Sen. William Delgado

Filed: 5/20/2011

 

 


 

 


 
09700HB1530sam003LRB097 09356 CEL 55958 a

1
AMENDMENT TO HOUSE BILL 1530

2    AMENDMENT NO. ______. Amend House Bill 1530 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 370c and by adding Section 370c.1 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 the effective date of this amendatory
9Act of the 97th General Assembly Section, every insurer which
10amends, delivers, issues, or renews delivers, issues for
11delivery or renews or modifies group accident and health A&H
12policies providing coverage for hospital or medical treatment
13or services for illness on an expense-incurred basis shall
14offer to the applicant or group policyholder subject to the
15insurer's insurers standards of insurability, coverage for
16reasonable and necessary treatment and services for mental,

 

 

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1emotional or nervous disorders or conditions, other than
2serious mental illnesses as defined in item (2) of subsection
3(b), consistent with the parity requirements of Section 370c.1
4of this Code up to the limits provided in the policy for other
5disorders or conditions, except (i) the insured may be required
6to pay up to 50% of expenses incurred as a result of the
7treatment or services, and (ii) the annual benefit limit may be
8limited to the lesser of $10,000 or 25% of the lifetime policy
9limit.
10    (2) Each insured that is covered for mental, emotional, or
11nervous, or substance use disorders or conditions shall be free
12to select the physician licensed to practice medicine in all
13its branches, licensed clinical psychologist, licensed
14clinical social worker, licensed clinical professional
15counselor, or licensed marriage and family therapist, licensed
16speech-language pathologist, or other licensed or certified
17professional at a program licensed pursuant to the Illinois
18Alcoholism and Other Drug Abuse and Dependency Act of his
19choice to treat such disorders, and the insurer shall pay the
20covered charges of such physician licensed to practice medicine
21in all its branches, licensed clinical psychologist, licensed
22clinical social worker, licensed clinical professional
23counselor, or licensed marriage and family therapist, licensed
24speech-language pathologist, or other licensed or certified
25professional at a program licensed pursuant to the Illinois
26Alcoholism and Other Drug Abuse and Dependency Act up to the

 

 

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1limits of coverage, provided (i) the disorder or condition
2treated is covered by the policy, and (ii) the physician,
3licensed psychologist, licensed clinical social worker,
4licensed clinical professional counselor, or licensed marriage
5and family therapist, licensed speech-language pathologist, or
6other licensed or certified professional at a program licensed
7pursuant to the Illinois Alcoholism and Other Drug Abuse and
8Dependency Act is authorized to provide said services under the
9statutes of this State and in accordance with accepted
10principles of his profession.
11    (3) Insofar as this Section applies solely to licensed
12clinical social workers, licensed clinical professional
13counselors, and licensed marriage and family therapists,
14licensed speech-language pathologist, and other licensed or
15certified professionals at programs licensed pursuant to the
16Illinois Alcoholism and Other Drug Abuse and Dependency Act,
17those persons who may provide services to individuals shall do
18so after the licensed clinical social worker, licensed clinical
19professional counselor, or licensed marriage and family
20therapist, licensed speech-language pathologist, or other
21licensed or certified professional at a program licensed
22pursuant to the Illinois Alcoholism and Other Drug Abuse and
23Dependency Act has informed the patient of the desirability of
24the patient conferring with the patient's primary care
25physician and the licensed clinical social worker, licensed
26clinical professional counselor, or licensed marriage and

 

 

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1family therapist, licensed speech-language pathologist, or
2other licensed or certified professional at a program licensed
3pursuant to the Illinois Alcoholism and Other Drug Abuse and
4Dependency Act has provided written notification to the
5patient's primary care physician, if any, that services are
6being provided to the patient. That notification may, however,
7be waived by the patient on a written form. Those forms shall
8be retained by the licensed clinical social worker, licensed
9clinical professional counselor, or licensed marriage and
10family therapist, licensed speech-language pathologist, or
11other licensed or certified professional at a program licensed
12pursuant to the Illinois Alcoholism and Other Drug Abuse and
13Dependency Act for a period of not less than 5 years.
14    (b) (1) An insurer that provides coverage for hospital or
15medical expenses under a group policy of accident and health
16insurance or health care plan amended, delivered, issued, or
17renewed on or after the effective date of this amendatory Act
18of the 97th 92nd General Assembly shall provide coverage under
19the policy for treatment of serious mental illness and
20substance use disorders consistent with the parity
21requirements of Section 370c.1 of this Code under the same
22terms and conditions as coverage for hospital or medical
23expenses related to other illnesses and diseases. The coverage
24required under this Section must provide for same durational
25limits, amount limits, deductibles, and co-insurance
26requirements for serious mental illness as are provided for

