Illinois Mental Health Parity Bill Passes House, Moves to Senate

(Springfield) — Illinois Senate Bill 1707, described by the Kennedy Forum Illinois as “the strongest mental health parity law in the nation,” passed the House on May 30 with a 106-9 vote. Sponsored by House Deputy Majority Leader Lou Lang, the bill strengthens parity law, increasing compliance and access to treatment, so that health insurance plans cover mental illness and addictions on par with other medical conditions.

TASC is part of a broad coalition of support for the legislation, which now moves to the Senate for concurrence. Senator Kwame Raoul is the bill’s lead sponsor in the Senate.


With thanks for permission to share, below is the May 30 news release from the Kennedy Forum Illinois:

Illinois families and individuals struggling with mental health and addiction challenges won hard-fought victory for better access to services today. On a strong bipartisan vote of 106-9, the Illinois House of Representatives just passed Senate Bill 1707 – the strongest mental health parity law in the nation. The bill now goes onto the Senate for a vote, possibly as soon as today.

SB1707 is the result of a multi-year Kennedy Forum Illinois campaign to improve parity law enforcement so that people with mental health and addiction challenges can access the treatment they need as required by state and federal law. As part of this campaign, The Kennedy Forum Illinois convened an Illinois Parity Implementation Workgroup with nearly 30 member organizations and spearheaded an Illinois provider survey on the frequency of mental health and addiction treatment denials with key partners.

These efforts resulted in numerous media articles on the damage that mental health and addiction coverage discrimination causes, as well as two House Mental Health Committee hearings on parity, including one on how inadequate parity compliance is helping to fuel our state’s ongoing opioid epidemic, which continues to worsen and killed 2,100 last year.

Specifically, this landmark legislation:

  • Tackles the Opioid Crisis by expanding access to life-saving addiction treatment.

    • The bill prohibits prior authorization and step-therapy requirements for FDA-approved medications to treat substance use disorders;

    • Requires generic FDA-approved medications for substance use disorders to be on lowest-tier of prescription formularies, with branded medications on the lowest tier for branded medications;

    • Prohibits exclusions of prescription coverage and related support services for substance use disorder because they are court ordered, and

    • Requires state regulators to actively ensure plan compliance with parity law utilizing information provided by plans/MCOs and through independent oversight.

  • Increases transparency by requiring health plans to submit parity compliance analyses to the Illinois Dept. of Insurance and the Illinois Dept. of Healthcare and Family Services that align with The Kennedy Forum’s six-step process that shows compliance with federal parity rules and requires plans/MCOs to make parity compliance information available to DOI, HFS, and to individuals via a public website.

  • Improves parity enforcement by requiring the Departments to conduct market conduct examinations/parity compliance audits and report on their enforcement activities annually to the General Assembly and requires the Illinois Auditor General to review implementation state parity law and report to the General Assembly.

  • Closes a loophole in state law that allowed school district health plans to discriminate against mental health and addiction coverage.

By improving accountability and transparency, this legislation will increase parity compliance and access to needed treatment. While there remains much work left to do to end coverage discrimination, SB1707 represents a major milestone not just in Illinois, but the country as a whole.

The Kennedy Forum Illinois thanks Rep. Lou Lang for his tireless leadership on mental health and addiction parity, as well as the Illinois Association for Behavioral Health for its partnership in helping to advance this important legislation. Many thanks also to our numerous partners* for their steadfast support.

*Thank You Supporters and Coalition Members!
American Foundation for Suicide Prevention, American Nurses Association-Illinois, American Psychiatric Association, Chicago Urban League, Community Behavioral Healthcare Association, Depression & Bipolar Support Alliance, Family Guidance Centers, Gateway Foundation, Health & Medicine Policy Research Group, IARF, Illinois Association for Behavioral Health, Illinois Collaboration on Youth, Illinois State Medical Society, Illinois Society for Advanced Practice Nursing, Illinois Psychiatric Society, Live4Lali, NAMI Barrington Area, NAMI Chicago, NAMI Illinois, Rosecrance, Safer Foundation, Smart Policy Works, Sargent Shriver National Center on Poverty Law, TASC, Thresholds


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TASC Joins Partners in West Side Heroin Task Force to Address Chicago’s Opiate Epidemic

(Chicago) – TASC Vice President of Community and Government Affairs George Williams joined other members of the new West Side Heroin Task Force assembled on International Overdose Awareness Day to announce findings of a study on the impact of heroin in Chicago’s west side neighborhoods.

