Bill Text: IL SB2294 | 2021-2022 | 102nd General Assembly | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Creates the Illinois Certified Community Behavioral Health Clinics Act. Requires the Department of Healthcare and Family Services to develop a Comprehensive Statewide Behavioral Health Strategy and to submit this Strategy to the Governor and General Assembly no later than July 1, 2022. Provides that the Strategy shall address key components of current and past legislation as well as current initiatives related to behavioral health services in order to develop a cohesive behavioral health system. Requires the Department to establish, by January 1, 2022, a program for the implementation of certified community behavioral health clinics. Amends the Medical Assistance Article of the Illinois Public Aid Code. Contains provisions concerning inpatient hospitalization for opioid-related overdose or withdrawal patients; services provided by licensed clinical professional counselors and marriage and family therapists; payments for long-acting injectable medications for mental health or substance use disorders; medical assistance benefits for persons determined eligible during the COVID-19 public health emergency; medical assistance coverage for services performed by a chiropractic physician, including, but not limited to, chiropractic manipulative treatment; medical assistance coverage for federally approved tobacco cessation medications and for tobacco cessation counseling services and medications provided through the Illinois Tobacco Quitline; medical assistance coverage for noncitizens for immunosuppressive drugs and related services associated with post-kidney transplant management, excluding long-term care costs; hospital reimbursements for immunizations; supplemental per diem rates for supportive living facilities; a supports waiver program for young adults with developmental disabilities; prior approval for wheelchair repairs; increased funding for dental services; and other matters. Removes a provision that requires the Department of Healthcare and Family Services to post the contracted claims report required by HealthChoice Illinois on its website every 3 months. In a provision requiring vendor payment claims to be received by the Department of Healthcare and Family Services within a specified time period, provides an exception to the filing deadline in cases established by Department rule. Provides that subject to federal approval, children younger than 19 with income at or below 313% of the federal poverty level shall be eligible for medical assistance. Grants the Department of Healthcare and Family Services emergency rulemaking authority. Provides that those provisions under the Illinois Public Aid Code that grant the Department of Healthcare and Family Services the authority to recover the value of health care benefits provided to a recipient under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act shall remain in force as to those causes of actions that accrued prior to the date upon which the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act become inoperative. Permits the Department to forgive, compromise, or reduce any debt owed by a former or current recipient of medical assistance under the Illinois Public Aid Code or health care benefits under the Children's Health Insurance Program or the Covering ALL KIDS Health Insurance Program. Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. Makes the Acts inoperative if (i) the Department of Healthcare and Family Services receives federal approval to make children younger than 19 who have countable income at or below 313% of the federal poverty level eligible for medical assistance under the Illinois Public Aid Code and (ii) the Department, upon federal approval, transitions children eligible for health care benefits under the Acts into the medical assistance program. Amends the Department of Healthcare and Family Services Law. Requires the Department of Healthcare and Family Services to recognize veteran support specialists who are certified by, and in good standing with, the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc. as mental health professionals as defined in the Illinois Title XIX State Plan and in the Illinois Administrative Code. Amends the All-Inclusive Care for the Elderly Act. Changes the name of the Act to the "Program of All-Inclusive Care for the Elderly Act". Requires the Department of Healthcare and Family Services to prepare and submit a PACE State Plan amendment no later than December 31, 2022 to the federal Centers for Medicare and Medicaid Services to establish the Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the Illinois Title XIX State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the Department of Healthcare and Family Services, and PACE organizations. Amends the Illinois Health Information Exchange and Technology Act. Changes the repeal date for the Act to January 1, 2027 (rather than January 1, 2022). Amends the Children with Disabilities Article of the School Code. Provides that the Community and Residential Services Authority shall have the power and duty to establish a pilot program to act as a residential research hub to research and identify appropriate residential settings for youth who are being housed in an emergency room for more than 72 hours or who are deemed beyond medical necessity in a psychiatric hospital. Provides that if a child is deemed beyond medical necessity in a psychiatric hospital and is in need of residential placement, the goal of the program is to prevent a lock-out pursuant to the goals of the Custody Relinquishment Prevention Act. Provides that the Executive Director of the Authority or his or her designee shall be added as a participant on the Interagency Clinical Team established in the intergovernmental agreement among the Department of Healthcare and Family Services, the Department of Children and Family Services, the Department of Human Services, the State Board of Education, the Department of Juvenile Justice, and the Department of Public Health, with consent of the youth or the youth's guardian or family pursuant to the Custody Relinquishment Prevention Act. Effective immediately.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Passed) 2021-07-06 - Public Act . . . . . . . . . 102-0043 [SB2294 Detail]

