101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2085

 

Introduced 2/15/2019, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.33 new
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Requires an individual or group policy of accident and health insurance or managed care organization that provides mental health benefits to provide reimbursement for benefits that are delivered through the psychiatric Collaborative Care Model. Provides that an individual or group policy of accident and health insurance or managed care organization that provides mental health benefits may deny reimbursement of any current procedural terminology code listed on the grounds of medical necessity if medical necessity determinations are in compliance with federal law and related regulations. Makes conforming changes to the Illinois Public Aid Code. Effective immediately.


LRB101 08661 RAB 53745 b

 

 

A BILL FOR

 

SB2085LRB101 08661 RAB 53745 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by adding
5Section 356z.33 as follows:
 
6    (215 ILCS 5/356z.33 new)
7    Sec. 356z.33. Coverage of the psychiatric Collaborative
8Care Model.
9    (a) As used in this Section, "psychiatric Collaborative
10Care Model" means the evidence-based, integrated behavioral
11health service delivery method described at 81 FR 80230.
12    (b) An individual or group policy of accident and health
13insurance amended, delivered, issued, or renewed on or after
14the effective date of this amendatory Act of the 101st General
15Assembly or managed care organization that provides mental
16health benefits shall provide reimbursement for benefits that
17are delivered through the psychiatric Collaborative Care
18Model. The following American Medical Association 2018 current
19procedural terminology codes and Healthcare Common Procedure
20Coding System code shall be used to bill for benefits delivered
21through the psychiatric Collaborative Care Model:
22        (1) 99492;
23        (2) 99493;

 

 

SB2085- 2 -LRB101 08661 RAB 53745 b

1        (3) 99494; and
2        (4) G0512.
3    (c) The Director of Insurance shall update the billing
4codes in subsection (b) if there are any alterations or
5additions to the billing codes for the psychiatric
6Collaborative Care Model.
7    (d) An individual or group policy or managed care
8organization that provides benefits under this Section may deny
9reimbursement of any billing code listed in this Section on the
10grounds of medical necessity if such medical necessity
11determinations are in compliance with the Paul Wellstone and
12Pete Domenici Mental Health Parity and Addiction Equity Act of
132008 and its implementing and related regulations and that such
14determinations are made in accordance with the utilization
15review requirements under Section 85 of the Managed Care Reform
16and Patient Rights Act.
 
17    Section 10. The Illinois Public Aid Code is amended by
18changing Section 5-16.8 as follows:
 
19    (305 ILCS 5/5-16.8)
20    Sec. 5-16.8. Required health benefits. The medical
21assistance program shall (i) provide the post-mastectomy care
22benefits required to be covered by a policy of accident and
23health insurance under Section 356t and the coverage required
24under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and

 

 

SB2085- 3 -LRB101 08661 RAB 53745 b

1356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code
2and (ii) be subject to the provisions of Sections 356z.19,
3364.01, 370c, and 370c.1 of the Illinois Insurance Code.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9    To ensure full access to the benefits set forth in this
10Section, on and after January 1, 2016, the Department shall
11ensure that provider and hospital reimbursement for
12post-mastectomy care benefits required under this Section are
13no lower than the Medicare reimbursement rate.
14(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
1599-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
168-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1710-4-18.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.