The Roosevelt University study, “Hidden in Plain Sight: Heroin’s Impact on Chicago’s West Side,” found that while media coverage of the current epidemic has focused on “the new face of heroin”—white, suburban or rural users—the west side for many years has been ground zero of the crisis and its consequences.

“To continue to ignore the west side of Chicago is like a firefighter putting out a fire in part of the house and leaving the house burning,” said State Rep. La Shawn Ford (D-8) at the August 31 press conference. The task force, led by Ford and comprised of dozens of partners and organizations, including TASC, will support and intensify existing efforts in the fight against heroin.

Long considered to be a place where people with heroin addictions travel from the suburbs and other parts of Chicago to get their drugs and leave, “the city’s west side actually is a hotbed for heroin hospitalizations, arrests and deaths,” Roosevelt University’s news announced.

State Rep. Camille Y. Lilly, (D-78), vice president of external affairs at Loretto Hospital, highlighted broader community issues related to the heroin crisis. “The overdosing is the outcome of other factors and issues that are going on in our society. People are using drugs to deal with life, lack of jobs, lack of money, lack of housing, lack of healthcare,” she said. “Policy is what’s going to make the difference, and how we fund the policies that are enhancing the lives of individuals.”

Task force member Kathie Kane-Willis, director of the Illinois Consortium on Drug Policy at Roosevelt University, authored the study, which found that opioid-related hospital admissions of Chicagoans on the west side constitute almost one in four such hospitalizations across Illinois. Additionally, heroin possession arrest rates in these neighborhoods continue to exceed those in other parts of the city, even increasing during times of overall citywide decline.

Further, the study indicated that the Chicago metro area experienced the second greatest decline in publicly funded drug treatment admissions among all state metro areas, falling by 61 percent over the past 5 years.

The study found that recent heroin overdose rates were higher in Chicago than in suburban Cook, Will, Lake, McHenry, DuPage, and Kane counties, and the overdose mortality rate across the state was significantly higher for African Americans (8.94 per 100,000 population) than for whites (5.86).

The report includes recommendations to increase community-based treatment, reclassify drug possession related to small amounts as a misdemeanor offense, and provide medication-assisted treatment to individuals incarcerated in Cook County jail, among others.

Joining fellow task force members to release the report, Williams noted that the world is moving to a platform of public health, and not a criminal justice response to heroin addiction.

“Everyone deserves the right to their life and to live,” said Williams. “That’s why we need the necessary services that our state reps, particularly Representative Lilly and Representative Ford have fought for… to continue to make sure that the west side does not continue to be the epicenter, but the west side becomes the model of how the community has gathered together and interrupted men and women and families and communities losing their lives when it’s not necessary.”

Ford advocated that resources, services, and cutting-edge programs be directed to residents, and also encouraged funding for House Bill 1, a comprehensive measure to fight heroin.

In addition to Ford, Willis, and Williams, speakers at the press conference included Dr. Sonia Mehta, CEO of Loretto Hospital; Jacqui Colyer, regional administrator of the Illinois Department of Children and Family Services; Dr. Dan Lustig, vice president of clinical services at Haymarket Center; Jamelia Hand, overdose prevention advocate; Marianne Schiavone, chairperson of West Suburban Hospital; Doris Davenport, president of the Center of Community Connections; and Chelsea Laliberte, executive director of Live4Lali.

George A. H. Williams, TASC vice president of community and government affairs.

George A. H. Williams, TASC vice president of community and government affairs, speaking at the August 31, 2016 press conference.

Paths to Addiction Treatment Fraught With Barriers; Misinformed Expectations Can Set Up Disappointment

(Chicago) – For people in need of addiction treatment, and for families struggling to find help for a loved one, the barriers can be overwhelming.

Desperation can lead families to fall prey to unsavory treatment marketing practices, reported Alison Knopf in the June 13 edition of Alcoholism and Drug Abuse Weekly. The issue’s lead article describes how a Florida treatment center targets Illinois patients who have out-of-network insurance, which has no contract-based cost limitations.

TASC’s Peter Palanca was one of the experts quoted:

“These are predatory marketing tactics,” said Peter Palanca, executive vice president and chief operating officer of TASC, based in Chicago. “I don’t think there’s any question about that,” he told ADAW. “To prey on families who are scared to death, grasping at straws, terrified about their son or daughter dying” is wrong, he said.

Knopf also spoke with Illinois experts Kathie Kane-Willis, director of the Illinois Consortium on Drug Policy at Roosevelt University; Jud DeLoss, external counsel for the Illinois Alcoholism and Drug Dependence Association, and Phil Eaton, president and CEO of Rosecrance, all of whom expressed concern over certain business models and tactics that take advantage of uninformed consumers. The treatment center in Florida, for example, employs a full-time Midwest outreach coordinator, making Illinois the center’s main referral source.

