OP-ED: IABH Charts Behavioral Health Course for COVID-19 and Post-COVID-19 Illinois

OP-ED: In 2020, the Illinois Association for Behavioral Health and its members face some of the most trying circumstances in its fifty-plus years of existence. A global pandemic, civil rights abuses, financial hardship, and uncertainty in our government makes this point one of our most critical. The Association will face this turbulent future by focusing on our immediate needs but also looking ahead and keeping in mind future opportunities.

First, IABH will continue to champion funding for its members to ensure uninterrupted operations during this crisis. Our staff and our lobbying team will work to ensure that the Pritzker Administration’s promise to make providers whole under grant funding and under Medicaid relying upon rate increases, directed payments, and other options. Additionally, IABH intends to leverage federal and state regulations permitting directed, pass-through, and/or hardship payments to fully fund providers, while working in collaboration with our partners to obtain increases in rates for critical mental health and addiction treatment.

From the outset of the COVID-19 pandemic, IABH led the effort to expand treatment flexibility to permit providers to engage in alternative treatment models and locations. IABH prepared an Executive Order on telehealth, signed by Governor JB Pritzker, that not only mandated commercial insurance coverage for telehealth services but also removed prior authorization requirements and unnecessary utilization review protocols.

These changes eliminated cost-sharing for clients and guaranteed parity. And it ensured that services provided remotely would be reimbursed the same as those provided face-to-face. IABH advocated for additional funding and for the full benefits of the Medicaid waivers so members could continue to provide services during the pandemic.

Second, building upon the COVID-19 efforts, IABH turns toward the future. The Association will be pushing for the permanent adoption of telehealth flexibility so that clients can receive mental health and substance use disorder (SUD) treatment without the need for travel or close proximity in the post-COVID-19 environment.

Looking to the future, IABH introduced first-of-its-kind legislation, House Bill 4970, for the creation of Certified Community Behavioral Health Clinics (CCBHCs), legislation that is being held up by the National Council for Behavioral Health as a national model. The CCBHC bill, sponsored by State Rep. Deb Conroy (D-Villa Park), proposes to create a tailored CCBHC model that takes into consideration the requirements and unique aspects of the Illinois mental health and SUD field.

The cornerstone of this advocacy effort is a transition to value-based payment and the adoption of a prospective payment system (PPS) that focuses upon quality rather than traditional fee-for-service reimbursement. The goal of PPS is to obtain the full reimbursement of all provider costs while at the same time removing unnecessary and costly interference in provider operations by focusing on the outcome rather than the process. Management should be left to the sound professional judgment of our expert healthcare professionals and clinicians.

The shift to PPS also aims to remove the interference of managed care organizations (MCOs), which have been imposing barriers to quality treatment. No longer will the emphasis be upon processes that produce unneeded and unnecessary paperwork and red tape. The future model will focus on how our clients respond to treatment and return to productive, healthy lives.

The short-term goal to ensure adequate funding and the long-term goal of system transformation both further the same vision.

IABH will be crafting a strategic plan to provide capacity for a current population in need of treatment as well as a long-term plan providing for full treatment capacity. The improved capacity will seek to help those have suffered through the pandemic, through financial crisis, survived civil unrest and police brutality. And we need to be ready as we transition out of the pandemic and crisis to provide the necessary behavioral health services our clients will desperately need over the long-term.

We are up to the challenge.

Jud DeLoss, CEO, Illinois Association for Behavioral Health

Illinois Medicaid Budget Cuts Would Hurt Illinois Economy, Study Says

(Springfield, IL) – Two health-care advocacy groups are predicting thousands of job losses and billions of dollars in economic damage to Illinois, if Gov. Pat Quinn’s plan to conjure $2.7 billion in savings from the Medicaid program is implemented.

Quinn’s plan would jeopardize 25,615 jobs and cost the state’s economy $3.2 billion, according to a report released Wednesday by the Illinois Hospital Association, which lobbies for Illinois hospitals, and the Campaign for Better Health Care, an organization that advocates for health-care access

“Drastic Medicaid cuts hurt everyone, not just the Medicaid patients. Hospitals will be forced to reduce jobs. Local businesses will be impacted,” Illinois Hospital Association President Maryjane Wurth said.

“And hospitals will be forced to cut or eliminate medical services that everyone uses — there is not a separate set of staff, equipment and facilities just for Medicaid patients.”

Quinn’s proposal reduces the amount Medicaid providers get paid by $675 million, accounting for 25 percent of the $2.7 billion in savings.


Illinois Medicaid Spending to Increase 41% in 5 Years, Civic Federation Report Says

(Springfield, IL) – A new report released Monday from the Civic Federation, a Chicago-based nonpartisan policy group that focuses on state spending, predicts Illinois’ Medicaid costs will skyrocket over the next five years.

Laurence Msall, federation president, said lawmakers and governors have spent Illinois into a deep hole by expanding Medicaid, which provides health-care coverage to low-income families.

“What is most frightening is that even after the income tax, the state was not able to pass a budget to fully fund Medicaid,” Msall said, referring to a 67 percent personal income tax increase and a 48 percent corporate income tax increase in January 2011.

But even with that additional revenue, Illinois lawmakers still had to pay more than $1 billion in 2011 Medicaid bills.

The Civic Federation report paints a grim picture for Medicaid spending:


Topinka Says State to Reap Nearly $100 Million from U.S. Government for Illinois Medicaid Bills

(Springfield, IL) — Illinois lawmakers on Wednesday approved a plan to delay a $365 million payment into Illinois’ rainy day fund, and instead use that money to pay some of the billions of dollars Illinois owes to Medicaid providers.

Comptroller Judy Baar Topinka said the state is racing to maximize a federal Medicaid match that expires at the end of the month. Illinois is getting 57 cents on the dollar for qualifying Medicaid bills that it pays this month. Starting in July, that rate falls back to the normal 50 cents on the dollar.

Maximizing the $365 million, Topinka said, should allow her to pay $1.85 billion in Medicaid bills by June 30. She estimates Illinois could receive an extra $90 million to $100 million from the federal government.


As Other States Health Cut Care for the Poor, Gov. Pat Quinn Embraces Illinois Medicaid Reform, Patient Care Safeguards

(Springfield, IL) — States across the nation are ratcheting down Medicaid services and eligibility to hold down costs, but Illinois officials are standing by Medicaid reforms passed in January that Republicans claim just skim the surface.

The $14 billion state-federal program offers health insurance for mostly low-income children, pregnant women, parents with young children, senior citizens and the disabled. Chief among the reforms passed in January were a requirement to move 50 percent of the state’s 2.8 million Medicaid participants to a “medical home” within the next four years through “coordinated” or managed care, and to move residents from nursing homes and other institutional care into community-based settings.

Illinois Senate Republicans believe the state can do better than the $800 million in savings expected from the reforms during the next five years.

“That was a good step one,” said state Sen. Pam Althoff, R- Crystal Lake, who served on the Medicaid reform task force. “But there’s now a step two.”

Julie Hamos, director of the Illinois Department of Healthcare and Family Services, noted the reforms are intended to keep people healthy and thereby hold down costs.