HB 5315

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Full Text of HB5315
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	HB5315 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5315
Introduced 2/10/2026, by Rep. Dagmara Avelar
SYNOPSIS AS INTRODUCED:
305 ILCS 66/20-10
Amends the Rebuild Illinois Mental Health Workforce Act. Provides that, subject to federal approval, for dates of service on and after July 1, 2026, the Medicaid reimbursement rates for Assertive Community Treatment and Community Support Team services shall be increased by an amount appropriated for the purposes enumerated in the Act. Effective July 1, 2026.
LRB104 20593 KTG 34083 b
A BILL FOR
		HB5315		LRB104 20593 KTG 34083 b
1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Rebuild Illinois Mental Health Workforce
5Act is amended by changing Section 20-10 as follows:
6    (305 ILCS 66/20-10)
7    Sec. 20-10. Medicaid funding for community mental health
8services.  Medicaid funding for the specific community mental
9health services listed in this Act shall be adjusted and paid
10as set forth in this Act. Such payments shall be paid in
11addition to the base Medicaid reimbursement rate and add-on
12payment rates per service unit.
13    (a) The following payment adjustments shall begin on July
141, 2022 for State Fiscal Year 2023 and shall continue for every
15State fiscal year thereafter.
16        (1) Individual Therapy Medicaid Payment rate for
17    services provided under the H0004 Code:
18            (A) The Medicaid total payment rate for individual
19        therapy provided by a qualified mental health
20        professional shall be increased by no less than $9 per
21        service unit.
22            (B) The Medicaid total payment rate for individual
23        therapy provided by a mental health professional shall
		HB5315	- 2 -	LRB104 20593 KTG 34083 b
1        be increased by no less than $9 per service unit.
2        (2) Community Support - Individual Medicaid Payment
3    rate for services provided under the H2015 Code: All
4    community support - individual services shall be increased
5    by no less than $15 per service unit.
6        (3) Case Management Medicaid Add-on Payment for
7    services provided under the T1016 code: All case
8    management services rates shall be increased by no less
9    than $15 per service unit.
10        (4) Assertive Community Treatment Medicaid Add-on
11    Payment for services provided under the H0039 code: The
12    Medicaid total payment rate for assertive community
13    treatment services shall increase by no less than $8 per
14    service unit.
15    (b) [(5)] Medicaid user-based directed payments. The 
16following directed payments shall be paid to qualifying 
17providers for State Fiscal Year 2023 through State Fiscal Year 
182026.
19        (1) [(A)] For each State fiscal year, a monthly directed
20    payment shall be paid to a community mental health
21    provider of community support team services based on the
22    number of Medicaid users of community support team
23    services documented by Medicaid fee-for-service and
24    managed care encounter claims delivered by that provider
25    in the base year. The Department of Healthcare and Family
26    Services shall make the monthly directed payment to each
		HB5315	- 3 -	LRB104 20593 KTG 34083 b
1    provider entitled to directed payments under this Act by
2    no later than the last day of each month throughout each
3    State fiscal year.
4            (A) [(i)] The monthly directed payment for a
5        community support team provider shall be calculated as
6        follows: The sum total number of individual Medicaid
7        users of community support team services delivered by
8        that provider throughout the base year, multiplied by
9        $4,200 per Medicaid user, divided into 12 equal
10        monthly payments for the State fiscal year.
11            (B) [(ii)] As used in this subparagraph, "user"
12        means an individual who received at least 200 units of
13        community support team services (H2016) during the
14        base year.
15        (2) [(B)] For each State fiscal year, a monthly directed
16    payment shall be paid to each community mental health
17    provider of assertive community treatment services based
18    on the number of Medicaid users of assertive community
19    treatment services documented by Medicaid fee-for-service
20    and managed care encounter claims delivered by the
21    provider in the base year.
22            (A) [(i)] The monthly direct payment for an
23        assertive community treatment provider shall be
24        calculated as follows: The sum total number of
25        Medicaid users of assertive community treatment
26        services provided by that provider throughout the base
		HB5315	- 4 -	LRB104 20593 KTG 34083 b
1        year, multiplied by $6,000 per Medicaid user, divided
2        into 12 equal monthly payments for that State fiscal
3        year.
