From IABH:

HFS has recently announced its proposal to modify the existing Behavioral Health Transformation Demonstration under Section 1115. The 1115 Demonstration was previously approved by the Centers for Medicare & Medicaid Services (CMS). The proposed extension application and other related materials will be available for review and public input through June 12, 2023 using the process set forth below. Pursuant to CMS federal rules for section 1115 demonstrations, the hearings will provide the opportunity to learn about and provide input on the draft extension proposal. HFS posted documents to its 1115 Demonstration Waiver Home Page.

Proposed Modification:

Illinois is proposing to extend the demonstration with a revamped program design that broadens the focus of this section 1115 demonstration program to address several key social determinants of health (SDOH) by implementing health related social needs (HRSN) benefits to reduce healthcare disparities in Illinois’ healthcare system. Accordingly, the proposed new name for this demonstration program extension is the “Illinois Healthcare Transformation Section 1115 Demonstration.”

This section 1115 demonstration was originally approved on May 7, 2018, to pilot the provision of targeted services aimed at treating addictions to opioids and other substances that were not directly available to Illinois Medicaid beneficiaries. Through the implementation of 10 pilot programs, the state intended to test how the provision of additional opioid use disorder/substance use disorder (OUD/SUD) services informed its efforts to transform the behavioral health system in Illinois. These OUD/SUD pilots provided access to less costly community-based services that were anticipated to help beneficiaries improve their health and avoid more costly services provided through an institution. Illinois implemented the demonstration effective July 1, 2018, and the demonstration is currently set to end on June 30, 2023.

The initiatives within the draft extension Section 1115 demonstration will help HFS achieve the following goals:

  • Identify and assess causes of disparities, including the identification and revision of policies and operations that perpetuate health inequities in order to effectively close gaps in health and improve healthcare access, quality, and outcomes;
  • Implement effective technologies and solutions that expand data collection, reporting, and analysis in order to make data-informed and person-centered decisions that will lead to better access to equitable care and coverage;
  • Create and sustain capacity within healthcare organizations with a workforce skilled at meeting the unique needs of the communities of Illinois;
  • Offer culturally and linguistically responsive care, providing communities with improved health care, patient safety, and experiences; and,
  • Tailor programs to individuals and communities, resulting in improved access to care and services.

The following are the proposed benefits within the draft extension:

  • SUD Services in Institutions for Mental Diseases (IMD)
  • SUD Case Management
  • Housing Supports
  • Employment Assistance
  • Medical Respite
  • Food and Nutrition Services
  • Violence Prevention and Intervention, Addressing Adverse Childhood Events
  • Non-Medical Transportation
  • Community Reintegration: Transitioning from Incarceration
  • Community Reintegration: Transitioning from Institutions

The following are the proposed pilots or program features within the draft extension:

  • Healthcare Transformation Collaboratives that drive local, innovative approaches to deliver high-quality health care, with an intentional focus on HRSN
  • Supports for Justice-Involved Populations to assist in successful community reintegration and promote health and well-being
  • Violence Prevention and Intervention community-led initiatives, in partnership with local and state agencies, along with person-centered and trauma-informed case management and other services, to prevent and reduce the health impact of violence in communities and homes
  • Outreach and Engagement to promote health and well-being, with a focus on preventive health in underserved communities through culturally responsive, enhanced care management services
  • Community Health Worker (CHW) Training that will create a workforce of CHWs who serve people of the communities in which they live
  • Safety Net Hospital Health Equity and Access Leadership (HEAL) Grant Program that will support projects that reduce health disparities, advance health equity, and improve access to quality healthcare services
  • Treatment for Individuals with SUD Pilot that will continue to authorize expenditures for primary SUD treatment services to short-term residents in facilities that meet the definition of an IMD, including providing SUD case management services to assist beneficiaries with accessing needed medical, social, educational, and other services Housing Support Services Pilot that will authorize pre-tenancy supports and tenancy sustaining services
  • Supported Employment Services Pilot that will authorize supported employment services to eligible beneficiaries through a person-centered planning process when eligible services are identified in the individuals’ plan of care
  • Continuum of Care Facility Licensure that will provide individuals with intellectual or developmental disabilities with a person-centered and inclusive environment by allowing seamless transitions and promoting choice

The draft section 1115 demonstration extension, the full public notice, and related materials were posted for a minimum 30-day public comment period starting May 12, 2023 through June 12, 2023, on the 1115 Demonstration Waiver Home page located on the HFS website