an advanced practice registered
nurse shall be increased by no less than $18.07 per
service unit for on-site services. Off-site rates for
these services must be increased by an amount which at
least maintains the current differential between
on-site and off-site services as represented on the
July 1, 2022 fee schedule.
(C) The Medicaid total payment rate for medication
monitoring provided by all other levels of provider
shall be increased by no less than $15.00 per service
unit for on-site services. Off-site rates for these
services must be increased by an amount which at least
maintains the current differential between on-site and
off-site services as represented on the July 1, 2022

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fee schedule.
(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)
(305 ILCS 66/20-20)
Sec. 20-20. Base Medicaid rates or add-on payments.
(a) For services under subsection (a) of Section 20-10: .
No base Medicaid rate or Medicaid rate add-on payment or
any other payment for the provision of Medicaid community
mental health services in place on July 1, 2021 shall be
diminished or changed to make the reimbursement changes
required by this Act. Any payments required under this Act
that are delayed due to implementation challenges or federal
approval shall be made retroactive to July 1, 2022 for the full
amount required by this Act.
(b) For directed payments under subsection (b) of Section
20-10: .
No base Medicaid rate payment or any other payment for the
provision of Medicaid community mental health services in
place on January 1, 2023 shall be diminished or changed to make
the reimbursement changes required by this Act. The Department
of Healthcare and Family Services must pay the directed
payment in one installment within 60 days of receiving federal
approval.
(c) For directed payments under subsection (c) of Section
20-10:
No base Medicaid rate payment or any other payment for the

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provision of Medicaid community mental health services in
place on January 1, 2023 shall be diminished or changed to make
the reimbursement changes required by this amendatory Act of
the 103rd General Assembly. Any payments required under this
amendatory Act of the 103rd General Assembly that are delayed
due to implementation challenges or federal approval shall be
made retroactive to January 1, 2024 for the full amount
required by this amendatory Act of the 103rd General Assembly.
(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23.)