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

Report: 60% of IL Behavioral Health Providers Say Budget Impasse Pushes Out Physicians, Clinical Staff over “Job Insecurities”

IABH CEO Sara Howe

(Springfield, IL) – Illinois’ behavioral health first responders are abandoning community providers across the state as the state budget impasse has unleashed a “tsunami” of “job insecurities,” according to new a survey.

The Illinois Association for Behavioral Health and the Illinois Association of Rehabilitation Facilities on Wednesday rolled out a statewide membership survey that reveals that 60.3% of Illinois behavioral health providers have “lost physicians or clinical staff due to job insecurities.”

“A tsunami of job insecurities is washing over behavioral health providers from Chicago to Cairo and is igniting a brain drain of vital behavioral health first responders for mental health crisis and drug overdoses,” said Illinois Association for Behavioral Health C.E.O. Sara Howe. “When we talk about ‘infrastructure’ collapse because of the Illinois budget impasse, this is what we mean. That is the loss of clinical staff, doctors, and psychiatrists who are no longer willing to endure the chaotic lack of funding.”

The state currently owes behavioral health providers $143 million for Fiscal Year 2017 for services already delivered, stretching back to July 1, 2016, or 90% of the amount budgeted for the current year.

“Worry over whether someone’s job will be around next month or next week is pushing talented clinical staff to find more secure employment,” said Howe. “Who can blame them?”


$1.3 Million from Feds Will Help IL Bolster Mental Health, Drug Treatment Parity

IABH CEO Sara Moscato Howe

IABH CEO Sara Moscato Howe

(Springfield, IL) – The Illinois Department of Insurance has received a $1.3 million federal grant to improve consumer and healthcare provider outreach, focusing on parity in mental health & substance use disorder benefits, and preventative health services.

“This is a tremendous opportunity to further our Administration’s coordinated efforts on mental health,” Acting Director of DOI Anne Melissa Dowling said. “These funds will help extend our outreach.”

Illinois Association Behavioral Healthcare CEO Sara Moscato Howe echoed Dowling comments.

“The grant does present an important outreach opportunity to help individuals struggling mental health or substance use disorders to get the care that they need, but otherwise may forgo by being unaware of insurance benefits to which they are entitled,” Howe said.

A portion of the grant will be directed to the Office of Consumer Health Insurance to improve data tracking and consumer complaint analysis. It will also help in increasing awareness of the internal and external appeals processes for health insurance consumers.  The grant will allow the state insurance department to develop community-focused health insurance consumer education for Illinois residents.

The state agency will also work with health plans, consumers and providers to ensure that mental health parity compliance is understood.

“I am committed to furthering this collaboration to achieve mental health parity in the commercial health care system by collaborating with my colleagues as well as with the provider community in Illinois,” said Dowling.


Quinn Acts on Obamacare Fix to Bolster Illinois Substance Abuse Treatment Care

Governor Pat Quinn

Governor Pat Quinn

(Springfield, IL) – Quinn Administration officials have agreed to a state-level fix of an Obamacare loophole that has stymied the vast majority of Illinois’ residential substance abuse providers from serving new Medicaid enrollees.

A federal Medicaid law, which predates the Affordable Care Act, prohibits Medicaid certification of residential treatment providers with more than 16 beds, a measure intended to prevent the warehousing of individuals struggling to recover from substance abuse.

But Obamacare provides a new, guaranteed benefit of substance abuse treatment through Medicaid, and residential treatment is a key benefit. The situation of federal laws working at cross-purposes has bedeviled Illinois officials and those in other states, according to the chief of Illinois’ top advocate group.

“It’s a tale of two federal laws in conflict with each other creating havoc across the county and an ineffective Congress unwilling to fix the problem,” Illinois Alcoholism and Drug Dependence Association CEO Sara Moscato Howe. “The Affordable Care Act authorizes residential treatment in the benefits package, but the bill’s architects failed to reconcile it with the older law”.

Howe said that the problem has been festering in Illinois for more than a year, but state officials, realizing that Washington gridlock made a federal solution impossible, have been forced to design their own plan.

Earlier this summer, State Senator Heather Steans (D-Chicago), State Rep. Greg Harris (D-Chicago), Illinois House and Senate staff, Governor’s Office of Management and Budget officials, Healthcare & Family Services Director Julie Hamos, Department of Human Services Secretary Michelle Saddler, and DHS Division of Alcoholism & Substance Abuse Director Theodora Binion met with representatives of IADDA, the Community Behavioral Healthcare Association, and the Illinois Association of Rehabilitation Facilities to discuss options to solve the problem.

