Full Text of SB0338 100th General Assembly
SB0338sam001 100TH GENERAL ASSEMBLY | Sen. Julie A. Morrison Filed: 3/6/2018
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| 1 | | AMENDMENT TO SENATE BILL 338
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 338 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 370c.1 as follows: | 6 | | (215 ILCS 5/370c.1) | 7 | | Sec. 370c.1. Mental health and addiction parity. | 8 | | (a) On and after the effective date of this amendatory Act | 9 | | of the 99th General Assembly, every insurer that amends, | 10 | | delivers, issues, or renews a group or individual policy of | 11 | | accident and health insurance or a qualified health plan | 12 | | offered through the Health Insurance Marketplace in this State | 13 | | providing coverage for hospital or medical treatment and for | 14 | | the treatment of mental, emotional, nervous, or substance use | 15 | | disorders or conditions shall ensure that: | 16 | | (1) the financial requirements applicable to such |
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| 1 | | mental, emotional, nervous, or substance use disorder or | 2 | | condition benefits are no more restrictive than the | 3 | | predominant financial requirements applied to | 4 | | substantially all hospital and medical benefits covered by | 5 | | the policy and that there are no separate cost-sharing | 6 | | requirements that are applicable only with respect to | 7 | | mental, emotional, nervous, or substance use disorder or | 8 | | condition benefits; and | 9 | | (2) the treatment limitations applicable to such | 10 | | mental, emotional, nervous, or substance use disorder or | 11 | | condition benefits are no more restrictive than the | 12 | | predominant treatment limitations applied to substantially | 13 | | all hospital and medical benefits covered by the policy and | 14 | | that there are no separate treatment limitations that are | 15 | | applicable only with respect to mental, emotional, | 16 | | nervous, or substance use disorder or condition benefits. | 17 | | (a-5) On and after the effective date of this amendatory | 18 | | Act of the 100th General Assembly, every insurer that amends, | 19 | | delivers, issues, or renews a group or individual policy or | 20 | | certificate of disability insurance or disability income | 21 | | insurance in or to any person in this State shall ensure that: | 22 | | (1) the benefits applicable to such mental, emotional, | 23 | | nervous, or substance use disorders or conditions are no | 24 | | more restrictive than the benefits available for all other | 25 | | medical conditions covered by the policy or certificate and | 26 | | that there are no separate requirements that are applicable |
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| 1 | | only with respect to mental, emotional, nervous, or | 2 | | substance use disorder or condition benefits; and | 3 | | (2) the treatment limitations or other coverage | 4 | | limitations applicable to such
mental, emotional, nervous, | 5 | | or substance use disorder or condition benefits are no more | 6 | | restrictive than the benefits available for other | 7 | | physiologic conditions covered by the policy and that there | 8 | | are no separate payment limitations that may be applied | 9 | | specifically with respect to mental, emotional, nervous, | 10 | | or substance use disorder or condition benefits. | 11 | | (b) The following provisions shall apply concerning | 12 | | aggregate lifetime limits: | 13 | | (1) In the case of a group or individual policy of | 14 | | accident and health insurance or a qualified health plan | 15 | | offered through the Health Insurance Marketplace amended, | 16 | | delivered, issued, or renewed in this State on or after the | 17 | | effective date of this amendatory Act of the 99th General | 18 | | Assembly that provides coverage for hospital or medical | 19 | | treatment and for the treatment of mental, emotional, | 20 | | nervous, or substance use disorders or conditions the | 21 | | following provisions shall apply: | 22 | | (A) if the policy does not include an aggregate | 23 | | lifetime limit on substantially all hospital and | 24 | | medical benefits, then the policy may not impose any | 25 | | aggregate lifetime limit on mental, emotional, | 26 | | nervous, or substance use disorder or condition |
