101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4633

 

Introduced 2/5/2020, by Rep. Lindsey LaPointe

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/370c  from Ch. 73, par. 982c

    Amends the Illinois Insurance Code. Provides that an insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for hospital or medical treatment or services for illness entered into on or after January 1, 2021 shall ensure that the insured have timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions. Provides that network adequacy standards for timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions must satisfy specified minimum requirements. Provides that if there is no in-network facility or provider available for an insured to receive timely and proximate access to treatment for mental, emotional, nervous, or substance use disorders or conditions in accordance with the minimum network adequacy standards, the insurer shall provide necessary exceptions to its network to ensure admission and treatment with a provider or at a treatment facility in accordance with those network adequacy standards. Effective immediately.


LRB101 17909 BMS 69642 b

 

 

A BILL FOR

 

HB4633LRB101 17909 BMS 69642 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
5changing Section 370c as follows:
 
6    (215 ILCS 5/370c)  (from Ch. 73, par. 982c)
7    Sec. 370c. Mental and emotional disorders.
8    (a)(1) On and after August 16, 2019 January 1, 2019 (the
9effective date of Public Act 101-386 this amendatory Act of the
10101st General Assembly Public Act 100-1024), every insurer that
11amends, delivers, issues, or renews group accident and health
12policies providing coverage for hospital or medical treatment
13or services for illness on an expense-incurred basis shall
14provide coverage for reasonable and necessary treatment and
15services for mental, emotional, nervous, or substance use
16disorders or conditions consistent with the parity
17requirements of Section 370c.1 of this Code.
18    (2) Each insured that is covered for mental, emotional,
19nervous, or substance use disorders or conditions shall be free
20to select the physician licensed to practice medicine in all
21its branches, licensed clinical psychologist, licensed
22clinical social worker, licensed clinical professional
23counselor, licensed marriage and family therapist, licensed

 

 

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1speech-language pathologist, or other licensed or certified
2professional at a program licensed pursuant to the Substance
3Use Disorder Act of his choice to treat such disorders, and the
4insurer shall pay the covered charges of such physician
5licensed to practice medicine in all its branches, licensed
6clinical psychologist, licensed clinical social worker,
7licensed clinical professional counselor, licensed marriage
8and family therapist, licensed speech-language pathologist, or
9other licensed or certified professional at a program licensed
10pursuant to the Substance Use Disorder Act up to the limits of
11coverage, provided (i) the disorder or condition treated is
12covered by the policy, and (ii) the physician, licensed
13psychologist, licensed clinical social worker, licensed
14clinical professional counselor, licensed marriage and family
15therapist, licensed speech-language pathologist, or other
16licensed or certified professional at a program licensed
17pursuant to the Substance Use Disorder Act is authorized to
18provide said services under the statutes of this State and in
19accordance with accepted principles of his profession.
20    (3) Insofar as this Section applies solely to licensed
21clinical social workers, licensed clinical professional
22counselors, licensed marriage and family therapists, licensed
23speech-language pathologists, and other licensed or certified
24professionals at programs licensed pursuant to the Substance
25Use Disorder Act, those persons who may provide services to
26individuals shall do so after the licensed clinical social

 

 

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1worker, licensed clinical professional counselor, licensed
2marriage and family therapist, licensed speech-language
3pathologist, or other licensed or certified professional at a
4program licensed pursuant to the Substance Use Disorder Act has
5informed the patient of the desirability of the patient
6conferring with the patient's primary care physician.
7    (4) "Mental, emotional, nervous, or substance use disorder
8or condition" means a condition or disorder that involves a
9mental health condition or substance use disorder that falls
10under any of the diagnostic categories listed in the mental and
11behavioral disorders chapter of the current edition of the
12International Classification of Disease or that is listed in
13the most recent version of the Diagnostic and Statistical
14Manual of Mental Disorders. "Mental, emotional, nervous, or
15substance use disorder or condition" includes any mental health
16condition that occurs during pregnancy or during the postpartum
17period and includes, but is not limited to, postpartum
18depression.
19    (b) Notwithstanding the requirements provided in
20subsection (d) of Section 10 of the Network Adequacy and
21Transparency Act, every insurer that amends, delivers, issues,
22or renews group accident and health policies providing coverage
23for hospital or medical treatment or services for illness
24entered into on or after January 1, 2021 shall ensure that
25insureds have timely and proximate access to treatment for
26mental, emotional, nervous, or substance use disorders or

