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Bill > HB4475

IL HB4475

IL HB4475
INS CD-BEHAVIORIAL HEALTH

summary

Introduced
01/17/2024
In Committee
04/24/2024
Crossed Over
04/19/2024
Passed
Dead
01/08/2025

Introduced Session

103rd General Assembly

Bill Summary

Reinserts the provisions of the bill, as amended by House Amendment No. 1, with the following changes. Provides that for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2026, or any contracted third party administering the behavioral health benefits for the insurer, reimbursement for in-network mental health and substance use disorder treatment services delivered by Illinois providers and facilities must be equal to or greater than 141% of the Medicare rate for the mental health or substance use disorder service delivered (rather than on average, at least as favorable as professional services provided by in-network primary care providers). Removes language providing that reimbursement rates for services paid to Illinois mental health and substance use disorder treatment providers and facilities do not meet the required standard unless the reimbursement rates are, on average, equal to or greater than 141% of the Medicare reimbursement rate for the same service. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 (rather than $5,000) for each violation. Excludes health care plans serving Medicaid populations that provide, arrange for, pay for, or reimburse the cost of any health care service for persons who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Makes other changes. Effective immediately.

AI Summary

This bill, the Strengthening Mental Health and Substance Use Parity Act, aims to improve mental health and substance use parity in Illinois. The key provisions are: 1. Requiring insurance reimbursement rates for in-network mental health and substance use disorder treatment services delivered by Illinois providers and facilities to be equal to or greater than 141% of the Medicare rate for the same service. For services not covered by Medicare, the rates must be on average equal to or greater than 144% of the insurer's in-network rate for that service. 2. Mandating insurance coverage for all medically necessary mental health or substance use disorder services received by the same insured on the same day, for both outpatient and inpatient care. 3. Requiring insurance coverage of medically necessary mental health or substance use disorder services provided by behavioral health trainees under the supervision of licensed providers. 4. Specifying that insurers must complete the contracting process, including credential verification, with mental health and substance use disorder providers within 60 days of a completed application, and must reimburse providers for services provided during the contracting process. 5. Authorizing the Department of Insurance to enforce the provisions of the bill and impose civil penalties of $1,000 per violation for non-compliance. The bill excludes Medicaid health plans from these requirements. The amendments are intended to strengthen mental health and substance use parity in Illinois by addressing network adequacy and other barriers to accessing care.

Committee Categories

Health and Social Services

Sponsors (57)

Lindsey LaPointe (D)*,  Karina Villa (D)*,  Dee Avelar (D),  Christopher Belt (D),  Terri Bryant (R),  Kelly Cassidy (D),  Javier Cervantes (D),  Lakesia Collins (D),  Terra Costa Howard (D),  Bill Cunningham (D),  Mary Edly-Allen (D),  Laura Faver Dias (D),  Sara Feigenholtz (D),  Laura Fine (D),  Will Guzzardi (D),  Matt Hanson (D),  Sonya Harper (D),  Erica Harriss (R),  Michael Hastings (D),  Bill Hauter (R),  Norma Hernandez (D),  Maura Hirschauer (D),  Jay Hoffman (D),  Linda Holmes (D),  Hoan Huynh (D),  Adriane Johnson (D),  Gregg Johnson (D),  Patrick Joyce (D),  Tracy Katz Muhl (D),  Michael Kelly (D),  Stephanie Kifowit (D),  Dave Koehler (D),  Jenn Ladisch Douglass (D),  Meg Loughran Cappel (D),  Theresa Mah (D),  Rob Martwick (D),  Bob Morgan (D),  Yolonda Morris (D),  Julie Morrison (D),  Laura Murphy (D),  Michelle Mussman (D),  Suzanne Ness (D),  Kevin Olickal (D),  Robert Peters (D),  Mike Porfirio (D),  Mike Simmons (D),  Steve Stadelman (D),  Anne Stava-Murray (D),  Katie Stuart (D),  Nabeela Syed (D),  Natalie Toro (D),  Doris Turner (D),  Rachel Ventura (D),  Celina Villanueva (D),  Ram Villivalam (D),  Mark Walker (D),  Maurice West (D), 

Last Action

Session Sine Die (on 01/07/2025)

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