103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB2847

 

Introduced 2/16/2023, by Rep. Lindsey LaPointe

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 2310/2310-720 new
215 ILCS 5/356z.61 new
215 ILCS 5/356z.62 new
215 ILCS 5/356z.63 new
215 ILCS 5/367n new

    Provides that the Act may be referred to as the Mental Health Equity Access and Prevention Act. Amends the Department of Public Health Powers and Duties Law. Provides that subject to appropriation, the Department of Public Health shall undertake a public educational campaign to bring broad public awareness to communities across the State on the importance of mental health and wellness. Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover all medically necessary out-of-network mental health visits, treatment, and services provided by a mental health provider or facility. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for 2 annual mental health prevention and wellness visits for children and for adults. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall not require the diagnosis of a mental, emotional, or nervous disorder or condition to establish medical necessity for mental health care, services, or treatment. Provides that the Department of Insurance shall contract with an independent third party with expertise in analyzing commercial insurance premiums and costs to perform an independent analysis of the impact of the coverage of services pursuant to the provisions has had on insurance premiums. Provides that the Department shall adopt any rules necessary to implement the provisions by no later than October 31, 2024. Makes other changes. Effective immediately.


LRB103 26943 BMS 53308 b

 

 

A BILL FOR

 

HB2847LRB103 26943 BMS 53308 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 1. References to Act; purpose.
5    (a) References to Act. This Act may be referred to as the
6Mental Health Equity Access and Prevention Act.
7    (b) Purpose. This Act is intended to address Illinois'
8skyrocketing mental health needs for children, youth, and
9adults following the COVID-19 pandemic, cover preventive
10mental health care to address symptoms early, increase access
11to affordable care, and maximize the full mental health
12workforce.
 
13    Section 5. Findings. The General Assembly finds that:
14        (1) According to a recent U.S. Surgeon General's
15    Advisory on Protecting Youth Mental Health, the proportion
16    of high school students reporting persistent feelings of
17    hopelessness and sadness increased by 40% between 2009 and
18    2019, and rates of depression and anxiety doubled during
19    the COVID-19 pandemic.
20        (2) Death by suicide is alarmingly high, particularly
21    among Black children. Black children under 13 are now
22    nearly twice as likely to die by suicide than White
23    children.

 

 

HB2847- 2 -LRB103 26943 BMS 53308 b

1        (3) According to a bipartisan United States Senate
2    Finance Committee report on Mental Health Care in the
3    United States, symptoms for depression and anxiety in
4    adults increased nearly fourfold during the COVID-19
5    pandemic.
6        (4) At the same time of unprecedented demand for
7    treatment and support, the mental health workforce crisis
8    is causing severe mental health care access challenges.
9        (5) Private insurance does not cover preventive mental
10    health care. Preventive mental health care can address
11    mental health issues before symptoms worsen or before a
12    mental health crisis occurs.
13        (6) Commercial insurance networks that include mental
14    health providers are severely restrictive, meaning a small
15    percentage of the mental health workforce is contracted as
16    in-network providers. This forces individuals and patients
17    to seek costly treatment through out-of-network care.
18        (7) The cost of mental health treatment is
19    inaccessible and unaffordable for many Illinoisans for
20    these reasons.
21        (8) A recent Milliman research report that analyzed
22    insurance claims for 37 million Americans, including
23    Illinois residents, found major disparities in insurance
24    contracting with in-network mental health providers and
25    contracting with medical/surgical providers. The report's
26    findings include the following:

 

 