 

 

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1conditions. Insurers shall use a comparable process, strategy,
2evidentiary standard, and other factors in the development and
3application of the network adequacy standards for timely and
4proximate access to treatment for mental, emotional, nervous,
5or substance use disorders or conditions and those for the
6access to treatment for medical and surgical conditions. As
7such, the network adequacy standards for timely and proximate
8access shall equally be applied to treatment facilities and
9providers for mental, emotional, nervous, or substance use
10disorders or conditions and specialists providing medical or
11surgical benefits pursuant to the parity requirements of
12Section 370c.1 of this Code and the federal Paul Wellstone and
13Pete Domenici Mental Health Parity and Addiction Equity Act of
142008. Notwithstanding the foregoing, the network adequacy
15standards for timely and proximate access to treatment for
16mental, emotional, nervous, or substance use disorders or
17conditions shall, at a minimum, satisfy the following
18requirements:
19        (1) For insureds residing in Counties of Cook, DuPage,
20    Kane, Lake, McHenry, and Will, network adequacy standards
21    for timely and proximate access to treatment for mental,
22    emotional, nervous, or substance use disorders or
23    conditions means an insured shall not have to travel longer
24    than 30 minutes or 30 miles from the insured's residence to
25    receive outpatient treatment for mental, emotional,
26    nervous, or substance use disorders or conditions.

 

 

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1    Insureds shall not be required to wait longer than 10
2    business days between requesting an initial or repeat
3    appointment and being seen by the facility or provider of
4    mental, emotional, nervous, or substance use disorders or
5    conditions outpatient treatment.
6        (2) For insureds residing in Illinois counties other
7    than those counties listed in paragraph (1) of this
8    subsection, network adequacy standards for timely and
9    proximate access to treatment for mental, emotional,
10    nervous, or substance use disorders or conditions means an
11    insured shall not have to travel longer than 60 minutes or
12    60 miles from the insured's residence to receive outpatient
13    treatment for mental, emotional, nervous, or substance use
14    disorders or conditions. Insureds shall not be required to
15    wait longer than 10 business days between requesting an
16    initial or repeat appointment and being seen by the
17    facility or provider of mental, emotional, nervous, or
18    substance use disorders or conditions outpatient
19    treatment.
20        (2.5) For insureds residing in all Illinois counties,
21    network adequacy standards for timely and proximate access
22    to treatment for mental, emotional, nervous, or substance
23    use disorders or conditions means an insured shall not have
24    to travel longer than 60 minutes or 60 miles from the
25    insured's residence to receive inpatient or residential
26    treatment for mental, emotional, nervous, or substance use

 

 

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1    disorders or conditions.
2        (2.7) If there is no in-network facility or provider
3    available for an insured to receive timely and proximate
4    access to treatment for mental, emotional, nervous, or
5    substance use disorders or conditions in accordance with
6    the network adequacy standards outlined in this
7    subsection, the insurer shall provide necessary exceptions
8    to its network to ensure admission and treatment with a
9    provider or at a treatment facility in accordance with the
10    network adequacy standards in this subsection.
11    (b)(1) (Blank).
12    (2) (Blank).
13    (2.5) (Blank).
14        (3) Unless otherwise prohibited by federal law and
15    consistent with the parity requirements of Section 370c.1
16    of this Code, the reimbursing insurer that amends,
17    delivers, issues, or renews a group or individual policy of
18    accident and health insurance, a qualified health plan
19    offered through the health insurance marketplace, or a
20    provider of treatment of mental, emotional, nervous, or
21    substance use disorders or conditions shall furnish
22    medical records or other necessary data that substantiate
23    that initial or continued treatment is at all times
24    medically necessary. An insurer shall provide a mechanism
25    for the timely review by a provider holding the same
26    license and practicing in the same specialty as the

