Illinois Legislation

The bill amends the ILCS by adding a new section 215 ILCS 5/370c.2 to provide that the Department of Insurance shall form a task force to review the plans and policies for individual and group short-term and long-term disability income insurance issued and offered to individuals and employers in this State to examine the use of such insurance for behavioral health conditions. The task force shall be comprised of experts in the disability income insurance industry, experts in the behavioral health conditions and treatment industry, members of the general public, and members of the General Assembly.  The task force shall submit findings and recommendations to the Governor and the General Assembly by December 31, 2020. Dissolves the task force on December 31, 2021.

HB 3473/ SB 35

This bill amends the ILCS by adding section 215 ILCS 5/356z.33 to require that a group or individual policy of accident and health insurance or managed care plan shall provide coverage for the treatment of serious mental illnesses and serious emotional disturbances. Provides that coverage shall include, but not be limited to, certain evidence-based and evidence-informed bundled treatment approaches. Provides that payment for the services performed under the treatment models shall be based on all the components of the treatment model combined, rather than for each separate service. Provides that disability or functional impairment shall not be a precondition to receive treatment under the provisions. Provides that if federal regulations require the State to defray the cost of coverage for serious mental illnesses or serious emotional disturbances, then the provisions are inoperative and the State shall not assume any obligation for the cost of the coverage.

Amends 5 ILCS 140/7.5 to create the Children’s Mental Health Ombudsman Program Act for the purposes of advocating on behalf of children with mental health disorders, identifying barriers to effective mental health treatment and proposed solutions; monitoring and ensuring compliance with relevant statutes, regulations, rules, and policies pertaining to children’s behavioral health services; and investigating complaints that a State or a government agency has engaged in activities, practices, or omissions that constitute violations of applicable court orders, statutes, or regulations or that may have an adverse effect upon the health, safety, welfare, or rights of children.

Creates the Office of the Ombudsman for Behavioral Health Access to Care within the Department of Human Services for the purpose of assisting residents of Illinois in accessing behavioral health care.

Section 30 of IL S 3213 proposes to amend the Illinois Insurance Code by adding Section 356z.20, which discusses coverage for the early treatment of serious mental illnesses and serious emotional disturbances. Specifically, it provides that coverage of treatment shall include evidence-based and evidence-informed bundled treatment approaches, including but not limited to (1) assertive community treatment and community support team treatment and (2) first episode psychosis treatment, covering at a minimum the elements of the coordinated specialty care model applied in the research trials conducted by the National Institute of Mental Health in the Recovery of an Initial Schizophrenia Episode studies. The proposed bill also discusses payment for such services and precludes disability and functional impairment as precondition requirements for determining medical necessity.

Section 5 amends 215 ILS 5/370c.1 by adding a new paragraph to require all individual and group insurers and health insurance or qualified plans that offer mental health and substance use disorder benefits to submit to the Department of Insurance or Department of Healthcare and Family Services a detailed report that includes a certification and comparative analysis to demonstrate the insurers compliance with parity requirements.

Section 5 amends 215 ILCS 5/370c to require group and individual insurers offering mental health and substance use disorder benefits to provide coverage for mental health and substance use disorder services accessed through telehealth services if the individual resides in an area designated as a mental health professional shortage area.

This bill amends 215 ILCS 5/370c by adding subsection “g” to prohibit the following plans from imposing prior authorization requirements on specified ASAM level SUD treatment benefits: group health insurance policies, individual health benefit plans, qualified health plans that is offered through the health insurance marketplace, small employer group health plans and large employer group health plans. Furthermore, S.682 prohibits additional or unrelated diagnosis to be used as a barrier to deny related benefits to a beneficiary with a diagnosis of a SUD. Additionally, S.682 sets notification requirements, guidelines, and timelines for SUD providers to follow in order inform insurers or managed care organizations of the initiation of treatment and notice of discharge.
Beneficiaries are provided the right to external review and expedited external review pursuant to the Health Carrier External Review Act.

This bill tries to change the state insurance law so Illinois residents can get telehealth treatment for mental health conditions if they live in a “mental health professional shortage area,” as designated by the U.S. Department of Health and Human Services.

This bill tried to change the state insurance law about autism so that plans would have to cover autism services through age 21 instead of age 20, as the law currently states. It also would have set the annual maximum for autism services at $50,000 instead of $36,000, as it is now.

This bill tried to change the state insurance law about autism so that plans would have to follow the state parity law for coverage of autism services. The bill also included sections about other behavioral health coverage that are identical to those in HB 1530, which was signed into law and is summarized above.

Among many other things, this bill tried to change the state insurance law so that a patient’s doctor is the only person who can decide if the patient’s mental health treatment is medically necessary. Currently insurance plans have significant input in this process and can deny coverage during a medical necessity review.

For the section of the law applying to behavioral health coverage, this bill is identical to SB1331, listed directly above.

However, there are two notable differences in the parity-related section of this bill and HB 1530:

• There is nothing in this bill that requires insurance plans to use criteria from the American Society of Addiction Medicine for medical necessity reviews for substance use disorder treatment.
• There is no requirement that insurance plans comply with what is in the interim final regulation (pdf | Get Adobe® Reader®) for the Federal Parity Law because it had not yet been issued when this bill was introduced.