Download: Illinois-2021-SB2294-Engrossed.html

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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.17 as follows:
(215 ILCS 5/356z.17)
Sec. 356z.17. Wellness coverage.
(a) A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed after January 1, 2010 (the effective date of Public
Act 96-639) that provides coverage for hospital or medical
treatment on an expense incurred basis may offer a reasonably
designed program for wellness coverage that allows for a
reward, a contribution, a reduction in premiums or reduced
medical, prescription drug, or equipment copayments,
coinsurance, or deductibles, or a combination of these
incentives, for participation in any health behavior wellness,
maintenance, or improvement program approved or offered by the
insurer or managed care plan. The insured or enrollee may be
required to provide evidence of participation in a program.
Individuals unable to participate in these incentives due to
an adverse health factor shall not be penalized based upon an
adverse health status.

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(b) For purposes of this Section, "wellness coverage"
means health care coverage with the primary purpose to engage
and motivate the insured or enrollee through: incentives;
provision of health education, counseling, and self-management
skills; identification of modifiable health risks; and other
activities to influence health behavior changes.
For the purposes of this Section, "reasonably designed
program" means a program of wellness coverage that has a
reasonable chance of improving health or preventing disease;
is not overly burdensome; does not discriminate based upon
factors of health; and is not otherwise contrary to law.
(c) Incentives as outlined in this Section are specific
and unique to the offering of wellness coverage and have no
application to any other required or optional health care
benefit.
(d) Such wellness coverage must satisfy the requirements
for an exception from the general prohibition against
discrimination based on a health factor under the federal
Health Insurance Portability and Accountability Act of 1996
(P.L. 104-191; 110 Stat. 1936), including any federal
regulations that are adopted pursuant to that Act.
(e) A plan offering wellness coverage must do the
following:
(i) give participants the opportunity to qualify for
offered incentives at least once a year;
(ii) allow a reasonable alternative to any individual

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for whom it is unreasonably difficult, due to a medical
condition, to satisfy otherwise applicable wellness
program standards. Plans may seek physician verification
that health factors make it unreasonably difficult or
medically inadvisable for the participant to satisfy the
standards; and
(iii) not provide a total incentive that exceeds 30%
20% of the cost of self-only or employee-only coverage,
except that the incentive may be increased by up to an
additional 20%, for a total incentive of 50%, to the
extent that the additional percentage is in connection
with a program designed to prevent or reduce tobacco use.
The cost of employee-only or family coverage provided
through group health insurance coverage includes both
employer and employee contributions. For group or
individual plans offering family coverage, the 20%
limitation applies to cost of family coverage and applies
to the entire family.
(f) A reward, contribution, or reduction established under
this Section and included in the policy or certificate does
not violate Section 151 of this Code.
(Source: P.A. 96-639, eff. 1-1-10; 96-833, eff. 6-1-10.)
Section 10. The Navigator Certification Act is amended by
changing Sections 5, 10, 15, 30, 35, and 45 as follows:

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(215 ILCS 121/5)
Sec. 5. Definitions. As used in this Act:
"Certified application counselor" has the same meaning as
in federal regulations and guidelines, including 45 CFR
155.225.
"Director" means the Director of Insurance.
"Exchange" means any health benefit exchange established
or operating in this State, including any exchange established
or operated by the United States Department of Health and
Human Services.
"Navigator" means a person or entity selected to perform
the activities and duties identified in 42 U.S.C. 18031(i) in
this State. "Navigator" includes any person or entity who
receives grant funds from the United States Department of
Health and Human Services, the State of Illinois, or an
exchange or private funds to perform any of the activities and
duties identified in 42 U.S.C. 18031(i), including, but not
limited to, in-person assisters as defined by federal
regulations or guidelines.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/10)
Sec. 10. Certificate required.
(a) No individual or entity shall perform, offer to
perform, or advertise any service as a navigator or certified
application counselor in this State or receive navigator grant

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funding from the United States Department of Health and Human
Services, the State of Illinois, or an exchange or private
funds unless certified as a navigator or certified application
counselor by the Director under this Act.
(b) The Director may establish exemptions from
certification by rule. A navigator who complies with the
requirements of this Act shall do the following:
(1) conduct public education activities to raise
awareness of the availability of qualified health plans;
(2) distribute fair and impartial information
concerning enrollment in qualified health plans offered
within the exchange and the availability of the premium
tax credits under Section 36B of the Internal Revenue Code
of 1986, 26 U.S.C. 36B, and cost-sharing reductions under
Section 1402 of the federal Patient Protection and
Affordable Care Act;
(3) facilitate enrollment in qualified health plans;
(4) provide referrals to appropriate federal and State
agencies for any enrollee with a grievance, complaint, or
question regarding their health plan or coverage or a
determination under such plan or coverage;
(5) provide information in a manner that is culturally
and linguistically appropriate to the needs of the
population being served by the exchange.
(c) A navigator or certified application counselor may
not:

