IL House OKs Bill Targeting “Patient Brokers” Exploiting Opioids Crisis

(Springfield, IL) – Bipartisan legislation that targets out-of-state “patient brokers” taking advantage of Illinois residents struggling with opioid addiction and other behavioral health crisis by marketing expensive, questionable ‘treatment’ services  has been approved by the full Illinois House.

The measure, House Bill 4949, zipped through the House 110-0 last week.

The legislation seeks to prohibit marketers from falsely encouraging patients and families to seek treatment outside of Illinois, which would result in out-of-network expenses and travel costs.

“Scam artists marketing unscrupulous drug treatment providers have mushroomed since the opioid crisis exploded in Illinois, and they’re preying on desperate families seeking to help a loved one overcome their addiction,” said Illinois Association for Behavioral Health C.E.O. Sara Howe. “This legislation bans the tactics that are driving patient brokering, such as barring marketers and patient brokers from seeking kickbacks and referral fees in exchange for directing patients for mental health and substance use disorder treatment.”

State Rep. Sara Feigenholtz (D-Chicago) is sponsoring the bill.


Bill Targeting “Patient Brokers” Exploiting Opioids Crisis Faces Illinois House Vote


Illinois Association for Behavioral Health C.E.O. Sara Howe (R) testifies at Illinois House Mental Health Committee hearing on “patient brokering” bill. State Rep. Sara Feigenholtz (D-Chicago) (L).

(Springfield, IL) – Bipartisan legislation that targets out-of-state “patient brokers” taking advantage of Illinois residents struggling with opioid addiction and other behavioral health crisis by marketing expensive, questionable ‘treatment’ services faces a looming vote by the full Illinois House.

The measure, House Bill 4949, in which the Illinois House Mental Health Committee voted 21-0 in favor on March 8, seeks to prohibit marketers from falsely encouraging patients and families to seek treatment outside of Illinois, which would result in out-of-network expenses and travel costs.

“Scam artists marketing unscrupulous drug treatment providers have mushroomed since the opioid crisis exploded in the United States and in Illinois, and they’re preying on desperate families seeking to help a loved one overcome their addiction,” said Illinois Association for Behavioral Health C.E.O. Sara Howe. “This legislation bans the tactics that are driving patient brokering, such as barring marketers and patient brokers from seeking kickbacks and referral fees in exchange for directing patients for mental health and substance use disorder treatment.”

State Rep. Sara Feigenholtz (D-Chicago) is sponsoring the bill.

Howe, who testified before lawmakers in behalf of the bill, said the patient brokers specifically target families with private insurance and aim to run up out-of-network expenses. She cited a case to lawmakers of an Illinois woman, 26, who had travelled to Florida for drug treatment but ended dying from a drug overdose but not before her insurance company had paid more than $1.3 million to the treatment provider.

“In the case of the Illinois woman who died in Florida, the so-called treatment provider had, for example, been performing three drug tests per day, way over the industry standard, for the sole purpose of running up the bill,” said Howe. “These type of facilities, which are marketed as ‘beach front locations; are also advertising that an individual can continue using drugs while in treatment.”

In addition to prohibiting referral fees, Feigenholtz’s plan would require marketers located outside of Illinois to inform patients and families that free or low-cost treatment services may be available in Illinois and directs them to the Department of Human Services, Division of Mental Health and Division of Alcoholism and Substance Abuse for more information. Importantly, the legislation would also require that marketers inform consumers whether the facility offers services that could be covered by an Illinois insurance or managed care plan and if they are in-network of those plans as well as note that free or low-cost treatment services may be available in Illinois.

“Patient brokers operate like predators, pushing unscrupulous drug treatment programs on families who are desperate to find treatment for opioid addiction and mental illness for their loved ones,” said Feigenholtz. “HB4949 will shut down these deceptive marketing practices and dry up ‘finder fees’ for brokers referring patients. Illinois must end this practice now.”

