Governor signs measures to ramp up treatment of mental illness, opioid abuse

SPRINGFIELD — Gov. Bruce Rauner this week signed a bill package that increases access to mental health and substance use disorder treatment and addresses the state's opioid crisis.

"We are taking steps to dramatically improve mental health and substance use disorder treatment for the people of Illinois," Rauner said. "These five initiatives work together to improve the quality of care and hopefully, the quality of life for so many Illinoisans suffering from mental health and substance use disorders."

Signed Wednesday:

• Senate Bill 1707 improves insurance companies' coverage of mental health and substance use disorder treatments and strengthens the ability of the Department of Insurance to protect consumers.
• Senate Bill 682 allows providers to give immediate access to outpatient treatment by removing prior authorization barriers.
• Senate Bill 3049 expands access to behavioral and mental health experts for Medicaid patients by allowing them to utilize telehealth technology.

Signed Tuesday:

• Senate Bill 3023 partners law enforcement agencies with licensed substance abuse service providers.
• Senate Bill 2951 provides the Department of Healthcare and Family Services the opportunity to apply for a waiver that would allow treatment for serious mental illness on the first episode of psychosis.

"The Opioid Helpline has received over 5,000 calls in eight months," Rauner said. "The State Police have trained approximately 1,600 officers in the use of NARCAN. And now, with this signing, we are reaffirming our efforts, putting Illinois on the path to becoming the nation's leader in mental health and substance use disorder treatment."

In a ceremony at Memorial Center for Learning & Innovation in Springfield on Wednesday, Rauner signed the bill package to improve the quality of care for Illinoisans with mental health and substance use disorders.

"This is no time for moral platitudes, judgment or shame," Rauner said. "We are amid an opioid crisis in our state and around the country. We need comprehensive, evidence-based solutions. And that is what we have here today."

Senate Bill 1707, passed with overwhelming bipartisan support, improves the scope and coverage of Illinois' parity laws and provides clear enforcement power to the Department of Insurance (DOI). The legislation prohibits prior authorization and step-therapy requirements for FDA-approved medications to treat substance use disorders and requires generic medications be on the lowest-tier of prescription formularies.

"This law is putting the ability to treat people and get them well back in the hands of providers," Rauner said. "It lets providers do their jobs saving lives."

The legislation also prohibits exclusions of the prescription coverage and related support services for substance use disorders because they are court-ordered.

"These medications are a critical component in the state's efforts to combat the opioid crisis and get people, including those who are ordered by the court to seek treatment, the help they need," said DOI Director Jennifer Hammer. "This isn't just about rules and regulations, it's about not giving up on people."

This legislation also aims to improve transparency by requiring insurance companies to make parity compliance information available via a public website.

"I applaud the Illinois legislature and Gov. Rauner for enacting this landmark parity legislation, which will hold insurers accountable for complying with state and federal mental health parity laws," said former Congressman Patrick J. Kennedy, founder of The Kennedy Forum. "By increasing access to treatment amid skyrocketing rates of overdoses and suicides in this country, SB 1707 will save lives! I call on other states to follow Illinois' lead in demanding insurer and regulator transparency and accountability to help end coverage discrimination against people with mental health and addiction challenges."

The legislation clarifies that medication-assisted treatment medical necessity determinations must comply with the American Society of Addiction medicine guidelines.

"This state, like many others, has a serious problem with the overuse of prescription painkillers and runaway opioid addictions," said Rep. Margo McDermed, R-Mokena, who co-sponsored the bill. "Simplifying this process will most certainly improve patients' quality of life and it will hopefully lead to less opioid overdoses."

Finally, the legislation requires that school district plans comply with state parity laws.

"Mental health and substance abuse issues are a serious problem that affect many citizens in Illinois," said Sen. Laura Murphy, D-Des Plaines, who co-sponsored the bill. "Information about and access to adequate treatments is often difficult for those suffering from these issues to find or afford. These treatments have the potential to save the lives of those who need them, so it's critical that we as a legislature do all that we can to ensure that anyone who needs treatment can get it."

Senate Bill 682 is a key component in addressing the opioid crisis by providing people in need immediate access to outpatient treatment.

"Obtaining treatment is often a matter of life and death for people fighting addiction," Rauner said. "SB 682 helps give them the tools to win that fight."

Currently, individuals experiencing an opioid overdose or reaction must wait for their treatment to be approved by their insurance plan before entering a facility. The legislation removes prior authorization barriers so people do not have to wait for treatment.

