SB0726 EngrossedLRB103 03199 CPF 48205 b SB0726 Engrossed LRB103 03199 CPF 48205 b SB0726 Engrossed LRB103 03199 CPF 48205 b 1 AN ACT concerning health. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The School Code is amended by changing and 5 renumbering Section 2-3.196, as added by Public Act 103-546, 6 as follows: 7 (105 ILCS 5/2-3.203) 8 Sec. 2-3.203 2-3.196. Mental health screenings. 9 (a) On or before December 15, 2023, the State Board of 10 Education, in consultation with the Children's Behavioral 11 Health Transformation Officer, Children's Behavioral Health 12 Transformation Team, and the Office of the Governor, shall 13 file a report with the Governor and the General Assembly that 14 includes recommendations for implementation of mental health 15 screenings in schools for students enrolled in kindergarten 16 through grade 12. This report must include a landscape scan of 17 current district-wide screenings, recommendations for 18 screening tools, training for staff, and linkage and referral 19 for identified students. 20 (b) On or before October 1, 2024, the State Board of 21 Education, in consultation with the Children's Behavioral 22 Health Transformation Team, the Office of the Governor, and 23 relevant stakeholders as needed shall release a strategy that SB0726 Engrossed LRB103 03199 CPF 48205 b SB0726 Engrossed- 2 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 2 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 2 - LRB103 03199 CPF 48205 b 1 includes a tool for measuring capacity and readiness to 2 implement universal mental health screening of students. The 3 strategy shall build upon existing efforts to understand 4 district needs for resources, technology, training, and 5 infrastructure supports. The strategy shall include a 6 framework for supporting districts in a phased approach to 7 implement universal mental health screenings. The State Board 8 of Education shall issue a report to the Governor and the 9 General Assembly on school district readiness and plan for 10 phased approach to universal mental health screening of 11 students on or before April 1, 2025. 12 (Source: P.A. 103-546, eff. 8-11-23; revised 9-25-23.) 13 (105 ILCS 155/Act rep.) 14 Section 10. The Wellness Checks in Schools Program Act is 15 repealed. 16 Section 15. The Illinois Public Aid Code is amended by 17 changing Section 5-30.1 as follows: 18 (305 ILCS 5/5-30.1) 19 Sec. 5-30.1. Managed care protections. 20 (a) As used in this Section: 21 "Managed care organization" or "MCO" means any entity 22 which contracts with the Department to provide services where 23 payment for medical services is made on a capitated basis. SB0726 Engrossed - 2 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 3 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 3 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 3 - LRB103 03199 CPF 48205 b 1 "Emergency services" include: 2 (1) emergency services, as defined by Section 10 of 3 the Managed Care Reform and Patient Rights Act; 4 (2) emergency medical screening examinations, as 5 defined by Section 10 of the Managed Care Reform and 6 Patient Rights Act; 7 (3) post-stabilization medical services, as defined by 8 Section 10 of the Managed Care Reform and Patient Rights 9 Act; and 10 (4) emergency medical conditions, as defined by 11 Section 10 of the Managed Care Reform and Patient Rights 12 Act. 13 (b) As provided by Section 5-16.12, managed care 14 organizations are subject to the provisions of the Managed 15 Care Reform and Patient Rights Act. 16 (c) An MCO shall pay any provider of emergency services 17 that does not have in effect a contract with the contracted 18 Medicaid MCO. The default rate of reimbursement shall be the 19 rate paid under Illinois Medicaid fee-for-service program 20 methodology, including all policy adjusters, including but not 21 limited to Medicaid High Volume Adjustments, Medicaid 22 Percentage Adjustments, Outpatient High Volume Adjustments, 23 and all outlier add-on adjustments to the extent such 24 adjustments are incorporated in the development of the 25 applicable MCO capitated rates. 26 (d) An MCO shall pay for all post-stabilization services SB0726 Engrossed - 3 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 4 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 4 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 4 - LRB103 03199 CPF 48205 b 1 as a covered service in any of the following situations: 2 (1) the MCO authorized such services; 3 (2) such services were administered to maintain the 4 enrollee's stabilized condition within one hour after a 5 request to the MCO for authorization of further 6 post-stabilization services; 7 (3) the MCO did not respond to a request to authorize 8 such services within one hour; 9 (4) the MCO could not be contacted; or 10 (5) the MCO and the treating provider, if the treating 11 provider is a non-affiliated provider, could not reach an 12 agreement concerning the enrollee's care and an affiliated 13 provider was unavailable for a consultation, in which case 14 the MCO must pay for such services rendered by the 15 treating non-affiliated provider until an affiliated 16 provider was reached and either concurred with the 17 treating non-affiliated provider's plan of care or assumed 18 responsibility for the enrollee's care. Such payment shall 19 be made at the default rate of reimbursement paid under 20 Illinois Medicaid fee-for-service program methodology, 21 including all policy adjusters, including but not limited 22 to Medicaid High Volume Adjustments, Medicaid Percentage 23 Adjustments, Outpatient High Volume Adjustments and all 24 outlier add-on adjustments to the extent that such 25 adjustments are incorporated in the development of the 26 applicable MCO capitated rates. SB0726 Engrossed - 4 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 5 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 5 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 5 - LRB103 03199 CPF 48205 b 1 (e) The following requirements apply to MCOs in 2 determining payment for all emergency services: 3 (1) MCOs shall not impose any requirements for prior 4 approval of emergency services. 