Full Text of HB1957 102nd General Assembly
HB1957enr 102ND GENERAL ASSEMBLY |
| | HB1957 Enrolled | | LRB102 10644 BMS 15973 b |
|
| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Sections 107a.12, 130.4, 370c.1, 500-30, 500-130, | 6 | | 1510, and 1565 as follows:
| 7 | | (215 ILCS 5/107a.12)
| 8 | | Sec. 107a.12. Annual statement.
| 9 | | (a) A pool authorized to do business in this State shall | 10 | | file with the
Director by March
1st in each year 2 copies of | 11 | | its financial statement for the year ending
December 31st
| 12 | | immediately preceding on forms prescribed by the Director, | 13 | | which shall conform
substantially to
the form of statement | 14 | | adopted by the National Association of Insurance
| 15 | | Commissioners. Unless
the Director provides otherwise, the | 16 | | annual statement is to be prepared in
accordance with the
| 17 | | annual statement instructions and the Accounting Practices and | 18 | | Procedures
Manual adopted by
the National Association of | 19 | | Insurance Commissioners. The Director may
promulgate rules for
| 20 | | determining which portions of the annual statement | 21 | | instructions and Accounting
Practices and
Procedures Manual | 22 | | adopted by the National Association of Insurance
Commissioners | 23 | | are
germane for the purpose of ascertaining the condition and |
| | | HB1957 Enrolled | - 2 - | LRB102 10644 BMS 15973 b |
|
| 1 | | affairs of a pool.
| 2 | | (b) The Director shall have authority to extend the time | 3 | | for filing any
statement by any
pool for reasons that he | 4 | | considers good and sufficient. The admitted assets
shall be | 5 | | shown in the
statement at the actual values as of the last day | 6 | | of the preceding year, in
accordance with Section
126.7 of | 7 | | this Code. The statement shall be verified by oaths of a | 8 | | majority of
the trustees
or directors of the
pool. In | 9 | | addition, when the Director considers it to be necessary and
| 10 | | appropriate for the
protection of policyholders, creditors, | 11 | | shareholders, or claimants, the
Director may require the
pool | 12 | | to file, within 60 days after mailing to the pool a notice that | 13 | | a
supplemental summary
statement is required, a supplemental | 14 | | summary statement, as of the last day of
any calendar
month | 15 | | occurring during the 100 days next preceding the mailing of | 16 | | the notice,
designated by him
or her on forms prescribed and | 17 | | furnished by the Director. The Director may
require | 18 | | supplemental
summary statements to be certified by an | 19 | | independent actuary deemed competent
by the Director
or by an | 20 | | independent certified public accountant.
| 21 | | (c) On or before June 1 of each year, a pool shall file | 22 | | with the Director an
audited financial
statement reporting the | 23 | | financial condition of the pool as of the end of the
most | 24 | | recent calendar year
and changes in the surplus funds for the | 25 | | year then ending. The annual audited
financial report shall
| 26 | | include the following:
|
| | | HB1957 Enrolled | - 3 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (1) a report of an independent certified public | 2 | | accountant;
| 3 | | (2) a balance sheet reporting assets, as defined in | 4 | | this Article,
liabilities, and surplus funds;
| 5 | | (3) a statement of gain and loss from operations;
| 6 | | (4) a statement of changes in financial position;
| 7 | | (5) a statement of changes in surplus funds; and
| 8 | | (6) the notes to financial statements.
| 9 | | (d) The Director shall require a pool to file an | 10 | | independent actuarial
opinion
as to the
sufficiency of the | 11 | | loss and loss adjustment expense reserves. This opinion
shall | 12 | | be due on March June 1 of
each year.
| 13 | | (Source: P.A. 91-757, eff. 1-1-01.)