"This year Illinois tackled the issue of substance use, working closely with providers to remove barriers to admission," said Rep. Sara Feigenholtz, D-Chicago, chief sponsor of the legislation in the House. "The moment a person decides they are ready to enter a recovery program is a crucial one — and that person should never be turned away. SB 682 removes the prior authorization requirement to eliminate barriers to recovery treatment."

"When a provider determines that an individual with a substance abuse addiction needs immediate treatment that is medically critical, prior authorization from an insurance company can cause delay in care," said Sen. John Mulroe, D-Chicago, chief sponsor of the bill in the Senate. "That delay in care has resulted in death. Senate Bill 682 will remove an administrative barrier to treat substance abuse addiction and will aid in the fight against the opioid epidemic."

In the event the insurance company denies treatment, SB 682 requires the insurance plan to cover outpatient treatment for 72 hours while the patient challenges the denial.

"It gives those in need the option for immediate coverage while they determine future coverage," said the Department of Insurance's Hammer. "It provides the support these people need at the right place at the right time. We hope it will encourage treatment and save and improve countless lives."

The legislation also defines that those who are insured will be free to select the professional of their choice to treat their disorder and the insurer must pay the covered charges if they are listed in the policy.

"Both rural and urban Illinois families have lost loved ones to drug overdoses that, in many cases, could have been prevented with immediate access to addiction treatment," said Illinois Association for Behavioral Health CEO Sara Howe. "By eliminating insurance pre-authorization red tape for critical care, Gov. Rauner deserves praise for now ensuring swift access to vital addiction services that will save lives."

Senate Bill 3023 partners law enforcement agencies with licensed substance abuse service providers to focus on preventive measures in dealing with the opioid crisis and other substance use issues.

"Our police officers want to help us solve the problem, not just punish people," Rauner said. "This effort builds community and allows our law enforcement and peace officers a way to give people help instead of a criminal record."

"Substance abuse contributes to crime, hurts Illinois families and deteriorates communities," said Rep. Marcus Evans, D-Chicago, the chief sponsor of the bill in the House. "Our Illinois law enforcement and human services leaders understand this reality, and I applaud their support of a solution in the form of SB 3023. I am happy to see this community- and family-improving idea become law."

The legislation allows for a deflection program where peace officers or members of law enforcement agencies facilitate contact between an individual and licensed substance abuse treatment provider or other such professionals.

"We know the factors involved with treating mental health and substance abuse are multilayered and complex," said Sen. Melinda Bush, D-Grayslake, chief sponsor of the bill in the Senate. "Early detection is key, as both issues can manifest into a lifetime of challenges if left untreated." 

"This new law focuses on preventive measures in dealing with the opioid crisis and other substance abuse issues," said Sen. Tim Bivins, R-Dixon, who co-sponsored the legislation. "It partners law enforcement agencies with licensed substance abuse service providers to treat individuals with substance abuse problems before they are arrested. Getting these individuals help before they enter the jail system will make it easier for them to resume their daily routines later without a criminal record, and will reduce the burden on local jail and court systems."

"This legislation is modeled off the Safe-Passage Program in Dixon, Illinois," said Rep. Tom Demmer, R-Dixon, who co-sponsored the legislation in the House. "Dixon has had great success with 215 people placed directly into treatment over incarceration. This has resulted in a 39 percent reduction in arrests for drug crimes, as well as properly deflecting people to get the medically driven substance abuse help they need instead of making it difficult for them to get help because of a criminal record."

"Deflection programs provide police officers with another option when dealing with someone they believe may have opioid or other substance abuse problems," said Sen. Dan McConchie, R-Hawthorn Woods, who co-sponsored the legislation in the Senate. "Continuously arresting and locking up such troubled individuals rarely fixes their underlying issue. It is my hope that with these deflection programs, we can get people the treatment and help they need to get better."

Senate Bill 3049, signed Tuesday night, expands access to behavioral and mental health experts for Medicaid beneficiaries by allowing patients to meet their behavior and mental health needs via telehealth technology — as is the current practice in over 30 states.

"By encouraging telehealth services through reimbursement, we can lower the cost of our health care system and allow more people to receive vital treatment that can improve their lives," Rauner said. "We are grateful to the leadership of Lt. Gov. Sanguinetti and the Illinois Telemedicine Task Force for all the hard work they have put in to make this life-changing initiative a reality for so many people."

Lt. Gov. Evelyn Sanguinetti has visited nearly two dozen hospitals and medical offices across Illinois the past two years to learn how telemedicine improves access to quality health care while reducing costs. As co-chair of the Illinois Medicaid Telemedicine Task Force, she has passionately advocated for expansive telemedicine reform and strongly supported the legislation.