HB2847- 3 -LRB103 26943 BMS 53308 b

1            (A) Illinois out-of-network mental health
2        utilization was 18.2% for outpatient services in 2017
3        compared to just 3.9% for medical/surgical services.
4            (B) Illinois out-of-network mental health
5        utilization was 12.1% in 2017 for inpatient care
6        compared to just 2.8% for medical/surgical services.
7            (C) The disparity between out-of-network usage for
8        mental health compared to medical/surgical services
9        grew significantly between 2013 and 2017:
10        out-of-network mental health utilization for
11        outpatient visits grew by 44% while out-of-network
12        utilization for medical/surgical services decreased by
13        42% over the same period in Illinois.
14            (D) Nearly 14% of mental health office visits for
15        individuals with a PPO plan were out-of-network in
16        Illinois.
17        (9) According to a report in JAMA Psychiatry, 26% of
18    psychiatrists see patients who do not use their insurance
19    to pay for their visit because it is an out-of-network
20    visit; according to a 2015 American Psychological
21    Association Survey of Psychology Health Service Providers,
22    21% of psychologists report that most of their patients
23    pay out-of-pocket because their visit is out-of-network.
24        (10) Illinois must maximize its full mental health
25    workforce to address the mental health crisis the state is
26    experiencing post-COVID-19 and improve access to

 

 

HB2847- 4 -LRB103 26943 BMS 53308 b

1    affordable, timely care.
 
2    Section 10. The Department of Public Health Powers and
3Duties Law of the Civil Administrative Code of Illinois is
4amended by adding Section 2310-720 as follows:
 
5    (20 ILCS 2310/2310-720 new)
6    Sec. 2310-720. Public educational effort on mental health
7and wellness. Subject to appropriation, the Department shall
8undertake a public educational campaign to bring broad public
9awareness to communities across this State on the importance
10of mental health and wellness, including the expanded coverage
11of mental health treatment, and consistent with the
12recommendations of the Illinois Children's Mental Health
13Partnership's Children's Mental Health Plan of 2022 and Public
14Act 102-899. The Department shall look to other successful
15public educational campaigns to guide this effort, such as the
16public educational campaign related to Get Covered Illinois.
17Additionally, the Department shall work with the Department of
18Insurance, the Illinois State Board of Education, the
19Department of Human Services, the Department of Healthcare and
20Family Services, the Department of Juvenile Justice, the
21Department of Children and Family Services, and other State
22agencies as necessary to promote consistency in messaging and
23distribution methods between this campaign and other
24concurrent public educational campaigns related to mental

 

 

HB2847- 5 -LRB103 26943 BMS 53308 b

1health and mental wellness. Public messaging for this campaign
2shall be simple, easy to understand, and shall include
3culturally competent messaging for different communities and
4regions throughout this State.
 
5    Section 15. The Illinois Insurance Code is amended by
6adding Sections 356z.61, 356z.62, 356z.63, and 367n as
7follows:
 
8    (215 ILCS 5/356z.61 new)
9    Sec. 356z.61. Coverage of out-of-network mental health
10care.
11    (a) A group or individual policy of accident and health
12insurance or a managed care plan that is amended, delivered,
13issued, or renewed on or after January 1, 2025 shall cover all
14medically necessary out-of-network mental health visits,
15including prevention and wellness visits, mental health
16treatment, and mental health services provided by a mental
17health provider or facility.
18    (b) For purposes of insured cost sharing, the insured
19shall pay no more for the out-of-network services and visits
20than the insured would have paid for in-network services and
21visits.
22    (c) No action shall be required by the insured to use
23out-of-network mental health services covered pursuant to this
24Section. The insured has the right to select the provider of

 

 

HB2847- 6 -LRB103 26943 BMS 53308 b

1their choice and the modality, in-person visit or telehealth,
2for medically necessary care.
3    (d) The insurer shall reimburse the out-of-network mental
4health provider or facility at the provider's usual and
5customary in-network charges for medically necessary patient
6care.
7    (e) This Section shall apply to each plan until the plan
8reduces by 50% the annual disparity between out-of-network
9mental health utilization and out-of-network medical/surgical
10utilization for both out-patient mental health visits and
11inpatient mental health visits from the Base Year by
12increasing the number of in-network mental health providers
13and facilities. Outpatient mental health visits and inpatient
14mental health visits shall be measured separately. The Base
15Year shall be calendar year 2017 for purposes of measuring the
16disparity against future years. A plan is exempt from this
17Section for inpatient care or outpatient care, or both, once
18the 50% reduction in the disparity between mental health and
19medical/surgical out-of-network utilization is met.
20    (f) The Department or a contracted third party shall
21monitor annually the metrics established in this Section for
22each plan. If a plan becomes exempt from this Section in a
23given year but fails to maintain the 50% reduction in the
24disparity between mental health and medical/surgical
25out-of-network utilization in a future plan year, the
26exemption lapses for the following plan year and shall be

