Bill Text: IL SB2951 | 2017-2018 | 100th General Assembly | Engrossed


Bill Title: Creates the Early Mental Health and Addictions Treatment Act. Requires the Department of Healthcare and Family Services, and other specified agencies and entities, to develop a pilot program under which a qualifying adolescent or young adult may receive community-based mental health treatment from a youth-focused community support team for early treatment that is specifically tailored to the needs of youth and young adults in the early stages of a serious emotional disturbance or serious mental illness. Requires the Department to apply, no later than September 30, 2019, for any necessary federal waiver or State Plan amendment to implement the pilot program. Requires the Department to implement the pilot program no later than December 31, 2019 if federal approval is not necessary. Contains provisions concerning the creation of a community-based treatment model under the pilot program; the development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Requires the Department to develop an Assertive Engagement and Community-Based Clinical Treatment Pilot Program for individuals with opioid and other drug addictions. Contains provisions on in-office, in-home, and in-community services provided under the pilot program; application for a federal waiver or State Plan amendment to implement the pilot program; development of a pay-for-performance payment model; Department rules to implement the pilot program; and analytics and outcomes report. Effective immediately.

Spectrum: Slight Partisan Bill (Democrat 22-10)

Status: (Engrossed) 2018-05-21 - Placed on Calendar 2nd Reading - Short Debate [SB2951 Detail]

Download: Illinois-2017-SB2951-Engrossed.html



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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the Early
5Mental Health and Addictions Treatment Act.
6 Section 5. Medicaid Pilot Program; early treatment for
7youth and young adults.
8 (a) The General Assembly finds as follows:
9 (1) Most mental health conditions begin in adolescence
10 and young adulthood, yet it can take an average of 10 years
11 before the right diagnosis and treatment are received.
12 (2) Over 850,000 Illinois youth under age 25 will
13 experience a mental health condition.
14 (3) Early treatment of significant mental health
15 conditions can enable wellness and recovery and prevent a
16 life of disability or early death from suicide.
17 (4) Early treatment leads to higher rates of school
18 completion and employment.
19 (5) Illinois' mental health system is aimed at adults
20 with advanced mental illnesses who have become disabled,
21 rather than focusing on youth in the early stages of a
22 mental health condition to prevent progression.
23 (6) Many states are implementing programs and services

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1 for the early treatment of significant mental health
2 conditions in youth.
3 (7) The cost of early community-based treatment is a
4 fraction of the cost of a life of multiple
5 hospitalizations, disability, criminal justice
6 involvement, and homelessness, the common trajectory for
7 someone with a serious mental health condition.
8 (8) Early treatment for adolescents and young adults
9 with mental health conditions will save lives and State
10 dollars.
11 (b) As the sole Medicaid State agency, the Department of
12Healthcare and Family Services, in partnership with the
13Department of Human Services' Division of Mental Health and
14with meaningful input from stakeholders, shall develop a pilot
15program under which a qualifying adolescent or young adult, as
16defined in subsection (d), may receive community-based mental
17health treatment from a youth-focused community support team
18for early treatment, as provided in subsection (e), that is
19specifically tailored to the needs of youth and young adults in
20the early stages of a serious emotional disturbance or serious
21mental illness for purposes of stabilizing the youth's
22condition and symptoms and preventing the worsening of the
23illness and debilitating or disabling symptoms. The pilot
24program shall be implemented across a broad spectrum of
25geographic regions across the State.
26 (c) Federal waiver or State Plan amendment; implementation

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1timeline.
2 (1) Federal approval. The Department of Healthcare and
3 Family Services shall submit any necessary application to
4 the federal Centers for Medicare and Medicaid Services for
5 a waiver or State Plan amendment to implement the pilot
6 program described in this Section no later than September
7 30, 2019. If the Department determines the pilot program
8 can be implemented without federal approval, the
9 Department shall implement the program no later than
10 December 31, 2019. The Department shall not draft any rules
11 in contravention of this timetable for pilot program
12 development and implementation. This pilot program shall
13 be implemented only to the extent that federal financial
14 participation is available.
15 (2) Implementation. After federal approval is secured,
16 if federal approval is required, the Department of
17 Healthcare and Family Services shall implement the pilot
18 program within 6 months after the date of federal approval.
19 (d) Qualifying adolescent or young adult. As used in this
20Section, "qualifying adolescent or young adult" means a person
21age 16 through 26 who is enrolled in the Medical Assistance
22Program under Article V of the Illinois Public Aid Code and has
23a diagnosis of a serious emotional disturbance as interpreted
24by the federal Substance Abuse and Mental Health Services
25Administration or a serious mental illness listed in the most
26recent edition of the Diagnostic and Statistical Manual of