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(1) sell, solicit, or negotiate, as these terms are
defined in Section 500-10 of the Illinois Insurance Code,
any of the classes of insurance enumerated in Section 4 of
the Illinois Insurance Code;
(2) offer advice about which health plan is better or
worse for a particular individual or employer;
(3) recommend or endorse a particular health plan or
advise consumers about which health plan to choose;
(4) provide any information or services related to
health benefit plans or other insurance products not
offered in the exchange, except for health care providers
when furnishing information or services related to a
patient's existing health benefit plan or other existing
health insurance coverage; or
(5) accept any compensation or consideration, directly
or indirectly, from any issuer of accident and health
insurance or stop-loss insurance that is dependent, in
whole or in part, on whether a person enrolls in or
purchases a particular private health benefit plan; or .
(6) engage in an unfair method of competition or a
fraudulent, deceptive, or dishonest act or practice with
respect to the health insurance marketplace or with
respect to that individual's or entity's absence of a
conflict of interest in connection with the enrollment of
an individual or employee in a particular private health
benefit plan.

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(d) Items (1), (2), (3), (4), and (5) of subsection (c) of
this Section do not apply to navigators or certified
application counselors when assisting individuals with the
enrollment process in the State Medicaid program or other
public programs.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/15)
Sec. 15. Application for certificate.
(a) An entity or individual applying for an initial or
renewal a navigator or certified application counselor
certificate shall make application to the Director on a form
developed by the Director and declare under penalty of
refusal, suspension, or revocation of the certificate that the
statements made in the application are true, correct, and
complete to the best of the individual's or entity's knowledge
and belief. Before approving the application, the Director
shall find that the individual:
(1) is at least 18 years of age;
(2) resides in this State or maintains his or her
principal place of business in this State;
(3) is not disqualified due to having committed any
act that would be grounds for denial, suspension, or
revocation of a navigator certification in accordance with
Section 30 of this Act;
(4) has successfully completed the federal and State

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training provided by the exchange or equivalent State
requirements as determined by the Department; and
(5) when applicable, has the written consent of the
Director pursuant to 18 U.S.C. 1033, or any successor
statute regulating crimes by or affecting persons engaged
in the business of insurance whose activities affect
interstate commerce.
(b) The Director shall establish certification terms and
requirements for completed applications, including educational
requirements, by rule. An entity that acts as a navigator,
supervises the activities of individual navigators, or
receives funding to perform such activities shall obtain a
navigator entity certificate. An entity applying for a
navigator entity certificate shall make application on a form
containing the information prescribed by the Director and
shall list the individuals acting as navigators under the
entity certificate.
(1) The entity shall designate a certified navigator
responsible for the navigator entity's compliance with the
laws of this State and the exchange.
(2) The entity, under penalty of revocation,
suspension, or other discipline prescribed by the
Director, shall certify that each individual completes the
mandatory training required by item (4) of subsection (a)
of Section 15 of this Act.
(c) The Director may require any documents deemed

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necessary to verify the information contained in an
application submitted in accordance with subsections (a) and
(b) of this Section.
(d) Any navigator or certified application counselor who
fails to timely file for certificate renewal shall be charged
a late fee in an amount prescribed by the Director Entities
certified as navigators shall provide the Director with a list
of all individual navigators that it employs, supervises, or
is affiliated with at renewal.
(e) The Director may require, in a manner determined by
the Director, that each entity that acts as a navigator or
certified application counselor demonstrate a level of
financial responsibility capable of protecting all persons
against the wrongful acts, misrepresentations, or negligence
of the navigator or certified application counselor.
(f) Prior to any exchange becoming operational in this
State, the Director, in coordination with the exchange, shall
prescribe the initial training and continuing education
requirements for navigators and certified application
counselors.
(g) Certificate holders must inform the Director, in
writing, of a change of address within 30 days after the
change.
(h) In order to assist in the performance of the
Director's duties, the Director may contract with the National
Association of Insurance Commissioners (NAIC), or any