The full Illinois House is set to vote on the bill.

For more information, contact: Sara Howe,

IL Graded “C” on Mental Health Parity Law; Advocates Join National Compliance Push

(Springfield, IL) – Next year will mark the 10th anniversary of landmark federal legislation providing insurance parity for mental health and addiction treatment, but lagging enforcement in Illinois and elsewhere around the country has pushed state behavioral health advocates to join a national compliance campaign to “jumpstart” the law and nudged state lawmakers to launch a probe of parity gaps.

“On the U.S. Mental Health Parity and Addiction Equity Act, Illinois gets a “C” on enforcement,” said Illinois Association for Behavioral Health CEO Sara Moscato Howe, who will lead Illinois’ compliance effort. “Too often, insurance companies get away with denying care to individuals struggling with mental illness or addiction. That’s why we are joining a national effort to pursue full enforcement of the law.”

Illinois and four other states – Maryland, New Jersey, New York, and Ohio – form the vanguard of the Parity@10 Compliance Campaign, a three-year, 10-state push to ensure that the federal law lives up to its promise nationwide.

Spearheading the campaign nationally are the Legal Action Center, The Kennedy Forum, The National Center on Addiction and Substance Abuse, Partnership for Drug-Free Kids, and the Research & Evaluation Group at Public Health Management Corporation.

“The campaign is ready to jumpstart parity enforcement,” said Ellen Weber, vice president for health initiatives at the Legal Action Center and the director of the campaign. “Achieving more robust parity compliance in 10 states over the next three years will not only benefit millions of people living in those states, but will also establish models that can be adopted by other states.”

Howe says that the campaign’s goal in Illinois is to ensure that insurance carriers and State Medicaid programs offer fully parity compliant substance use and mental health benefits and that regulators end complaint-driven enforcement models that put the onus on consumers.

“Generally, insurance plan documents fail to provide sufficient information for consumers to determine whether coverage complies with the law or not, which stifles complaints, and without consumers filing complaints regulators are unable to act,” said Howe. “The system is rigged in favor of insurance companies, not consumers. That’s why we need proactive enforcement that empowers regulators to police insurance companies before their plans are sold.”

Howe says that in Illinois, the campaign will work with lawmakers, regulators, and the Attorney General to develop more effective compliance and enforcement frameworks.

Howe noted that a September 2017 report by the Kennedy Forum, with whom Howe’s group collaborated, revealed that 75 percent of Illinois behavioral health providers surveyed reported that Medicaid Managed Care Organizations “sometimes/often/always” denied coverage for mental health and addiction inpatient and outpatient treatment, among other services, prompting State Rep. Steve Andersson (R-Geneva), member of the House Mental Health Committee, to file a resolution urging action to address the report findings.

Meanwhile, the House mental health panel will hold a hearing in Chicago on December 4 to launch its own investigation of mental health and addiction treatment service “barriers” experienced by community behavioral health providers.

IABH’s work with The Kennedy Forum on the report and on other parity initiatives lead the national Parity@10 Compliance Campaign organizers to select Illinois in the effort’s roll out.

“Illinois is one of five states selected to launch the campaign based on the work the Illinois Association of Behavioral Health (IABH) and The Kennedy Forum Illinois have been doing to advocate for comprehensive health insurance coverage of mental health and substance use disorders,” said the Legal Action Center’s Weber.

Top Behavior Health Advocate Group Praises Rauner Approval of Youth DUI Law


Illinois Association for Behavioral Health Vice President for Substance Use Policy Eric Foster

(Springfield, IL) – A top Illinois behavioral health advocated lauded Governor Bruce Rauner’s approval on Tuesday of legislation requiring law enforcement to develop policies to care for intoxicated young people after a D.U.I. arrest, including attempts to contact a responsible adult.