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1Mental Disorders. Because the purpose of the pilot program is
2treatment in the early stages of a significant mental health
3condition or emotional disturbance for purposes of preventing
4progression of the illness, debilitating symptoms and
5disability, a qualifying adolescent or young adult shall not be
6required to demonstrate disability due to the mental health
7condition, show a reduction in functioning as a result of the
8condition, or have a reality impairment (psychosis) to be
9eligible for services through the pilot program. A qualifying
10adolescent or young adult who is determined to be eligible for
11pilot program services before the age of 21 shall continue to
12be eligible for such services without interruption through age
1326 as long as he or she remains enrolled in the Medical
14Assistance Program.
15 (e) Community-based treatment model. The pilot program
16shall create youth-focused community support teams for early
17treatment. The community-based treatment model shall be a
18multidisciplinary, team-based model specifically tailored for
19adolescents and young adults and their needs for wellness,
20symptom management, and recovery. The model shall take into
21consideration area workforce, community uniqueness, and
22cultural diversity. All services shall be evidence-based or
23evidence-informed as applicable, and the services shall be
24flexibly provided in-office, in-home, and in-community with an
25emphasis on in-home and in-community services. The model shall
26allow for and include each of the following:

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1 (1) Community-based, outreach treatment, and
2 wrap-around services that begin in the early stages of a
3 serious mental illness or serious emotional disturbance
4 (functional impairment shall not be required for service
5 eligibility under the pilot program).
6 (2) Youth specific engagement strategies to encourage
7 participation and retention in services.
8 (3) Same-age or similar-age peer services to foster
9 resiliency.
10 (4) Family psycho-education and family involvement.
11 (5) Expertise or knowledge in school and university
12 systems, special education and work, volunteer and social
13 life for youth.
14 (6) Evidence-informed and young person-specific
15 psychotherapies.
16 (7) Care coordination for primary care.
17 (8) Medication management.
18 (9) Case management for problem solving to address
19 practicable problems, including criminal justice
20 involvement and housing challenges; and assisting the
21 young person or family in organizing all treatment and
22 goals.
23 (10) Supported education and employment to keep the
24 young person engaged in school and work to attain
25 self-sufficiency.
26 (11) Trauma-informed expertise for youth.

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1 (12) Substance use treatment expertise.
2 (f) Pay-for-performance payment model. The Department of
3Healthcare and Family Services, with meaningful input from
4stakeholders, shall develop a pay-for-performance payment
5model aimed at achieving high-quality mental health and overall
6health and quality of life outcomes for the youth, rather than
7a fee-for-service payment model. The payment model shall allow
8for service flexibility to achieve such outcomes, shall cover
9actual provider costs of delivering the pilot program services
10to enable sustainability, and shall include all provider costs
11associated with the data collection for purposes of the
12analytics and outcomes reporting required under subsection
13(h). The Department shall ensure that the payment model works
14as intended by this Section within managed care.
15 (g) Rulemaking. The Department of Healthcare and Family
16Services, in partnership with the Department of Human Services'
17Division of Mental Health and with meaningful input from
18stakeholders, shall develop rules for purposes of
19implementation of the pilot program contemplated in this
20Section within 6 months of federal approval of the pilot
21program. If the Department determines federal approval is not
22required for implementation, the Department shall develop
23rules with meaningful stakeholder input no later than December
2431, 2019.
25 (h) Pilot program analytics and outcomes reports. The
26Department of Healthcare and Family Services shall engage a

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1third party partner with expertise in program evaluation,
2analysis, and research at the end of 5 years of implementation
3to review the outcomes of the pilot program in stabilizing
4youth with significant mental health conditions early on in
5their condition to prevent debilitating symptoms and
6disability and enable youth to reach their full potential. For
7purposes of evaluating the outcomes of the pilot program, the
8Department shall require providers of the pilot program
9services to track the following annual data:
10 (1) days of inpatient hospital stays of service
11 recipients;
12 (2) periods of homelessness of service recipients and
13 periods of housing stability;
14 (3) periods of criminal justice involvement of service
15 recipients;
16 (4) avoidance of disability and the need for
17 Supplemental Security Income;
18 (5) rates of high school, college, or vocational school
19 engagement and graduation for service recipients;
20 (6) rates of employment annually of service
21 recipients;
22 (7) average length of stay in pilot program services;
23 (8) symptom management over time; and
24 (9) youth satisfaction with their quality of life,
25 pre-pilot and post-pilot program services.
26 (i) The Department of Healthcare and Family Services shall

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1deliver a final report to the General Assembly on the outcomes
2of the pilot program within one year after 4 years of full
3implementation, and after 7 years of full implementation,
4compared to typical treatment available to other youth with
5significant mental health conditions, as well as the cost
6savings associated with the pilot program taking into account
7all public systems used when an individual with a significant
8mental health condition does not have access to the right
9treatment and supports in the early stages of his or her
10illness.
11 The reports to the General Assembly shall be filed with the
12Clerk of the House of Representatives and the Secretary of the
13Senate in electronic form only, in the manner that the Clerk
14and the Secretary shall direct.
15 Post-pilot program discharge outcomes shall be collected
16for all service recipients who exit the pilot program for up to
173 years after exit. This includes youth who exit the program
18with planned or unplanned discharges. The post-exit data
19collected shall include the annual data listed in paragraphs
20(1) through (9) of subsection (h). Data collection shall be
21done in a manner that does not violate individual privacy laws.
22Outcomes for enrollees in the pilot and post-exit outcomes
23shall be included in the final report to the General Assembly
24under this subsection (i) within one year of 4 full years of
25implementation, and in an additional report within one year of
267 full years of implementation in order to provide more

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1information about post-exit outcomes on a greater number of
2youth who enroll in pilot program services in the final years
3of the pilot program.
4 Section 10. Medicaid pilot program for opioid and other
5drug addictions.
6 (a) Legislative findings. The General Assembly finds as
7follows:
8 (1) Illinois continues to face a serious and ongoing
9 opioid epidemic.
10 (2) Opioid-related overdose deaths rose 76% between
11 2013 and 2016.
12 (3) Opioid and other drug addictions are life-long
13 diseases that require a disease management approach and not
14 just episodic treatment.
15 (4) There is an urgent need to create a treatment
16 approach that proactively engages and encourages
17 individuals with opioid and other drug addictions into
18 treatment to help prevent chronic use and a worsening
19 addiction and to significantly curb the rate of overdose
20 deaths.
21 (b) With the goal of early initial engagement of
22individuals who have an opioid or other drug addiction in
23addiction treatment and for keeping individuals engaged in
24treatment following detoxification, a residential treatment
25stay, or hospitalization to prevent chronic recurrent drug use,

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1the Department of Healthcare and Family Services, in
2partnership with the Department of Human Services' Division of
3Alcoholism and Substance Abuse and with meaningful input from
4stakeholders, shall develop an Assertive Engagement and
5Community-Based Clinical Treatment Pilot Program for early
6treatment of an opioid or other drug addiction. The pilot
7program shall be implemented across a broad spectrum of
8geographic regions across the State.
9 (c) Assertive engagement and community-based clinical
10treatment services. All services included in the pilot program
11established under this Section shall be evidence-based or
12evidence-informed as applicable and the services shall be
13flexibly provided in-office, in-home, and in-community with an
14emphasis on in-home and in-community services. The model shall
15take into consideration area workforce, community uniqueness,
16and cultural diversity. The model shall, at a minimum, allow
17for and include each of the following:
18 (1) Assertive community outreach, engagement, and
19 continuing care strategies to encourage participation and
20 retention in addiction treatment services for both initial
21 engagement into addiction treatment services, and for
22 post-hospitalization, post-detoxification, and
23 post-residential treatment.
24 (2) Case management for purposes of linking
25 individuals to treatment, ongoing monitoring, problem
26 solving, and assisting individuals in organizing their