On Friday, August 22, the advocates and lawmakers learned that the Quinn Administration had met on Thursday, last week, with the CEOs of Illinois’ Medicaid Managed Care Organizations, which are gradually assuming responsibility for all Illinois Medicaid patients, and instructed them to begin covering medically-necessary residential treatment services and room and board costs at both Medicaid and Non-Medicaid certified facilities.

“This order includes already-existing Medicaid patient populations, as well as the expanded ACA patient population,” said Howe. “Additionally, the Department of Healthcare & Family Services is now working with an actuary to determine if the rate currently paid to the managed care providers adequately covers residential services”.

Howe noted that Quinn Administration officials reminded community-based treatment advocates that the managed care companies would remain as the decision makers regarding patient residential placement, not the providers.

The managed care organizations will not be, however, the only group slated for a rate review, Howe said.

“It was also acknowledged by Quinn Administration officials that the state’s current rates for all levels of addiction treatment care are inadequate,” Howe stated. “A state rate review for community based providers will also be undertaken”.

IADDA recently commissioned an actuarial report comparing current state treatment service rates to known cost indices and that study revealed that from 1990-2013, medical costs in Illinois rose 162% while addiction treatment reimbursement rose by only 21% during the same 23-year time period, a circumstance that strictly limits the number of people served.

“The state’s current rates are relic of the early 1990s,” said Howe. “Obsolete funding is preventing Illinois from confront modern addiction challenges, such as the heroin and prescription drug epidemics raging in Illinois and tightly limits the number of people that we can help.”

Still, last week’s announcement was a “big win” for Illinois residents working to overcome addiction and key officials warranted advocates’ “gratitude”, Howe noted.

“For those who seek and need residential treatment, the Quinn Administration’s announcement is a big win,” said Howe. “And Rep. Harris, Senator Steans, Secretary Saddler, Director Hamos, and Director Binion deserve our deepest gratitude for their work and commitment to find a solution.”

Sara Moscato Howe, showe@iadda.org

OP-ED: Stuck in a Silo: Wall Street Journal Stigmatizes Addiction Healthcare

OP-ED: By failing to provide a global context for his critique of addiction healthcare treatment (“10 things rehab centers won’t tell you,” May 21, 2014), Wall Street Journal Market Watch reporter Charles Passy undercut the credibility of his argument and stigmatized – which seemed to be his real goal – a reputable branch of the U.S. healthcare system.

Passy sought to focus his assessment of behavior-related disease healthcare treatment only on the consumption of alcohol or drugs, while ignoring behaviors such as smoking or poor eating habits, behaviors that lead to asthma, hypertension, heart diseases, and diabetes.

Instead of providing a balanced and nuanced perspective, Passy preferred to play on existing social prejudices of alcohol and drugs and analyzed the subject in a silo.

For example, Passy noted, correctly, that the National Institute on Drug Abuse estimates the relapse rate among drug addicts to be 40% to 60%.

What is the point of highlighting this isolated statistic?

Stop the presses! Drug treatment is a failure!



It’s wrong when drug addiction relapse is more accurately assessed in the broader context of other addictive behavior healthcare treatments.

In an article, published in The Lancet in 1996 by Charles O’Brien and Thomas McLellan (former Deputy Director of the White House Office of National Drug Control Policy) found that 30-60% of insulin-dependent diabetic patients have a reoccurrence of their symptoms each year and require at least re-stabilization of their medication and/or additional medical interventions to re-establish symptom remission.

The authors also noted that 50-80% of hypertensive and asthmatic patients have a reoccurrence of their symptoms each year and they too require at least re-stabilization of their medication and/or additional medical interventions to re-establish symptom remission.

This means that they relapsed into behaviors that spawned their disease.

Comparatively, they found relapse rates for alcoholism treatment are 30% – 60%, opioid dependence are 20-50% and cocaine dependence are 40-50%.

O’Brien and McLellan point out that despite these relapse rates for diabetes, asthma and hypertension there is no debate in the public of the value of health care for these chronic, relapsing conditions. Yet, with similar or better results, addiction treatment is continually questioned as effective or even necessary.

And that’s what Passy is doing.

By targeting only alcohol and drug treatment – and leaving out an analysis of health care treatment of other behavior-related, chronic diseases – Passy is, essentially, undermining and stigmatizing the underlying credibility of substance abuse treatment.