| 14 | | (215 ILCS 5/130.4) | 15 | | Sec. 130.4. Disclosure requirement. | 16 | | (a) An insurer, or the insurance group of which the | 17 | | insurer is a member, shall, no later than June 1 of each | 18 | | calendar year, submit to the Director a corporate governance | 19 | | annual disclosure that contains the information described in | 20 | | subsection (b) of Section 130.5. Notwithstanding any request | 21 | | from the Director made pursuant to subsection (c), if the | 22 | | insurer is a member of an insurance group, the insurer shall | 23 | | submit the report required by this Section to the Director of | 24 | | the lead state for the insurance group, in accordance with the | 25 | | laws of the lead state, as determined by the procedures |
| | | HB1957 Enrolled | - 4 - | LRB102 10644 BMS 15973 b |
|
| 1 | | outlined in the most recent Financial Analysis Handbook | 2 | | adopted by the National Association of Insurance | 3 | | Commissioners. | 4 | | (b) The corporate governance annual disclosure must | 5 | | include a signature of the insurer's or insurance group's | 6 | | chief executive officer or corporate secretary attesting to | 7 | | the best of that individual's belief and knowledge that the | 8 | | insurer has implemented the corporate governance practices | 9 | | required by this Section and that a copy of the disclosure has | 10 | | been provided to the insurer's board of directors or the | 11 | | appropriate committee thereof. | 12 | | (c) An insurer not required to submit a corporate | 13 | | governance annual disclosure under this Section shall do so | 14 | | upon the Director's request. | 15 | | (d) For purposes of completing the corporate governance | 16 | | annual disclosure, the insurer or insurance group may provide | 17 | | information regarding corporate governance at the ultimate | 18 | | controlling parent level, an intermediate holding company | 19 | | level, or the individual legal entity level, depending upon | 20 | | how the insurer or insurance group has structured its system | 21 | | of corporate governance. The insurer or insurance group is | 22 | | encouraged to make the corporate governance annual disclosure | 23 | | at the level at which the insurer's or insurance group's risk | 24 | | appetite is determined, the level at which the earnings, | 25 | | capital, liquidity, operations, and reputation of the insurer | 26 | | are overseen collectively and at which the supervision of |
| | | HB1957 Enrolled | - 5 - | LRB102 10644 BMS 15973 b |
|
| 1 | | those factors is coordinated and exercised, or the level at | 2 | | which legal liability for failure of general corporate | 3 | | governance duties would be placed. If the insurer or insurance | 4 | | group determines the level of reporting based on these | 5 | | criteria, it shall indicate which of the 3 criteria was used to | 6 | | determine the level of reporting and explain any subsequent | 7 | | changes in the level of reporting. | 8 | | (e) The review of the corporate governance annual | 9 | | disclosure and any additional requests for information shall | 10 | | be made through the lead state as determined by the procedures | 11 | | within the most recent Financial Analysis Handbook adopted by | 12 | | the National Association of Insurance Commissioners. | 13 | | (f) Insurers providing information substantially similar | 14 | | to the information required by this Article in other documents | 15 | | provided to the Director, including proxy statements filed in | 16 | | conjunction with the requirements of Section 131.13 or other | 17 | | State or federal filings provided to the Department, are not | 18 | | required to duplicate that information in the corporate | 19 | | governance annual disclosure but are only required to | 20 | | cross-reference the document in which the information is | 21 | | included.