“You shouldn’t have to get on a plane to get treatment,” advised TASC President Pam Rodriguez. “Recovery doesn’t happen magically in a program far away from home. It’s a long process involving changes in physiology, changes in behavior, changes in relationships, and changes in many other aspects of a person’s life. Ultimately, it happens day by day, in the community where people live and work and learn.”

Common barriers to entering treatment can be external influences, such as lack of access, funding, or time, or internal factors, such as stigma, depression, and personal beliefs. These barriers may be compounded by variables such as insurance coverage, geography, race and ethnicity, genderage, and other factors.

Misinformed expectations about treatment also contribute to people not getting to into treatment, or not getting the treatment that works for them, said Rodriguez.

The biggest misconception about treatment is that it’s going to magically fix you,” she said. “People often have wrong expectations about what’s going to happen as a result of going to treatment. You don’t go to treatment to get fixed. You go to treatment to learn entirely new ways to live your life. And that can be scary and difficult.

“You need to find treatment that feels right for you,” she added. “If your gut says it isn’t right, it probably isn’t. Just as with any other health issue, you might go through a few doctors before you find one that works for you. It’s the same with treatment.”

The Illinois Department of Human Services, Division of Alcoholism and Substance Abuse publishes a county-by-county list of substance use disorder treatment programs. Nationwide, call or visit the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP.

Medicaid Expansion: Improving Access to Substance Use and Mental Health Treatment for Justice Populations

(Chicago) – April 2016 marks the third anniversary of Cook County’s groundbreaking jail-based Medicaid application project, through which people detained at the jail have received assistance in applying for health coverage. Some 15,000 detainees have gained Medicaid coverage since 2013, making Cook County’s initiative the nation’s largest and most ambitious projects of its kind to date.

Most of the 11 million admissions to local jails in the U.S. each year—646,000 are detained at any given time—represent people who have untreated medical and behavioral health issues, perpetuating cycles of arrest and incarceration. With health coverage, they have the means to access care in the community, which is far less expensive than corrections-based care and emergency rooms—the predominant healthcare options for uninsured people prior to Medicaid expansion.

What’s happening in Cook County is occurring in many counties and jurisdictions across the country, as local governments seek to reduce the cost burdens of corrections and emergency care, and ultimately improve public safety and public health.

Since Medicaid expansion came about as a result of the Affordable Care Act, TASC (Treatment Alternatives for Safe Communities) has been working with partners in Cook County and across the U.S. to bring aspects of this national public policy from concept to local implementation and results.

Early Adopters: Cook County and Medicaid Expansion

Before Medicaid expansion, nine out of 10 people entering jails lacked health insurance. At the same time, justice-involved populations have high rates of substance use disorders, mental health conditions, and chronic medical conditions requiring treatment during detention and immediately after release. For decades, large and small counties have struggled to meet these needs with very limited resources. The expansion of coverage to low-income adults provides new and welcome means to address this perennial challenge.

Cook County has been a national leader in implementing processes for Medicaid application assistance at the jail, having obtained a waiver in 2012 for early expansion of Medicaid. Transformation has come about through coordinated planning and collaboration between the Cook County Health and Hospitals System, the Cook County Sheriff’s Office, and TASC, aided by significant public and private support from the Cook County Justice Advisory Council, The Chicago Community Trust, the Michael Reese Health Trust, and the Polk Bros. Foundation.

A National Sea Change

TASC President Pam Rodriguez: We have "an unprecedented opportunity to shrink the oversized justice system."

TASC President Pam Rodriguez: We have “an unprecedented opportunity to shrink the oversized justice system.”

Building on the Cook County experience, the Center for Health and Justice at TASC works with counties and states to leverage available federal health care funding in order to create linkages to care, divert people from the justice system, and improve individual and community health. To these ends, and in partnership with the National Association of Counties, TASC provides national consulting, which also is supported by the Open Society Foundations and the Public Welfare Foundation.

Working in more than a dozen states, TASC has observed the following trends with regard to Medicaid expansion for justice populations:

  • The proportion of people entering large county jails with Medicaid coverage has increased from 10% to 40-60% since 2014;
  • Most jails in large urban counties are assisting some of their detainees in applying for coverage;
  • Jails vary as to where applications are taken. It is relatively rare to take applications at jail intake (as in Cook County). It is increasingly common for medical providers to assist with applications and for applications to be taken at release;
  • Jails in rural communities are less likely to have application processes in place, though there are notable examples of small and rural community jails taking Medicaid applications routinely; and
  • States such as New Mexico and Indiana have passed legislation that enables or requires state and county corrections to facilitate applications. These states are leading the way in building statewide infrastructure and processes that institutionalize access to coverage and care for people under justice supervision.

