§ 71a — Community Behavioral Health Care

(a) The Department shall strive to guarantee that persons, including children, suffering from mental illness, substance abuse, and other behavioral disorders have access to locally accessible behavioral health care providers who have the ability to treat the person's conditions in a cost effective, outcome-based manner. To ensure continuity and quality of care that is integrated with the person's overall medical care, the Department shall: (1) Designate as essential community behavioral health care providers organizations that meet the qualifications set forth in subsection (b) of this Section. (2) Promote the co-location of primary and behavioral health care services centers. (3) Promote access to necessary behavioral health care services in the State's Health Insurance Exchange policies. (4) Promote continuity of care for persons moving between Medicaid, SCHIP, and programs administered by the Department that provide behavioral health care services. (5) Promote continuity of care for persons not yet eligible for Medicaid or who are without insurance coverage for their conditions. (6) Work toward improving access in Illinois' underserved and health professional shortage areas. (b) The Department shall designate certain community behavioral health care providers as essential community behavioral health care providers. To qualify for the designation an organization must be a not-for-profit organization under the Internal Revenue Code or a governmental entity that: (1) Demonstrates a commitment to serving low-income and underserved populations. (2) Provides outcome-based community behavioral health care treatment or services. (3) Does not restrict access or services because of a client's financial limitation. (4) Is a community behavioral health care provider certified by the Department, or a licensed community behavioral health care provider holding a purchase of care contract with the State under the State's Medicaid program. An organization that is licensed or certified by the Department may apply to the Department for designation as an essential community behavioral health care provider. The Department, through administrative rule, shall describe the standards and process of designating an essential community behavioral health care provider, establishing the community to be served, other criteria for selection, and grounds for termination. (c) An organization designated as an essential community behavioral health care provider under subsection (b) and all members of the care treatment and service staff of the essential community behavioral health care provider shall agree to serve enrollees of all health insurers or health care service contractors operating in the area that the designated essential community behavioral health care provider serves. Health insurers shall include State programs funded under Title XIX and Title XXI of the federal Social Security Act, including the State's Medicaid program and the Covering ALL KIDS Health Insurance Program; other programs funded by the Department of Healthcare and Family Services for non-public employees; and programs for both the insured and uninsured funded by the Department of Human Services. (d) An essential community behavioral health care provider shall be compensated on a fee-for-service basis within a global budget or within a risk-based incentive contract in accordance with the contracts and standards of the respective payors. Staff members and other health care providers in the service area of the designated essential community behavioral health care provider shall not be restricted from providing care, treatment, or services through affiliation with any other health insurer or health care service contractor. (e) A designation of a community behavioral health care provider as an essential community behavioral health care provider shall end 5 years after the date the designation is granted. The Department, however, may terminate the designation for cause before the end of the 5-year period if the essential community behavioral health care provider fails to comply with the eligibility standards set forth in subsection (b). A designated essential community behavioral health care provider may reapply for designation 6 months prior to the designation ending and shall provide documented evidence that the provider continues to meet all criteria for designation. If the essential community behavioral health care provider continues to meet all criteria for designation, the Department shall continue the designation for an additional 5-year period.

Legislative History

(Source: P.A. 97-166, eff. 7-22-11.)