“Providing new, standardized training for local law enforcement across the state on the appropriate police responses to youth arrested for being under the influence of alcohol or drugs can potentially help avert individual and community tragedies,” said Illinois Association for Behavioral Health Vice President for Substance Use Policy Eric Foster. “We commend Governor Rauner for signing this measure to help to decrease harm to youth and others.”

The legislation is named after Conor Vesper, a 20-year old college student from Macoupin County who committed suicide hours after a drunk driving arrest. Vesper was the valedictorian of Staunton High School and an active campus leader at Blackburn College where he had earned a full ride scholarship.

“Following an arrest, it is critical that we protect impaired young people while they are still at risk for dangerous decision-making,” said Rauner. “Ensuring law enforcement has thoughtful policies related to the care of individuals under the influence that focus on reaching out to responsible adults will help prevent tragic situations and protect all Illinoisans.”

Conor’s Law requires the Illinois Law Enforcement Training Standards Board to develop policies regarding the response and care for intoxicated young people after an arrest.

The bill’s chief sponsor, State Senator Andy Manar (D-Bunker Hill), expressed his appreciation to Rauner and cited the bi-partisan effort to advance the legislation.

“I appreciate that Gov. Rauner saw the merit of this bipartisan legislation and chose to make it the law in Illinois,” said Manar. “Well over a year of work went into Conor’s Law and my only hope is that it prevents other families from experiencing the same heartbreak and anguish the Vespers experienced when they tragically lost their son, Conor. The Vesper family should be commended for their determination.”

Foster noted that IABH worked on the bill with Manar and praised the senator for his “thoughtful collaboration.”

“IABH worked with Senator Manar and his staff on the bill,” said Foster. “The senator’s thoughtful collaboration made it a good bill that we could support.”

OP-ED: Illinois Budget Impasse Impact: A Behavioral Healthcare Autopsy Report

OP-ED: Unlike the warnings two years ago directed at Illinois lawmakers about human services program closures and employee layoffs at the beginning of the Illinois budget impasse, now the warnings have ended.

They have been replaced by autopsy reports.

Since the budget stalemate began, more than 1 million Illinois residents have lost access to critical human services. 1 million.

More specifically, regarding behavioral healthcare, 80,000 people in Illinois have lost access to needed mental health services and more than 24,000 fewer residents have been admitted to addiction treatment services.

In the past, governors from the executive branch and lawmakers from previous General Assemblies had determined critical human services were best delivered at the local level by the private sector as Illinois moved away from expensive state-operated institutional models to community level care.  As those decisions were made, policy makers turned to our community providers and other human service provider organizations to carry out the policy of providing government services more effectively and efficiently. And the private sector delivered.

Yet, the executive branch and the legislative branch have walked away from community care providers who delivered their goals, evidenced by year-after-year of budget cuts and financial starvation of crucial behavioral health programs.

Currently, lawmakers and the governor are making impossible, no, absurd, demands: accept months or sometimes years-long wait for payments of services delivered. The wait has financially brutalized our agencies. We’ve exhausted our reserves. We’ve sapped our lines of credit.  We’ve drained our staff. Our employees, who are on the front line of providing care to those with substance abuse and mental health disorders, arrive at work each week wondering: is this the last day?

Have you the merest notion of how such uncertainty disables a workforce?

To heave insult on top of injury, providers and their staff often hear some lawmakers and policy makers in the executive branch refer to human services as a “drain” on the General Revenue Fund. A drain?

Well, let’s be clear: when your local human service agency lays of staff – staff who pay taxes, buy homes, cars, furniture, groceries, sodas, sandwiches, etc. from your districts’ local businesses – those businesses, local chambers of commerce, and lawmakers’ districts suffer.

As of last March 2016, more than 1,000 mental health and substance abuse clinicians alone had lost their jobs. That doesn’t include case workers or administrative staff. The number of job losses has only grown in the last 12 months as the impasse has grinded forward.

The budget crisis is both a human service crisis that strikes at vulnerable citizens of Illinois and it’s an economic crisis that undermines local business owners and lawmakers’ constituents and communities and local economies.