 

 

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1    patient's provider, who is unaffiliated with the insurer,
2    jointly selected by the patient (or the patient's next of
3    kin or legal representative if the patient is unable to act
4    for himself or herself), the patient's provider, and the
5    insurer in the event of a dispute between the insurer and
6    patient's provider regarding the medical necessity of a
7    treatment proposed by a patient's provider. If the
8    reviewing provider determines the treatment to be
9    medically necessary, the insurer shall provide
10    reimbursement for the treatment. Future contractual or
11    employment actions by the insurer regarding the patient's
12    provider may not be based on the provider's participation
13    in this procedure. Nothing prevents the insured from
14    agreeing in writing to continue treatment at his or her
15    expense. When making a determination of the medical
16    necessity for a treatment modality for mental, emotional,
17    nervous, or substance use disorders or conditions, an
18    insurer must make the determination in a manner that is
19    consistent with the manner used to make that determination
20    with respect to other diseases or illnesses covered under
21    the policy, including an appeals process. Medical
22    necessity determinations for substance use disorders shall
23    be made in accordance with appropriate patient placement
24    criteria established by the American Society of Addiction
25    Medicine. No additional criteria may be used to make
26    medical necessity determinations for substance use

 

 

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1    disorders.
2        (4) A group health benefit plan amended, delivered,
3    issued, or renewed on or after January 1, 2019 (the
4    effective date of Public Act 100-1024) or an individual
5    policy of accident and health insurance or a qualified
6    health plan offered through the health insurance
7    marketplace amended, delivered, issued, or renewed on or
8    after January 1, 2019 (the effective date of Public Act
9    100-1024):
10            (A) shall provide coverage based upon medical
11        necessity for the treatment of a mental, emotional,
12        nervous, or substance use disorder or condition
13        consistent with the parity requirements of Section
14        370c.1 of this Code; provided, however, that in each
15        calendar year coverage shall not be less than the
16        following:
17                (i) 45 days of inpatient treatment; and
18                (ii) beginning on June 26, 2006 (the effective
19            date of Public Act 94-921), 60 visits for
20            outpatient treatment including group and
21            individual outpatient treatment; and
22                (iii) for plans or policies delivered, issued
23            for delivery, renewed, or modified after January
24            1, 2007 (the effective date of Public Act 94-906),
25            20 additional outpatient visits for speech therapy
26            for treatment of pervasive developmental disorders

 

 

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1            that will be in addition to speech therapy provided
2            pursuant to item (ii) of this subparagraph (A); and
3            (B) may not include a lifetime limit on the number
4        of days of inpatient treatment or the number of
5        outpatient visits covered under the plan.
6            (C) (Blank).
7        (5) An issuer of a group health benefit plan or an
8    individual policy of accident and health insurance or a
9    qualified health plan offered through the health insurance
10    marketplace may not count toward the number of outpatient
11    visits required to be covered under this Section an
12    outpatient visit for the purpose of medication management
13    and shall cover the outpatient visits under the same terms
14    and conditions as it covers outpatient visits for the
15    treatment of physical illness.
16        (5.5) An individual or group health benefit plan
17    amended, delivered, issued, or renewed on or after
18    September 9, 2015 (the effective date of Public Act 99-480)
19    shall offer coverage for medically necessary acute
20    treatment services and medically necessary clinical
21    stabilization services. The treating provider shall base
22    all treatment recommendations and the health benefit plan
23    shall base all medical necessity determinations for
24    substance use disorders in accordance with the most current
25    edition of the Treatment Criteria for Addictive,
26    Substance-Related, and Co-Occurring Conditions established

 

 

