Deb Conroy
- Democratic
Amends the Illinois Insurance Code. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in the State and Medicaid managed care organizations providing coverage for hospital or medical treatment shall provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions. Provides that an insurer shall not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public program. Provides that an insurer shall base any medical necessity determination or the utilization review criteria on current generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care. Provides that in conducting utilization review of covered health care services and benefits for the diagnosis, prevention, and treatment of mental, emotional, and nervous disorders or conditions in children, adolescents, and adults, an insurer shall exclusively apply the criteria and guidelines set forth in the most recent versions of the treatment criteria developed by the nonprofit professional association for the relevant clinical specialty. Provides that an insurer shall not apply different, additional, conflicting, or more restrictive utilization review criteria than the criteria and guidelines set forth in the treatment criteria. Provides that the Director may, after appropriate notice and opportunity for hearing, assess a civil penalty between $5,000 and $20,000 for each violation. Amends the Health Carrier External Review Act. Provides that the independent review organization shall comply with specified requirements for an adverse determination or final adverse determination involving mental, emotional, nervous, or substance use disorders or conditions. Makes other changes. Effective immediately. House Floor Amendment No. 1 In provisions concerning mental and emotional disorders, provides that an insurer shall not set a specific limit on the duration of benefits or coverage of medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions or limit coverage only to alleviation of the insured's current symptoms. Provides that nothing shall require the insurer to cover a treatment when the authorization was granted based on a material misrepresentation by the insured, the policyholder, or the provider. Provides that an insurer may apply specified utilization review criteria to health care services and benefits for mental, emotional, and nervous disorders or conditions that are outside the scope of specified criteria and guidelines or relate to advancements in technology or types of care that are not covered in the most recent versions of specified sources. Provides that if the Director of Insurance determines that an insurer has violated the provisions, the Director may assess a civil penalty between $1,000 and $5,000 for each violation (rather than between $5,000 and $20,000). Removes language that provides that changes in terminology, organization, or classification of mental, emotional, nervous, substance use disorder or condition in future versions of specified publications shall not affect the conditions covered by provisions concerning mental and emotional disorders as long as a condition is commonly understood to be a mental, emotional, nervous, or substance use disorder or condition by health care providers practicing in relevant clinical specialties. Removes language that provides that an insurer shall not limit benefits or coverage for mental, emotional, nervous, or substance use disorders or conditions to short-term or acute treatment at any level of placement. Makes other changes. Changes the effective date to January 1, 2022 (rather than an immediate effective date). Senate Committee Amendment No. 1 Adds reference to: 215 ILCS 5/370c.1 Replaces everything after the enacting clause with the provisions of the engrossed bill with the following changes. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in the State and Medicaid managed care organizations providing coverage for hospital or medical treatment shall provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions on or after January 1, 2023 (rather than January 1, 2022). Provides that an insurer or Medicaid managed care organization shall not be required to pay for services if the individual was not the insurer's enrollee or eligible for Medicaid at the time the service was rendered. Provides that an insurer shall not be required to cover benefits that have been authorized and provided for a covered person by a public entitlement program. Provides that for medical necessity determinations (rather than in conducting utilization review of covered health care services and benefits) relating to level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental, emotional, and nervous disorders or conditions, insurers and Medicaid managed care organizations shall apply specified patient placement criteria. Makes various changes to provisions concerning requirements for insurers regarding education of the insurer's staff and other stakeholders, publishing of utilization review criteria, and documentation of interrater reliability testing and remediation actions. Further amends the Illinois Insurance Code. In provisions concerning mental, emotional, nervous, or substance use disorder or condition parity, provides that not later than January 1 (rather than August 1) of each year, the Department of Insurance shall issue a joint report to the General Assembly and provide an educational presentation to the General Assembly. Removes language that provides that insurers shall base the duration of treatment on the insured's individual needs; that an insurer shall only engage applicable qualified providers in the treatment of mental, emotional, nervous, or substance use disorders or conditions or the appropriate subspecialty and who possess an active professional license or certificate to review, approve, or deny services; and that every insurer shall sponsor a formal education program by nonprofit clinical specialty associations. Makes other changes. Effective January 1, 2022, except that specified provisions take effect immediately.