 

 

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1other illnesses and diseases. This subsection does not apply to
2any group policy of accident and health insurance or health
3care plan for any plan year of a small employer as defined in
4Section 5 of the Illinois Health Insurance Portability and
5Accountability Act coverage provided to employees by employers
6who have 50 or fewer employees.
7    (2) "Serious mental illness" means the following
8psychiatric illnesses as defined in the most current edition of
9the Diagnostic and Statistical Manual (DSM) published by the
10American Psychiatric Association:
11        (A) schizophrenia;
12        (B) paranoid and other psychotic disorders;
13        (C) bipolar disorders (hypomanic, manic, depressive,
14    and mixed);
15        (D) major depressive disorders (single episode or
16    recurrent);
17        (E) schizoaffective disorders (bipolar or depressive);
18        (F) pervasive developmental disorders;
19        (G) obsessive-compulsive disorders;
20        (H) depression in childhood and adolescence;
21        (I) panic disorder;
22        (J) post-traumatic stress disorders (acute, chronic,
23    or with delayed onset); and
24        (K) anorexia nervosa and bulimia nervosa.
25    (2.5) "Substance use disorder" means the following mental
26disorders as defined in the most current edition of the

 

 

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1Diagnostic and Statistical Manual (DSM) published by the
2American Psychiatric Association:
3        (A) substance abuse disorders;
4        (B) substance dependence disorders; and
5        (C) substance induced disorders.
6    (3) Unless otherwise prohibited by federal law and
7consistent with the parity requirements of Section 370c.1 of
8this Code, Upon request of the reimbursing insurer, a provider
9of treatment of serious mental illness or substance use
10disorder shall furnish medical records or other necessary data
11that substantiate that initial or continued treatment is at all
12times medically necessary. An insurer shall provide a mechanism
13for the timely review by a provider holding the same license
14and practicing in the same specialty as the patient's provider,
15who is unaffiliated with the insurer, jointly selected by the
16patient (or the patient's next of kin or legal representative
17if the patient is unable to act for himself or herself), the
18patient's provider, and the insurer in the event of a dispute
19between the insurer and patient's provider regarding the
20medical necessity of a treatment proposed by a patient's
21provider. If the reviewing provider determines the treatment to
22be medically necessary, the insurer shall provide
23reimbursement for the treatment. Future contractual or
24employment actions by the insurer regarding the patient's
25provider may not be based on the provider's participation in
26this procedure. Nothing prevents the insured from agreeing in

 

 

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1writing to continue treatment at his or her expense. When
2making a determination of the medical necessity for a treatment
3modality for serious serous mental illness or substance use
4disorder, an insurer must make the determination in a manner
5that is consistent with the manner used to make that
6determination with respect to other diseases or illnesses
7covered under the policy, including an appeals process. Medical
8necessity determinations for substance use disorders shall be
9made in accordance with appropriate patient placement criteria
10established by the American Society of Addiction Medicine.
11    (4) A group health benefit plan amended, delivered, issued,
12or renewed on or after the effective date of this amendatory
13Act of the 97th General Assembly:
14        (A) shall provide coverage based upon medical
15    necessity for the following treatment of mental illness and
16    substance use disorders consistent with the parity
17    requirements of Section 370c.1 of this Code; provided,
18    however, that in each calendar year coverage shall not be
19    less than the following:
20            (i) 45 days of inpatient treatment; and
21            (ii) beginning on June 26, 2006 (the effective date
22        of Public Act 94-921), 60 visits for outpatient
23        treatment including group and individual outpatient
24        treatment; and
25            (iii) for plans or policies delivered, issued for
26        delivery, renewed, or modified after January 1, 2007

 

 

