104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 HB2993 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED: 305 ILCS 66/20-10 Amends the Rebuild Illinois Mental Health Workforce Act. Provides that beginning January 1, 2026, for each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of community support individual services based on the number of Medicaid users of community support individual services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. Sets forth how the monthly directed payment shall be calculated. Requires the Department of Healthcare and Family Services to adjust and pay community mental health providers for any payments authorized for all services from a community mental health provider which have been paid by a Medicaid managed care organization but no encounter claim has been recorded in the Departments' Enterprise Data Warehouse. Provides that the Department must develop a process for community mental health providers to reconcile these payments and submit claims for which the Department has not used for making payments. Permits the Department to sanction Medicaid managed care organizations for services not received by the Department. LRB104 10054 KTG 20125 b A BILL FOR 104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 HB2993 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED: 305 ILCS 66/20-10 305 ILCS 66/20-10 Amends the Rebuild Illinois Mental Health Workforce Act. Provides that beginning January 1, 2026, for each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of community support individual services based on the number of Medicaid users of community support individual services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. Sets forth how the monthly directed payment shall be calculated. Requires the Department of Healthcare and Family Services to adjust and pay community mental health providers for any payments authorized for all services from a community mental health provider which have been paid by a Medicaid managed care organization but no encounter claim has been recorded in the Departments' Enterprise Data Warehouse. Provides that the Department must develop a process for community mental health providers to reconcile these payments and submit claims for which the Department has not used for making payments. Permits the Department to sanction Medicaid managed care organizations for services not received by the Department. LRB104 10054 KTG 20125 b LRB104 10054 KTG 20125 b A BILL FOR
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 HB2993 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
305 ILCS 66/20-10 305 ILCS 66/20-10
305 ILCS 66/20-10
Amends the Rebuild Illinois Mental Health Workforce Act. Provides that beginning January 1, 2026, for each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of community support individual services based on the number of Medicaid users of community support individual services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. Sets forth how the monthly directed payment shall be calculated. Requires the Department of Healthcare and Family Services to adjust and pay community mental health providers for any payments authorized for all services from a community mental health provider which have been paid by a Medicaid managed care organization but no encounter claim has been recorded in the Departments' Enterprise Data Warehouse. Provides that the Department must develop a process for community mental health providers to reconcile these payments and submit claims for which the Department has not used for making payments. Permits the Department to sanction Medicaid managed care organizations for services not received by the Department.
LRB104 10054 KTG 20125 b LRB104 10054 KTG 20125 b
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A BILL FOR
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HB2993 LRB104 10054 KTG 20125 b
1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Rebuild Illinois Mental Health Workforce
5 Act is amended by changing Section 20-10 as follows:
6 (305 ILCS 66/20-10)
7 Sec. 20-10. Medicaid funding for community mental health
8 services. Medicaid funding for the specific community mental
9 health services listed in this Act shall be adjusted and paid
10 as set forth in this Act. Such payments shall be paid in
11 addition to the base Medicaid reimbursement rate and add-on
12 payment rates per service unit.
13 (a) The payment adjustments shall begin on July 1, 2022
14 for State Fiscal Year 2023 and shall continue for every State
15 fiscal year thereafter.
16 (1) Individual Therapy Medicaid Payment rate for
17 services provided under the H0004 Code:
18 (A) The Medicaid total payment rate for individual
19 therapy provided by a qualified mental health
20 professional shall be increased by no less than $9 per
21 service unit.
22 (B) The Medicaid total payment rate for individual
23 therapy provided by a mental health professional shall
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 HB2993 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
305 ILCS 66/20-10 305 ILCS 66/20-10
305 ILCS 66/20-10
Amends the Rebuild Illinois Mental Health Workforce Act. Provides that beginning January 1, 2026, for each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of community support individual services based on the number of Medicaid users of community support individual services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year. Sets forth how the monthly directed payment shall be calculated. Requires the Department of Healthcare and Family Services to adjust and pay community mental health providers for any payments authorized for all services from a community mental health provider which have been paid by a Medicaid managed care organization but no encounter claim has been recorded in the Departments' Enterprise Data Warehouse. Provides that the Department must develop a process for community mental health providers to reconcile these payments and submit claims for which the Department has not used for making payments. Permits the Department to sanction Medicaid managed care organizations for services not received by the Department.
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LRB104 10054 KTG 20125 b
A BILL FOR
305 ILCS 66/20-10
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1 be increased by no less than $9 per service unit.
2 (2) Community Support - Individual Medicaid Payment
3 rate for services provided under the H2015 Code: All
4 community support - individual services shall be increased
5 by no less than $15 per service unit.
6 (3) Case Management Medicaid Add-on Payment for
7 services provided under the T1016 code: All case
8 management services rates shall be increased by no less
9 than $15 per service unit.
10 (4) Assertive Community Treatment Medicaid Add-on
11 Payment for services provided under the H0039 code: The
12 Medicaid total payment rate for assertive community
13 treatment services shall increase by no less than $8 per
14 service unit.
15 (5) Medicaid user-based directed payments.
16 (A) For each State fiscal year, a monthly directed
17 payment shall be paid to a community mental health
18 provider of community support team services based on
19 the number of Medicaid users of community support team
20 services documented by Medicaid fee-for-service and
21 managed care encounter claims delivered by that
22 provider in the base year. The Department of
23 Healthcare and Family Services shall make the monthly
24 directed payment to each provider entitled to directed
25 payments under this Act by no later than the last day
26 of each month throughout each State fiscal year.