| 22 | | (Source: P.A. 101-600, eff. 12-6-19.) | 23 | | (215 ILCS 5/370c.1) | 24 | | Sec. 370c.1. Mental, emotional, nervous, or substance use | 25 | | disorder or condition parity. |
| | | HB1957 Enrolled | - 6 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (a) On and after the effective date of this amendatory Act | 2 | | of the 102nd General Assembly this amendatory Act of the 99th | 3 | | General Assembly , every insurer that amends, delivers, issues, | 4 | | or renews a group or individual policy of accident and health | 5 | | insurance or a qualified health plan offered through the | 6 | | Health Insurance Marketplace in this State providing coverage | 7 | | for hospital or medical treatment and for the treatment of | 8 | | mental, emotional, nervous, or substance use disorders or | 9 | | conditions shall ensure prior to policy issuance that: | 10 | | (1) the financial requirements applicable to such | 11 | | mental, emotional, nervous, or substance use disorder or | 12 | | condition benefits are no more restrictive than the | 13 | | predominant financial requirements applied to | 14 | | substantially all hospital and medical benefits covered by | 15 | | the policy and that there are no separate cost-sharing | 16 | | requirements that are applicable only with respect to | 17 | | mental, emotional, nervous, or substance use disorder or | 18 | | condition benefits; and | 19 | | (2) the treatment limitations applicable to such | 20 | | mental, emotional, nervous, or substance use disorder or | 21 | | condition benefits are no more restrictive than the | 22 | | predominant treatment limitations applied to substantially | 23 | | all hospital and medical benefits covered by the policy | 24 | | and that there are no separate treatment limitations that | 25 | | are applicable only with respect to mental, emotional, | 26 | | nervous, or substance use disorder or condition benefits. |
| | | HB1957 Enrolled | - 7 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (b) The following provisions shall apply concerning | 2 | | aggregate lifetime limits: | 3 | | (1) In the case of a group or individual policy of | 4 | | accident and health insurance or a qualified health plan | 5 | | offered through the Health Insurance Marketplace amended, | 6 | | delivered, issued, or renewed in this State on or after | 7 | | the effective date of this amendatory Act of the 99th | 8 | | General Assembly that provides coverage for hospital or | 9 | | medical treatment and for the treatment of mental, | 10 | | emotional, nervous, or substance use disorders or | 11 | | conditions the following provisions shall apply: | 12 | | (A) if the policy does not include an aggregate | 13 | | lifetime limit on substantially all hospital and | 14 | | medical benefits, then the policy may not impose any | 15 | | aggregate lifetime limit on mental, emotional, | 16 | | nervous, or substance use disorder or condition | 17 | | benefits; or | 18 | | (B) if the policy includes an aggregate lifetime | 19 | | limit on substantially all hospital and medical | 20 | | benefits (in this subsection referred to as the | 21 | | "applicable lifetime limit"), then the policy shall | 22 | | either: | 23 | | (i) apply the applicable lifetime limit both | 24 | | to the hospital and medical benefits to which it | 25 | | otherwise would apply and to mental, emotional, | 26 | | nervous, or substance use disorder or condition |
| | | HB1957 Enrolled | - 8 - | LRB102 10644 BMS 15973 b |
|
| 1 | | benefits and not distinguish in the application of | 2 | | the limit between the hospital and medical | 3 | | benefits and mental, emotional, nervous, or | 4 | | substance use disorder or condition benefits; or | 5 | | (ii) not include any aggregate lifetime limit | 6 | | on mental, emotional, nervous, or substance use | 7 | | disorder or condition benefits that is less than | 8 | | the applicable lifetime limit. | 9 | | (2) In the case of a policy that is not described in | 10 | | paragraph (1) of subsection (b) of this Section and that | 11 | | includes no or different aggregate lifetime limits on | 12 | | different categories of hospital and medical benefits, the | 13 | | Director shall establish rules under which subparagraph | 14 | | (B) of paragraph (1) of subsection (b) of this Section is | 15 | | applied to such policy with respect to mental, emotional, | 16 | | nervous, or substance use disorder or condition benefits | 17 | | by substituting for the applicable lifetime limit an | 18 | | average aggregate lifetime limit that is computed taking | 19 | | into account the weighted average of the aggregate | 20 | | lifetime limits applicable to such categories. | 21 | | (c) The following provisions shall apply concerning annual | 22 | | limits: | 23 | | (1) In the case of a group or individual policy of | 24 | | accident and health insurance or a qualified health plan | 25 | | offered through the Health Insurance Marketplace amended, | 26 | | delivered, issued, or renewed in this State on or after |
| | | HB1957 Enrolled | - 9 - | LRB102 10644 BMS 15973 b |
|