As coverage becomes more common, counties and states can build reentry systems and expand diversion from jail to services in the community. Elements of success in building these processes include:

  • Understanding the impact of coverage on people’s use of treatment for substance use disorders and psychiatric conditions after release and on subsequent arrests;
  • Building comprehensive systems that provide seamless bridges to care upon release from jail;
  • Expanding substance abuse and mental health capacity in the community to support safe reentry; and
  • Building jail diversion projects that take full advantage of these new health care services.

Ultimately, these systems changes are intended to bring about not only cost savings and the more efficient use of public resources, but a healthier society as well, where quality treatment and other health services are accessible in the community. “For decades now, jails have been inundated with people who have severe substance use and mental health conditions,” said TASC President Pam Rodriguez. “Medicaid expansion offers the means to change that. Together with our partners in the public and private sectors, we are leveraging an unprecedented opportunity to shrink the oversized justice system.”

U.S. Senate Passes Comprehensive Addiction and Recovery Act (CARA), Bipartisan Bill Moves to House of Representatives

On March 10, the U.S. Senate overwhelmingly approved the Comprehensive Addiction and Recovery Act (CARA). The legislation embodies a comprehensive response to addiction and the opioid crisis, earning the support of over 130 organizations—including TASC—in the fields of prevention, treatment, recovery, law enforcement, and state and local governments.

CARA garnered strong, bipartisan support in the Senate, passing on a vote of 94-1. Among the bill’s strong leaders and supporters were Senators Sheldon Whitehouse (D-RI), Rob Portman (R-OH), Amy Klobuchar (D-MN), and Kelly Ayotte (R-NH), as well as both Illinois Senators, Dick Durbin (D-IL) and Mark Kirk (R-IL).

More people died in 2014 from drug overdoses than in any previous year on record, according to the Centers for Disease Control and Prevention. The vast majority of people who need addiction treatment do not receive it. The Substance Abuse and Mental Health Services Administration estimates that only 2.6 million of the 22.5 million people across the country who needed help with a substance use disorder got it in 2014. The treatment gap also exists for people in prisons and jails, where an estimated 85 percent have been found to be substance-involved, but only 11 percent received any kind of treatment.

CARA’s key provisions include:

  • Expanding the availability of naloxone—an overdose antidote—to law enforcement and first responders to help save lives.
  • Expanding resources to identify and treat incarcerated individuals with addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence­based treatment.
  • Launching an evidence-­based opioid and heroin treatment and intervention program to expand best practices throughout the country.
  • Launching a medication-assisted treatment and intervention demonstration program.

Appropriations to implement the bill were not included in the legislation.

For more information about CARA, visit here, and to ask your U.S. Representative to support the bill, click here.

 

Researchers to Study Impact of Affordable Care Act on Public Safety; Cook County Key Research Site

(New York)Laura and John Arnold Foundation (LAJF) has announced a grant to a team of researchers at Johns Hopkins Bloomberg School of Public Health and Harvard Medical School to study the Affordable Care Act’s (ACA) impact on public safety.

The project will examine innovative programs focused on providing formerly incarcerated individuals with access to medical, behavioral health, and social services under the Affordable Care Act (ACA).

“Our aim is to identify possible links that may help to explain whether improved access to health care can contribute to a reduction in crime,” said Haiden Huskamp, a professor in the Department of Health Care Policy at Harvard Medical School. Dr. Huskamp is leading the study along with Colleen Barry, an associate professor and associate chair for Research and Practice at Johns Hopkins Bloomberg School of Public Health.

An inventory will be produced as part of the overall Hopkins/Harvard study and will be available at the end of the calendar year. The research will include an in-depth study of a unique partnership in Illinois between the Cook County Health and Hospitals System, the Cook County Sheriff’s Office, and TASC (Treatment Alternatives for Safe Communities), with the location being inside the Cook County Jail where thousands of individuals who are exiting the jail have been signed up for Medicaid coverage.

People involved in the criminal justice system often have extensive health care needs. More than two thirds of jail detainees meet clinical criteria for substance dependence or abuse, and 14.5 percent of men and 31 percent of women entering jail have a serious mental illness. Yet, studies find that the overwhelming majority of people leaving jail – 80-90 percent – do not have health insurance. New health care options under the ACA will allow many of these individuals to receive coverage.