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| 1 | | benefits; or | 2 | | (B) if the policy includes an aggregate lifetime | 3 | | limit on substantially all hospital and medical | 4 | | benefits (in this subsection referred to as the | 5 | | "applicable lifetime limit"), then the policy shall | 6 | | either: | 7 | | (i) apply the applicable lifetime limit both | 8 | | to the hospital and medical benefits to which it | 9 | | otherwise would apply and to mental, emotional, | 10 | | nervous, or substance use disorder or condition | 11 | | benefits and not distinguish in the application of | 12 | | the limit between the hospital and medical | 13 | | benefits and mental, emotional, nervous, or | 14 | | substance use disorder or condition benefits; or | 15 | | (ii) not include any aggregate lifetime limit | 16 | | on mental, emotional, nervous, or substance use | 17 | | disorder or condition benefits that is less than | 18 | | the applicable lifetime limit. | 19 | | (2) In the case of a policy that is not described in | 20 | | paragraph (1) of subsection (b) of this Section and that | 21 | | includes no or different aggregate lifetime limits on | 22 | | different categories of hospital and medical benefits, the | 23 | | Director shall establish rules under which subparagraph | 24 | | (B) of paragraph (1) of subsection (b) of this Section is | 25 | | applied to such policy with respect to mental, emotional, | 26 | | nervous, or substance use disorder or condition benefits by |
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| 1 | | substituting for the applicable lifetime limit an average | 2 | | aggregate lifetime limit that is computed taking into | 3 | | account the weighted average of the aggregate lifetime | 4 | | limits applicable to such categories. | 5 | | (c) The following provisions shall apply concerning annual | 6 | | limits: | 7 | | (1) In the case of a group or individual policy of | 8 | | accident and health insurance or a qualified health plan | 9 | | offered through the Health Insurance Marketplace amended, | 10 | | delivered, issued, or renewed in this State on or after the | 11 | | effective date of this amendatory Act of the 99th General | 12 | | Assembly that provides coverage for hospital or medical | 13 | | treatment and for the treatment of mental, emotional, | 14 | | nervous, or substance use disorders or conditions the | 15 | | following provisions shall apply: | 16 | | (A) if the policy does not include an annual limit | 17 | | on substantially all hospital and medical benefits, | 18 | | then the policy may not impose any annual limits on | 19 | | mental, emotional, nervous, or substance use disorder | 20 | | or condition benefits; or | 21 | | (B) if the policy includes an annual limit on | 22 | | substantially all hospital and medical benefits (in | 23 | | this subsection referred to as the "applicable annual | 24 | | limit"), then the policy shall either: | 25 | | (i) apply the applicable annual limit both to | 26 | | the hospital and medical benefits to which it |
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| 1 | | otherwise would apply and to mental, emotional, | 2 | | nervous, or substance use disorder or condition | 3 | | benefits and not distinguish in the application of | 4 | | the limit between the hospital and medical | 5 | | benefits and mental, emotional, nervous, or | 6 | | substance use disorder or condition benefits; or | 7 | | (ii) not include any annual limit on mental, | 8 | | emotional, nervous, or substance use disorder or | 9 | | condition benefits that is less than the | 10 | | applicable annual limit. | 11 | | (2) In the case of a policy that is not described in | 12 | | paragraph (1) of subsection (c) of this Section and that | 13 | | includes no or different annual limits on different | 14 | | categories of hospital and medical benefits, the Director | 15 | | shall establish rules under which subparagraph (B) of | 16 | | paragraph (1) of subsection (c) of this Section is applied | 17 | | to such policy with respect to mental, emotional, nervous, | 18 | | or substance use disorder or condition benefits by | 19 | | substituting for the applicable annual limit an average | 20 | | annual limit that is computed taking into account the | 21 | | weighted average of the annual limits applicable to such | 22 | | categories. | 23 | | (d) With respect to substance use disorders, an insurer | 24 | | shall use policies and procedures for the election and | 25 | | placement of substance abuse treatment drugs on their formulary | 26 | | that are no less favorable to the insured as those policies and |