5 (2) The MCO shall cover emergency services provided to 6 enrollees who are temporarily away from their residence 7 and outside the contracting area to the extent that the 8 enrollees would be entitled to the emergency services if 9 they still were within the contracting area. 10 (3) The MCO shall have no obligation to cover medical 11 services provided on an emergency basis that are not 12 covered services under the contract. 13 (4) The MCO shall not condition coverage for emergency 14 services on the treating provider notifying the MCO of the 15 enrollee's screening and treatment within 10 days after 16 presentation for emergency services. 17 (5) The determination of the attending emergency 18 physician, or the provider actually treating the enrollee, 19 of whether an enrollee is sufficiently stabilized for 20 discharge or transfer to another facility, shall be 21 binding on the MCO. The MCO shall cover emergency services 22 for all enrollees whether the emergency services are 23 provided by an affiliated or non-affiliated provider. 24 (6) The MCO's financial responsibility for 25 post-stabilization care services it has not pre-approved 26 ends when: SB0726 Engrossed - 5 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 6 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 6 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 6 - LRB103 03199 CPF 48205 b 1 (A) a plan physician with privileges at the 2 treating hospital assumes responsibility for the 3 enrollee's care; 4 (B) a plan physician assumes responsibility for 5 the enrollee's care through transfer; 6 (C) a contracting entity representative and the 7 treating physician reach an agreement concerning the 8 enrollee's care; or 9 (D) the enrollee is discharged. 10 (f) Network adequacy and transparency. 11 (1) The Department shall: 12 (A) ensure that an adequate provider network is in 13 place, taking into consideration health professional 14 shortage areas and medically underserved areas; 15 (B) publicly release an explanation of its process 16 for analyzing network adequacy; 17 (C) periodically ensure that an MCO continues to 18 have an adequate network in place; 19 (D) require MCOs, including Medicaid Managed Care 20 Entities as defined in Section 5-30.2, to meet 21 provider directory requirements under Section 5-30.3; 22 (E) require MCOs to ensure that any 23 Medicaid-certified provider under contract with an MCO 24 and previously submitted on a roster on the date of 25 service is paid for any medically necessary, 26 Medicaid-covered, and authorized service rendered to SB0726 Engrossed - 6 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 7 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 7 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 7 - LRB103 03199 CPF 48205 b 1 any of the MCO's enrollees, regardless of inclusion on 2 the MCO's published and publicly available directory 3 of available providers; and 4 (F) require MCOs, including Medicaid Managed Care 5 Entities as defined in Section 5-30.2, to meet each of 6 the requirements under subsection (d-5) of Section 10 7 of the Network Adequacy and Transparency Act; with 8 necessary exceptions to the MCO's network to ensure 9 that admission and treatment with a provider or at a 10 treatment facility in accordance with the network 11 adequacy standards in paragraph (3) of subsection 12 (d-5) of Section 10 of the Network Adequacy and 13 Transparency Act is limited to providers or facilities 14 that are Medicaid certified. 15 (2) Each MCO shall confirm its receipt of information 16 submitted specific to physician or dentist additions or 17 physician or dentist deletions from the MCO's provider 18 network within 3 days after receiving all required 19 information from contracted physicians or dentists, and 20 electronic physician and dental directories must be 21 updated consistent with current rules as published by the 22 Centers for Medicare and Medicaid Services or its 23 successor agency. 24 (g) Timely payment of claims. 25 (1) The MCO shall pay a claim within 30 days of 26 receiving a claim that contains all the essential SB0726 Engrossed - 7 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 8 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 8 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 8 - LRB103 03199 CPF 48205 b 1 information needed to adjudicate the claim. 2 (2) The MCO shall notify the billing party of its 3 inability to adjudicate a claim within 30 days of 4 receiving that claim. 