INSURANCE-MENTAL HEALTH House SponsorsRep. Deb Conroy-Jennifer Gong-Gershowitz-Terra Costa Howard, Jonathan Carroll, Maura Hirschauer, Robyn Gabel, Bob Morgan, Will Guzzardi, Maurice A. West, II, Kelly M. Cassidy, Mary E. Flowers, Nicholas K. Smith, Katie Stuart, Angelica Guerrero-Cuellar, Natalie A. Manley, Lindsey LaPointe, Marcus C. Evans, Jr., William Davis, Margaret Croke, Barbara Hernandez, Ryan Spain, Frances Ann Hurley, Amy Grant, Joyce Mason, Anna Moeller, Greg Harris, Mark L. Walker, La Shawn K. Ford, Kathleen Willis, Delia C. Ramirez, Sam Yingling, Lawrence Walsh, Jr., Janet Yang Rohr, Emanuel Chris Welch, Elizabeth Hernandez, Jaime M. Andrade, Jr. and Ann M. Williams Senate Sponsors(Sen. Laura Fine-Sara Feigenholtz, Ram Villivalam, David Koehler-Doris Turner-Jacqueline Y. Collins, Patricia Van Pelt, Robert Peters-Kimberly A. Lightford, Adriane Johnson, Celina Villanueva, Julie A. Morrison, Laura M. Murphy, Thomas Cullerton, Mattie Hunter, Antonio Muņoz, Mike Simmons, Karina Villa, Melinda Bush, Christopher Belt, Linda Holmes, Michael E. Hastings, Bill Cunningham, Meg Loughran Cappel, Cristina Castro, Suzy Glowiak Hilton, Omar Aquino, Rachelle Crowe, Robert F. Martwick, John Connor, Patrick J. Joyce and Ann Gillespie) 8/25/2021HousePublic Act . . . . . . . . . 102-0579 215 ILCS 5/370cfrom Ch. 73, par. 982c215 ILCS 180/35215 ILCS 180/40 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.1Replaces 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. 2/17/2021HouseFiled with the Clerk by Rep. Deb Conroy 2/19/2021HouseAdded Chief Co-Sponsor Rep. Jennifer Gong-Gershowitz 2/19/2021HouseFirst Reading 2/19/2021HouseReferred to Rules Committee 2/23/2021HouseAdded Co-Sponsor Rep. Jonathan Carroll 2/26/2021HouseAdded Co-Sponsor Rep. Terra Costa Howard 2/26/2021HouseRemoved Co-Sponsor Rep. Terra Costa Howard 3/1/2021HouseAdded Co-Sponsor Rep. Maura Hirschauer 3/2/2021HouseAdded Co-Sponsor Rep. Robyn Gabel 3/9/2021HouseAssigned to Mental Health & Addiction Committee 3/11/2021HouseAdded Co-Sponsor Rep. Bob Morgan 3/12/2021HouseAdded Co-Sponsor Rep. Will Guzzardi 3/17/2021HouseAdded Co-Sponsor Rep. Maurice A. West, II 3/18/2021HouseAdded Co-Sponsor Rep. Kelly M. Cassidy 3/18/2021HouseAdded Co-Sponsor Rep. Mary E. Flowers 3/18/2021HouseAdded Co-Sponsor Rep. Nicholas K. Smith 3/23/2021HouseAdded Co-Sponsor Rep. Katie Stuart 3/24/2021HouseAdded Co-Sponsor Rep. Angelica Guerrero-Cuellar 3/24/2021HouseAdded Co-Sponsor Rep. Natalie A. Manley 3/25/2021HouseAdded Co-Sponsor Rep. Lindsey LaPointe 3/26/2021HouseAdded Co-Sponsor Rep. Marcus C. Evans, Jr. 3/26/2021HouseDo Pass / Short Debate Mental Health & Addiction Committee; 016-000-000 3/26/2021HouseAdded Co-Sponsor Rep. William Davis 4/6/2021HouseAdded Co-Sponsor Rep. Margaret Croke 4/7/2021HouseAdded Co-Sponsor Rep. Barbara Hernandez 4/8/2021HousePlaced on Calendar 2nd Reading - Short Debate 4/8/2021HouseAdded Co-Sponsor Rep. Ryan Spain 4/12/2021HouseAdded Co-Sponsor Rep. Frances Ann Hurley 4/12/2021HouseAdded Co-Sponsor Rep. Amy Grant 4/12/2021HouseAdded Co-Sponsor Rep. Joyce Mason 4/12/2021HouseAdded Co-Sponsor Rep. Anna Moeller 4/13/2021HouseAdded Co-Sponsor Rep. Greg Harris 4/13/2021HouseAdded Co-Sponsor Rep. Mark L. Walker 4/14/2021HouseSecond Reading - Short Debate 4/14/2021HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/19/2021HouseHouse Floor Amendment No. 1 Filed with Clerk by Rep. Deb Conroy 4/19/2021HouseHouse Floor Amendment No. 1 Referred to Rules Committee 4/19/2021HouseAdded Co-Sponsor Rep. La Shawn K. Ford 4/19/2021HouseAdded Co-Sponsor Rep. Kathleen Willis 4/20/2021HouseAdded Co-Sponsor Rep. Delia C. Ramirez 4/20/2021HouseAdded Co-Sponsor Rep. Sam Yingling 4/20/2021HouseHouse Floor Amendment No. 1 Rules Refers to Mental Health & Addiction Committee 4/21/2021HouseHouse Floor Amendment No. 1 Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000 4/21/2021HouseAdded Co-Sponsor Rep. Lawrence Walsh, Jr. 4/21/2021HouseAdded Co-Sponsor Rep. Janet Yang Rohr 4/22/2021HouseAdded Co-Sponsor Rep. Emanuel Chris Welch 4/22/2021HouseRecalled to Second Reading - Short Debate 4/22/2021HouseHouse Floor Amendment No. 1 Adopted 4/22/2021HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/22/2021HouseThird Reading - Short Debate - Passed 114-000-000 4/22/2021HouseAdded Chief Co-Sponsor Rep. Terra Costa Howard 4/22/2021HouseAdded Co-Sponsor Rep. Elizabeth Hernandez 4/22/2021HouseAdded Co-Sponsor Rep. Jaime M. Andrade, Jr. 4/22/2021HouseAdded Co-Sponsor Rep. Ann M. Williams 4/23/2021SenateArrive in Senate 4/23/2021SenatePlaced on Calendar Order of First Reading 4/23/2021SenateChief Senate Sponsor Sen. Laura Fine 4/23/2021SenateFirst Reading 4/23/2021SenateReferred to Assignments 4/26/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Sara Feigenholtz 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Ram Villivalam 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. David Koehler 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Doris Turner 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Patricia Van Pelt 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Robert Peters 4/27/2021SenateAdded as Alternate Chief Co-Sponsor Sen. Kimberly A. Lightford 4/27/2021SenateAdded as Alternate Co-Sponsor Sen. Adriane Johnson 4/28/2021SenateAdded as Alternate Co-Sponsor Sen. Celina Villanueva 4/29/2021SenateAdded as Alternate Co-Sponsor Sen. Julie A. Morrison 4/29/2021SenateAdded as Alternate Co-Sponsor Sen. Laura M. Murphy 5/4/2021SenateAssigned to Insurance 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Thomas Cullerton 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Mattie Hunter 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Antonio Muņoz 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Mike Simmons 5/4/2021SenateAdded as Alternate Co-Sponsor Sen. Karina Villa 5/5/2021SenateAdded as Alternate Co-Sponsor Sen. Melinda Bush 5/5/2021SenateAdded as Alternate Co-Sponsor Sen. Christopher Belt 5/6/2021SenateAdded as Alternate Co-Sponsor Sen. Linda Holmes 5/14/2021SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Laura Fine 5/14/2021SenateSenate Committee Amendment No. 1 Referred to Assignments 5/17/2021SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance 5/19/2021SenateSenate Committee Amendment No. 1 Adopted 5/19/2021SenateDo Pass as Amended Insurance; 012-000-000 5/19/2021SenatePlaced on Calendar Order of 2nd Reading May 20, 2021 5/20/2021SenateSecond Reading 5/20/2021SenatePlaced on Calendar Order of 3rd Reading May 21, 2021 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Michael E. Hastings 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Bill Cunningham 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Meg Loughran Cappel 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Cristina Castro 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Omar Aquino 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Rachelle Crowe 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Robert F. Martwick 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. John Connor 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Patrick J. Joyce 5/20/2021SenateAdded as Alternate Co-Sponsor Sen. Ann Gillespie 5/27/2021SenatePlaced on Calendar Order of 3rd Reading ** May 28, 2021 5/29/2021SenateThird Reading - Passed; 059-000-000 5/29/2021HouseArrived in House 5/29/2021HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 1 5/30/2021HouseSenate Committee Amendment No. 1 Motion Filed Concur Rep. Deb Conroy 5/30/2021HouseSenate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee 5/30/2021HouseSenate Committee Amendment No. 1 Motion to Concur Rules Referred to Mental Health & Addiction Committee 5/30/2021HouseSenate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Mental Health & Addiction Committee; 014-000-000 5/31/2021HouseSenate Committee Amendment No. 1 House Concurs 116-000-002 5/31/2021HouseHouse Concurs 5/31/2021HousePassed Both Houses 6/29/2021HouseSent to the Governor 8/25/2021HouseGovernor Approved 8/25/2021HouseEffective Date August 25, 2021; - some provisions effective January 1, 2022 8/25/2021HousePublic Act . . . . . . . . . 102-0579