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affiliates or subsidiaries that the NAIC oversees, to perform
any ministerial functions, including the collection of fees,
related to certification that the Director and the
nongovernmental entity may deem appropriate.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/30)
Sec. 30. Certificate denial, nonrenewal, or revocation.
(a) The Director may place on probation, suspend, revoke,
or refuse to issue or renew a navigator or certified
application counselor navigator's certificate or may levy a
civil penalty as established by rule.
(b) If an action by the Director is to nonrenew, suspend,
or revoke a certificate or to deny an application for a
certificate, then the Director shall notify the applicant or
certificate holder and advise, in writing, the applicant or
certificate holder of the reason for the suspension,
revocation, or denial or nonrenewal of the applicant's or
certificate holder's certificate. The applicant or certificate
holder may make written demand upon the Director within 30
days after the date of mailing for a hearing before the
Director to determine the reasonableness of the Director's
action. The hearing must be held within not fewer than 20 days
nor more than 30 days after the mailing of the notice of
hearing and shall be held pursuant to Part 2402 of Title 50 of
the Illinois Administrative Code.

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(c) A navigator or certified application counselor entity
certificate may be suspended, revoked, or refused or
information turned over to the U.S. Department of Health and
Human Services and applicable state agencies if the Director
finds, after hearing, that a certified individual's violation
was known or should have been known by one or more of the
partners, officers, or managers acting on behalf of the
navigator entity.
(d) In addition to or instead of any applicable denial,
suspension, or revocation of a certificate, a person may,
after hearing, be subject to a civil penalty in accordance
with emergency rules issued by the Director.
(e) The Director has the authority to enforce the
provisions of and impose any penalty or remedy authorized by
this Act against any person who is under investigation of or
charged with a violation of this Act or rules, even if the
person's certificate has been surrendered or has lapsed by
operation of law.
(f) Upon the suspension, denial, or revocation of a
certificate, the certificate holder or other person having
possession or custody of the certificate shall promptly
deliver it to the Director in person or by mail. The Director
shall publish all suspensions, denials, or revocations after
the suspensions, denials, or revocations become final in a
manner designed to notify the public.
(g) A person whose certificate is revoked or whose

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application is denied pursuant to this Section is ineligible
to apply for any certificate for 3 years after the revocation
or denial. A person whose certificate as a navigator or
certified application counselor has been revoked, suspended,
or denied may not be employed, contracted, or engaged in an
exchange-related capacity during the time the revocation,
suspension, or denial is in effect.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/35)
Sec. 35. Reporting to the Director.
(a) Each navigator or certified application counselor
shall report to the Director within 30 calendar days after the
final disposition of a matter that violates the provisions set
forth in this Act that results in any administrative action
taken against the navigator or certified application counselor
him in another jurisdiction or by another governmental agency
in this State. The report shall include a copy of the order,
consent to order, or other relevant legal documents.
(b) Within 30 days after the initial pretrial hearing
date, a navigator or certified application counselor shall
report to the Director any criminal prosecution of the
navigator or certified application counselor of a matter that
violates the provisions set forth in this Act taken in any
jurisdiction. The report shall include a copy of the initial
complaint filed, the order resulting from the hearing, and any

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other relevant legal documents.
(c) An entity that is certified acts as a navigator or
certified application counselor that terminates the
employment, engagement, affiliation, or other relationship
with an individual navigator or certified application
counselor shall notify the Director within 30 days following
the effective date of the termination, using a format
prescribed by the Director, if the reason for termination is
related to the requirements or standards one of the reasons
set forth in this Act or the rules adopted by the Director
pursuant to this Act, or the entity has knowledge the
navigator or certified application counselor was found by a
court or government body to have engaged in any of the
activities prohibited by this Act or the rules adopted by the
Director pursuant to this Act. Upon the written request of the
Director, the entity shall provide additional information,
documents, records, or other data pertaining to the
termination or activity of the individual.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/45)
Sec. 45. Other laws; rulemaking authority.
(a) The requirements of this Act shall not apply to any
individual or entity licensed as an insurance producer in this
State.
(b) Pursuant to the authority granted by this Act, the

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Director may adopt rules as may be necessary or appropriate
for the administration and enforcement of this Act. Such rules
may not conflict with or prevent the application of the
provisions of Title I of the Patient Protection and Affordable
Care Act or the federal regulations promulgated under such
provisions.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/20 rep.)
(215 ILCS 121/25 rep.)
(215 ILCS 121/40 rep.)
Section 15. The Navigator Certification Act is amended by
repealing Sections 20, 25, and 40.
Section 99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance