Rep. Yehiel M. Kalish

Filed: 4/2/2019

 

 


 

 


 
10100HB0122ham002LRB101 02888 KTG 59034 a

1
AMENDMENT TO HOUSE BILL 122

2    AMENDMENT NO. ______. Amend House Bill 122 by replacing
3everything after the enacting clause with the following:
 
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

 

 

10100HB0122ham002- 2 -LRB101 02888 KTG 59034 a

1    registered to provide mental health services by the
2    Department of Financial and Professional Regulation;
3        (3) any other health care provider regulated by the
4    State when engaged in assisting consumers with behavioral
5    health care access and coverage issues; or
6        (4) a health care facility licensed or regulated by the
7    State, when the facility is engaged in assisting consumers
8    with behavioral health care access and coverage issues,
9    excluding any facility that is listed under subsection (b)
10    of Section 4.04 of the Illinois Act on the Aging.
11    (b) "Office" means the Office of the Ombudsman for
12Behavioral Health Access to Care created in Section 7-10.
13    (c) "Ombudsman" means the individual designated under
14Section 7-10 as the Ombudsman for Behavioral Health Access to
15Care.
 
16    (20 ILCS 301/7-10 new)
17    Sec. 7-10. Office of the Ombudsman for Behavioral Health
18Access to Care; appointment; duties.
19    (a) There is created in the Department of Human Services
20the Office of the Ombudsman for Behavioral Health Access to
21Care for the purpose of assisting residents of Illinois in
22accessing behavioral health care.
23    (b) The Office and the Department shall operate in
24accordance with a memorandum of understanding between the 2
25entities. The memorandum of understanding shall contain, at a

 

 

10100HB0122ham002- 3 -LRB101 02888 KTG 59034 a

1minimum:
2        (1) a requirement that the Office has its own personnel
3    rules;
4        (2) a requirement that the Ombudsman has independent
5    hiring and termination authority over Office employees;
6        (3) a requirement that the Office must follow State
7    fiscal rules;
8        (4) a requirement that the Department of Human
9    Services' Division of Mental Health shall offer the Office
10    limited support with respect to:
11            (A) personnel matters;
12            (B) recruitment;
13            (C) payroll;
14            (D) benefits;
15            (E) budget submission, as needed;
16            (F) accounting;
17            (G) office space, facilities, and technical
18        support; and
19            (H) other provisions regarding administrative
20        support that will help maintain the independence of the
21        Office.
22    (c) The Office shall operate with full independence and has
23complete autonomy, control, and authority over operations,
24budget, and personnel decisions related to the Office and the
25Ombudsman.
26    (d) By November 1, 2019, the Governor shall designate an

 

 

10100HB0122ham002- 4 -LRB101 02888 KTG 59034 a

1Ombudsman for Behavioral Health Access to Care, who shall serve
2as Director of the Office. The Ombudsman shall serve as a
3neutral party to help consumers, including consumers who are
4uninsured or have public or private health benefit coverage,
5including coverage that is not subject to State regulation, and
6health care providers, acting on their own behalf, on behalf of
7a consumer with the consumer's written permission, or on behalf
8of a group of health care providers, navigate and resolve
9issues related to consumer access to behavioral health care,
10including care for mental health conditions and substance use
11disorders.
12    (e) The Ombudsman shall:
13        (1) interact with consumers and health care providers
14    with concerns or complaints to help the consumers and
15    providers resolve behavioral health care access and
16    coverage issues;
17        (2) identify, track, and report to the appropriate
18    regulatory or oversight agency concerns, complaints, and
19    potential violations of State or federal rules,
20    regulations, or statutes concerning the availability of,
21    and terms and conditions of, benefits for mental health
22    conditions or substance use disorders, including potential
23    violations related to quantitative and non-quantitative
24    treatment limitations;
25        (3) receive and assist consumers and providers in
26    reporting concerns and filing complaints with appropriate

 

 

10100HB0122ham002- 5 -LRB101 02888 KTG 59034 a

1    regulatory or oversight agencies relating to inappropriate
2    care or involuntary admissions or judicial admissions
3    under the Mental Health and Developmental Disabilities
4    Code;
5        (4) provide appropriate information to help consumers
6    obtain behavioral health care;
7        (5) develop appropriate points of contact for
8    referrals to other State and federal agencies; and
9        (6) provide appropriate information to help consumers
10    or health care providers file appeals or complaints with
11    the appropriate entities, including insurers and other
12    State and federal agencies.
13    (f) The Ombudsman, employees of the Office, and any persons
14acting on behalf of the Office shall comply with all State and
15federal confidentiality laws that govern the Department of
16Human Services with respect to the treatment of confidential
17information or records and the disclosure of such information
18and records.
19    (g) In the performance of his or her duties, the Ombudsman
20shall act independently of the Department of Human Services'
21Division of Mental Health. Any recommendations made or
22positions taken by the Ombudsman do not reflect those of the
23Department of Human Services or the Division of Mental Health.
 