5 (3) The MCO shall pay a penalty that is at least equal 6 to the timely payment interest penalty imposed under 7 Section 368a of the Illinois Insurance Code for any claims 8 not timely paid. 9 (A) When an MCO is required to pay a timely payment 10 interest penalty to a provider, the MCO must calculate 11 and pay the timely payment interest penalty that is 12 due to the provider within 30 days after the payment of 13 the claim. In no event shall a provider be required to 14 request or apply for payment of any owed timely 15 payment interest penalties. 16 (B) Such payments shall be reported separately 17 from the claim payment for services rendered to the 18 MCO's enrollee and clearly identified as interest 19 payments. 20 (4)(A) The Department shall require MCOs to expedite 21 payments to providers identified on the Department's 22 expedited provider list, determined in accordance with 89 23 Ill. Adm. Code 140.71(b), on a schedule at least as 24 frequently as the providers are paid under the 25 Department's fee-for-service expedited provider schedule. 26 (B) Compliance with the expedited provider requirement SB0726 Engrossed - 8 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 9 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 9 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 9 - LRB103 03199 CPF 48205 b 1 may be satisfied by an MCO through the use of a Periodic 2 Interim Payment (PIP) program that has been mutually 3 agreed to and documented between the MCO and the provider, 4 if the PIP program ensures that any expedited provider 5 receives regular and periodic payments based on prior 6 period payment experience from that MCO. Total payments 7 under the PIP program may be reconciled against future PIP 8 payments on a schedule mutually agreed to between the MCO 9 and the provider. 10 (C) The Department shall share at least monthly its 11 expedited provider list and the frequency with which it 12 pays providers on the expedited list. 13 (g-5) Recognizing that the rapid transformation of the 14 Illinois Medicaid program may have unintended operational 15 challenges for both payers and providers: 16 (1) in no instance shall a medically necessary covered 17 service rendered in good faith, based upon eligibility 18 information documented by the provider, be denied coverage 19 or diminished in payment amount if the eligibility or 20 coverage information available at the time the service was 21 rendered is later found to be inaccurate in the assignment 22 of coverage responsibility between MCOs or the 23 fee-for-service system, except for instances when an 24 individual is deemed to have not been eligible for 25 coverage under the Illinois Medicaid program; and 26 (2) the Department shall, by December 31, 2016, adopt SB0726 Engrossed - 9 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 10 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 10 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 10 - LRB103 03199 CPF 48205 b 1 rules establishing policies that shall be included in the 2 Medicaid managed care policy and procedures manual 3 addressing payment resolutions in situations in which a 4 provider renders services based upon information obtained 5 after verifying a patient's eligibility and coverage plan 6 through either the Department's current enrollment system 7 or a system operated by the coverage plan identified by 8 the patient presenting for services: 9 (A) such medically necessary covered services 10 shall be considered rendered in good faith; 11 (B) such policies and procedures shall be 12 developed in consultation with industry 13 representatives of the Medicaid managed care health 14 plans and representatives of provider associations 15 representing the majority of providers within the 16 identified provider industry; and 17 (C) such rules shall be published for a review and 18 comment period of no less than 30 days on the 19 Department's website with final rules remaining 20 available on the Department's website. 21 The rules on payment resolutions shall include, but 22 not be limited to: 23 (A) the extension of the timely filing period; 24 (B) retroactive prior authorizations; and 25 (C) guaranteed minimum payment rate of no less 26 than the current, as of the date of service, SB0726 Engrossed - 10 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 11 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 11 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 11 - LRB103 03199 CPF 48205 b 1 fee-for-service rate, plus all applicable add-ons, 2 when the resulting service relationship is out of 3 network. 4 The rules shall be applicable for both MCO coverage 5 and fee-for-service coverage. 6 If the fee-for-service system is ultimately determined to 7 have been responsible for coverage on the date of service, the 8 Department shall provide for an extended period for claims 9 submission outside the standard timely filing requirements. 10 (g-6) MCO Performance Metrics Report. 11 (1) The Department shall publish, on at least a 12 quarterly basis, each MCO's operational performance, 13 including, but not limited to, the following categories of 14 metrics: 15 (A) claims payment, including timeliness and 16 accuracy; 17 (B) prior authorizations; 18 (C) grievance and appeals; 19 (D) utilization statistics; 20 (E) provider disputes; 21 (F) provider credentialing; and 22 (G) member and provider customer service. 23 (2) The Department shall ensure that the metrics 24 report is accessible to providers online by January 1, 25 2017. 