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1        (the effective date of Public Act 94-906), 20
2        additional outpatient visits for speech therapy for
3        treatment of pervasive developmental disorders that
4        will be in addition to speech therapy provided pursuant
5        to item (ii) of this subparagraph (A); and
6        (B) may not include a lifetime limit on the number of
7    days of inpatient treatment or the number of outpatient
8    visits covered under the plan. ; and
9        (C) (Blank). shall include the same amount limits,
10    deductibles, copayments, and coinsurance factors for
11    serious mental illness as for physical illness.
12    (5) An issuer of a group health benefit plan may not count
13toward the number of outpatient visits required to be covered
14under this Section an outpatient visit for the purpose of
15medication management and shall cover the outpatient visits
16under the same terms and conditions as it covers outpatient
17visits for the treatment of physical illness.
18    (6) An issuer of a group health benefit plan may provide or
19offer coverage required under this Section through a managed
20care plan.
21    (7) (Blank). This Section shall not be interpreted to
22require a group health benefit plan to provide coverage for
23treatment of:
24        (A) an addiction to a controlled substance or cannabis
25    that is used in violation of law; or
26        (B) mental illness resulting from the use of a

 

 

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1    controlled substance or cannabis in violation of law.
2    (8) (Blank).
3    (9) With respect to substance use disorders, coverage for
4inpatient treatment shall include coverage for treatment in a
5residential treatment center licensed by the Department of
6Public Health or the Department of Human Services, Division of
7Alcoholism and Substance Abuse.
8    (c) This Section shall not be interpreted to require
9coverage for speech therapy or other habilitative services for
10those individuals covered under Section 356z.15 of this Code.
11(Source: P.A. 95-331, eff. 8-21-07; 95-972, eff. 9-22-08;
1295-973, eff. 1-1-09; 95-1049, eff. 1-1-10; 96-328, eff.
138-11-09; 96-1000, eff. 7-2-10.)
 
14    (215 ILCS 5/370c.1 new)
15    Sec. 370c.1. Mental health parity.
16    (a) On and after the effective date of this amendatory Act
17of the 97th General Assembly, every insurer that amends,
18delivers, issues, or renews a group policy of accident and
19health insurance in this State providing coverage for hospital
20or medical treatment and for the treatment of mental,
21emotional, nervous, or substance use disorders or conditions
22shall ensure that:
23        (1) the financial requirements applicable to such
24    mental, emotional, nervous, or substance use disorder or
25    condition benefits are no more restrictive than the

 

 

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1    predominant financial requirements applied to
2    substantially all hospital and medical benefits covered by
3    the policy and that there are no separate cost-sharing
4    requirements that are applicable only with respect to
5    mental, emotional, nervous, or substance use disorder or
6    condition benefits; and
7        (2) the treatment limitations applicable to such
8    mental, emotional, nervous, or substance use disorder or
9    condition benefits are no more restrictive than the
10    predominant treatment limitations applied to substantially
11    all hospital and medical benefits covered by the policy and
12    that there are no separate treatment limitations that are
13    applicable only with respect to mental, emotional,
14    nervous, or substance use disorder or condition benefits.
15    (b) The following provisions shall apply concerning
16aggregate lifetime limits:
17        (1) In the case of a group policy of accident and
18    health insurance amended, delivered, issued, or renewed in
19    this State on or after the effective date of this
20    amendatory Act of the 97th General Assembly that provides
21    coverage for hospital or medical treatment and for the
22    treatment of mental, emotional, nervous, or substance use
23    disorders or conditions the following provisions shall
24    apply:
25            (A) if the policy does not include an aggregate
26        lifetime limit on substantially all hospital and

 

 

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1        medical benefits, then the policy may not impose any
2        aggregate lifetime limit on mental, emotional,
3        nervous, or substance use disorder or condition
4        benefits; or
5            (B) if the policy includes an aggregate lifetime
6        limit on substantially all hospital and medical
7        benefits (in this subsection referred to as the
8        "applicable lifetime limit"), then the policy shall
9        either:
10                (i) apply the applicable lifetime limit both
11            to the hospital and medical benefits to which it
12            otherwise would apply and to mental, emotional,
13            nervous, or substance use disorder or condition
14            benefits and not distinguish in the application of
15            the limit between the hospital and medical
16            benefits and mental, emotional, nervous, or
17            substance use disorder or condition benefits; or
18                (ii) not include any aggregate lifetime limit
19            on mental, emotional, nervous, or substance use
20            disorder or condition benefits that is less than
21            the applicable lifetime limit.
22        (2) In the case of a policy that is not described in
23    paragraph (1) of subsection (b) of this Section and that
24    includes no or different aggregate lifetime limits on
25    different categories of hospital and medical benefits, the
26    Director shall establish rules under which subparagraph

 

 