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1    by the American Society of Addiction Medicine. The treating
2    provider shall base all treatment recommendations and the
3    health benefit plan shall base all medical necessity
4    determinations for medication-assisted treatment in
5    accordance with the most current Treatment Criteria for
6    Addictive, Substance-Related, and Co-Occurring Conditions
7    established by the American Society of Addiction Medicine.
8        As used in this subsection:
9        "Acute treatment services" means 24-hour medically
10    supervised addiction treatment that provides evaluation
11    and withdrawal management and may include biopsychosocial
12    assessment, individual and group counseling,
13    psychoeducational groups, and discharge planning.
14        "Clinical stabilization services" means 24-hour
15    treatment, usually following acute treatment services for
16    substance abuse, which may include intensive education and
17    counseling regarding the nature of addiction and its
18    consequences, relapse prevention, outreach to families and
19    significant others, and aftercare planning for individuals
20    beginning to engage in recovery from addiction.
21        (6) An issuer of a group health benefit plan may
22    provide or offer coverage required under this Section
23    through a managed care plan.
24        (6.5) An individual or group health benefit plan
25    amended, delivered, issued, or renewed on or after January
26    1, 2019 (the effective date of Public Act 100-1024):

 

 

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1            (A) shall not impose prior authorization
2        requirements, other than those established under the
3        Treatment Criteria for Addictive, Substance-Related,
4        and Co-Occurring Conditions established by the
5        American Society of Addiction Medicine, on a
6        prescription medication approved by the United States
7        Food and Drug Administration that is prescribed or
8        administered for the treatment of substance use
9        disorders;
10            (B) shall not impose any step therapy
11        requirements, other than those established under the
12        Treatment Criteria for Addictive, Substance-Related,
13        and Co-Occurring Conditions established by the
14        American Society of Addiction Medicine, before
15        authorizing coverage for a prescription medication
16        approved by the United States Food and Drug
17        Administration that is prescribed or administered for
18        the treatment of substance use disorders;
19            (C) shall place all prescription medications
20        approved by the United States Food and Drug
21        Administration prescribed or administered for the
22        treatment of substance use disorders on, for brand
23        medications, the lowest tier of the drug formulary
24        developed and maintained by the individual or group
25        health benefit plan that covers brand medications and,
26        for generic medications, the lowest tier of the drug

 

 

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1        formulary developed and maintained by the individual
2        or group health benefit plan that covers generic
3        medications; and
4            (D) shall not exclude coverage for a prescription
5        medication approved by the United States Food and Drug
6        Administration for the treatment of substance use
7        disorders and any associated counseling or wraparound
8        services on the grounds that such medications and
9        services were court ordered.
10        (7) (Blank).
11        (8) (Blank).
12        (9) With respect to all mental, emotional, nervous, or
13    substance use disorders or conditions, coverage for
14    inpatient treatment shall include coverage for treatment
15    in a residential treatment center certified or licensed by
16    the Department of Public Health or the Department of Human
17    Services.
18    (c) This Section shall not be interpreted to require
19coverage for speech therapy or other habilitative services for
20those individuals covered under Section 356z.15 of this Code.
21    (d) With respect to a group or individual policy of
22accident and health insurance or a qualified health plan
23offered through the health insurance marketplace, the
24Department and, with respect to medical assistance, the
25Department of Healthcare and Family Services shall each enforce
26the requirements of this Section and Sections 356z.23 and

 

 

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1370c.1 of this Code, the Paul Wellstone and Pete Domenici
2Mental Health Parity and Addiction Equity Act of 2008, 42
3U.S.C. 18031(j), and any amendments to, and federal guidance or
4regulations issued under, those Acts, including, but not
5limited to, final regulations issued under the Paul Wellstone
6and Pete Domenici Mental Health Parity and Addiction Equity Act
7of 2008 and final regulations applying the Paul Wellstone and
8Pete Domenici Mental Health Parity and Addiction Equity Act of
92008 to Medicaid managed care organizations, the Children's
10Health Insurance Program, and alternative benefit plans.
11Specifically, the Department and the Department of Healthcare
12and Family Services shall take action:
13        (1) proactively ensuring compliance by individual and
14    group policies, including by requiring that insurers
15    submit comparative analyses, as set forth in paragraph (6)
16    of subsection (k) of Section 370c.1, demonstrating how they
17    design and apply nonquantitative treatment limitations,
18    both as written and in operation, for mental, emotional,
19    nervous, or substance use disorder or condition benefits as
20    compared to how they design and apply nonquantitative
21    treatment limitations, as written and in operation, for
22    medical and surgical benefits;
23        (2) evaluating all consumer or provider complaints
24    regarding mental, emotional, nervous, or substance use
25    disorder or condition coverage for possible parity
26    violations;