24    (20 ILCS 301/7-15 new)
25    Sec. 7-15. Liaisons. The Director of Insurance and the

 

 

10100HB0122ham002- 6 -LRB101 02888 KTG 59034 a

1Secretary of Human Services shall each appoint a liaison to the
2Ombudsman to receive reports of concerns, complaints, and
3potential violations described in paragraph (2) of subsection
4(e) of Section 7-10 from the Ombudsman, consumers, or health
5care providers.
 
6    (20 ILCS 301/7-20 new)
7    Sec. 7-20. Qualified immunity. The Ombudsman and employees
8or persons acting on behalf of the Office are immune from suit
9and liability, either personally or in their official
10capacities, for any claim for damage to or loss of property, or
11for personal injury or other civil liability caused by or
12arising out of any actual or alleged act, error, or omission
13that occurred within the scope of employment, duties, or
14responsibilities pertaining to the Office, including issuing
15reports or recommendations; except that nothing in this Section
16protects those persons from suit or liability for damage, loss,
17injury, or liability caused by the intentional or willful and
18wanton misconduct of the person.
 
19    (20 ILCS 301/7-25 new)
20    Sec. 7-25. Annual report.
21    (a) On or before September 1, 2021, and on or before
22September 1 of each year thereafter, the Ombudsman shall
23prepare and submit, in accordance with subsection (b), a
24written report that includes information from the preceding

 

 

10100HB0122ham002- 7 -LRB101 02888 KTG 59034 a

1fiscal year concerning actions taken by the Ombudsman relating
2to the duties of the Office set forth in Section 7-10.
3    (b) The Ombudsman shall submit the report required by this
4Section to the Governor, the Secretary of Human Services, the
5Director of Insurance, the Senate Human Services Committee or
6any successor committee, and the House Committees on Human
7Services, Insurance, Energy & Environment, and Mental Health or
8any successor committees.
9    (c) The Ombudsman shall post the annual report on the
10Department of Human Services' website.
11    (d) The Ombudsman shall not include in the report required
12by this Section any personally identifying information about an
13individual consumer or health care provider or identifying
14information about a health care facility licensed by the State
15or an emergency medical services system as defined in Section
163.20 of the Emergency Medical Services (EMS) Systems Act.
 
17    Section 10. The Illinois Insurance Code is amended by
18adding Section 370c.2 as follows:
 
19    (215 ILCS 5/370c.2 new)
20    Sec. 370c.2. Parity reporting.
21    (a) By March 1, 2020, and every other March 1 thereafter,
22the Director shall submit a written report and provide a
23presentation of the report to the General Assembly that:
24        (1) specifies the methodology the Director uses to

 

 

10100HB0122ham002- 8 -LRB101 02888 KTG 59034 a

1    verify that insurance carriers are complying with Section
2    370c and rules adopted under that Section and with the
3    federal Paul Wellstone and Pete Domenici Mental Health
4    Parity and Addiction Equity Act of 2008, Public Law
5    110-343, as amended, any regulations adopted in accordance
6    with that Act, or guidance related to compliance with and
7    oversight of that Act;
8        (2) identifies market conduct examinations initiated,
9    conducted, or completed during the preceding 12 months
10    regarding compliance with Section 370c and rules adopted
11    under that Section and with the Paul Wellstone and Pete
12    Domenici Mental Health Parity and Addiction Equity Act of
13    2008 and regulations adopted under that Act and summarizes
14    the outcomes of those market conduct examinations; and
15        (3) details any educational or corrective actions the
16    Director has taken to ensure insurance carrier compliance
17    with Section 370c and rules adopted under that Section and
18    with the Paul Wellstone and Pete Domenici Mental Health
19    Parity and Addiction Equity Act of 2008 and regulations
20    adopted under that Act.
21    (b) The Director shall ensure that the report is written in
22plain language and is made available to the public by, at a
23minimum, posting the report on the Department's website.
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.".