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| 1 | | procedures the insurer uses for the selection and placement of | 2 | | other drugs and shall follow the expedited coverage | 3 | | determination requirements for substance abuse treatment drugs | 4 | | set forth in Section 45.2 of the Managed Care Reform and | 5 | | Patient Rights Act. | 6 | | (e) This Section shall be interpreted in a manner | 7 | | consistent with all applicable federal parity regulations | 8 | | including, but not limited to, the Mental Health Parity and | 9 | | Addiction Equity Act of 2008 at 78 FR 68240. | 10 | | (f) The provisions of subsections (b) and (c) of this | 11 | | Section shall not be interpreted to allow the use of lifetime | 12 | | or annual limits otherwise prohibited by State or federal law. | 13 | | (g) As used in this Section: | 14 | | "Financial requirement" includes deductibles, copayments, | 15 | | coinsurance, and out-of-pocket maximums, but does not include | 16 | | an aggregate lifetime limit or an annual limit subject to | 17 | | subsections (b) and (c). | 18 | | "Treatment limitation" includes limits on benefits based | 19 | | on the frequency of treatment, number of visits, days of | 20 | | coverage, days in a waiting period, or other similar limits on | 21 | | the scope or duration of treatment , and shall also include | 22 | | benefit payments under disability insurance or disability | 23 | | income insurance policies or certificates . "Treatment | 24 | | limitation" includes both quantitative treatment limitations, | 25 | | which are expressed numerically (such as 50 outpatient visits | 26 | | per year), and nonquantitative treatment limitations, which |
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| 1 | | otherwise limit the scope or duration of treatment , or the | 2 | | duration of benefit payments under the terms of a disability | 3 | | insurance policy or certificate or disability income insurance | 4 | | policy or certificate . A permanent exclusion of all benefits | 5 | | for a particular condition or disorder shall not be considered | 6 | | a treatment limitation. "Nonquantitative treatment" means | 7 | | those limitations as described under federal regulations (26 | 8 | | CFR 54.9812-1).
| 9 | | (h) The Department of Insurance shall implement the | 10 | | following education initiatives: | 11 | | (1) By January 1, 2016, the Department shall develop a | 12 | | plan for a Consumer Education Campaign on parity. The | 13 | | Consumer Education Campaign shall focus its efforts | 14 | | throughout the State and include trainings in the northern, | 15 | | southern, and central regions of the State, as defined by | 16 | | the Department, as well as each of the 5 managed care | 17 | | regions of the State as identified by the Department of | 18 | | Healthcare and Family Services. Under this Consumer | 19 | | Education Campaign, the Department shall: (1) by January 1, | 20 | | 2017, provide at least one live training in each region on | 21 | | parity for consumers and providers and one webinar training | 22 | | to be posted on the Department website and (2) establish a | 23 | | consumer hotline to assist consumers in navigating the | 24 | | parity process by March 1, 2016. By January 1, 2018 the | 25 | | Department shall issue a report to the General Assembly on | 26 | | the success of the Consumer Education Campaign, which shall |
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| 1 | | indicate whether additional training is necessary or would | 2 | | be recommended. | 3 | | (2) The Department, in coordination with the | 4 | | Department of Human Services and the Department of | 5 | | Healthcare and Family Services, shall convene a working | 6 | | group of health care insurance carriers, mental health | 7 | | advocacy groups, substance abuse patient advocacy groups, | 8 | | and mental health physician groups for the purpose of | 9 | | discussing issues related to the treatment and coverage of | 10 | | substance abuse disorders and mental illness. The working | 11 | | group shall meet once before January 1, 2016 and shall meet | 12 | | semiannually thereafter. The Department shall issue an | 13 | | annual report to the General Assembly that includes a list | 14 | | of the health care insurance carriers, mental health | 15 | | advocacy groups, substance abuse patient advocacy groups, | 16 | | and mental health physician groups that participated in the | 17 | | working group meetings, details on the issues and topics | 18 | | covered, and any legislative recommendations. | 19 | | (i) The Parity Education Fund is created as a special fund | 20 | | in the State treasury. Moneys deposited into the Fund for | 21 | | appropriation by the General Assembly to the Department of | 22 | | Insurance shall be used for the purpose of providing financial | 23 | | support of the Consumer Education Campaign. | 24 | | (Source: P.A. 99-480, eff. 9-9-15.)".
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