(a)Definitions. As used in this Section: "Substance use disorder" and "case management" have the meanings ascribed to those terms in Section 1-10 of the Substance Use Disorder Act. "Hospital" means a facility licensed by the Department of Public Health under the Hospital Licensing Act. "Federally qualified health center" means a facility as defined in Section 1905(l)(2)(B) of the federal Social Security Act. "Recovery housing" means a residential extended care treatment facility or a recovery home as defined and licensed in 77 Illinois Administrative Code, Part 2060, by the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery.
(b)A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on
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(a) Definitions. As used in this Section: "Substance use disorder" and "case management" have the meanings ascribed to those terms in Section 1-10 of the Substance Use Disorder Act. "Hospital" means a facility licensed by the Department of Public Health under the Hospital Licensing Act. "Federally qualified health center" means a facility as defined in Section 1905(l)(2)(B) of the federal Social Security Act. "Recovery housing" means a residential extended care treatment facility or a recovery home as defined and licensed in 77 Illinois Administrative Code, Part 2060, by the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2019 (the effective date of Public Act 100-1065) may provide coverage for residential extended care services and supports for persons recovery housing for persons with substance use disorders who are at risk of a relapse following discharge from a health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department so long as all of the following conditions are met: (1) A health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department has conducted an individualized assessment, using criteria established by the American Society of Addiction Medicine, of the person's condition prior to discharge and has identified the person as being at risk of a relapse and in need of supportive services, including employment and training and case management, to maintain long-term recovery. A determination of whether a person is in need of supportive services shall also be based on whether the person has a history of poverty, job insecurity, and lack of a safe and sober living environment. (2) The recovery housing is administered by a community-based agency that is licensed by or under contract with the Department of Human Services, Division of Substance Use Prevention and Recovery. (3) The recovery housing is administered by a community-based agency as described in paragraph (2) upon the referral of a health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department. (c) Based on the individualized needs assessment, any coverage provided in accordance with this Section may include, but not be limited to, the following: (1) Substance use disorder treatment services that are in accordance with licensure standards promulgated by the Department of Human Services, Division of Substance Use Prevention and Recovery. (2) Transitional housing services, including food or meal plans. (3) Individualized case management and referral services, including case management and social services for the families of persons who are seeking treatment for a substance use disorder. (4) Job training or placement services. (d) The insurer may rate each community-based agency that is licensed by or under contract with the Department of Human Services, Division of Substance Use Prevention and Recovery to provide recovery housing based on an evaluation of each agency's ability to: (1) reduce health care costs; (2) reduce recidivism rates for persons suffering from a substance use disorder; (3) improve outcomes; (4) track persons with substance use disorders; and (5) improve the quality of life of persons with substance use disorders through the utilization of sustainable recovery, education, employment, and housing services. The insurer may publish the results of the ratings on its official website and shall, on an annual basis, update the posted results. (e) The Department of Insurance may adopt any rules necessary to implement the provisions of this Section in accordance with the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules; any purported rule not so adopted, for whatever reason, is unauthorized.