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