 

 

HB2847- 7 -LRB103 26943 BMS 53308 b

1reinstated once the plan meets the 50% reduction in disparity.
2Plan beneficiaries shall be notified when there is any change
3in benefit coverage.
4    (g) The Department or a contracted third party shall
5monitor annually whether there are increases in in-network
6contracts with mental health providers and facilities for a
7plan, and shall also monitor whether there is a mental health
8industry-wide pattern that indicates that mental health
9providers and facilities are unwilling to contract with a plan
10for in-network services at a reimbursement rate that is at
11least at parity with medical/surgical and primary care
12providers. This analysis shall be applied separately to
13inpatient mental health services and to outpatient mental
14health services. If such a pattern is found with respect to a
15plan for inpatient mental health services or for outpatient
16mental health services, then the plan is exempt from this
17Section for inpatient or outpatient services in the following
18plan year. The plan must notify plan beneficiaries that the
19coverage for out-of-network services pursuant to this Section
20no longer applies to their coverage. In the plan year
21following the plan exemption, the plan must comply with the
22out-of-network coverage requirements of this Section. Plan
23beneficiaries shall be notified when there is any change in
24benefit coverage.
25    (h) If, at any time, the Secretary of the United States
26Department of Health and Human Services, or its successor

 

 

HB2847- 8 -LRB103 26943 BMS 53308 b

1agency, adopts rules or regulations to be published in the
2Federal Register or publishes a comment in the Federal
3Register or issues an opinion, guidance, or other action that
4would require the State, under any provision of the Patient
5Protection and Affordable Care Act (P.L. 111-148), including,
6but not limited to, 42 U.S.C. 18031(d)(3)(b), or any successor
7provision, to defray the cost of any service covered pursuant
8to this Section, then the requirement that a group or
9individual policy of accident and health insurance or managed
10care plan cover such service is inoperative other than any
11such coverage authorized under Section 1902 of the Social
12Security Act, 42 U.S.C. 1396a, and the State shall not assume
13any obligation for the cost of the coverage.
14    (i) The Department shall adopt a rule to define "mental
15health industry-wide pattern" with meaningful input from
16mental health provider associations and insurers.
17    (j) The Department shall adopt any rules necessary to
18implement this Section by no later than October 31, 2023.
 
19    (215 ILCS 5/356z.62 new)
20    Sec. 356z.62. Coverage of no-cost mental health prevention
21and wellness visits.
22    (a) A group or individual policy of accident and health
23insurance or managed care plan that is amended, delivered,
24issued, or renewed on or after January 1, 2025 shall provide
25coverage for 2 annual mental health prevention and wellness

 

 

HB2847- 9 -LRB103 26943 BMS 53308 b

1visits for children and for adults.
2    (b) Mental health prevention and wellness visits shall
3include any age-appropriate screening recommended by the
4United States Preventive Services Task Force or by the
5American Academy of Pediatrics' Bright Futures: Guidelines for
6Health Supervision of Infants, Children, and Adolescents for
7purposes of identifying a mental health issue, including
8trauma, mental health condition, or mental health disorder;
9discussion of any mental health symptoms that might be
10present, including discussion of a previously diagnosed mental
11health condition or disorder and symptoms; an evaluation of
12adverse childhood experiences; discussion of mental health and
13wellness; and, when necessary, assistance with a needed
14connection to any further recommended or medically necessary
15mental health assessment, treatment, or peer support.
16    (c) A mental health prevention and wellness visit shall be
17up to 60 minutes and may be performed by a physician licensed
18to practice medicine in all of its branches, a licensed
19clinical psychologist, a licensed clinical social worker, a
20licensed clinical professional counselor, a licensed marriage
21and family therapist, a licensed social worker, or a licensed
22professional counselor.
23    (d) No cost sharing shall be imposed and no prior
24authorization shall be required for mental health prevention
25and wellness visits.
26    (e) A mental health prevention and wellness visit shall