| 1 | | the effective date of this amendatory Act of the 99th | 2 | | General Assembly that provides coverage for hospital or | 3 | | medical treatment and for the treatment of mental, | 4 | | emotional, nervous, or substance use disorders or | 5 | | conditions the following provisions shall apply: | 6 | | (A) if the policy does not include an annual limit | 7 | | on substantially all hospital and medical benefits, | 8 | | then the policy may not impose any annual limits on | 9 | | mental, emotional, nervous, or substance use disorder | 10 | | or condition benefits; or | 11 | | (B) if the policy includes an annual limit on | 12 | | substantially all hospital and medical benefits (in | 13 | | this subsection referred to as the "applicable annual | 14 | | limit"), then the policy shall either: | 15 | | (i) apply the applicable annual limit both to | 16 | | the hospital and medical benefits to which it | 17 | | otherwise would apply and to mental, emotional, | 18 | | nervous, or substance use disorder or condition | 19 | | benefits and not distinguish in the application of | 20 | | the limit between the hospital and medical | 21 | | benefits and mental, emotional, nervous, or | 22 | | substance use disorder or condition benefits; or | 23 | | (ii) not include any annual limit on mental, | 24 | | emotional, nervous, or substance use disorder or | 25 | | condition benefits that is less than the | 26 | | applicable annual limit. |
| | | HB1957 Enrolled | - 10 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (2) In the case of a policy that is not described in | 2 | | paragraph (1) of subsection (c) of this Section and that | 3 | | includes no or different annual limits on different | 4 | | categories of hospital and medical benefits, the Director | 5 | | shall establish rules under which subparagraph (B) of | 6 | | paragraph (1) of subsection (c) of this Section is applied | 7 | | to such policy with respect to mental, emotional, nervous, | 8 | | or substance use disorder or condition benefits by | 9 | | substituting for the applicable annual limit an average | 10 | | annual limit that is computed taking into account the | 11 | | weighted average of the annual limits applicable to such | 12 | | categories. | 13 | | (d) With respect to mental, emotional, nervous, or | 14 | | substance use disorders or conditions, an insurer shall use | 15 | | policies and procedures for the election and placement of | 16 | | mental, emotional, nervous, or substance use disorder or | 17 | | condition treatment drugs on their formulary that are no less | 18 | | favorable to the insured as those policies and procedures the | 19 | | insurer uses for the selection and placement of drugs for | 20 | | medical or surgical conditions and shall follow the expedited | 21 | | coverage determination requirements for substance abuse | 22 | | treatment drugs set forth in Section 45.2 of the Managed Care | 23 | | Reform and Patient Rights Act. | 24 | | (e) This Section shall be interpreted in a manner | 25 | | consistent with all applicable federal parity regulations | 26 | | including, but not limited to, the Paul Wellstone and Pete |
| | | HB1957 Enrolled | - 11 - | LRB102 10644 BMS 15973 b |
|
| 1 | | Domenici Mental Health Parity and Addiction Equity Act of | 2 | | 2008, final regulations issued under the Paul Wellstone and | 3 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 4 | | 2008 and final regulations applying the Paul Wellstone and | 5 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 6 | | 2008 to Medicaid managed care organizations, the Children's | 7 | | Health Insurance Program, and alternative benefit plans. | 8 | | (f) The provisions of subsections (b) and (c) of this | 9 | | Section shall not be interpreted to allow the use of lifetime | 10 | | or annual limits otherwise prohibited by State or federal law. | 11 | | (g) As used in this Section: | 12 | | "Financial requirement" includes deductibles, copayments, | 13 | | coinsurance, and out-of-pocket maximums, but does not include | 14 | | an aggregate lifetime limit or an annual limit subject to | 15 | | subsections (b) and (c). | 16 | | "Mental, emotional, nervous, or substance use disorder or | 17 | | condition" means a condition or disorder that involves a | 18 | | mental health condition or substance use disorder that falls | 19 | | under any of the diagnostic categories listed in the mental | 20 | | and behavioral disorders chapter of the current edition of the | 21 | | International Classification of Disease or that is listed in | 22 | | the most recent version of the Diagnostic and Statistical | 23 | | Manual of Mental Disorders. | 24 | | "Treatment limitation" includes limits on benefits based | 25 | | on the frequency of treatment, number of visits, days of | 26 | | coverage, days in a waiting period, or other similar limits on |
| | | HB1957 Enrolled | - 12 - | LRB102 10644 BMS 15973 b |
|
| 1 | | the scope or duration of treatment. "Treatment limitation" | 2 | | includes both quantitative treatment limitations, which are | 3 | | expressed numerically (such as 50 outpatient visits per year), | 4 | | and nonquantitative treatment limitations, which otherwise | 5 | | limit the scope or duration of treatment. A permanent | 6 | | exclusion of all benefits for a particular condition or | 7 | | disorder shall not be considered a treatment limitation. | 8 | | "Nonquantitative treatment" means those limitations as | 9 | | described under federal regulations (26 CFR 54.9812-1). | 10 | | "Nonquantitative treatment limitations" include, but are not | 11 | | limited to, those limitations described under federal | 12 | | regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR | 13 | | 146.136.