26 (3) The metrics shall be developed in consultation SB0726 Engrossed - 11 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 12 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 12 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 12 - LRB103 03199 CPF 48205 b 1 with industry representatives of the Medicaid managed care 2 health plans and representatives of associations 3 representing the majority of providers within the 4 identified industry. 5 (4) Metrics shall be defined and incorporated into the 6 applicable Managed Care Policy Manual issued by the 7 Department. 8 (g-7) MCO claims processing and performance analysis. In 9 order to monitor MCO payments to hospital providers, pursuant 10 to Public Act 100-580, the Department shall post an analysis 11 of MCO claims processing and payment performance on its 12 website every 6 months. Such analysis shall include a review 13 and evaluation of a representative sample of hospital claims 14 that are rejected and denied for clean and unclean claims and 15 the top 5 reasons for such actions and timeliness of claims 16 adjudication, which identifies the percentage of claims 17 adjudicated within 30, 60, 90, and over 90 days, and the dollar 18 amounts associated with those claims. 19 (g-8) Dispute resolution process. The Department shall 20 maintain a provider complaint portal through which a provider 21 can submit to the Department unresolved disputes with an MCO. 22 An unresolved dispute means an MCO's decision that denies in 23 whole or in part a claim for reimbursement to a provider for 24 health care services rendered by the provider to an enrollee 25 of the MCO with which the provider disagrees. Disputes shall 26 not be submitted to the portal until the provider has availed SB0726 Engrossed - 12 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 13 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 13 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 13 - LRB103 03199 CPF 48205 b 1 itself of the MCO's internal dispute resolution process. 2 Disputes that are submitted to the MCO internal dispute 3 resolution process may be submitted to the Department of 4 Healthcare and Family Services' complaint portal no sooner 5 than 30 days after submitting to the MCO's internal process 6 and not later than 30 days after the unsatisfactory resolution 7 of the internal MCO process or 60 days after submitting the 8 dispute to the MCO internal process. Multiple claim disputes 9 involving the same MCO may be submitted in one complaint, 10 regardless of whether the claims are for different enrollees, 11 when the specific reason for non-payment of the claims 12 involves a common question of fact or policy. Within 10 13 business days of receipt of a complaint, the Department shall 14 present such disputes to the appropriate MCO, which shall then 15 have 30 days to issue its written proposal to resolve the 16 dispute. The Department may grant one 30-day extension of this 17 time frame to one of the parties to resolve the dispute. If the 18 dispute remains unresolved at the end of this time frame or the 19 provider is not satisfied with the MCO's written proposal to 20 resolve the dispute, the provider may, within 30 days, request 21 the Department to review the dispute and make a final 22 determination. Within 30 days of the request for Department 23 review of the dispute, both the provider and the MCO shall 24 present all relevant information to the Department for 25 resolution and make individuals with knowledge of the issues 26 available to the Department for further inquiry if needed. SB0726 Engrossed - 13 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 14 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 14 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 14 - LRB103 03199 CPF 48205 b 1 Within 30 days of receiving the relevant information on the 2 dispute, or the lapse of the period for submitting such 3 information, the Department shall issue a written decision on 4 the dispute based on contractual terms between the provider 5 and the MCO, contractual terms between the MCO and the 6 Department of Healthcare and Family Services and applicable 7 Medicaid policy. The decision of the Department shall be 8 final. By January 1, 2020, the Department shall establish by 9 rule further details of this dispute resolution process. 10 Disputes between MCOs and providers presented to the 11 Department for resolution are not contested cases, as defined 12 in Section 1-30 of the Illinois Administrative Procedure Act, 13 conferring any right to an administrative hearing. 14 (g-9)(1) The Department shall publish annually on its 15 website a report on the calculation of each managed care 16 organization's medical loss ratio showing the following: 17 (A) Premium revenue, with appropriate adjustments. 18 (B) Benefit expense, setting forth the aggregate 19 amount spent for the following: 20 (i) Direct paid claims. 21 (ii) Subcapitation payments. 22 (iii) Other claim payments. 23 (iv) Direct reserves. 24 (v) Gross recoveries. 25 (vi) Expenses for activities that improve health 26 care quality as allowed by the Department. SB0726 Engrossed - 14 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 15 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 15 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 15 - LRB103 03199 CPF 48205 b 1 (2) The medical loss ratio shall be calculated consistent 2 with federal law and regulation following a claims runout 3 period determined by the Department. 