"Medicaid clients with behavioral health needs represent 25 percent of all Medicaid enrollees but account for 56 percent of all Medicaid spending," Sanguinetti said. "By signing SB 3049 today, Gov. Rauner will immediately improve access to mental health experts for Medicaid beneficiaries. The result will be fewer emergency visits, reduced hospital stays and readmissions, and lower costs to taxpayers — but most importantly, a better quality of life for those with mental and behavioral health needs."

After researching cost analyses of other states' programs and third-party studies, Sanguinetti and members of the Illinois Medicaid Telemedicine Task Force recommended expanding Medicaid telehealth coverage to improve access to quality health care in a way that lowers the overall cost to Medicaid. 

"This plan begins to solve a problem in central and southern Illinois by breaking down a significant barrier to mental health care, which is access," said Sen. Andy Manar, D-Bunker Hill, chief sponsor of the measure in the Senate. "By chipping away at some of Illinois' outdated regulations, we can help families begin to get more of the help they need in a timely manner closer to home for a fraction of the cost."

"Telehealth medicine is the way of the future," said Rep. Sue Scherer, D-Decatur, chief co-sponsor of the legislation in the House. "After working nine months on this bill, it is now becoming law. I appreciate the bipartisan support from both the House of Representatives and the Senate."

The legislation requires Medicaid to reimburse eligible behavioral and mental health providers at the same rate it would reimburse for in-person care.

"I'm grateful to Gov. Rauner for signing this important piece of legislation that will help so many residents in Illinois have better access to behavioral health services," said Rep. Sara Wojcicki Jimenez, R-Leland Grove, who co-sponsored the bill in the House. "As we continue to study this issue in our house mental health committee meetings, we continue to prioritize access issues to this important service, especially in downstate Illinois."

The measure will also allow schools, hospitals, substance abuse centers and other Medicaid-eligible facilities that serve as the location of the patient at the time of a telehealth appointment to receive a $25 facility fee from Medicaid.

"The Illinois Health and Hospital Association (IHA) and the hospital community commend Gov. Rauner and the General Assembly, especially sponsors Sen. Andy Manar and Rep. Sue Scherer, for enacting this important legislation to improve telehealth coverage for critically needed behavioral health services," said IHA President and CEO A.J. Wilhelmi. "This is a positive step in strengthening Illinoisans' access to provider networks, contributing to timely care in the most appropriate setting and helping facilitate the integration of physical and behavioral health care in hospital and primary care settings. This will help enhance the efficient delivery of care, such as by avoiding unnecessary hospital emergency department utilization."

Currently, reimbursement is only provided to psychiatrists and Federally Qualified Health Centers for telepsychiatry.

"Health care providers that offer mental health services are crucial to combating mental health issues in Illinois," said Sen. Murphy of Des Plaines, who co-sponsored the bill in the Senate. "By expanding the number of mental health care providers who can bill Medicaid for telehealth services, we hope to avoid a situation where a health care provider who is facing financial trouble has to turn away a patient in need."  

Senate Bill 2951, signed Tuesday night, provides the Department of Health and Family Services (HFS) the opportunity to apply for a waiver that would allow treatment for serious mental illness on the first episode of psychosis.

"The Early Mental Health and Addictions Treatment Act puts Illinois in the forefront nationally in tackling the country's long-standing mental health crisis," said Senior Vice President of Advocacy and Public Policy at Thresholds Heather O'Donnell. "If federal approval is granted, Illinois will be the first state in the country to cover through Medicaid a treatment model, including intensive wrap-around services, tailored specifically for young people in the early stages of a serious mental health condition."

Early intervention is important in reducing the severity of the progression of the disease as well as preventing future emergency room visits. It is especially vital for young people who will benefit from early intervention.

"First episode treatment has proven to be highly successful," said Feigenholtz, chief sponsor of the bill in the Senate. "Illinois should be proud to be among the first states to pilot these interventions around the state."

Praising the overall package of bills was Ed Curtis, president and CEO of Memorial Health System.

"Health care is about people serving people. It's not something any of our organizations can do alone," Curtis said. "These bills illustrate the importance of collaboration within our community and our state to improve the healthcare of our citizens."

Last year, Rauner issued an executive order to create the Governor's Opioid Prevention and Intervention Task Force to help combat the epidemic. This spring he launched Better Care Illinois which, through an 1115 waiver, will allow the state to better address substance abuse in Illinois.

"Mental health often determines our physical health," Rauner said. "It is vital we increase Illinoisans' access to treatments that can improve and save their lives. This bill package is the culmination of almost four years of bipartisan, public-private sector work, and I couldn't be more proud of what we have accomplished together."