4            (B) [(ii)] As used in this subparagraph, "user"
5        means an individual that received at least 300 units
6        of assertive community treatment services during the
7        base year.
8        (3) [(C)] The base year for directed payments under this
9    Section shall be calendar year 2019 for State Fiscal Year
10    2023 and State Fiscal Year 2024. For the State fiscal year
11    beginning on July 1, 2024, and for every State fiscal year
12    thereafter, the base year shall be the calendar year that
13    ended 18 months prior to the start of the State fiscal year
14    in which payments are made.
15    (b-5) [(b)] Subject to federal approval, a one-time directed
16payment must be made in calendar year 2023 for community
17mental health services provided by community mental health
18providers. The one-time directed payment shall be for an
19amount appropriated for these purposes. The one-time directed
20payment shall be for services for Integrated Assessment and
21Treatment Planning and other intensive services, including,
22but not limited to, services for Mobile Crisis Response,
23crisis intervention, and medication monitoring. The amounts
24and services used for designing and distributing these
25one-time directed payments shall not be construed to require
26any future rate or funding increases for the same or other
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1mental health services.
2    (b-6) Subject to federal approval, for dates of service on 
3and after July 1, 2026, the Medicaid reimbursement rates for 
4Assertive Community Treatment and Community Support Team 
5services shall be increased by an amount appropriated for the 
6purposes enumerated in this Act.
7    (c) The following payment adjustments shall be made:
8        (1) Subject to federal approval, beginning on January
9    1, 2024, the Department shall introduce rate increases to
10    behavioral health services no less than by the following
11    targeted pool for the specified services provided by
12    community mental health centers:
13            (A) Mobile Crisis Response, $6,800,000;
14            (B) Crisis Intervention, $4,000,000;
15            (C) Integrative Assessment and Treatment Planning
16        services, $10,500,000;
17            (D) Group Therapy, $1,200,000;
18            (E) Family Therapy, $500,000;
19            (F) Community Support Group, $4,000,000; and
20            (G) Medication Monitoring, $3,000,000.
21        (2) Rate increases shall be determined with
22    significant input from Illinois behavioral health trade
23    associations and advocates. The Department must use
24    service units delivered under the fee-for-service and
25    managed care programs by community mental health centers
26    during State Fiscal Year 2022. These services are used for
		HB5315	- 6 -	LRB104 20593 KTG 34083 b
1    distributing the targeted pools and setting rates but do
2    not prohibit the Department from paying providers not
3    enrolled as community mental health centers the same rate
4    if providing the same services.
5    (d) Rate simplification for team-based services.
6        (1) The Department shall work with stakeholders to
7    redesign reimbursement rates for behavioral health
8    team-based services established under the Rehabilitation
9    Option of the Illinois Medicaid State Plan supporting
10    individuals with chronic or complex behavioral health
11    conditions and crisis services. Subject to federal
12    approval, the redesigned rates shall seek to introduce
13    bundled payment systems that minimize provider claiming
14    activities while transitioning the focus of treatment
15    towards metrics and outcomes. Federally approved rate
16    models shall seek to ensure reimbursement levels are no
17    less than the State's total reimbursement for similar
18    services in calendar year 2023, including all service
19    level payments, add-ons, and all other payments specified
20    in this Section.
21        (2) In State Fiscal Year 2024, the Department shall
22    identify an existing, or establish a new, Behavioral
23    Health Outcomes Stakeholder Workgroup to help inform the
24    identification of metrics and outcomes for team-based
25    services.
26        (3) In State Fiscal Year 2025, subject to federal
		HB5315	- 7 -	LRB104 20593 KTG 34083 b
1    approval, the Department shall introduce a
2    pay-for-performance model for team-based services to be
3    informed by the Behavioral Health Outcomes Stakeholder
4    Workgroup.
5(Source: P.A. 102-699, eff. 4-19-22; 102-1118, eff. 1-18-23;
6103-102, eff. 7-1-23; 103-154, eff. 6-30-23.)
7    Section 99. Effective date. This Act takes effect July 1,
82026.