Illinois Behavioral Health System Overview

National Association of County Behavioral Health & Developmental Disability Directors State of Illinois Behavioral Health System Design Scott A. Block MA, LCPC, CADC, CCJP Scott A. Block MA, LCPC, CADC, CCJP April 29, 2021 1:00pm 1

State of Illinois Behavioral Health System Design 2

Department of Human Services Division of Mental Health/Community & Forensic Division of Substance Use Prevention & Recovery Division of Family and Community Services State Agencies That Fund Behavioral Health Department of Healthcare and Family Service (Medicaid Authority) Department of Children and Family Services (Child Welfare Authority) Illinois State Board of Education Department of Public Health Department of Juvenile Justice 3

Medicaid (Medicaid individuals with diagnosed behavioral health needs make up ~20% of the population, but ~56% of the total spend) State Grants Federal Grants 708 Boards Commercial Foundations Self Pay (Sliding scale) Behavioral Health Funding 4

Medicaid FFS Program: Behavioral Health Benefits FFS Addiction Treatment Benefits FFS Mental Health Benefits 1. Inpatient treatment 2. Outpatient treatment 3. Intensive outpatient treatment 4. Residential treatment including in IMDs 5. Medication assisted treatment 6. Medically supervised withdrawal management 1. Inpatient treatment 2. Assessment and evaluation 3. Crisis services 4. Medication administration, management, monitoring, and training 5. Individual, family, and group psychotherapy 6. Community support services and team 7. Assertive community treatment (ACT) 8. Psychosocial rehabilitation services 9. Intensive outpatient 10. Case management 11. Transition linkage and aftercare 5

Mental Health Providers 214 Community-based Mental Health Centers 27 community hospitals with psychiatric units 7 state-operated hospitals, containing both civil and forensic beds Community Based Behavioral Health Providers Independent Medicaid Practitioners Licensed Clinical Social Worker Licensed Clinical Psychologist Psychiatrist Substance Use Providers 1037 licenses, 469 corporations and 922 sites. 119 of those corps are funded by SUPR. 6

Part 140 establishes the broad range of requirements all providers (Rule 132) and (Part 140) perform different functions in the Illinois Administrative Code Administrative Rules Part I40 replace 132 Rule 132, establishes the requirements an entity must meet in order to be certified as a Community Mental Health Center (CMHC/BHC). Illinois Medical Assistance Program HFS is able to standardize the definition of mental health services across multiple provider types while reducing the overall administrative burdens placed upon providers. Any and all service references or requirements in Rule 132 pertain specifically to state-funded services purchased by Department of Human Services / Division of Mental Health (DHS-DMH) using 7

What is the difference between a Behavioral Health Clinic (BHC) and a Community Mental Health Center (CMHC)? Provider Types 8

Began in 2011, for seniors and persons with disabilities who are eligible for Medicaid but not eligible for Medicare. Covered 6 Counties Expanded to cover a total of 29 Counties in 2013 In 2018 moved to cover all 102 Counties in the state Covers medical, behavioral health and pharmacy 1 in 5 individuals with behavioral health needs 6 MCOs (4 statewide) Medicaid Managed Care Program 9

In FY20 CBHA reported an increase of 82,000 individuals seeking mental health or addiction services via Medicaid reimbursement. Medicaid Individuals Served This is a 19% increase in the number of individuals on the Medicaid rolls from FY 2019 to 2020. As of November 2020, Illinois has enrolled 3,167,577 individuals in Medicaid and CHIP 10

Screening for Depression and Follow- Up Plan: Ages 12 to 17 Developmental Screening in the First Three Years of Life Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Quality of Care Children (BH) Disorder (ADHD) Medication Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Follow-Up After Hospitalization for Mental Illness: Ages 6 to 17 11

Follow-Up After Hospitalization for Mental Illness: Age 18 and Older Follow-Up After Emergency Department Visit for Mental Illness Quality of Care Adults (BH) Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment Use of Opioids at High Dosage in Persons Without Cancer Antidepressant Medication Management Adherence to Antipsychotic Medications for Individuals with Schizophrenia Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications 12

The Consent Decree requires the State to implement several provisions to ensure the availability of services, supports and other resources of sufficient quality, scope and variety Integrated Health Homes (IHH) that will provide care coordination for Class Members through either High- Fidelity Wraparound, Intensive Care Coordination or Care Coordination for Transition Age Class Members Behavioral health screenings by Primary Care Physicians, Mobile Crisis Response, Crisis Stabilization, Intensive In- Home Services, Crisis Beds , Respite and Integrated Assessment and Treatment Planning, as well as proposed services of Family Peer Support and Therapeutic Mentoring N.B. CONSENT DECREE 13

Recent System Changes Reduction in Managed Care Organizations Mental Health Rule Changes and Shift of Services to another State Agency (132/140) Integrated Assessment & Treatment Plan (IM- CANS) 1115 Wavier/1915 waiver State Plan Amendments (Integrated Health Homes) Consent Decrees (N.B.) HB16 ABA Therapy (BCBA + LCSW) 14

HFS Healthcare Transformation There are four major components to the Transformation plan: Focus on community needs, for all levels of healthcare, with an emphasis on addressing social and structural determinants of health. Improve health and wellness for individuals and communities. Tailor solutions to meet the unique needs of individual communities. Invest in projects, large and small, that improve outcomes, decrease disparities, and are sustainable over time. 15

Current System Strengths Dedicated, high quality, compassionate, skilled service providers Increasing BH and primary healthcare integration Growing support from the legislature and governor's office Strong partnerships with people who are not traditional behavioral health providers but interact with our clients (schools, police, etc.) Increase interest by state in integration, telehealth and value base payment models 16

Where do we go from here .. 17

Current Challenges The low reimbursement rates that do not cover the costs of providing services. Lack of payment for infrastructure to adapt to changing state policies. Rapidly increasing costs in certain areas, such as psychiatry and IT Recruiting and retaining high quality staff Workforce Disjointed system of care, lack of adequate resources, constant changes in system

Thanks Open Dialogue Scott A. Block Executive Director McHenry County Mental Health Board sblock@mc708.org 815-788-4364 19