Effective Date August 25, 2021; - some provisions effective January 1, 2022
Governor Approved
Public Act . . . . . . . . . 102-0579
Sent to the Governor
Senate Committee Amendment No. 1 House Concurs 116-000-002
Passed Both Houses
House Concurs
Senate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee
Senate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000
Senate Committee Amendment No. 1 Motion to Concur Rules Referred to Mental Health & Addiction Committee
Senate Committee Amendment No. 1 Motion Filed Concur Rep. Deb Conroy
Third Reading - Passed; 059-000-000
Placed on Calendar Order of Concurrence Senate Amendment(s) 1
Arrived in House
Placed on Calendar Order of 3rd Reading ** May 28, 2021
Added as Alternate Co-Sponsor Sen. Omar Aquino
Added as Alternate Co-Sponsor Sen. Ann Gillespie
Added as Alternate Co-Sponsor Sen. Patrick J. Joyce
Added as Alternate Co-Sponsor Sen. John Connor
Added as Alternate Co-Sponsor Sen. Robert F. Martwick
Added as Alternate Co-Sponsor Sen. Rachelle Crowe
Added as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton
Added as Alternate Co-Sponsor Sen. Cristina Castro
Added as Alternate Co-Sponsor Sen. Meg Loughran Cappel
Added as Alternate Co-Sponsor Sen. Bill Cunningham
Added as Alternate Co-Sponsor Sen. Michael E. Hastings
Placed on Calendar Order of 3rd Reading May 21, 2021
Second Reading
Senate Committee Amendment No. 1 Adopted
Placed on Calendar Order of 2nd Reading May 20, 2021
Do Pass as Amended Insurance; 012-000-000
Senate Committee Amendment No. 1 Assignments Refers to Insurance
Senate Committee Amendment No. 1 Referred to Assignments
Senate Committee Amendment No. 1 Filed with Secretary by Sen. Laura Fine
Added as Alternate Co-Sponsor Sen. Linda Holmes
Added as Alternate Co-Sponsor Sen. Christopher Belt
Added as Alternate Co-Sponsor Sen. Melinda Bush
Added as Alternate Co-Sponsor Sen. Thomas Cullerton
Added as Alternate Co-Sponsor Sen. Karina Villa
Added as Alternate Co-Sponsor Sen. Mike Simmons
Added as Alternate Co-Sponsor Sen. Antonio Muñoz
Added as Alternate Co-Sponsor Sen. Mattie Hunter
Assigned to Insurance
Added as Alternate Co-Sponsor Sen. Julie A. Morrison
Added as Alternate Co-Sponsor Sen. Laura M. Murphy
Added as Alternate Co-Sponsor Sen. Celina Villanueva
Added as Alternate Co-Sponsor Sen. David Koehler
Added as Alternate Co-Sponsor Sen. Adriane Johnson
Added as Alternate Co-Sponsor Sen. Ram Villivalam
Added as Alternate Chief Co-Sponsor Sen. Kimberly A. Lightford
Added as Alternate Co-Sponsor Sen. Robert Peters
Added as Alternate Co-Sponsor Sen. Patricia Van Pelt
Added as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins
Added as Alternate Chief Co-Sponsor Sen. Doris Turner
Added as Alternate Chief Co-Sponsor Sen. Sara Feigenholtz
First Reading
Arrive in Senate
Placed on Calendar Order of First Reading
Chief Senate Sponsor Sen. Laura Fine
Referred to Assignments
Added Co-Sponsor Rep. Emanuel Chris Welch
Added Co-Sponsor Rep. Ann M. Williams
Added Co-Sponsor Rep. Jaime M. Andrade, Jr.
Added Co-Sponsor Rep. Elizabeth Hernandez
Added Chief Co-Sponsor Rep. Terra Costa Howard
Third Reading - Short Debate - Passed 114-000-000
Placed on Calendar Order of 3rd Reading - Short Debate
House Floor Amendment No. 1 Adopted
Recalled to Second Reading - Short Debate
Added Co-Sponsor Rep. Lawrence Walsh, Jr.
Added Co-Sponsor Rep. Janet Yang Rohr
House Floor Amendment No. 1 Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000
Added Co-Sponsor Rep. Sam Yingling
House Floor Amendment No. 1 Rules Refers to Mental Health & Addiction Committee
Added Co-Sponsor Rep. Delia C. Ramirez
House Floor Amendment No. 1 Referred to Rules Committee
Added Co-Sponsor Rep. Kathleen Willis
Added Co-Sponsor Rep. La Shawn K. Ford
House Floor Amendment No. 1 Filed with Clerk by Rep. Deb Conroy
Placed on Calendar Order of 3rd Reading - Short Debate
Second Reading - Short Debate
Added Co-Sponsor Rep. Mark L. Walker
Added Co-Sponsor Rep. Greg Harris
Added Co-Sponsor Rep. Frances Ann Hurley
Added Co-Sponsor Rep. Anna Moeller
Added Co-Sponsor Rep. Joyce Mason
Added Co-Sponsor Rep. Amy Grant
Added Co-Sponsor Rep. Ryan Spain
Placed on Calendar 2nd Reading - Short Debate
Added Co-Sponsor Rep. Barbara Hernandez
Added Co-Sponsor Rep. Margaret Croke
Added Co-Sponsor Rep. Marcus C. Evans, Jr.
Added Co-Sponsor Rep. William Davis
Do Pass / Short Debate Mental Health & Addiction Committee; 016-000-000
Added Co-Sponsor Rep. Lindsey LaPointe
Added Co-Sponsor Rep. Angelica Guerrero-Cuellar
Added Co-Sponsor Rep. Natalie A. Manley
Added Co-Sponsor Rep. Katie Stuart
Added Co-Sponsor Rep. Mary E. Flowers
Added Co-Sponsor Rep. Nicholas K. Smith
Added Co-Sponsor Rep. Kelly M. Cassidy
Added Co-Sponsor Rep. Maurice A. West, II
Added Co-Sponsor Rep. Will Guzzardi
Added Co-Sponsor Rep. Bob Morgan
Assigned to Mental Health & Addiction Committee
Added Co-Sponsor Rep. Robyn Gabel
Added Co-Sponsor Rep. Maura Hirschauer
Added Co-Sponsor Rep. Terra Costa Howard
Removed Co-Sponsor Rep. Terra Costa Howard
Added Co-Sponsor Rep. Jonathan Carroll
Added Chief Co-Sponsor Rep. Jennifer Gong-Gershowitz
Referred to Rules Committee
First Reading
Filed with the Clerk by Rep. Deb Conroy
Bill Text Versions | Format |
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Introduced | HTML PDF |
Engrossed | HTML PDF |
Enrolled | HTML PDF |
House Amendment 001 | HTML PDF |
Senate Amendment 001 | HTML PDF |
Document | Format |
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Public Act |
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