The budget standoff and its impact are ravaging communities across the state from those who receive care, their families, the agencies that provide the care, to the local businesses that earn their income from serving them.

Without the adoption of a FY 2018 budget, the autopsy report that community behavioral healthcare providers deliver next year will only be more gruesome.

Jessica Hayes, Vice President, Board of Directors, Illinois Association for Behavioral Healthcare

IL Mental Health, Addiction Treatment Advocates Want “Quick, Responsible” Budget Resolution

(Springfield, IL) – Illinois Association for Behavioral Health CEO Sara Moscato Howe today issued a statement calling on Governor Bruce Rauner and the four legislative leaders to act “quickly and responsibly” in order to produce a full Fiscal Year 2017 state budget.

“With the FY 2017 stop gap budget expiring at the end of December, the Illinois Association for Behavioral Health urges both the legislative leaders and the governor to approve quickly and responsibly a full-year state budget that reverses the budget cuts that have been imposed on mental health care and addiction prevention and treatment in recent years,” Howe said.

Top Advocates Launch 1st of 3 Illinois Mental Health Policy Forums on August 30

(Springfield, IL) – As Governor Bruce Rauner’s Administration embarks on a “transformation” of the state’s of health and human services programs, Illinois’ top behavioral health care advocates will roll out the first of three mental health policy forums at the end of August that will aim to help shape state policies.

The Community Behavioral Healthcare Association (CBHA), the Illinois Association of Rehabilitation Facilities (IARF), and the Illinois Association for Behavioral Health (IABH), in partnership with the Behavioral Health + Economics Network (BHECON) led by the National Council for Behavioral Health, will host the first of the series of behavioral health forums on August 30 in Normal.

“The state’s planned ‘transformation’ of Illinois’ health care system prioritizes behavioral health services, which promote overall health and lower health costs,” said IABH CEO Sara Moscato Howe. “The state’s effort will align with our behavioral health policy forums, forums that we expect will provide a platform to help shape’s the Administration’s policies going forward.”

The August 30 forum in Normal, “Illinois Behavioral Health Pre-Transformation: Where Are We Now and Where Are We Going?,” will provide a scan of the current system in Illinois. Presenters will discuss Illinois’ current system of care along with future considerations, such as:

  • Range of treatment options and care settings for individuals with acute, chronic and mild needs;
  • Specialized services available to children and adolescents;
  • Services for co-occurring mental health and addiction disorders;
  • Financing and payment reforms; and
  • Policy reforms that ensure individuals access to care at all stages, including prevention and early intervention.

Speakers from a diverse array of industries will also discuss creative approaches to integrating care, the impact and cost savings of a housing-first approach, how early intervention and prevention programs could be implemented across the state, and how available resources drive capacity, according to Howe.

“In Illinois, the burden of untreated mental health conditions and lack of access to substance use prevention and treatment falls on hospital emergency departments, jails, prisons, child welfare systems, schools, communities, and families,” said Howe. “That burden and the policy solutions will be the centerpiece of the forum series.”

This initial forum is expected to lead discussion towards fundamental questions:

  • What is our vision for a comprehensive, high-performing delivery system in Illinois?
  • Where are current gaps in care that create poor health outcomes and increase expenditures in the system?

The next planned forum in Normal will be on October 6.

“Throughout the three forums, participants will hear from experienced executives and clinicians from community clinics, state agency representatives, legislators, and educators,” said Howe. “They will share innovative approaches to address the continuum of care and share data from economic research on the impact of community-based care.”

The date of the third forum in Normal remains to be determined.

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Cash Reserves Exhausted, Hispanic Drug Treatment Agency Closure Looms

Illinois’ budget impasse is driving a suburban non-for-profit substance abuse treatment agency, which serves mostly Hispanic residents, to close all offices by July 1.

Without payment from the state on the $59,326 owed, the Elgin-based Latino Treatment Agency will begin to shut down two agency facilities by June 15 and the final office by July 1.