| 14 | | (h) The Department of Insurance shall implement the | 15 | | following education initiatives: | 16 | | (1) By January 1, 2016, the Department shall develop a | 17 | | plan for a Consumer Education Campaign on parity. The | 18 | | Consumer Education Campaign shall focus its efforts | 19 | | throughout the State and include trainings in the | 20 | | northern, southern, and central regions of the State, as | 21 | | defined by the Department, as well as each of the 5 managed | 22 | | care regions of the State as identified by the Department | 23 | | of Healthcare and Family Services. Under this Consumer | 24 | | Education Campaign, the Department shall: (1) by January | 25 | | 1, 2017, provide at least one live training in each region | 26 | | on parity for consumers and providers and one webinar |
| | | HB1957 Enrolled | - 13 - | LRB102 10644 BMS 15973 b |
|
| 1 | | training to be posted on the Department website and (2) | 2 | | establish a consumer hotline to assist consumers in | 3 | | navigating the parity process by March 1, 2017. By January | 4 | | 1, 2018 the Department shall issue a report to the General | 5 | | Assembly on the success of the Consumer Education | 6 | | Campaign, which shall indicate whether additional training | 7 | | is necessary or would be recommended. | 8 | | (2) The Department, in coordination with the | 9 | | Department of Human Services and the Department of | 10 | | Healthcare and Family Services, shall convene a working | 11 | | group of health care insurance carriers, mental health | 12 | | advocacy groups, substance abuse patient advocacy groups, | 13 | | and mental health physician groups for the purpose of | 14 | | discussing issues related to the treatment and coverage of | 15 | | mental, emotional, nervous, or substance use disorders or | 16 | | conditions and compliance with parity obligations under | 17 | | State and federal law. Compliance shall be measured, | 18 | | tracked, and shared during the meetings of the working | 19 | | group. The working group shall meet once before January 1, | 20 | | 2016 and shall meet semiannually thereafter. The | 21 | | Department shall issue an annual report to the General | 22 | | Assembly that includes a list of the health care insurance | 23 | | carriers, mental health advocacy groups, substance abuse | 24 | | patient advocacy groups, and mental health physician | 25 | | groups that participated in the working group meetings, | 26 | | details on the issues and topics covered, and any |
| | | HB1957 Enrolled | - 14 - | LRB102 10644 BMS 15973 b |
|
| 1 | | legislative recommendations developed by the working | 2 | | group. | 3 | | (3) Not later than August 1 of each year, the | 4 | | Department, in conjunction with the Department of | 5 | | Healthcare and Family Services, shall issue a joint report | 6 | | to the General Assembly and provide an educational | 7 | | presentation to the General Assembly. The report and | 8 | | presentation shall: | 9 | | (A) Cover the methodology the Departments use to | 10 | | check for compliance with the federal Paul Wellstone | 11 | | and Pete Domenici Mental Health Parity and Addiction | 12 | | Equity Act of 2008, 42 U.S.C. 18031(j), and any | 13 | | federal regulations or guidance relating to the | 14 | | compliance and oversight of the federal Paul Wellstone | 15 | | and Pete Domenici Mental Health Parity and Addiction | 16 | | Equity Act of 2008 and 42 U.S.C. 18031(j). | 17 | | (B) Cover the methodology the Departments use to | 18 | | check for compliance with this Section and Sections | 19 | | 356z.23 and 370c of this Code. | 20 | | (C) Identify market conduct examinations or, in | 21 | | the case of the Department of Healthcare and Family | 22 | | Services, audits conducted or completed during the | 23 | | preceding 12-month period regarding compliance with | 24 | | parity in mental, emotional, nervous, and substance | 25 | | use disorder or condition benefits under State and | 26 | | federal laws and summarize the results of such market |
| | | HB1957 Enrolled | - 15 - | LRB102 10644 BMS 15973 b |
|
