HB0122 EngrossedLRB101 02888 RJF 47896 b

1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Substance Use Disorder Act is amended by
5adding Article 7 as follows:
 
6    (20 ILCS 301/Art. 7 heading new)
7
ARTICLE 7. BEHAVIORAL HEALTH ACCESS TO CARE OMBUDSMAN

 
8    (20 ILCS 301/7-5 new)
9    Sec. 7-5. Definitions. As used in this Article:
10    (a) "Health care provider" or "provider" means:
11        (1) a physician licensed under the Medical Practice Act
12    of 1987 to practice medicine in all of its branches; a
13    clinical psychologist licensed under the Clinical
14    Psychologist Licensing Act;
15        (2) a mental health professional who is licensed or
16    registered to provide mental health services by the
17    Department of Financial and Professional Regulation;
18        (3) any other health care provider regulated by the
19    State when engaged in assisting consumers with behavioral
20    health care access and coverage issues; or
21        (4) a health care facility licensed or regulated by the
22    State, when the facility is engaged in assisting consumers

 

 

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1    with behavioral health care access and coverage issues,
2    excluding any facility that is listed under subsection (b)
3    of Section 4.04 of the Illinois Act on the Aging.
4    (b) "Office" means the Office of the Ombudsman for
5Behavioral Health Access to Care created in Section 7-10.
6    (c) "Ombudsman" means the individual designated under
7Section 7-10 as the Ombudsman for Behavioral Health Access to
8Care.
 
9    (20 ILCS 301/7-10 new)
10    Sec. 7-10. Office of the Ombudsman for Behavioral Health
11Access to Care; appointment; duties.
12    (a) Subject to appropriation, the Department of Human
13Services shall establish the Office of the Ombudsman for
14Behavioral Health Access to Care for the purpose of assisting
15residents of Illinois in accessing behavioral health care.
16    (b) The Office and the Department shall operate in
17accordance with a memorandum of understanding between the 2
18entities. The memorandum of understanding shall contain, at a
19minimum:
20        (1) a requirement that the Office has its own personnel
21    rules;
22        (2) a requirement that the Ombudsman has independent
23    hiring and termination authority over Office employees;
24        (3) a requirement that the Office must follow State
25    fiscal rules;

 

 

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1        (4) a requirement that the Department of Human
2    Services' Division of Mental Health shall offer the Office
3    limited support with respect to:
4            (A) personnel matters;
5            (B) recruitment;
6            (C) payroll;
7            (D) benefits;
8            (E) budget submission, as needed;
9            (F) accounting;
10            (G) office space, facilities, and technical
11        support; and
12            (H) other provisions regarding administrative
13        support that will help maintain the independence of the
14        Office.
15    (c) The Office shall operate with full independence and has
16complete autonomy, control, and authority over operations,
17budget, and personnel decisions related to the Office and the
18Ombudsman.
19    (d) By November 1, 2019, the Governor shall designate an
20Ombudsman for Behavioral Health Access to Care, who shall serve
21as Director of the Office. The Ombudsman shall serve as a
22neutral party to help consumers, including consumers who are
23uninsured or have public or private health benefit coverage,
24including coverage that is not subject to State regulation, and
25health care providers, acting on their own behalf, on behalf of
26a consumer with the consumer's written permission, or on behalf

 

 

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1of a group of health care providers, navigate and resolve
2issues related to consumer access to behavioral health care,
3including care for mental health conditions and substance use
4disorders.
5    (e) The Ombudsman shall:
6        (1) interact with consumers and health care providers
7    with concerns or complaints to help the consumers and
8    providers resolve behavioral health care access and
9    coverage issues;
10        (2) identify, track, and report to the appropriate
11    regulatory or oversight agency concerns, complaints, and
12    potential violations of State or federal rules,
13    regulations, or statutes concerning the availability of,
14    and terms and conditions of, benefits for mental health
15    conditions or substance use disorders, including potential
16    violations related to quantitative and non-quantitative
17    treatment limitations;
18        (3) receive and assist consumers and providers in
19    reporting concerns and filing complaints with appropriate
20    regulatory or oversight agencies relating to inappropriate
21    care or involuntary admissions or judicial admissions
22    under the Mental Health and Developmental Disabilities
23    Code;
24        (4) provide appropriate information to help consumers
25    obtain behavioral health care;
26        (5) develop appropriate points of contact for

 

 