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1 (i) The monthly directed payment for a
2 community support team provider shall be
3 calculated as follows: The sum total number of
4 individual Medicaid users of community support
5 team services delivered by that provider
6 throughout the base year, multiplied by $4,200 per
7 Medicaid user, divided into 12 equal monthly
8 payments for the State fiscal year.
9 (ii) As used in this subparagraph, "user"
10 means an individual who received at least 200
11 units of community support team services (H2016)
12 during the base year.
13 (B) For each State fiscal year, a monthly directed
14 payment shall be paid to each community mental health
15 provider of assertive community treatment services
16 based on the number of Medicaid users of assertive
17 community treatment services documented by Medicaid
18 fee-for-service and managed care encounter claims
19 delivered by the provider in the base year.
20 (i) The monthly direct payment for an
21 assertive community treatment provider shall be
22 calculated as follows: The sum total number of
23 Medicaid users of assertive community treatment
24 services provided by that provider throughout the
25 base year, multiplied by $6,000 per Medicaid user,
26 divided into 12 equal monthly payments for that
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1 State fiscal year.
2 (ii) As used in this subparagraph, "user"
3 means an individual that received at least 300
4 units of assertive community treatment services
5 during the base year.
6 (B-5) Beginning January 1, 2026, for each State
7 fiscal year, a monthly directed payment shall be paid
8 to each community mental health provider of community
9 support individual services based on the number of
10 Medicaid users of community support individual
11 services documented by Medicaid fee-for-service and
12 managed care encounter claims delivered by the
13 provider in the base year. The monthly direct payment
14 for a community support individual provider shall be
15 calculated as follows: The sum total number of
16 Medicaid users of community support individual
17 services provided by that provider throughout the base
18 year, multiplied by $2,400 per Medicaid user, divided
19 into 12 equal monthly payments for that State fiscal
20 year.
21 As used in this subparagraph, "user" means an
22 individual that received at least 100 units of
23 community support individual services during the base
24 year.
25 (C) The base year for directed payments under this
26 Section shall be calendar year 2019 for State Fiscal
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1 Year 2023 and State Fiscal Year 2024. For the State
2 fiscal year beginning on July 1, 2024, and for every
3 State fiscal year thereafter, the base year shall be
4 the calendar year that ended 18 months prior to the
5 start of the State fiscal year in which payments are
6 made.
7 (D) The Department must adjust and pay community
8 mental health providers for any payments authorized
9 under this paragraph (5) for all services from a
10 community mental health provider which have been paid
11 by a Medicaid managed care organization but no
12 encounter claim has been recorded in the Departments'
13 Enterprise Data Warehouse. The Department must develop
14 a process for community mental health providers to
15 reconcile these payments and submit claims for which
16 the Department has not used for making payments. The
17 Department may sanction Medicaid managed care
18 organizations for services not received by the
19 Department.
20 (b) Subject to federal approval, a one-time directed
21 payment must be made in calendar year 2023 for community
22 mental health services provided by community mental health
23 providers. The one-time directed payment shall be for an
24 amount appropriated for these purposes. The one-time directed
25 payment shall be for services for Integrated Assessment and
26 Treatment Planning and other intensive services, including,
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1 but not limited to, services for Mobile Crisis Response,
2 crisis intervention, and medication monitoring. The amounts
3 and services used for designing and distributing these
4 one-time directed payments shall not be construed to require
5 any future rate or funding increases for the same or other
6 mental health services.
7 (c) The following payment adjustments shall be made:
8 (1) Subject to federal approval, beginning on January
9 1, 2024, the Department shall introduce rate increases to
10 behavioral health services no less than by the following
11 targeted pool for the specified services provided by
12 community mental health centers:
13 (A) Mobile Crisis Response, $6,800,000;
14 (B) Crisis Intervention, $4,000,000;
15 (C) Integrative Assessment and Treatment Planning
16 services, $10,500,000;
17 (D) Group Therapy, $1,200,000;
18 (E) Family Therapy, $500,000;
19 (F) Community Support Group, $4,000,000; and
20 (G) Medication Monitoring, $3,000,000.
21 (2) Rate increases shall be determined with
22 significant input from Illinois behavioral health trade
23 associations and advocates. The Department must use
24 service units delivered under the fee-for-service and
25 managed care programs by community mental health centers
26 during State Fiscal Year 2022. These services are used for
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1 distributing the targeted pools and setting rates but do
2 not prohibit the Department from paying providers not
3 enrolled as community mental health centers the same rate
4 if providing the same services.
5 (d) Rate simplification for team-based services.
6 (1) The Department shall work with stakeholders to
7 redesign reimbursement rates for behavioral health
8 team-based services established under the Rehabilitation
9 Option of the Illinois Medicaid State Plan supporting
10 individuals with chronic or complex behavioral health
11 conditions and crisis services. Subject to federal
12 approval, the redesigned rates shall seek to introduce
13 bundled payment systems that minimize provider claiming
14 activities while transitioning the focus of treatment
15 towards metrics and outcomes. Federally approved rate
16 models shall seek to ensure reimbursement levels are no
17 less than the State's total reimbursement for similar
18 services in calendar year 2023, including all service
19 level payments, add-ons, and all other payments specified
20 in this Section.
21 (2) In State Fiscal Year 2024, the Department shall
22 identify an existing, or establish a new, Behavioral
23 Health Outcomes Stakeholder Workgroup to help inform the
24 identification of metrics and outcomes for team-based
25 services.
26 (3) In State Fiscal Year 2025, subject to federal
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