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1    (B) of paragraph (1) of subsection (b) of this Section is
2    applied to such policy with respect to mental, emotional,
3    nervous, or substance use disorder or condition benefits by
4    substituting for the applicable lifetime limit an average
5    aggregate lifetime limit that is computed taking into
6    account the weighted average of the aggregate lifetime
7    limits applicable to such categories.
8    (c) The following provisions shall apply concerning annual
9limits:
10        (1) In the case of a group policy of accident and
11    health insurance amended, delivered, issued, or renewed in
12    this State on or after the effective date of this
13    amendatory Act of the 97th General Assembly that provides
14    coverage for hospital or medical treatment and for the
15    treatment of mental, emotional, nervous, or substance use
16    disorders or conditions the following provisions shall
17    apply:
18            (A) if the policy does not include an annual limit
19        on substantially all hospital and medical benefits,
20        then the policy may not impose any annual limits on
21        mental, emotional, nervous, or substance use disorder
22        or condition benefits; or
23            (B) if the policy includes an annual limit on
24        substantially all hospital and medical benefits (in
25        this subsection referred to as the "applicable annual
26        limit"), then the policy shall either:

 

 

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1                (i) apply the applicable annual limit both to
2            the hospital and medical benefits to which it
3            otherwise would apply and to mental, emotional,
4            nervous, or substance use disorder or condition
5            benefits and not distinguish in the application of
6            the limit between the hospital and medical
7            benefits and mental, emotional, nervous, or
8            substance use disorder or condition benefits; or
9                (ii) not include any annual limit on mental,
10            emotional, nervous, or substance use disorder or
11            condition benefits that is less than the
12            applicable annual limit.
13        (2) In the case of a policy that is not described in
14    paragraph (1) of subsection (c) of this Section and that
15    includes no or different annual limits on different
16    categories of hospital and medical benefits, the Director
17    shall establish rules under which subparagraph (B) of
18    paragraph (1) of subsection (c) of this Section is applied
19    to such policy with respect to mental, emotional, nervous,
20    or substance use disorder or condition benefits by
21    substituting for the applicable annual limit an average
22    annual limit that is computed taking into account the
23    weighted average of the annual limits applicable to such
24    categories.
25    (d) This Section shall be interpreted in a manner
26consistent with the interim final regulations promulgated by

 

 

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1the U.S. Department of Health and Human Services at 75 FR 5410,
2including the prohibition against applying a cumulative
3financial requirement or cumulative quantitative treatment
4limitation for mental, emotional, nervous, or substance use
5disorder benefits that accumulates separately from any
6cumulative financial requirement or cumulative quantitative
7treatment limitation established for hospital and medical
8benefits in the same classification.
9    (e) The provisions of subsections (b) and (c) of this
10Section shall not be interpreted to allow the use of lifetime
11or annual limits otherwise prohibited by State or federal law.
12    (f) This Section shall not apply to individual health
13insurance coverage as defined in Section 5 of the Illinois
14Health Insurance Portability and Accountability Act.
15    (g) As used in this Section:
16    "Financial requirement" includes deductibles, copayments,
17coinsurance, and out-of-pocket maximums, but does not include
18an aggregate lifetime limit or an annual limit subject to
19subsections (b) and (c).
20    "Treatment limitation" includes limits on benefits based
21on the frequency of treatment, number of visits, days of
22coverage, days in a waiting period, or other similar limits on
23the scope or duration of treatment. "Treatment limitation"
24includes both quantitative treatment limitations, which are
25expressed numerically (such as 50 outpatient visits per year),
26and nonquantitative treatment limitations, which otherwise

 

 

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1limit the scope or duration of treatment. A permanent exclusion
2of all benefits for a particular condition or disorder shall
3not be considered a treatment limitation.
 
4    Section 10. The Health Maintenance Organization Act is
5amended by changing Section 5-3 as follows:
 
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
10141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
11154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
12356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
13356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
14356z.18, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
15368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
16409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
17Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
18XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
19    (b) For purposes of the Illinois Insurance Code, except for
20Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
21Maintenance Organizations in the following categories are
22deemed to be "domestic companies":
23        (1) a corporation authorized under the Dental Service
24    Plan Act or the Voluntary Health Services Plans Act;

 

 