4 (g-10)(1) "Liability effective date" means the date on 5 which an MCO becomes responsible for payment for medically 6 necessary and covered services rendered by a provider to one 7 of its enrollees in accordance with the contract terms between 8 the MCO and the provider. The liability effective date shall 9 be the later of: 10 (A) The execution date of a network participation 11 contract agreement. 12 (B) The date the provider or its representative 13 submits to the MCO the complete and accurate standardized 14 roster form for the provider in the format approved by the 15 Department. 16 (C) The provider effective date contained within the 17 Department's provider enrollment subsystem within the 18 Illinois Medicaid Program Advanced Cloud Technology 19 (IMPACT) System. 20 (2) The standardized roster form may be submitted to the 21 MCO at the same time that the provider submits an enrollment 22 application to the Department through IMPACT. 23 (3) By October 1, 2019, the Department shall require all 24 MCOs to update their provider directory with information for 25 new practitioners of existing contracted providers within 30 26 days of receipt of a complete and accurate standardized roster SB0726 Engrossed - 15 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 16 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 16 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 16 - LRB103 03199 CPF 48205 b 1 template in the format approved by the Department provided 2 that the provider is effective in the Department's provider 3 enrollment subsystem within the IMPACT system. Such provider 4 directory shall be readily accessible for purposes of 5 selecting an approved health care provider and comply with all 6 other federal and State requirements. 7 (g-11) The Department shall work with relevant 8 stakeholders on the development of operational guidelines to 9 enhance and improve operational performance of Illinois' 10 Medicaid managed care program, including, but not limited to, 11 improving provider billing practices, reducing claim 12 rejections and inappropriate payment denials, and 13 standardizing processes, procedures, definitions, and response 14 timelines, with the goal of reducing provider and MCO 15 administrative burdens and conflict. The Department shall 16 include a report on the progress of these program improvements 17 and other topics in its Fiscal Year 2020 annual report to the 18 General Assembly. 19 (g-12) Notwithstanding any other provision of law, if the 20 Department or an MCO requires submission of a claim for 21 payment in a non-electronic format, a provider shall always be 22 afforded a period of no less than 90 business days, as a 23 correction period, following any notification of rejection by 24 either the Department or the MCO to correct errors or 25 omissions in the original submission. 26 Under no circumstances, either by an MCO or under the SB0726 Engrossed - 16 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 17 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 17 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 17 - LRB103 03199 CPF 48205 b 1 State's fee-for-service system, shall a provider be denied 2 payment for failure to comply with any timely submission 3 requirements under this Code or under any existing contract, 4 unless the non-electronic format claim submission occurs after 5 the initial 180 days following the latest date of service on 6 the claim, or after the 90 business days correction period 7 following notification to the provider of rejection or denial 8 of payment. 9 (h) The Department shall not expand mandatory MCO 10 enrollment into new counties beyond those counties already 11 designated by the Department as of June 1, 2014 for the 12 individuals whose eligibility for medical assistance is not 13 the seniors or people with disabilities population until the 14 Department provides an opportunity for accountable care 15 entities and MCOs to participate in such newly designated 16 counties. 17 (h-5) Leading indicator data sharing. By January 1, 2024, 18 the Department shall obtain input from the Department of Human 19 Services, the Department of Juvenile Justice, the Department 20 of Children and Family Services, the State Board of Education, 21 managed care organizations, providers, and clinical experts to 22 identify and analyze key indicators and data elements that can 23 be used in an analysis of lead indicators from assessments and 24 data sets available to the Department that can be shared with 25 managed care organizations and similar care coordination 26 entities contracted with the Department as leading indicators SB0726 Engrossed - 17 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 18 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 18 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 18 - LRB103 03199 CPF 48205 b 1 for elevated behavioral health crisis risk for children, 2 including data sets such as the Illinois Medicaid 3 Comprehensive Assessment of Needs and Strengths (IM-CANS), 4 calls made to the State's Crisis and Referral Entry Services 5 (CARES) hotline, health services information from Health and 6 Human Services Innovators, or other data sets that may include 7 key indicators. The workgroup shall complete its 8 recommendations for leading indicator data elements on or 9 before September 1, 2024. To the extent permitted by State and 10 federal law, the identified leading indicators shall be shared 11 with managed care organizations and similar care coordination 12 entities contracted with the Department on or before December 13 1, 2024 within 6 months of identification for the purpose of 14 improving care coordination with the early detection of 15 elevated risk. Leading indicators shall be reassessed annually 16 with stakeholder input. The Department shall implement 17 guidance to managed care organizations and similar care 18 coordination entities contracted with the Department, so that 19 the managed care organizations and care coordination entities 20 respond to lead indicators with services and interventions 21 that are designed to help stabilize the child. 