A more honest analysis would acknowledge that in regards to healthcare treatment for behavior-related, chronic diseases that no single, one-time wonders or silver bullets exist.

The time has come to change this debate, dispense with prejudice, and, in fact, to emphasize the need to expand treatment of addiction.


Because it works.

A 2005 study of more than 800 Illinois adults and a 2009 study of more than 700 adolescent clients in Illinois found that 12 months post treatment:

  • Adults reported a 58% decrease and adolescents reported a 42% decrease in drug and alcohol use
  • Adults reported a 56% decrease in the number of days experiencing emotional or behavioral problems
  • Adolescents reported a 36% decrease in the number of days experiencing emotional or behavioral problem

What these numbers reveal is that substance abuse treatment is not perfect, but that it is indeed effective. And effective is the accepted, professional health care standard – not medical miracles.

Had Passy bothered to assess addiction treatment without prejudice, within a broader health care context, and with an accepted standard of success, he would have provided valuable insight to Wall Street Journal readers.

Sara Moscato Howe, CEO, IADDA

House GOP Heroin Legislation Welcomed, But Warned on “Half-Measures”

House Republican Lawmakers new legislation to combat heroin in DuPage County.

House Republican Lawmakers new legislation to combat heroin in DuPage County.

(Springfield, IL) – Action by House Republican lawmakers to fight Illinois’ growing heroin epidemic was welcomed by addiction advocates who urged the lawmakers to strengthen their proposals.

House Republican Leader Jim Durkin (R-Western Springs), State Reps. Dennis Reboletti (R-Elmhurst), Patti Bellock (R-Hinsdale), John Cabello (R-Machesney Park), and Sandy Pihos (R-Glen Ellyn) on Thursday announced a package of legislation designed to address heroin abuse.

“After seeing firsthand the toll heroin addiction takes on individuals and their families, it’s evident we need to take collaborative actions to stem the tide,” said Reboletti, a former narcotics prosecutor. “This year in Springfield, we are introducing a comprehensive package of legislation aimed at addressing the full range and scope of the heroin epidemic.”

The Republican plan includes substance abuse treatment facility for DuPage County, increased criminal penalties, enhanced data collection, among other measures.

Specifically, the GOP lawmakers have introduced five concrete, but limited proposals:

  • Create a pilot program in DuPage County to establish a secure substance abuse treatment facility that will be a joint partnership between the state and county to serve as a “last chance” option for those convicted of drug crimes.
  • Extend Illinois’ RICO statutes sunset date to 2022, which is currently scheduled to expire in 2017 and allow prosecutors to use a portion of the proceeds from seized assets accumulated by gangs to fund substance abuse treatment programs.
  • Require each county’s Department of Public Health to track and periodically report the number of drug overdose deaths to the State.
  • Enhance penalties for ‘Doctor Shopping’ to strengthen current law to prohibit patients from withholding the fact that they have received the same or similar controlled substance from health care practitioners within a specified time frame.
  • Creates an educational initiative to promote the “Good Samaritan” law by distributing pamphlets to educate holders of opiate prescriptions about the dangers of children and teens gaining access to medications.
  • Crack down on ‘krokodil,’ an often cheaper heroin alternative by enhancing penalties for the drug to be on par with those for heroin.

The leader of Illinois’ top addiction healthcare advocacy group welcomed the House GOP package, but wants more substantive steps.

“We’re grateful that House Republican lawmakers are proposing measures to address the deepening heroin crisis in DuPage,” said Illinois Alcoholism and Drug Dependence Association CEO Sara Moscato Howe.  “IADDA is committed to working with those legislators to rally our members to help advance their proposals, in particular those of which that will best help individuals working to overcome addiction.”

Howe proposed increasing the current state prevention funding from its historic low of $1 million to $2.5 million.

“Substantive funding for prevention can help begin to put a substantive dent in the crisis,” said Howe. “We’re beyond half measures being effective.”

Since 2009, the legislature has cut drug prevention funding by 88% and drug treatment by 41%, Howe noted.

“The painful reality is that the heroin crisis playing out in Illinois today is, in large part, a result of the legislature’s drastic reduction of drug prevention and treatment funding in the last five years,” said Howe. “If lawmakers want to be serious about fighting the heroin epidemic, they need to invest the money necessary to get the job done.”

And the challenge in DuPage, and elsewhere in Illinois, to blunt the heroin crisis is staggering, DuPage officials say.

