HB 2595

  • Illinois House Bill
  • 102nd Regular Session
  • Introduced in House May 29, 2021
  • Passed House Apr 22, 2021
  • Passed Senate May 29, 2021
  • Signed by Governor Aug 25, 2021

Insurance-Mental Health

Abstract

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.

Bill Sponsors (69)

Votes


Actions


Aug 25, 2021

House

Effective Date August 25, 2021; - some provisions effective January 1, 2022

House

Governor Approved

House

Public Act . . . . . . . . . 102-0579

Jun 29, 2021

House

Sent to the Governor

May 31, 2021

House

Senate Committee Amendment No. 1 House Concurs 116-000-002

House

Passed Both Houses

House

House Concurs

May 30, 2021

House

Senate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee

House

Senate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000

House

Senate Committee Amendment No. 1 Motion to Concur Rules Referred to Mental Health & Addiction Committee

House

Senate Committee Amendment No. 1 Motion Filed Concur Rep. Deb Conroy

May 29, 2021

Senate

Third Reading - Passed; 059-000-000

House

Placed on Calendar Order of Concurrence Senate Amendment(s) 1

House

Arrived in House

May 27, 2021

Senate

Placed on Calendar Order of 3rd Reading ** May 28, 2021

May 20, 2021

Senate

Added as Alternate Co-Sponsor Sen. Omar Aquino

Senate

Added as Alternate Co-Sponsor Sen. Ann Gillespie

Senate

Added as Alternate Co-Sponsor Sen. Patrick J. Joyce

Senate

Added as Alternate Co-Sponsor Sen. John Connor

Senate

Added as Alternate Co-Sponsor Sen. Robert F. Martwick

Senate

Added as Alternate Co-Sponsor Sen. Rachelle Crowe

Senate

Added as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton

Senate

Added as Alternate Co-Sponsor Sen. Cristina Castro

Senate

Added as Alternate Co-Sponsor Sen. Meg Loughran Cappel

Senate

Added as Alternate Co-Sponsor Sen. Bill Cunningham

Senate

Added as Alternate Co-Sponsor Sen. Michael E. Hastings

Senate

Placed on Calendar Order of 3rd Reading May 21, 2021

Senate

Second Reading

May 19, 2021

Senate

Senate Committee Amendment No. 1 Adopted

Senate

Placed on Calendar Order of 2nd Reading May 20, 2021

Senate

Do Pass as Amended Insurance; 012-000-000

May 17, 2021

Senate

Senate Committee Amendment No. 1 Assignments Refers to Insurance

May 14, 2021

Senate

Senate Committee Amendment No. 1 Referred to Assignments

Senate

Senate Committee Amendment No. 1 Filed with Secretary by Sen. Laura Fine

May 06, 2021

Senate

Added as Alternate Co-Sponsor Sen. Linda Holmes

May 05, 2021

Senate

Added as Alternate Co-Sponsor Sen. Christopher Belt

Senate

Added as Alternate Co-Sponsor Sen. Melinda Bush

May 04, 2021

Senate

Added as Alternate Co-Sponsor Sen. Thomas Cullerton

Senate

Added as Alternate Co-Sponsor Sen. Karina Villa

Senate

Added as Alternate Co-Sponsor Sen. Mike Simmons

Senate

Added as Alternate Co-Sponsor Sen. Antonio Muñoz

Senate

Added as Alternate Co-Sponsor Sen. Mattie Hunter

Senate

Assigned to Insurance

Apr 29, 2021

Senate

Added as Alternate Co-Sponsor Sen. Julie A. Morrison

Senate

Added as Alternate Co-Sponsor Sen. Laura M. Murphy

Apr 28, 2021

Senate

Added as Alternate Co-Sponsor Sen. Celina Villanueva

Apr 27, 2021

Senate

Added as Alternate Co-Sponsor Sen. David Koehler

Senate

Added as Alternate Co-Sponsor Sen. Adriane Johnson

Senate

Added as Alternate Co-Sponsor Sen. Ram Villivalam

Senate

Added as Alternate Chief Co-Sponsor Sen. Kimberly A. Lightford

Senate

Added as Alternate Co-Sponsor Sen. Robert Peters

Senate

Added as Alternate Co-Sponsor Sen. Patricia Van Pelt

Senate

Added as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins

Senate

Added as Alternate Chief Co-Sponsor Sen. Doris Turner

Apr 26, 2021

Senate

Added as Alternate Chief Co-Sponsor Sen. Sara Feigenholtz

Apr 23, 2021

Senate

First Reading

Senate

Arrive in Senate

Senate

Placed on Calendar Order of First Reading

Senate

Chief Senate Sponsor Sen. Laura Fine

Senate

Referred to Assignments

Apr 22, 2021

House

Added Co-Sponsor Rep. Emanuel Chris Welch

House

Added Co-Sponsor Rep. Ann M. Williams

House

Added Co-Sponsor Rep. Jaime M. Andrade, Jr.

