HB 4475

  • Illinois House Bill
  • 103rd Regular Session
  • Introduced in House Apr 24, 2024
  • Passed House Apr 19, 2024
  • Senate
  • Governor

Ins Cd-Behaviorial Health

Abstract

Amends the Illinois Insurance Code. Provides that the amendatory Act may be referred to as the Strengthening Mental Health and Substance Use Parity Act. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025, or any third-party administrator administering the behavioral health benefits for the insurer, shall cover all out-of-network medically necessary mental health and substance use benefits and services (inpatient and outpatient) as if they were in-network for purposes of cost sharing for the insured. Provides that the insured has the right to select the provider or facility of their choice and the modality, whether the care is provided via in-person visit or telehealth, for medically necessary care. Sets forth minimum reimbursement rates for certain behavioral health benefits. Sets forth provisions concerning responsibility for compliance with parity requirements; coverage and payment for multiple covered mental health and substance use services, mental health or substance use services provided under the supervision of a licensed mental health or substance treatment provider, and 60-minute individual psychotherapy; timely credentialing of mental health and substance use providers; Department of Insurance enforcement and rulemaking; civil penalties; and other matters. Amends the Illinois Administrative Procedure Act to authorize emergency rulemaking. Effective immediately. House Committee Amendment No. 1 Deletes reference to: 5 ILCS 100/5-45.55 new Adds reference to: 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 Replaces everything after the enacting clause. Provides that the amendatory Act may be referred to as the Strengthening Mental Health and Substance Use Parity Act. Amends the Illinois Insurance Code. 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, on average, at least as favorable as professional services provided by in-network primary care providers. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025, or a contracted third party administering the behavioral health benefits for the insurer, to cover all medically necessary mental health or substance use disorder services received by the same insured on the same day from the same or different mental health or substance use provider or facility for both outpatient and inpatient care. Requires coverage of medically necessary mental health or substance use disorder services provided by behavioral health trainees under certain circumstances. Requires coverage of medically necessary 60-minute psychotherapy billed using the CPT Code 90837 for Individual Therapy. Sets forth provisions concerning timely contracting for becoming a participating mental health or substance use disorder treatment provider, enforcement, and rulemaking. Amends the Health Maintenance Organization Act to require health maintenance organizations to comply with the provisions of the Illinois Insurance Code added by the amendatory Act. Effective immediately. House Floor Amendment No. 2 Replaces everything after the enacting clause. 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.

Bill Sponsors (50)

