HB2595 | Illinois 2021-2022 | INSURANCE-MENTAL HEALTH

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On August 25, 2021 in the House:

Governor Approved
Effective Date August 25, 2021; - some provisions effective January 1, 2022
Public Act . . . . . . . . . 102-0579

On June 29, 2021 in the House:

Sent to the Governor

On May 31, 2021 in the House:

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

On May 30, 2021 in the House:

Senate Committee Amendment No. 1 Motion Filed Concur Rep. Deb Conroy
Senate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee
Senate Committee Amendment No. 1 Motion to Concur Rules Referred to Mental Health & Addiction Committee
Senate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000

On May 29, 2021 in the House:

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

On May 29, 2021 in the Senate:

Third Reading - Passed; 059-000-000

On May 27, 2021 in the Senate:

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

On May 20, 2021 in the Senate:

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

On May 19, 2021 in the Senate:

Senate Committee Amendment No. 1 Adopted
Do Pass as Amended Insurance; 012-000-000
Placed on Calendar Order of 2nd Reading May 20, 2021

On May 17, 2021 in the Senate:

Senate Committee Amendment No. 1 Assignments Refers to Insurance

On May 14, 2021 in the Senate:

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

On May 4, 2021 in the Senate:

Assigned to Insurance

On April 23, 2021 in the Senate:

Arrive in Senate
Placed on Calendar Order of First Reading
Chief Senate Sponsor Sen. Laura Fine
First Reading
Referred to Assignments

On April 22, 2021 in the House:

Recalled to Second Reading - Short Debate
House Floor Amendment No. 1 Adopted
Placed on Calendar Order of 3rd Reading - Short Debate
Third Reading - Short Debate - Passed 114-000-000

On April 21, 2021 in the House:

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

On April 20, 2021 in the House:

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

On April 19, 2021 in the House:

House Floor Amendment No. 1 Filed with Clerk by Rep. Deb Conroy
House Floor Amendment No. 1 Referred to Rules Committee

On April 14, 2021 in the House:

Second Reading - Short Debate
Placed on Calendar Order of 3rd Reading - Short Debate

On April 8, 2021 in the House:

Placed on Calendar 2nd Reading - Short Debate

On March 26, 2021 in the House:

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

On March 9, 2021 in the House:

Assigned to Mental Health & Addiction Committee

On February 19, 2021 in the House:

First Reading
Referred to Rules Committee

On February 17, 2021 in the House:

Filed with the Clerk by Rep. Deb Conroy

Senate Amendment 001

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.

House Amendment 001

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).