House

Added Co-Sponsor Rep. Elizabeth Hernandez

House

Added Chief Co-Sponsor Rep. Terra Costa Howard

House

Third Reading - Short Debate - Passed 114-000-000

House

Placed on Calendar Order of 3rd Reading - Short Debate

House

House Floor Amendment No. 1 Adopted

House

Recalled to Second Reading - Short Debate

Apr 21, 2021

House

Added Co-Sponsor Rep. Lawrence Walsh, Jr.

House

Added Co-Sponsor Rep. Janet Yang Rohr

House

House Floor Amendment No. 1 Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000

Apr 20, 2021

House

Added Co-Sponsor Rep. Sam Yingling

House

House Floor Amendment No. 1 Rules Refers to Mental Health & Addiction Committee

House

Added Co-Sponsor Rep. Delia C. Ramirez

Apr 19, 2021

House

House Floor Amendment No. 1 Referred to Rules Committee

House

Added Co-Sponsor Rep. Kathleen Willis

House

Added Co-Sponsor Rep. La Shawn K. Ford

House

House Floor Amendment No. 1 Filed with Clerk by Rep. Deb Conroy

Apr 14, 2021

House

Placed on Calendar Order of 3rd Reading - Short Debate

House

Second Reading - Short Debate

Apr 13, 2021

House

Added Co-Sponsor Rep. Mark L. Walker

House

Added Co-Sponsor Rep. Greg Harris

Apr 12, 2021

House

Added Co-Sponsor Rep. Frances Ann Hurley

House

Added Co-Sponsor Rep. Anna Moeller

House

Added Co-Sponsor Rep. Joyce Mason

House

Added Co-Sponsor Rep. Amy Grant

Apr 08, 2021

House

Added Co-Sponsor Rep. Ryan Spain

House

Placed on Calendar 2nd Reading - Short Debate

Apr 07, 2021

House

Added Co-Sponsor Rep. Barbara Hernandez

Apr 06, 2021

House

Added Co-Sponsor Rep. Margaret Croke

Mar 26, 2021

House

Added Co-Sponsor Rep. Marcus C. Evans, Jr.

House

Added Co-Sponsor Rep. William Davis

House

Do Pass / Short Debate Mental Health & Addiction Committee; 016-000-000

Mar 25, 2021

House

Added Co-Sponsor Rep. Lindsey LaPointe

Mar 24, 2021

House

Added Co-Sponsor Rep. Angelica Guerrero-Cuellar

House

Added Co-Sponsor Rep. Natalie A. Manley

Mar 23, 2021

House

Added Co-Sponsor Rep. Katie Stuart

Mar 18, 2021

House

Added Co-Sponsor Rep. Mary E. Flowers

House

Added Co-Sponsor Rep. Nicholas K. Smith

House

Added Co-Sponsor Rep. Kelly M. Cassidy

Mar 17, 2021

House

Added Co-Sponsor Rep. Maurice A. West, II

Mar 12, 2021

House

Added Co-Sponsor Rep. Will Guzzardi

Mar 11, 2021

House

Added Co-Sponsor Rep. Bob Morgan

Mar 09, 2021

House

Assigned to Mental Health & Addiction Committee

Mar 02, 2021

House

Added Co-Sponsor Rep. Robyn Gabel

Mar 01, 2021

House

Added Co-Sponsor Rep. Maura Hirschauer

Feb 26, 2021

House

Added Co-Sponsor Rep. Terra Costa Howard

House

Removed Co-Sponsor Rep. Terra Costa Howard

Feb 23, 2021

House

Added Co-Sponsor Rep. Jonathan Carroll

Feb 19, 2021

House

Added Chief Co-Sponsor Rep. Jennifer Gong-Gershowitz

House

Referred to Rules Committee

House

First Reading

Feb 17, 2021

House

Filed with the Clerk by Rep. Deb Conroy

Bill Text

Bill Text Versions Format
Introduced HTML PDF
Engrossed HTML PDF
Enrolled HTML PDF
House Amendment 001 HTML PDF
Senate Amendment 001 HTML PDF

Related Documents

Document Format
Public Act

Sources

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