“Given the State’s inability to release the $59,326 owed to the Latino Treatment Agency from our state grant, we will be unable to provide services to our clients, mostly from the Hispanic community, if we do not receive these State funds by July 1,” said agency executive director Adriana Trino. “More than 160 clients will be terminated from services by July 1.”

Trino says that the agency, which has been in operation for more than 30-years, has cut salaries and exhausted bank lines of credit and cash reserves in order to maintain services to its 160 Hispanic clients spread through out Cook, DuPage, and Kane counties.

“We have cut our expenses; we have accumulated debt; and we have reduced salaries of every staff member,” Trino said. “We have exhausted cash reserves and our line of credit in order to remain afloat.”

The $59,326 owed to agency is on top of $60,690 cut from the group’s $273,008 budget by the Rauner Administration in August 2015.


Op-Ed: Proposed Rauner Budget Fails to Meet Mental Health, Addiction Health Care Needs

OP-ED: Illinois has a staggering behavioral healthcare challenge and it needs a budget to meet that challenge.

Recent data from the federal Substance Abuse and Mental Health Services Administration underscores the need for a strong, well-funded community-based system of addiction and mental health services in Illinois.

Between 2010 and 2014, the behavioral healthcare challenges, such as depression, suicide risk, drug and/or alcohol abuse, for Illinois men, women, and children have mounted.

  • About 105,000 adolescents’ ages 12-17 report having at least one major depressive episode, while only 38% received treatment for their depression.
  • 355,000 adults 18 and over report ‘serious thoughts of suicide’; while ~363,000 qualified for a Serious Mental Illness (SMI) diagnosis.
  • Of the 1.53 million Illinois adults having ‘any mental illness’ (AMI) in the previous year, more than 55% did not receive mental health treatment.
  • Similarly, only 11.7% of the estimated 267,000 individuals 12 and older dependent on or abusing illicit drugs received treatment for their substance use disorder.

While behavioral problems and needs are clear, funding for addiction and mental illness prevention and treatment has been continually reduced by the Illinois General Assembly. In the past five years, the legislature has slashed state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%.

Meanwhile, an epidemic of heroin and non-medical use of prescription drugs has exploded across the state, forcing Illinois’ jails and correctional centers to become ill-equipped triage centers for individuals with mental illnesses and/or substance use disorders. Cook County Sheriff Tom Dart has repeatedly stated that the Cook County Jail is now the ‘largest mental health institution in the country’, and a majority of the individuals under his care are also there as a result of untreated addiction.

Over the past several years, Illinois has witnessed an expansion of mental health and addiction parity, the implementation of the Affordable Care Act, and a shift from state General Revenue Funds and Medicaid funding to a system of Managed Care funding, all of which has been implemented by providers in the trenches. At the same time, providers have borne uncompensated, additional expenses associated with implementation of Electronic Health Records and electronic billing. These changes have occurred while the legislature has almost annually imposed funding reductions on community providers, refused to raise historically low reimbursement rates, and left unresolved a Fiscal Year 2016 budget impasse that threatens to undermine our system of community-based care at its core.

While the staggering challenges to Illinois behavioral healthcare community providers continue to bear down, the policy prescription in the form of Governor Bruce Rauner’s proposed FY 2017 falls, let us say, short. In fact, the Governor’s budget proposal continues to move Illinois in the wrong direction, threatening to decimate the already-weakened safety net for Illinois’ most vulnerable citizens.

At a time when the need to prioritize state dollars for the maximum return on investment, reductions to the community behavioral health system are short-sighted and ill-conceived.

Data from national studies have concluded that addiction and mental health treatment not only produces measurable, positive outcomes, but also yields substantial savings to states. A 2014 actuarial study by Milliman found that $26-$48 billion could be saved nationally through effective integration of medical and behavioral services.

