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Bill

HB 2993

Relating to linguistically appropriate health care.

2025 Regular Session Introduced by Lesly Muñoz and 1 co-sponsor

Creates monthly, user-based directed payments to community mental health providers for Medicaid services, adds per-unit rate boosts, and requires MCO payment reconciliation.

In committee upon adjournment.
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Bill Summary · HB 2993

HB 2993 — DHFS: Community Mental Health Provider (Summary)

Sponsor: Rep. Lindsey LaPointe
Introduced: Feb 6, 2025; current status: Rule 19(a) / Re‑referred to Rules Committee (passed the House on May 14, 2025; received from the House May 15, 2025)

Purpose

Amend the Rebuild Illinois Mental Health Workforce Act to (1) establish ongoing, user‑based monthly directed payments to community mental health providers for specified Medicaid behavioral health services, (2) set additional per‑unit Medicaid payment increases for certain service codes, and (3) require the Department of Healthcare and Family Services (HFS) to reconcile payments where managed care organizations (MCOs) have paid providers but no encounter claim is recorded.

Key provisions

  • Per‑unit Medicaid rate increases (added to base reimbursement):

    • H0004 (individual therapy/professional): increase by at least $9 per service unit.
    • H2015 (community support — individual): increase by at least $15 per service unit.
    • Case management services: increase by at least $15 per service unit.
    • H0039 (add‑on for Assertive Community Treatment): increase by at least $8 per service unit.

  • Monthly, Medicaid user‑based directed payments (divided into 12 monthly payments per State fiscal year):

    • Community Support — Team services (H2016): base‑year total Medicaid users × $4,200 per user ÷ 12.
    • "User" = individual who received at least 200 units of H2016 during the base year.
    • Assertive Community Treatment (ACT): base‑year total Medicaid users × $6,000 per user ÷ 12.
    • "User" = individual who received at least 300 units of ACT during the base year.
    • Community Support — Individual services (H2015): (new provision effective Jan 1, 2026) base‑year total Medicaid users × $2,400 per user ÷ 12.
    • "User" = individual who received at least 100 units of H2015 during the base year.

  • Base year determination:

    • Calendar year 2019 used as base year for State Fiscal Years (SFY) 2023 and 2024.
    • For the SFY beginning July 1, 2024 and thereafter, the base year is the calendar year that ended 18 months before the start of the SFY in which payments are made.

  • Reconciliation and claims:

    • HFS must identify and adjust/pay community mental health providers for payments authorized where an MCO has paid the provider but no encounter claim was recorded in HFS’s Enterprise Data Warehouse (EDW).
    • HFS must develop a reconciliation process allowing providers to submit/reconcile claims not previously used for payment calculations.

  • MCO accountability:

    • The Department is permitted to sanction Medicaid managed care organizations for services that were not received/not recorded by the Department (subject to federal Medicaid rules and other provisions in the Act).

  • One‑time directed payment (described in truncated text):

    • A one‑time directed payment was authorized in calendar year 2023 for integrated assessment/treatment planning and intensive services (mobile crisis, crisis intervention, medication monitoring); details and appropriation amounts were to be specified and are not continued obligations.

Who is affected

  • Community mental health providers who deliver H0004, H2015, H2016, ACT, case management and related services to Medicaid enrollees.
  • Medicaid enrollees receiving intensive community mental health services.
  • Medicaid managed care organizations (MCOs), which face new reconciliation requirements and potential sanctions.
  • The Illinois Department of Healthcare and Family Services (implementation, payment, and audit responsibilities).

Timeline / implementation

  • Per‑unit increases and earlier directed payments began with SFY 2023 (July 1, 2022) where specified.
  • New directed payments for community support — individual services commence January 1, 2026.
  • Directed payments are made monthly, and HFS must pay providers entitled to directed payments by no later than the last day of each month in the fiscal year.

Notes / uncertainties

  • The bill text included a truncated section describing a 2023 one‑time payment; exact appropriation amounts were not provided in the available text.
  • Fiscal impact: the bill creates recurring directed payments (examples: $2,400, $4,200, $6,000 per qualifying user annually) plus per‑unit increases; overall cost depends on provider counts and the number of qualifying Medicaid users based on the designated base year(s).
  • The Department’s reconciliation process and the scope of MCO sanctions will determine administrative implementation complexity.

If you’d like, I can produce a short table showing the payment formulas and qualifying unit thresholds, or estimate statewide fiscal impact given enrollment data.

Compiled from official sources — confirm details with the bill’s official record.

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