summary
Introduced
02/04/2025
02/04/2025
In Committee
04/11/2025
04/11/2025
Crossed Over
Passed
Dead
Introduced Session
Potential new amendment
104th General Assembly
Bill Summary
Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.
AI Summary
This bill aims to improve access to behavioral health services by prohibiting prior authorization and utilization management controls for such services across various Illinois insurance and healthcare programs. Specifically, the bill defines behavioral health services as any service intended to treat mental, emotional, nervous, or substance use disorders across a person's entire life span. Starting January 1, 2026, group and individual health insurance policies, managed care plans, state employee health benefits, municipal health plans, school employee insurance, and medical assistance programs will be prohibited from imposing prior authorization requirements or utilization management controls on covered behavioral health services. The bill empowers the Department of Insurance and the Department of Healthcare and Family Services to establish complaint processes, investigate potential violations, and issue cease and desist orders or administrative fines up to $250,000 for non-compliance. The legislation includes a provision ensuring that these new requirements do not conflict with federal laws, and it applies to health insurance policies and plans amended, delivered, issued, or renewed on or after January 1, 2026. The goal is to remove administrative barriers that might delay or prevent individuals from accessing mental health and substance use disorder treatments.
Committee Categories
Business and Industry
Sponsors (8)
Laura Fine (D)*,
Mary Edly-Allen (D),
Graciela Guzmán (D),
Adriane Johnson (D),
Robert Peters (D),
Mike Simmons (D),
Rachel Ventura (D),
Karina Villa (D),
Last Action
Added as Co-Sponsor Sen. Karina Villa (on 04/24/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=1603&GAID=18&DocTypeID=SB&SessionID=114&GA=104 |
| Senate Amendment 001 | https://www.ilga.gov/legislation/104/SB/10400SB1603sam001.htm |
| BillText | https://www.ilga.gov/legislation/104/SB/10400SB1603.htm |
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