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1 treatment and goals. Case management shall be covered for
2 individuals not yet engaged in treatment for purposes of
3 reaching such individuals early on in their addiction and
4 for individuals in treatment.
5 (3) Clinical treatment that is delivered in an
6 individual's natural environment, including in-home or
7 in-community treatment, to better equip the individual
8 with coping mechanisms that may trigger re-use.
9 (4) Coverage of provider transportation costs in
10 delivering in-home and in-community services in both rural
11 and urban settings. For rural communities, the model shall
12 take into account the wider geographic areas providers are
13 required to travel for in-home and in-community pilot
14 services for purposes of reimbursement.
15 (5) Recovery support services.
16 (6) For individuals who receive services through the
17 pilot program but disengage for a short duration (a period
18 of no longer than 9 months), allow seamless treatment
19 re-engagement in the pilot program.
20 (7) Supported education and employment.
21 (8) Working with the individual's family, school, and
22 other community support systems.
23 (9) Service flexibility to enable recovery and
24 positive health outcomes.
25 (d) Federal waiver or State Plan amendment; implementation
26timeline. The Department shall follow the timeline for

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1application for federal approval and implementation outlined
2in subsection (c) of Section 5. The pilot program contemplated
3in this Section shall be implemented only to the extent that
4federal financial participation is available.
5 (e) Pay-for-performance payment model. The Department of
6Healthcare and Family Services, in partnership with the
7Department of Human Services' Division of Alcoholism and
8Substance Abuse and with meaningful input from stakeholders,
9shall develop a pay-for-performance payment model aimed at
10achieving high quality treatment and overall health and quality
11of life outcomes, rather than a fee-for-service payment model.
12The payment model shall allow for service flexibility to
13achieve such outcomes, shall cover actual provider costs of
14delivering the pilot program services to enable
15sustainability, and shall include all provider costs
16associated with the data collection for purposes of the
17analytics and outcomes reporting required in subsection (g).
18The Department shall ensure that the payment model works as
19intended by this Section within managed care.
20 (f) Rulemaking. The Department of Healthcare and Family
21Services, in partnership with the Department of Human Services'
22Division of Alcoholism and Substance Abuse and with meaningful
23input from stakeholders, shall develop rules for purposes of
24implementation of the pilot program within 6 months after
25federal approval of the pilot program. If the Department
26determines federal approval is not required for

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1implementation, the Department shall develop rules with
2meaningful stakeholder input no later than December 31, 2019.
3 (g) Pilot program analytics and outcomes reports. The
4Department of Healthcare and Family Services shall engage a
5third party partner with expertise in program evaluation,
6analysis, and research at the end of 5 years of implementation
7to review the outcomes of the pilot program in treating
8addiction and preventing periods of symptom exacerbation and
9recurrence. For purposes of evaluating the outcomes of the
10pilot program, the Department shall require providers of the
11pilot program services to track all of the following annual
12data:
13 (1) Length of engagement and retention in pilot program
14 services.
15 (2) Recurrence of drug use.
16 (3) Symptom management (the ability or inability to
17 control drug use).
18 (4) Days of hospitalizations related to substance use
19 or residential treatment stays.
20 (5) Periods of homelessness and periods of housing
21 stability.
22 (6) Periods of criminal justice involvement.
23 (7) Educational and employment attainment during
24 following pilot program services.
25 (8) Enrollee satisfaction with his or her quality of
26 life and level of social connectedness, pre-pilot and

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1 post-pilot services.
2 (h) The Department of Healthcare and Family Services shall
3deliver a final report to the General Assembly on the outcomes
4of the pilot program within one year after 4 years of full
5implementation, and after 7 years of full implementation,
6compared to typical treatment available to other youth with
7significant mental health conditions, as well as the cost
8savings associated with the pilot program taking into account
9all public systems used when an individual with a significant
10mental health condition does not have access to the right
11treatment and supports in the early stages of his or her
12illness.
13 The reports to the General Assembly shall be filed with the
14Clerk of the House of Representatives and the Secretary of the
15Senate in electronic form only, in the manner that the Clerk
16and the Secretary shall direct.
17 Post-pilot program discharge outcomes shall be collected
18for all service recipients who exit the pilot program for up to
193 years after exit. This includes youth who exit the program
20with planned or unplanned discharges. The post-exit data
21collected shall include the annual data listed in paragraphs
22(1) through (8) of subsection (g). Data collection shall be
23done in a manner that does not violate individual privacy laws.
24Outcomes for enrollees in the pilot and post-exit outcomes
25shall be included in the final report to the General Assembly
26under this subsection (h) within one year of 4 full years of

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1implementation, and in an additional report within one year of
27 full years of implementation in order to provide more
3information about post-exit outcomes on a greater number of
4youth who enroll in pilot program services in the final years
5of the pilot program.
6 Section 99. Effective date. This Act takes effect upon
7becoming law.
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