| 1 | | conduct examinations and audits. This shall include: | 2 | | (i) the number of market conduct examinations | 3 | | and audits initiated and completed; | 4 | | (ii) the benefit classifications examined by | 5 | | each market conduct examination and audit; | 6 | | (iii) the subject matter of each market | 7 | | conduct examination and audit, including | 8 | | quantitative and nonquantitative treatment | 9 | | limitations; and | 10 | | (iv) a summary of the basis for the final | 11 | | decision rendered in each market conduct | 12 | | examination and audit. | 13 | | Individually identifiable information shall be | 14 | | excluded from the reports consistent with federal | 15 | | privacy protections. | 16 | | (D) Detail any educational or corrective actions | 17 | | the Departments have taken to ensure compliance with | 18 | | the federal Paul Wellstone and Pete Domenici Mental | 19 | | Health Parity and Addiction Equity Act of 2008, 42 | 20 | | U.S.C. 18031(j), this Section, and Sections 356z.23 | 21 | | and 370c of this Code. | 22 | | (E) The report must be written in non-technical, | 23 | | readily understandable language and shall be made | 24 | | available to the public by, among such other means as | 25 | | the Departments find appropriate, posting the report | 26 | | on the Departments' websites. |
| | | HB1957 Enrolled | - 16 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (i) The Parity Advancement Fund is created as a special | 2 | | fund in the State treasury. Moneys from fines and penalties | 3 | | collected from insurers for violations of this Section shall | 4 | | be deposited into the Fund. Moneys deposited into the Fund for | 5 | | appropriation by the General Assembly to the Department shall | 6 | | be used for the purpose of providing financial support of the | 7 | | Consumer Education Campaign, parity compliance advocacy, and | 8 | | other initiatives that support parity implementation and | 9 | | enforcement on behalf of consumers. | 10 | | (j) The Department of Insurance and the Department of | 11 | | Healthcare and Family Services shall convene and provide | 12 | | technical support to a workgroup of 11 members that shall be | 13 | | comprised of 3 mental health parity experts recommended by an | 14 | | organization advocating on behalf of mental health parity | 15 | | appointed by the President of the Senate; 3 behavioral health | 16 | | providers recommended by an organization that represents | 17 | | behavioral health providers appointed by the Speaker of the | 18 | | House of Representatives; 2 representing Medicaid managed care | 19 | | organizations recommended by an organization that represents | 20 | | Medicaid managed care plans appointed by the Minority Leader | 21 | | of the House of Representatives; 2 representing commercial | 22 | | insurers recommended by an organization that represents | 23 | | insurers appointed by the Minority Leader of the Senate; and a | 24 | | representative of an organization that represents Medicaid | 25 | | managed care plans appointed by the Governor. | 26 | | The workgroup shall provide recommendations to the General |
| | | HB1957 Enrolled | - 17 - | LRB102 10644 BMS 15973 b |
|
| 1 | | Assembly on health plan data reporting requirements that | 2 | | separately break out data on mental, emotional, nervous, or | 3 | | substance use disorder or condition benefits and data on other | 4 | | medical benefits, including physical health and related health | 5 | | services no later than December 31, 2019. The recommendations | 6 | | to the General Assembly shall be filed with the Clerk of the | 7 | | House of Representatives and the Secretary of the Senate in | 8 | | electronic form only, in the manner that the Clerk and the | 9 | | Secretary shall direct. This workgroup shall take into account | 10 | | federal requirements and recommendations on mental health | 11 | | parity reporting for the Medicaid program. This workgroup | 12 | | shall also develop the format and provide any needed | 13 | | definitions for reporting requirements in subsection (k). The | 14 | | research and evaluation of the working group shall include, | 15 | | but not be limited to: | 16 | | (1) claims denials due to benefit limits, if | 17 | | applicable; | 18 | | (2) administrative denials for no prior authorization; | 19 | | (3) denials due to not meeting medical necessity; | 20 | | (4) denials that went to external review and whether | 21 | | they were upheld or overturned for medical necessity; | 22 | | (5) out-of-network claims; | 23 | | (6) emergency care claims; | 24 | | (7) network directory providers in the outpatient | 25 | | benefits classification who filed no claims in the last 6 | 26 | | months, if applicable; |