“Heroin use in DuPage County and across the state has hit epidemic proportions resulting in nearly one death per week last year,” said Robert Berlin, DuPage County State’s Attorney.

“Last year, DuPage County suffered a record number of fatal heroin overdoses – 46. The victims ranged in age from 15 to 64,” said Grant Eckhoff, DuPage County Judicial and Public Safety Committee chairman. “These victims are not just statistics. Instead they are our neighbors and often our family members.”

“Meeting the threat posed by the growing suburban heroin epidemic requires the best efforts of parents, educators, law enforcement, public health officials and state policymakers,” said Bellock.

Howe agreed.

“One of the best efforts that lawmakers can make is to comprehensively fund drug prevention and treatment,” said Howe. “Otherwise, we are just fooling ourselves that half-measures will solve the problem.”


Op-Ed: Author David Sheff’s Drug Treatment Criticism “Irresponsible”

(Springfield, IL) – In the wake of actor Philip Seymour Hoffman’s death from a drug-overdose, the author of a Time magazine op-ed unconscionably distorted the reality of drug abuse treatment, potentially frightening away individuals, like Hoffman, who need help.

Author David Sheff outlandishly claimed (How Philip Seymour Hoffman Could Have Been Saved,” Time, February 2) “90% of those who enter addiction-treatment programs in the U.S. don’t receive evidence-based treatment.”

That’s an utterly irresponsible claim.

The author uses broad stroke generalizations of what, in his opinion, are the limitations the U.S. addiction treatment system, generalizations that are based entirely on anecdotes and conjecture.

In fact, evidence-based treatment has long formed the service core of publicly funded drug abuse treatment providers in Illinois and across the country. Period.

Additionally, one of the most obvious and glaring oversights in this article is the absence of any discussion of chronic care management. Addiction is a disease that is frequently chronic, progressive, and potentially fatal. A key feature of any chronic disease is: relapse. Assertive chronic disease management and recovery management could also have played a role in preventing Mr. Hoffman’s death, a concept embraced and adopted by professional treatment providers in the field today.

Here in Illinois, it is true we do have an escalating prescription drug and heroin crisis and, yes, our treatment system has been weakened by state budget cuts over the past five years, but it is simply unfounded to say that our providers do not employ evidence-based practices.

In fact, the Illinois Department of Human Services has engaged in performance based contracting for substance use disorder treatment services for several years, services that are evidenced based. Provider reports are not only given to the state but also they are posted online so any patient can review the outcomes.

Additionally, the federal government, through the Substance Abuse and Mental Health Services Administration, has implemented “National Outcome Measures” that the states must report in our annual federal block grant application. These measures are founded on evidence-based practice.

It’s unconscionable that Sheff would write and that Time would publish this kind of misinformation on such a wide scale. This blatantly inaccurate information could actually do more harm than good, deepening the stigma of addiction and undermining the ability of treatment providers to reach those in need who, after reading Sheff’s commentary, would ask themselves: why get any help?

Sheff’s foolish comments may jeopardize the lives of the very people about whom he expresses concern.

It is always heartbreaking to hear the news of another person lost to addiction. We mourn with Hoffman’s family and with the families of so many others who have succumbed to this disease. But it is wholly irresponsible to blame the very system that was responsible for providing him with many years of sobriety.

Sara Moscato Howe, CEO, Illinois Alcoholism and Drug Dependence Association


CBS 48 Hours Special on Chicago Drug Wars Features IADDA Member


Hadiya Pendleton

(Chicago) – Hadiya Pendleton was just 15 when she was shot dead near her Chicago school, the unintended victim of a gang battle.

She died just a week after attending President Barack Obama’s second inauguration and became a high-profile name added to a growing list of people killed in America’s third-largest city.

For six months, 48 HOURS Correspondent Maureen Maher and CBS News Correspondent Armen Keteyian have been investigating what’s driving the murder rate in Chicago and claiming the lives of young people like Pendleton.

Maher and Keteyian’s reporting reveals a deadly link between street violence and drug trafficking in the city and in the suburbs. 48 HOURS SPECIAL: “The War in Chicago,” to be broadcast Saturday May 18, 2013 (10:00 PM, ET/PT) on the CBS Television Network,  also focuses on what residents, city officials and the Drug Enforcement Administration are doing to fight back.