 

 

HB2847- 10 -LRB103 26943 BMS 53308 b

1not replace a Well Child visit or a general health or medical
2visit.
3    (f) A mental health prevention and wellness visit shall be
4reimbursed through the following American Medical Association
5current procedural terminology codes and at the same rate that
6current procedural terminology codes are reimbursed for the
7provision of other medical care: 99381-88387 and 99391-99397.
8    (g) Reimbursement of any of the current procedural
9terminology codes listed in this Section shall comply with the
10following:
11        (1) Reimbursement may be adjusted for payment of
12    claims that are billed by a nonphysician clinician so long
13    as the methodology to determine the adjustments are
14    comparable to and applied no more stringently than the
15    methodology for adjustments made for reimbursement of
16    claims billed by nonphysician clinicians for other medical
17    care, in accordance with 45 CFR 146.136(c)(4);
18        (2) for the purpose of covering a mental health
19    prevention and wellness visit, reimbursement shall not be
20    denied because the code was already reimbursed for the
21    purpose of covering a service other than such visit;
22        (3) for the purpose of covering a service other than a
23    mental health prevention and wellness visit, reimbursement
24    shall not be denied because the code was already
25    reimbursed for the purpose of covering a mental health
26    prevention and wellness visit; and

 

 

HB2847- 11 -LRB103 26943 BMS 53308 b

1        (4) for a mental health prevention and wellness visit
2    and for a service other than a mental health prevention
3    and wellness visit, reimbursement shall not be denied if
4    they occur on the same date by the same provider and the
5    provider is a primary care provider.
6    (h) If, at any time, the Secretary of the United States
7Department of Health and Human Services, or its successor
8agency, adopts rules or regulations to be published in the
9Federal Register or publishes a comment in the Federal
10Register or issues an opinion, guidance, or other action that
11would require the State, under any provision of the Patient
12Protection and Affordable Care Act (P.L. 111-148), including,
13but not limited to, 42 U.S.C. 18031(d)(3)(b), or any successor
14provision, to defray the cost of any service covered pursuant
15to this Section, then the requirement that a group or
16individual policy of accident and health insurance or managed
17care plan cover such service is inoperative other than any
18such coverage authorized under Section 1902 of the Social
19Security Act, 42 U.S.C. 1396a, and the State shall not assume
20any obligation for the cost of the coverage.
21    (i) The Department shall adopt any rules necessary to
22implement this Section by no later than October 31, 2023.
 
23    (215 ILCS 5/356z.63 new)
24    Sec. 356z.63. Coverage of medically necessary mental
25health care for individuals not diagnosed with a mental health

 

 

HB2847- 12 -LRB103 26943 BMS 53308 b

1disorder.
2    (a) A group or individual policy of accident and health
3insurance or managed care plan that is amended, delivered,
4issued, or renewed on or after January 1, 2025 shall not
5require the diagnosis of a mental, emotional, or nervous
6disorder or condition to establish medical necessity for
7mental health care, services, or treatment.
8    (b) The Department shall adopt any rules necessary to
9implement this Section by no later than October 31, 2024.
 
10    (215 ILCS 5/367n new)
11    Sec. 367n. Analysis of mental health care coverage on
12insurance premiums.
13    (a) After 5 years following the effective date of this
14Act, if requested by an insurer, the Department shall contract
15with an independent third party with expertise in analyzing
16commercial insurance premiums and costs to perform an
17independent analysis of the impact of the coverage of services
18pursuant to this Act has had on insurance premiums in
19Illinois. If the premiums increased by more than 2% annually
20solely due to coverage pursuant to Sections 356z.61, 356z.62,
21and 356z.63, a plan is exempt from those provisions for one
22policy year following the year the cost was incurred.
23Compliance with Sections 356z.61, 356z.62, and 356z.63 is
24required in the succeeding year and following years. The plan
25must notify plan beneficiaries of any changes pursuant to this

 

 

HB2847- 13 -LRB103 26943 BMS 53308 b

1Section.
2    (b) The Department shall adopt any rules necessary to
3implement this Section by no later than October 31, 2024.
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.