Votes


Actions


Oct 09, 2024

Senate

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

Sep 30, 2024

Senate

Added as Alternate Co-Sponsor Sen. David Koehler

Sep 25, 2024

Senate

Added as Alternate Co-Sponsor Sen. Mark L. Walker

Senate

Added as Alternate Co-Sponsor Sen. Mark L. Walker

Sep 17, 2024

Senate

Added as Alternate Co-Sponsor Sen. Steve Stadelman

Sep 05, 2024

Senate

Added as Alternate Co-Sponsor Sen. Doris Turner

Aug 26, 2024

Senate

Added as Alternate Co-Sponsor Sen. Adriane Johnson

Senate

Added as Alternate Co-Sponsor Sen. Javier L. Cervantes

Aug 19, 2024

Senate

Added as Alternate Co-Sponsor Sen. Natalie Toro

Aug 16, 2024

Senate

Added as Alternate Co-Sponsor Sen. Mike Porfirio

Aug 08, 2024

Senate

Added as Alternate Co-Sponsor Sen. Bill Cunningham

Senate

Added as Alternate Chief Co-Sponsor Sen. Robert Peters

May 21, 2024

Senate

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

May 15, 2024

Senate

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

May 14, 2024

Senate

Added as Alternate Co-Sponsor Sen. Mike Simmons

Senate

Added as Alternate Co-Sponsor Sen. Mary Edly-Allen

May 10, 2024

Senate

Added as Alternate Co-Sponsor Sen. Robert Peters

May 07, 2024

Senate

Added as Alternate Co-Sponsor Sen. Terri Bryant

Senate

Added as Alternate Co-Sponsor Sen. Erica Harriss

May 06, 2024

Senate

Added as Alternate Co-Sponsor Sen. Laura Fine

May 01, 2024

Senate

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

Senate

Added as Alternate Co-Sponsor Sen. Rachel Ventura

Apr 24, 2024

Senate

Placed on Calendar Order of First Reading

Senate

Referred to Assignments

Senate

First Reading

Senate

Chief Senate Sponsor Sen. Karina Villa

Senate

Arrive in Senate

Apr 19, 2024

House

Added Co-Sponsor Rep. Mark L. Walker

House

Added Co-Sponsor Rep. Yolonda Morris

House

House Floor Amendment No. 2 Adopted

House

Placed on Calendar Order of 3rd Reading - Short Debate

House

Added Co-Sponsor Rep. Maura Hirschauer

House

Third Reading - Short Debate - Passed 086-020-000

House

Added Chief Co-Sponsor Rep. Sonya M. Harper

House

Added Chief Co-Sponsor Rep. Michael J. Kelly

House

Added Co-Sponsor Rep. Janet Yang Rohr

House

Removed Co-Sponsor Rep. Janet Yang Rohr

House

Added Co-Sponsor Rep. William E Hauter

House

Added Co-Sponsor Rep. Matt Hanson

Apr 18, 2024

House

House Floor Amendment No. 2 Recommends Be Adopted Mental Health & Addiction Committee; 017-000-000

Apr 17, 2024

House

Second Reading - Short Debate

House

House Floor Amendment No. 2 Rules Refers to Mental Health & Addiction Committee

House

Held on Calendar Order of Second Reading - Short Debate

Apr 16, 2024

House

House Floor Amendment No. 2 Filed with Clerk by Rep. Lindsey LaPointe

House

House Floor Amendment No. 2 Referred to Rules Committee

Apr 15, 2024

House

Added Co-Sponsor Rep. Stephanie A. Kifowit

Apr 12, 2024

House

Added Co-Sponsor Rep. Jay Hoffman

House

Added Co-Sponsor Rep. Katie Stuart

Apr 10, 2024

House

Added Co-Sponsor Rep. Bob Morgan

Apr 04, 2024

House

House Committee Amendment No. 1 Adopted in Mental Health & Addiction Committee; by Voice Vote

House

Placed on Calendar 2nd Reading - Short Debate

House

Do Pass as Amended / Short Debate Mental Health & Addiction Committee; 017-000-000

Apr 03, 2024

House

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

Apr 02, 2024

House

House Committee Amendment No. 1 Referred to Rules Committee

House

House Committee Amendment No. 1 Filed with Clerk by Rep. Lindsey LaPointe

Apr 01, 2024

House

Added Co-Sponsor Rep. Laura Faver Dias

Mar 27, 2024

House

Added Co-Sponsor Rep. Theresa Mah

Mar 20, 2024

House

Added Co-Sponsor Rep. Tracy Katz Muhl

Mar 07, 2024

House

Added Co-Sponsor Rep. Nabeela Syed

Feb 27, 2024

House

Added Co-Sponsor Rep. Terra Costa Howard

Feb 22, 2024

House

Added Co-Sponsor Rep. Michelle Mussman

Feb 21, 2024

House

Added Co-Sponsor Rep. Gregg Johnson

Feb 20, 2024

House

Added Co-Sponsor Rep. Dagmara Avelar

House

Added Co-Sponsor Rep. Will Guzzardi

Feb 14, 2024

House

Assigned to Mental Health & Addiction Committee

Feb 09, 2024

House

Added Co-Sponsor Rep. Norma Hernandez

House

Added Co-Sponsor Rep. Hoan Huynh

House

Added Co-Sponsor Rep. Anne Stava-Murray

House

Added Co-Sponsor Rep. Kelly M. Cassidy

House

Added Co-Sponsor Rep. Suzanne M. Ness

House

Added Co-Sponsor Rep. Kevin John Olickal

Feb 07, 2024

House

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

House

Added Chief Co-Sponsor Rep. Jenn Ladisch Douglass

Jan 17, 2024

House

Filed with the Clerk by Rep. Lindsey LaPointe

House

Referred to Rules Committee

House

First Reading

Bill Text

Bill Text Versions Format
Introduced HTML PDF
Engrossed HTML PDF
House Amendment 001 HTML PDF
House Amendment 002 HTML PDF

Related Documents

Document Format
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Sources

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