Additionally, several studies underscore the positive impact of addiction and mental health services:

  • A 2004 randomized trial studying employer costs found that ‘consistently-employed patients in an enhanced depression management program had 8.2% greater productivity and 28.4% less absenteeism over two years than employees receiving ‘usual care’.
  • The reduction in absenteeism and increase in productivity had an estimated annual value of $2,601 per full-time equivalent employee.
  • The state of Washington compared disabled Medicaid enrollees receiving SU treatment with the untreated population, finding that average monthly medical costs were $414 higher for those not receiving treatment, and with the cost of the treatment added in, there was a net cost offset of $252 per month or $3,024 per year. For individuals with opiate-addiction, cost offsets rose to $899 per month for those who remain in methadone treatment for at least one year.
  • The same study also found that prior to their SUD treatment expansion initiative, healthcare costs for Medicaid disabled clients with SUD problems were rising at a rate of 11% per year. Under the SUD treatment expansion initiative, the growth in healthcare costs was slowed to just 2.8% per year.

The solution is clear.

The Illinois General Assembly and the Governor must prioritize funding for addiction and mental illness prevention, treatment, and recovery support. Lawmakers and the Governor need to end the funding reduction cycle. Now. Instead, Lawmakers and the Governor need to close the gap between those needing behavioral healthcare and those receiving it. Lawmakers and the Governor need to invest in behavioral healthcare.

The governor’s proposed FY 2017 budget fails to do that.

The budget needs a do over.

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

OP-ED: “Unbalanced Budget Response Act” Would Undermine Illinois Behavioral Healthcare


Eric Foster, Vice President for Substance for Policy, Illinois Alcoholism and Drug Dependence Association

OP-ED: Illinois behavioral healthcare providers are faced with many daunting, financial problems uncertainties as they struggle to deliver quality mental health and addiction treatment services to fathers, mothers, and children in need.

The “Unbalanced Budget Response Act” would make their job worse.

First, since Fiscal Year 2009 through Fiscal Year 2015, Illinois eliminated state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%. In Fiscal Year 2016, Governor Bruce Rauner cut behavioral health providers by another 25%.

Second, over the past several years, behavioral healthcare providers have had to shoulder the vast implementation expansion requirements for the Parity of Mental Health and Substance Abuse Act, the implementation of the ACA, and the shift from state GRF/Medicaid to Medicaid Managed Care. Moreover, non-profit providers have had to absorb the additional expense associated with implementation of Electronic Health Records and electronic billing.

These herculean bureaucratic demands had to be implemented while simultaneously being hit by the legislature and governor with budget reductions in overall funding for services and no meaningful increase in reimbursement rates to actually cover the growing costs of doing business, such as implementing new mandates.

A recent report from the Illinois Partners for Human Services has found that stagnant reimbursement rates have had significant negative impact on the provider’s ability to cover basic operation costs. Low rates contribute to high employee turnover. Low rates blunt the expansion services to meet the growing needs of Illinois citizens. Low rates leave Illinois exposed to each new drug crisis.

The report also shows that in order to be current with cost of living, reimbursement rates for substance abuse treatment would need to increase by 27% and rates for community mental health services would need to increase by 16%.

Meanwhile, the “Unbalanced Budget Response Act”, Senate Bill 2789, would grant the governor the power to reduce rates unilaterally and without appeal. That authority to gut the last remaining financial life-line that has helped to keep Illinois’ limping behavioral healthcare system function would be an abrogation of the legislature’s own authority and of its own responsibility to the constituents to whom they serve.

Behavioral healthcare providers will be unable to sustain a service if they cannot cover the costs of rendering that service. Granting authority to arbitrarily reduce provider reimbursement rates would be a fatal blow to an already crumbling mental health and substance abuse treatment system.

The Illinois Alcoholism and Drug Dependence Association vigorously opposes this legislation.

Eric Foster, Vice President for Substance Abuse Policy, Illinois Alcoholism and Drug Dependence Association