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1    referrals to other State and federal agencies; and
2        (6) provide appropriate information to help consumers
3    or health care providers file appeals or complaints with
4    the appropriate entities, including insurers and other
5    State and federal agencies.
6    (f) The Ombudsman, employees of the Office, and any persons
7acting on behalf of the Office shall comply with all State and
8federal confidentiality laws that govern the Department of
9Human Services with respect to the treatment of confidential
10information or records and the disclosure of such information
11and records.
12    (g) In the performance of his or her duties, the Ombudsman
13shall act independently of the Department of Human Services'
14Division of Mental Health. Any recommendations made or
15positions taken by the Ombudsman do not reflect those of the
16Department of Human Services or the Division of Mental Health.
 
17    (20 ILCS 301/7-15 new)
18    Sec. 7-15. Liaisons. The Director of Insurance and the
19Secretary of Human Services shall each appoint a liaison to the
20Ombudsman to receive reports of concerns, complaints, and
21potential violations described in paragraph (2) of subsection
22(e) of Section 7-10 from the Ombudsman, consumers, or health
23care providers.
 
24    (20 ILCS 301/7-20 new)

 

 

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1    Sec. 7-20. Qualified immunity. The Ombudsman and employees
2or persons acting on behalf of the Office are immune from suit
3and liability, either personally or in their official
4capacities, for any claim for damage to or loss of property, or
5for personal injury or other civil liability caused by or
6arising out of any actual or alleged act, error, or omission
7that occurred within the scope of employment, duties, or
8responsibilities pertaining to the Office, including issuing
9reports or recommendations; except that nothing in this Section
10protects those persons from suit or liability for damage, loss,
11injury, or liability caused by the intentional or willful and
12wanton misconduct of the person.
 
13    (20 ILCS 301/7-25 new)
14    Sec. 7-25. Annual report.
15    (a) On or before September 1, 2021, and on or before
16September 1 of each year thereafter, the Ombudsman shall
17prepare and submit, in accordance with subsection (b), a
18written report that includes information from the preceding
19fiscal year concerning actions taken by the Ombudsman relating
20to the duties of the Office set forth in Section 7-10.
21    (b) The Ombudsman shall submit the report required by this
22Section to the Governor, the Secretary of Human Services, the
23Director of Insurance, the Senate Human Services Committee or
24any successor committee, and the House Committees on Human
25Services, Insurance, Energy & Environment, and Mental Health or

 

 

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1any successor committees.
2    (c) The Ombudsman shall post the annual report on the
3Department of Human Services' website.
4    (d) The Ombudsman shall not include in the report required
5by this Section any personally identifying information about an
6individual consumer or health care provider or identifying
7information about a health care facility licensed by the State
8or an emergency medical services system as defined in Section
93.20 of the Emergency Medical Services (EMS) Systems Act.
 
10    Section 10. The Illinois Insurance Code is amended by
11adding Section 370c.2 as follows:
 
12    (215 ILCS 5/370c.2 new)
13    Sec. 370c.2. Parity reporting.
14    (a) By March 1, 2020, and every other March 1 thereafter,
15the Director shall submit a written report and provide a
16presentation of the report to the General Assembly that:
17        (1) specifies the methodology the Director uses to
18    verify that insurance carriers are complying with Section
19    370c and rules adopted under that Section and with the
20    federal Paul Wellstone and Pete Domenici Mental Health
21    Parity and Addiction Equity Act of 2008, Public Law
22    110-343, as amended, any regulations adopted in accordance
23    with that Act, or guidance related to compliance with and
24    oversight of that Act;

 

 

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1        (2) identifies market conduct examinations initiated,
2    conducted, or completed during the preceding 12 months
3    regarding compliance with Section 370c and rules adopted
4    under that Section and with the Paul Wellstone and Pete
5    Domenici Mental Health Parity and Addiction Equity Act of
6    2008 and regulations adopted under that Act and summarizes
7    the outcomes of those market conduct examinations; and
8        (3) details any educational or corrective actions the
9    Director has taken to ensure insurance carrier compliance
10    with Section 370c and rules adopted under that Section and
11    with the Paul Wellstone and Pete Domenici Mental Health
12    Parity and Addiction Equity Act of 2008 and regulations
13    adopted under that Act.
14    (b) The Director shall ensure that the report is written in
15plain language and is made available to the public by, at a
16minimum, posting the report on the Department's website.
 
17    Section 99. Effective date. This Act takes effect upon
18becoming law.