22 (i) The requirements of this Section apply to contracts 23 with accountable care entities and MCOs entered into, amended, 24 or renewed after June 16, 2014 (the effective date of Public 25 Act 98-651). 26 (j) Health care information released to managed care SB0726 Engrossed - 18 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 19 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 19 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 19 - LRB103 03199 CPF 48205 b 1 organizations. A health care provider shall release to a 2 Medicaid managed care organization, upon request, and subject 3 to the Health Insurance Portability and Accountability Act of 4 1996 and any other law applicable to the release of health 5 information, the health care information of the MCO's 6 enrollee, if the enrollee has completed and signed a general 7 release form that grants to the health care provider 8 permission to release the recipient's health care information 9 to the recipient's insurance carrier. 10 (k) The Department of Healthcare and Family Services, 11 managed care organizations, a statewide organization 12 representing hospitals, and a statewide organization 13 representing safety-net hospitals shall explore ways to 14 support billing departments in safety-net hospitals. 15 (l) The requirements of this Section added by Public Act 16 102-4 shall apply to services provided on or after the first 17 day of the month that begins 60 days after April 27, 2021 (the 18 effective date of Public Act 102-4). 19 (Source: P.A. 102-4, eff. 4-27-21; 102-43, eff. 7-6-21; 20 102-144, eff. 1-1-22; 102-454, eff. 8-20-21; 102-813, eff. 21 5-13-22; 103-546, eff. 8-11-23.) 22 Section 20. The Children's Mental Health Act is amended by 23 changing Section 5 as follows: 24 (405 ILCS 49/5) SB0726 Engrossed - 19 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 20 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 20 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 20 - LRB103 03199 CPF 48205 b 1 Sec. 5. Children's Mental Health Partnership; Children's 2 Mental Health Plan. 3 (a) The Children's Mental Health Partnership (hereafter 4 referred to as "the Partnership") created under Public Act 5 93-495 and continued under Public Act 102-899 shall advise 6 State agencies and the Children's Behavioral Health 7 Transformation Initiative on designing and implementing 8 short-term and long-term strategies to provide comprehensive 9 and coordinated services for children from birth to age 25 and 10 their families with the goal of addressing children's mental 11 health needs across a full continuum of care, including social 12 determinants of health, prevention, early identification, and 13 treatment. The recommended strategies shall build upon the 14 recommendations in the Children's Mental Health Plan of 2022 15 and may include, but are not limited to, recommendations 16 regarding the following: 17 (1) Increasing public awareness on issues connected to 18 children's mental health and wellness to decrease stigma, 19 promote acceptance, and strengthen the ability of 20 children, families, and communities to access supports. 21 (2) Coordination of programs, services, and policies 22 across child-serving State agencies to best monitor and 23 assess spending, as well as foster innovation of adaptive 24 or new practices. 25 (3) Funding and resources for children's mental health 26 prevention, early identification, and treatment across SB0726 Engrossed - 20 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 21 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 21 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 21 - LRB103 03199 CPF 48205 b 1 child-serving State agencies. 2 (4) Facilitation of research on best practices and 3 model programs and dissemination of this information to 4 State policymakers, practitioners, and the general public. 5 (5) Monitoring programs, services, and policies 6 addressing children's mental health and wellness. 7 (6) Growing, retaining, diversifying, and supporting 8 the child-serving workforce, with special emphasis on 9 professional development around child and family mental 10 health and wellness services. 11 (7) Supporting the design, implementation, and 12 evaluation of a quality-driven children's mental health 13 system of care across all child services that prevents 14 mental health concerns and mitigates trauma. 15 (8) Improving the system to more effectively meet the 16 emergency and residential placement needs for all children 17 with severe mental and behavioral challenges. 