“The goal of this project is to learn everything we can about how the ACA is being used nationally to make our communities safer and to improve public health,” said LJAF Vice President of Criminal Justice Anne Milgram.

Dr. Barry emphasized the importance of conducting in-depth studies of earlier innovator programs that are currently enrolling individuals exiting jails and prisons in Medicaid under the ACA, and developing ways to connect them to mental health, addiction, and other medical and social services in their communities.

“Early programs like the Cook County partnership have the potential to improve population health and may lower crime, so it is essential to learn lessons from their experiences and to share insights with jurisdictions in other areas of the country considering initiating similar efforts,” said Dr. Barry.

Research findings will be published in a peer-reviewed journal within the next year.

342,000 Low-Income Illinois Citizens to Have Access to Medical Care, Treatment for Substance Use and Mental Health Conditions, Beginning January 1

(Chicago) – In 90 days, 342,000 low-income Illinois citizens will have access to health care, including many of those involved in the Illinois criminal justice system who require treatment for mental health, substance use, and medical conditions.

On July 22, Governor Pat Quinn signed legislation, Senate Bill 26, that authorized Illinois’ participation in the new national health reform law called the Affordable Care Act.

As one of the outcomes of this legislation, starting on January 1, 2014, adults aged 19 through 64 with incomes below 138 percent of the Federal Poverty Level (about $15,400 per year for an individual and $20,000 per year for a couple) will gain access to Illinois Medicaid coverage.

What this means is that uninsured, low-income adults—describing the majority of individuals in Illinois jails and prisons—will have greater access to treatment for substance use and mental health conditions that often contribute to their criminal behavior. Eighty-six percent of male arrestees in Cook County, for example, test positive for illicit drugs. Nationally, about a quarter of people in jail convicted of property and drug offenses had committed their crimes to get money for drugs.

In addition to improving treatment access for low-income populations, the new law also answers a resounding public call: A Cook County referendum on state funding for substance abuse treatment passed overwhelmingly in 2004, with more than one million voters saying the state should pay for drug and alcohol treatment for any Illinois resident who demands it.

A long time coming, the new health care law begins to answer this public demand by providing the means to fund treatment programs.

Under the legislation, the federal government will pay 100 percent of the costs of the new Illinois Medicaid enrollees from 2014 through 2016. Starting in 2017, the match rate gradually will be reduced: 95 percent in 2017; 94 percent in 2018; 93 percent in 2019; and 90 percent in 2020.

The share paid by the federal government for care in Illinois will never dip below a 90 percent.

Even if the federal government were to change the law’s financing terms, Illinois’ share would never be more than 10 cents on each dollar spent on new Medicaid recipients. The legislation signed by Quinn includes language that would discontinue coverage if the federal government’s share of Medicaid matching funds drops below 90 percent.

Illinois currently receives a 50 percent match from the federal government for health programs under terms of the existing Medicaid program.

For individuals involved in the Illinois criminal justice system, the Illinois Medicaid expansion is critical, because they will be able to access adequate medical care and, equally if not more importantly, behavioral health care such as substance use treatment and mental health care, many for the first time, according to TASC President Pamela Rodriguez.

“TASC strongly supported this legislation because rates of addiction and mental health disorders are disproportionately high in the criminal justice population. Access to care for these conditions can help break costly cycles of crime and recidivism,” said Rodriguez. “Additionally, the new health law will help save counties and the state of Illinois enormous sums of money on justice and uncompensated health care costs.”

Rodriguez pointed out that the national and Illinois record on Medicaid access has been solid, noting that “Illinois has received bonus payments totaling over $50 million over the past four years for meeting enrollment targets and having program simplifications in place for our Medicaid and Children’s Health Insurance Program.”

Additionally, Medicaid cost controls outperform both Medicare and private health insurance. Nationally, the per enrollee cost growth in Medicaid is 6.1 percent, which is lower than the per enrollee cost growth in comparable coverage under Medicare (6.9 percent), private health insurance (10.6 percent), and monthly premiums for employer-sponsored coverage (12.6 percent).

To help criminal justice organizations and agencies establish enrollment processes, the Substance Abuse and Mental Health Services Administration (SAMHSA) has launched an online toolkit entitled, “Getting Ready for the Health Insurance Marketplace.” This narrated presentation describes the health care law, explains how the Health Insurance Marketplace works, and provides communication ideas and materials from the Centers for Medicaid & Medicare Services (CMS) for use in increasing awareness and helping uninsured individuals apply for coverage.

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