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1        (2) a corporation organized under the laws of this
2    State; or
3        (3) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a "domestic company" under Article VIII
8    1/2 of the Illinois Insurance Code.
9    (c) In considering the merger, consolidation, or other
10acquisition of control of a Health Maintenance Organization
11pursuant to Article VIII 1/2 of the Illinois Insurance Code,
12        (1) the Director shall give primary consideration to
13    the continuation of benefits to enrollees and the financial
14    conditions of the acquired Health Maintenance Organization
15    after the merger, consolidation, or other acquisition of
16    control takes effect;
17        (2)(i) the criteria specified in subsection (1)(b) of
18    Section 131.8 of the Illinois Insurance Code shall not
19    apply and (ii) the Director, in making his determination
20    with respect to the merger, consolidation, or other
21    acquisition of control, need not take into account the
22    effect on competition of the merger, consolidation, or
23    other acquisition of control;
24        (3) the Director shall have the power to require the
25    following information:
26            (A) certification by an independent actuary of the

 

 

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1        adequacy of the reserves of the Health Maintenance
2        Organization sought to be acquired;
3            (B) pro forma financial statements reflecting the
4        combined balance sheets of the acquiring company and
5        the Health Maintenance Organization sought to be
6        acquired as of the end of the preceding year and as of
7        a date 90 days prior to the acquisition, as well as pro
8        forma financial statements reflecting projected
9        combined operation for a period of 2 years;
10            (C) a pro forma business plan detailing an
11        acquiring party's plans with respect to the operation
12        of the Health Maintenance Organization sought to be
13        acquired for a period of not less than 3 years; and
14            (D) such other information as the Director shall
15        require.
16    (d) The provisions of Article VIII 1/2 of the Illinois
17Insurance Code and this Section 5-3 shall apply to the sale by
18any health maintenance organization of greater than 10% of its
19enrollee population (including without limitation the health
20maintenance organization's right, title, and interest in and to
21its health care certificates).
22    (e) In considering any management contract or service
23agreement subject to Section 141.1 of the Illinois Insurance
24Code, the Director (i) shall, in addition to the criteria
25specified in Section 141.2 of the Illinois Insurance Code, take
26into account the effect of the management contract or service

 

 

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1agreement on the continuation of benefits to enrollees and the
2financial condition of the health maintenance organization to
3be managed or serviced, and (ii) need not take into account the
4effect of the management contract or service agreement on
5competition.
6    (f) Except for small employer groups as defined in the
7Small Employer Rating, Renewability and Portability Health
8Insurance Act and except for medicare supplement policies as
9defined in Section 363 of the Illinois Insurance Code, a Health
10Maintenance Organization may by contract agree with a group or
11other enrollment unit to effect refunds or charge additional
12premiums under the following terms and conditions:
13        (i) the amount of, and other terms and conditions with
14    respect to, the refund or additional premium are set forth
15    in the group or enrollment unit contract agreed in advance
16    of the period for which a refund is to be paid or
17    additional premium is to be charged (which period shall not
18    be less than one year); and
19        (ii) the amount of the refund or additional premium
20    shall not exceed 20% of the Health Maintenance
21    Organization's profitable or unprofitable experience with
22    respect to the group or other enrollment unit for the
23    period (and, for purposes of a refund or additional
24    premium, the profitable or unprofitable experience shall
25    be calculated taking into account a pro rata share of the
26    Health Maintenance Organization's administrative and

 

 

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1    marketing expenses, but shall not include any refund to be
2    made or additional premium to be paid pursuant to this
3    subsection (f)). The Health Maintenance Organization and
4    the group or enrollment unit may agree that the profitable
5    or unprofitable experience may be calculated taking into
6    account the refund period and the immediately preceding 2
7    plan years.
8    The Health Maintenance Organization shall include a
9statement in the evidence of coverage issued to each enrollee
10describing the possibility of a refund or additional premium,
11and upon request of any group or enrollment unit, provide to
12the group or enrollment unit a description of the method used
13to calculate (1) the Health Maintenance Organization's
14profitable experience with respect to the group or enrollment
15unit and the resulting refund to the group or enrollment unit
16or (2) the Health Maintenance Organization's unprofitable
17experience with respect to the group or enrollment unit and the
18resulting additional premium to be paid by the group or
19enrollment unit.
20    In no event shall the Illinois Health Maintenance
21Organization Guaranty Association be liable to pay any
22contractual obligation of an insolvent organization to pay any
23refund authorized under this Section.
24    (g) Rulemaking authority to implement Public Act 95-1045,
25if any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure

 

 

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1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
595-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
695-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
71-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
86-1-10; 96-1000, eff. 7-2-10.)
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.".