18 (b) The Partnership shall have the responsibility of 19 developing and updating the Children's Mental Health Plan and 20 advising the relevant State agencies on implementation of the 21 Plan. The Children's Mental Health Partnership shall be 22 comprised of the following members: 23 (1) The Governor or his or her designee. 24 (2) The Attorney General or his or her designee. 25 (3) The Secretary of the Department of Human Services 26 or his or her designee. SB0726 Engrossed - 21 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 22 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 22 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 22 - LRB103 03199 CPF 48205 b 1 (4) The State Superintendent of Education or his or 2 her designee. 3 (5) The Director of the Department of Children and 4 Family Services or his or her designee. 5 (6) The Director of the Department of Healthcare and 6 Family Services or his or her designee. 7 (7) The Director of the Department of Public Health or 8 his or her designee. 9 (8) The Director of the Department of Juvenile Justice 10 or his or her designee. 11 (9) The Executive Director of the Governor's Office of 12 Early Childhood Development or his or her designee. 13 (10) The Director of the Criminal Justice Information 14 Authority or his or her designee. 15 (11) One member of the General Assembly appointed by 16 the Speaker of the House. 17 (12) One member of the General Assembly appointed by 18 the President of the Senate. 19 (13) One member of the General Assembly appointed by 20 the Minority Leader of the Senate. 21 (14) One member of the General Assembly appointed by 22 the Minority Leader of the House. 23 (15) Up to 25 representatives from the public 24 reflecting a diversity of age, gender identity, race, 25 ethnicity, socioeconomic status, and geographic location, 26 to be appointed by the Governor. Those public members SB0726 Engrossed - 22 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 23 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 23 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 23 - LRB103 03199 CPF 48205 b 1 appointed under this paragraph must include, but are not 2 limited to: 3 (A) a family member or individual with lived 4 experience in the children's mental health system; 5 (B) a child advocate; 6 (C) a community mental health expert, 7 practitioner, or provider; 8 (D) a representative of a statewide association 9 representing a majority of hospitals in the State; 10 (E) an early childhood expert or practitioner; 11 (F) a representative from the K-12 school system; 12 (G) a representative from the healthcare sector; 13 (H) a substance use prevention expert or 14 practitioner, or a representative of a statewide 15 association representing community-based mental health 16 substance use disorder treatment providers in the 17 State; 18 (I) a violence prevention expert or practitioner; 19 (J) a representative from the juvenile justice 20 system; 21 (K) a school social worker; and 22 (L) a representative of a statewide organization 23 representing pediatricians. 24 (16) Two co-chairs appointed by the Governor, one 25 being a representative from the public and one being the 26 Director of Public Health a representative from the State. SB0726 Engrossed - 23 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 24 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 24 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 24 - LRB103 03199 CPF 48205 b 1 The members appointed by the Governor shall be appointed 2 for 4 years with one opportunity for reappointment, except as 3 otherwise provided for in this subsection. Members who were 4 appointed by the Governor and are serving on January 1, 2023 5 (the effective date of Public Act 102-899) shall maintain 6 their appointment until the term of their appointment has 7 expired. For new appointments made pursuant to Public Act 8 102-899, members shall be appointed for one-year, 2-year, or 9 4-year terms, as determined by the Governor, with no more than 10 9 of the Governor's new or existing appointees serving the 11 same term. Those new appointments serving a one-year or 2-year 12 term may be appointed to 2 additional 4-year terms. If a 13 vacancy occurs in the Partnership membership, the vacancy 14 shall be filled in the same manner as the original appointment 15 for the remainder of the term. 16 The Partnership shall be convened no later than January 17 31, 2023 to discuss the changes in Public Act 102-899. 18 The members of the Partnership shall serve without 19 compensation but may be entitled to reimbursement for all 20 necessary expenses incurred in the performance of their 21 official duties as members of the Partnership from funds 22 appropriated for that purpose. 23 The Partnership may convene and appoint special committees 24 or study groups to operate under the direction of the 25 Partnership. Persons appointed to such special committees or 26 study groups shall only receive reimbursement for reasonable SB0726 Engrossed - 24 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 25 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 25 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 25 - LRB103 03199 CPF 48205 b 1 expenses. 