48 HOURS learns that it’s the estimated 70,000 gang members in Chicago who are doing most of the killing – and most of the dying – and mostly over one thing: the distribution of drugs. 48 HOURS is on hand as the DEA trains and then executes raids on drug dealers and mounts a new offensive to stem the tide of drugs, often heroin, flowing into the region from Mexico.

48 HOURS profiles Paula Nixon, a suburban teenager who became addicted to heroin when she was 16 and follows her from Cook County jail to treatment at IADDA member, the South Suburban Council on Alcoholism & Substance Abuse in East Hazel Crest. Nixon is the face of the growing demand for heroin, which then drives the gangs and the influx of drugs from Mexico.

Also, David Muhammad, a retired diesel mechanic, tells 48 HOURS he’s had enough. Muhammad is so enraged by the drug dealing in his Chicago neighborhood he has risked his life by recording and then posting videos of drug deals on YouTube.

“I don’t think I can stop it,” Muhammad tells 48 HOURS, “but I think that someone has to try and slow it down because it’s moving too fast.”

48 HOURS is there for the Chicago Police Department’s “surge” after Pendleton’s death, which helped substantially cut the murder rate. “We’re starting to hit a point that I’m hoping will be a turning point,” Chicago Police Superintendent Garry McCarthy says. By May, the homicide rate had dropped 53 percent compared to the same time a year ago. “We’re getting progress, not victory,” McCarthy says.

For a preview of the 48 Hours special, view it here…

Advocates Tell Gov. Pat Quinn Substance Abuse, Mental Illness Are “Connected”

Sara Moscato Howe

Sara Moscato Howe

(Springfield, IL) – Mental illness. Substance abuse. In most tragedies, the two are connected.

A top Illinois behavioral health advocate today praised Governor Pat Quinn for citing mental health care as a top priority in an Illinois public safety strategy in his recent state of the state speech, but warns that substance abuse treatment must be included in the policy mix.

“Any strategy to address mental health care without also addressing substance use disorders will fall short.”  said Sara Moscato Howe, CEO, Illinois Alcoholism and Drug Dependence Association.

“While there may be a high correlation of gun violence or domestic abuse tragedies with mental illness, there is also a strong relationship of mental illness with unaddressed substance use disorders,” Howe stated.

Quinn highlighted mental health care in his speech to Illinois lawmakers in Springfield on February 6.

“We must move forward with a comprehensive plan that includes gun safety legislation, mental health care, and violence prevention strategies,” said the governor during his remarks.

Shrinking access to care for those struggling with mental illness is a direct result of Illinois state government decreased funding support for mental healthcare.  For those with untreated, or undiagnosed mental health issues, it is common that symptoms are managed through the use and abuse of alcohol and other drugs, noted Howe.

“People struggling with mental illness who have no access to professional treatment, self-medicate, often abusing drugs or alcohol in an effort to manage their mental illness,” said Howe. “That’s why any behavioral health care strategy to address public safety must include substance abuse prevention and treatment.”

Howe noted that state funding for substance use disorder treatment has also plunged, dropping 29% since 2009.  State funding for addiction prevention has been obliterated, falling by 87% in the past five fiscal years.

“If behavioral healthcare is to play a central role in an Illinois public safety strategy to reduce violent crime, then Governor Quinn and the legislature will need to fully fund services for Substance Use and Mental Health Disorders,” said Howe.

“Illinois is already paying the price for past behavioral healthcare budget cuts.”

Top Illinois Drug Treatment Advocacy Group Praises Sen. Mark Kirk’s Push against “Pill Mills”

(Chicago, IL) — U.S. Senator Mark Kirk (R.-Ill) today announced new legislation at a Chicago press conference to combat the nation’s fastest growing drug epidemic – prescription drug abuse.

“Prescription drug abuse is rising. Drug fatalities have surpassed motor vehicle deaths, largely due to prescription drug overdoses,” Kirk said. “This bipartisan legislation makes common-sense reforms to the Controlled Substances Act that will help save lives from prescription drug overdoses.”

According to Kirk’s office, 2 1/2 times more Americans currently abuse prescription drugs than the number of those using cocaine, hallucinogens, heroin, and inhalants combined.

“’Pill mills’, or doctors, and pharmacies that either inappropriately prescribe or dispense prescription narcotics for non-medical reasons is a growing drug abuse problem in the U.S.,” said Illinois Alcoholism Drug and Dependence Association CEO Sara Moscato Howe. “I applaud Senator Kirk’s efforts to tackle this problem.”