House committee approves increased reimbursement rates for behavioral health services

Drug overdose deaths in Illinois dropped 8.3 percent in 2023, the first time the Department of Public Health has reported an annual drop since 2018.

According to IDPH data released Thursday, there were 3,502 total overdose deaths in Illinois in 2023, down 317 from 2022. Of those, 2,855 were opioid overdoses, down 9.7 percent from the prior year.

Deaths involving synthetic opioids like fentanyl, heroin and natural and semisynthetic opioids also saw a year-to-year drop.

There were 249 deaths related to xylazine, a non-opioid sedative used as an adulterant, a 6.4 percent increase from 2022.

Department Director Dr. Sameer Vohra said he was encouraged by the data, but stressed more work is needed to address mental health and substance use disorder.

“Our goal remains implementing evidence-based solutions to further decrease overdose deaths here in Illinois,” he said in a statement.

Racial disparities remain an issue, as Black Illinoisans have a 3.5 times higher overdose morbidity rate than other demographics. IDPH and the Department of Human Services said they will continue to invest in organizations that address health disparities.

Officials credited the overall decline to increased naloxone distribution, community outreach through harm reduction organizations and drug overdose prevention programs, the availability of fentanyl test strips and improved access to treatment and medication-assisted recovery.

Nationally, there was a 4 percent drop in overdose deaths in 2023, along with a 3 percent drop in opioid overdose deaths.

A House committee has approved a plan to boost reimbursement rates and improve network adequacy for behavioral health services.

The proposal from Rep. Lindsey LaPointe, D-Chicago, would set minimum reimbursement rates for in-network mental health and substance use disorder care at 141 percent of what Medicare pays for the same service.

Other provisions would allow behavioral health providers to work toward licensure under the supervision of another fully licensed provider, require same-day coverage of behavioral health services and require a 60-day network contracting process.

LaPointe said that behavioral health providers are not currently joining insurance networks due to low reimbursement rates from commercial insurance providers.

“The bill cuts a lot of the red tape that our providers have to face,” she told reporters after the plan passed the House’s Mental Health and Addiction Committee on Thursday morning.

The minimum reimbursement rate continued to draw pushback from the insurance industry.

Illinois Life and Health Insurance Council President Laura Minzer told the committee they have “deep concerns about putting reimbursement rates that are contractually negotiated between two private entities into statute.”

She also worried the language would prevent flexibility in the future as it relates to rates for value-based care.

“While that is not as great in the behavioral health space, the opportunity to look at that is not allowed for in this particular arrangement,” Minzer said.

LaPointe said the rate reimbursement floor is a “fundamental part” of the bill.

“That rate reimbursement floor is what is going to incentivize and compel providers to join networks,” she said. “With the current status quo, providers are losing money when they take certain insurance plans, and so they’re making the very hard choice to say, I’m just not going to contract with this insurance company at all.'”

Committee members also asked why the rates are tied to Medicare rather than Medicaid or other rates that are more under the state’s control.

LaPointe said Medicare’s fee schedule makes forecasting easier and that healthcare actuaries have all said benchmarking rates to Medicare is a very appropriate mechanism.

The plan passed out of committee with bipartisan support, 17-5, and heads to the full House for further consideration.

Healthcare leaders and other stakeholders rallied in Springfield on Wednesday to highlight the impact of potential Medicaid cuts on providers and the patients they serve.

Among those in attendance was José Sánchez, CEO of Humboldt Park Health in Chicago.

“We are unable to absorb the impact of such cuts,” he said of safety-net providers. “We cannot shift the burden elsewhere. We will be forced to make very difficult choices like reducing or eliminating services or even laying off vital staff.”

Sánchez spoke to Health News Illinois to discuss how safety nets are preparing for the potential cuts and how they might affect patients in the historically underserved communities where many such providers operate.

Edited excerpts below:

HNI: What’s the mentality among safety-net providers as these conversations happen?

JS: The reality is that we do not have control of what’s going to happen in Washington. Medicaid doesn’t really cover the cost of the services that we provide. It was actually compounding the financial pressure on hospitals right after the pandemic, where inflation, costs associated with labor, cost of supply and cost of just about everything that we were doing… cost a lot more money. Our concern is that we already are serving a number of uninsured people. Medicaid doesn’t cover the cost, and now, if we absorb additional cost reduction, literally, this hospital will close. There are hospitals today that do not have sufficient funds to cover the payroll. Yesterday, one hospital told me, ‘I got four weeks cash in our hands to cover all our obligations. After that, we don’t know what we are going to do.’ So there is a real threat that any reduction of the Medicaid program will close and devastate the healthcare system, especially in poor communities.

HNI: How could cuts affect patients like those in Humboldt Park and other areas with disproportionate health outcomes?

JS: What will happen to patients is that some of these institutions or hospitals will cut services and eliminate programs. The community will be without services, which means that already a community that is underserved and does not have enough services will have less. So we’re going to see people who are being in critical conditions, especially chronic conditions in these poor communities like diabetes, hypertension and heart failure, actually would not get the care that they need to be alive.

HNI: Are some of the safety nets starting to do some preparations for what they can and cannot cover if this goes through?

JS: When I look at all of the services that we provide at Humboldt Park Health, it is very clear that every service that we provide is essential. Just remember, safety-net hospitals in these underserved communities are providing — barely — the service critical to keep individuals healthy. We don’t do open heart surgery. We don’t do neurosurgical cases. We are providing primary care services and emergency services as needed, but we do not have any specialty care. So we are providing medical care to people who need it to send them someplace to get the services that they have. If we cannot screen our patients for the services that they need, there will be devastating consequences to those individuals.