2 (b-5) The Partnership shall include an adjunct council 3 comprised of no more than 6 youth aged 14 to 25 and 4 4 representatives of 4 different community-based organizations 5 that focus on youth mental health. Of the community-based 6 organizations that focus on youth mental health, one of the 7 community-based organizations shall be led by an 8 LGBTQ-identified person, one of the community-based 9 organizations shall be led by a person of color, and one of the 10 community-based organizations shall be led by a woman. Of the 11 representatives appointed to the council from the 12 community-based organizations, at least one representative 13 shall be LGBTQ-identified, at least one representative shall 14 be a person of color, and at least one representative shall be 15 a woman. The council members shall be appointed by the Chair of 16 the Partnership and shall reflect the racial, gender identity, 17 sexual orientation, ability, socioeconomic, ethnic, and 18 geographic diversity of the State, including rural, suburban, 19 and urban appointees. The council shall make recommendations 20 to the Partnership regarding youth mental health, including, 21 but not limited to, identifying barriers to youth feeling 22 supported by and empowered by the system of mental health and 23 treatment providers, barriers perceived by youth in accessing 24 mental health services, gaps in the mental health system, 25 available resources in schools, including youth's perceptions 26 and experiences with outreach personnel, agency websites, and SB0726 Engrossed - 25 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 26 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 26 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 26 - LRB103 03199 CPF 48205 b 1 informational materials, methods to destigmatize mental health 2 services, and how to improve State policy concerning student 3 mental health. The mental health system may include services 4 for substance use disorders and addiction. The council shall 5 meet at least 4 times annually. 6 (c) (Blank). 7 (d) The Illinois Children's Mental Health Partnership has 8 the following powers and duties: 9 (1) Conducting research assessments to determine the 10 needs and gaps of programs, services, and policies that 11 touch children's mental health. 12 (2) Developing policy statements for interagency 13 cooperation to cover all aspects of mental health 14 delivery, including social determinants of health, 15 prevention, early identification, and treatment. 16 (3) Recommending policies and providing information on 17 effective programs for delivery of mental health services. 18 (4) Using funding from federal, State, or 19 philanthropic partners, to fund pilot programs or research 20 activities to resource innovative practices by 21 organizational partners that will address children's 22 mental health. However, the Partnership may not provide 23 direct services. 24 (4.1) The Partnership shall work with community 25 networks and the Children's Behavioral Health 26 Transformation Initiative team to implement a community SB0726 Engrossed - 26 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 27 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 27 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 27 - LRB103 03199 CPF 48205 b 1 needs assessment, that will raise awareness of gaps in 2 existing community-based services for youth. 3 (5) Submitting an annual report, on or before December 4 30 of each year, to the Governor and the General Assembly 5 on the progress of the Plan, any recommendations regarding 6 State policies, laws, or rules necessary to fulfill the 7 purposes of the Act, and any additional recommendations 8 regarding mental or behavioral health that the Partnership 9 deems necessary. 10 (6) (Blank). Employing an Executive Director and 11 setting the compensation of the Executive Director and 12 other such employees and technical assistance as it deems 13 necessary to carry out its duties under this Section. 14 The Partnership may designate a fiscal and administrative 15 agent that can accept funds to carry out its duties as outlined 16 in this Section. 17 The Department of Public Health Healthcare and Family 18 Services shall provide technical and administrative support 19 for the Partnership. 20 (e) The Partnership may accept monetary gifts or grants 21 from the federal government or any agency thereof, from any 22 charitable foundation or professional association, or from any 23 reputable source for implementation of any program necessary 24 or desirable to carry out the powers and duties as defined 25 under this Section. 26 (f) On or before January 1, 2027, the Partnership shall SB0726 Engrossed - 27 - LRB103 03199 CPF 48205 b SB0726 Engrossed- 28 -LRB103 03199 CPF 48205 b SB0726 Engrossed - 28 - LRB103 03199 CPF 48205 b SB0726 Engrossed - 28 - LRB103 03199 CPF 48205 b 1 submit recommendations to the Governor and General Assembly 2 that includes recommended updates to the Act to reflect the 3 current mental health landscape in this State. 4 (Source: P.A. 102-16, eff. 6-17-21; 102-116, eff. 7-23-21; 5 102-899, eff. 1-1-23; 102-1034, eff. 1-1-23; 103-154, eff. 6 6-30-23.) 7 Section 25. The Interagency Children's Behavioral Health 8 Services Act is amended by adding Section 6 as follows: 9 (405 ILCS 165/6 new) 10 Sec. 6. Personal support workers. The Children's 11 Behavioral Health Transformation Team in collaboration with 12 the Department of Human Services shall develop a program to 13 provide one-on-one in-home respite behavioral health aids to 14 youth requiring intensive supervision due to behavioral health 15 needs. SB0726 Engrossed - 28 - LRB103 03199 CPF 48205 b