 

 

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1        (3) performing parity compliance market conduct
2    examinations or, in the case of the Department of
3    Healthcare and Family Services, parity compliance audits
4    of individual and group plans and policies, including, but
5    not limited to, reviews of:
6            (A) nonquantitative treatment limitations,
7        including, but not limited to, prior authorization
8        requirements, concurrent review, retrospective review,
9        step therapy, network admission standards,
10        reimbursement rates, and geographic restrictions;
11            (B) denials of authorization, payment, and
12        coverage; and
13            (C) other specific criteria as may be determined by
14        the Department.
15    The findings and the conclusions of the parity compliance
16market conduct examinations and audits shall be made public.
17    The Director may adopt rules to effectuate any provisions
18of the Paul Wellstone and Pete Domenici Mental Health Parity
19and Addiction Equity Act of 2008 that relate to the business of
20insurance.
21    (e) Availability of plan information.
22        (1) The criteria for medical necessity determinations
23    made under a group health plan, an individual policy of
24    accident and health insurance, or a qualified health plan
25    offered through the health insurance marketplace with
26    respect to mental health or substance use disorder benefits

 

 

HB4633- 15 -LRB101 17909 BMS 69642 b

1    (or health insurance coverage offered in connection with
2    the plan with respect to such benefits) must be made
3    available by the plan administrator (or the health
4    insurance issuer offering such coverage) to any current or
5    potential participant, beneficiary, or contracting
6    provider upon request.
7        (2) The reason for any denial under a group health
8    benefit plan, an individual policy of accident and health
9    insurance, or a qualified health plan offered through the
10    health insurance marketplace (or health insurance coverage
11    offered in connection with such plan or policy) of
12    reimbursement or payment for services with respect to
13    mental, emotional, nervous, or substance use disorders or
14    conditions benefits in the case of any participant or
15    beneficiary must be made available within a reasonable time
16    and in a reasonable manner and in readily understandable
17    language by the plan administrator (or the health insurance
18    issuer offering such coverage) to the participant or
19    beneficiary upon request.
20    (f) As used in this Section, "group policy of accident and
21health insurance" and "group health benefit plan" includes (1)
22State-regulated employer-sponsored group health insurance
23plans written in Illinois or which purport to provide coverage
24for a resident of this State; and (2) State employee health
25plans.
26    (g) (1) As used in this subsection:

 

 

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1    "Benefits", with respect to insurers, means the benefits
2provided for treatment services for inpatient and outpatient
3treatment of substance use disorders or conditions at American
4Society of Addiction Medicine levels of treatment 2.1
5(Intensive Outpatient), 2.5 (Partial Hospitalization), 3.1
6(Clinically Managed Low-Intensity Residential), 3.3
7(Clinically Managed Population-Specific High-Intensity
8Residential), 3.5 (Clinically Managed High-Intensity
9Residential), and 3.7 (Medically Monitored Intensive
10Inpatient) and OMT (Opioid Maintenance Therapy) services.
11    "Benefits", with respect to managed care organizations,
12means the benefits provided for treatment services for
13inpatient and outpatient treatment of substance use disorders
14or conditions at American Society of Addiction Medicine levels
15of treatment 2.1 (Intensive Outpatient), 2.5 (Partial
16Hospitalization), 3.5 (Clinically Managed High-Intensity
17Residential), and 3.7 (Medically Monitored Intensive
18Inpatient) and OMT (Opioid Maintenance Therapy) services.
19    "Substance use disorder treatment provider or facility"
20means a licensed physician, licensed psychologist, licensed
21psychiatrist, licensed advanced practice registered nurse, or
22licensed, certified, or otherwise State-approved facility or
23provider of substance use disorder treatment.
24    (2) A group health insurance policy, an individual health
25benefit plan, or qualified health plan that is offered through
26the health insurance marketplace, small employer group health

 

 

HB4633- 17 -LRB101 17909 BMS 69642 b

1plan, and large employer group health plan that is amended,
2delivered, issued, executed, or renewed in this State, or
3approved for issuance or renewal in this State, on or after
4January 1, 2019 (the effective date of Public Act 100-1023)
5shall comply with the requirements of this Section and Section
6370c.1. The services for the treatment and the ongoing
7assessment of the patient's progress in treatment shall follow
8the requirements of 77 Ill. Adm. Code 2060.
9    (3) Prior authorization shall not be utilized for the
10benefits under this subsection. The substance use disorder
11treatment provider or facility shall notify the insurer of the
12initiation of treatment. For an insurer that is not a managed
13care organization, the substance use disorder treatment
14provider or facility notification shall occur for the
15initiation of treatment of the covered person within 2 business
16days. For managed care organizations, the substance use
17disorder treatment provider or facility notification shall
18occur in accordance with the protocol set forth in the provider
19agreement for initiation of treatment within 24 hours. If the
20managed care organization is not capable of accepting the
21notification in accordance with the contractual protocol
22during the 24-hour period following admission, the substance
23use disorder treatment provider or facility shall have one
24additional business day to provide the notification to the
25appropriate managed care organization. Treatment plans shall
26be developed in accordance with the requirements and timeframes

 

 

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1established in 77 Ill. Adm. Code 2060. If the substance use
2disorder treatment provider or facility fails to notify the
3insurer of the initiation of treatment in accordance with these
4provisions, the insurer may follow its normal prior
5authorization processes.
6    (4) For an insurer that is not a managed care organization,
7if an insurer determines that benefits are no longer medically
8necessary, the insurer shall notify the covered person, the
9covered person's authorized representative, if any, and the
10covered person's health care provider in writing of the covered
11person's right to request an external review pursuant to the
12Health Carrier External Review Act. The notification shall
13occur within 24 hours following the adverse determination.
14    Pursuant to the requirements of the Health Carrier External
15Review Act, the covered person or the covered person's
16authorized representative may request an expedited external
17review. An expedited external review may not occur if the
18substance use disorder treatment provider or facility
19determines that continued treatment is no longer medically
20necessary. Under this subsection, a request for expedited
21external review must be initiated within 24 hours following the
22adverse determination notification by the insurer. Failure to
23request an expedited external review within 24 hours shall
24preclude a covered person or a covered person's authorized
25representative from requesting an expedited external review.
26    If an expedited external review request meets the criteria

 

 

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1of the Health Carrier External Review Act, an independent
2review organization shall make a final determination of medical
3necessity within 72 hours. If an independent review
4organization upholds an adverse determination, an insurer
5shall remain responsible to provide coverage of benefits
6through the day following the determination of the independent
7review organization. A decision to reverse an adverse
8determination shall comply with the Health Carrier External
9Review Act.
10    (5) The substance use disorder treatment provider or
11facility shall provide the insurer with 7 business days'
12advance notice of the planned discharge of the patient from the
13substance use disorder treatment provider or facility and
14notice on the day that the patient is discharged from the
15substance use disorder treatment provider or facility.
16    (6) The benefits required by this subsection shall be
17provided to all covered persons with a diagnosis of substance
18use disorder or conditions. The presence of additional related
19or unrelated diagnoses shall not be a basis to reduce or deny
20the benefits required by this subsection.
21    (7) Nothing in this subsection shall be construed to
22require an insurer to provide coverage for any of the benefits
23in this subsection.
24(Source: P.A. 100-305, eff. 8-24-17; 100-1023, eff. 1-1-19;
25100-1024, eff. 1-1-19; 101-81, eff. 7-12-19; 101-386, eff.
268-16-19; revised 9-20-19.)
 

 

 

HB4633- 20 -LRB101 17909 BMS 69642 b

1    Section 99. Effective date. This Act takes effect upon
2becoming law.