| | | HB1957 Enrolled | - 18 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (8) the impact of existing and pertinent limitations | 2 | | and restrictions related to approved services, licensed | 3 | | providers, reimbursement levels, and reimbursement | 4 | | methodologies within the Division of Mental Health, the | 5 | | Division of Substance Use Prevention and Recovery | 6 | | programs, the Department of Healthcare and Family | 7 | | Services, and, to the extent possible, federal regulations | 8 | | and law; and | 9 | | (9) when reporting and publishing should begin. | 10 | | Representatives from the Department of Healthcare and | 11 | | Family Services, representatives from the Division of Mental | 12 | | Health, and representatives from the Division of Substance Use | 13 | | Prevention and Recovery shall provide technical advice to the | 14 | | workgroup. | 15 | | (k) An insurer that amends, delivers, issues, or renews a | 16 | | group or individual policy of accident and health insurance or | 17 | | a qualified health plan offered through the health insurance | 18 | | marketplace in this State providing coverage for hospital or | 19 | | medical treatment and for the treatment of mental, emotional, | 20 | | nervous, or substance use disorders or conditions shall submit | 21 | | an annual report, the format and definitions for which will be | 22 | | developed by the workgroup in subsection (j), to the | 23 | | Department, or, with respect to medical assistance, the | 24 | | Department of Healthcare and Family Services starting on or | 25 | | before July 1, 2020 that contains the following information | 26 | | separately for inpatient in-network benefits, inpatient |
| | | HB1957 Enrolled | - 19 - | LRB102 10644 BMS 15973 b |
|
| 1 | | out-of-network benefits, outpatient in-network benefits, | 2 | | outpatient out-of-network benefits, emergency care benefits, | 3 | | and prescription drug benefits in the case of accident and | 4 | | health insurance or qualified health plans, or inpatient, | 5 | | outpatient, emergency care, and prescription drug benefits in | 6 | | the case of medical assistance: | 7 | | (1) A summary of the plan's pharmacy management | 8 | | processes for mental, emotional, nervous, or substance use | 9 | | disorder or condition benefits compared to those for other | 10 | | medical benefits. | 11 | | (2) A summary of the internal processes of review for | 12 | | experimental benefits and unproven technology for mental, | 13 | | emotional, nervous, or substance use disorder or condition | 14 | | benefits and those for
other medical benefits. | 15 | | (3) A summary of how the plan's policies and | 16 | | procedures for utilization management for mental, | 17 | | emotional, nervous, or substance use disorder or condition | 18 | | benefits compare to those for other medical benefits. | 19 | | (4) A description of the process used to develop or | 20 | | select the medical necessity criteria for mental, | 21 | | emotional, nervous, or substance use disorder or condition | 22 | | benefits and the process used to develop or select the | 23 | | medical necessity criteria for medical and surgical | 24 | | benefits. | 25 | | (5) Identification of all nonquantitative treatment | 26 | | limitations that are applied to both mental, emotional, |
| | | HB1957 Enrolled | - 20 - | LRB102 10644 BMS 15973 b |
|
| 1 | | nervous, or substance use disorder or condition benefits | 2 | | and medical and surgical benefits within each | 3 | | classification of benefits. | 4 | | (6) The results of an analysis that demonstrates that | 5 | | for the medical necessity criteria described in | 6 | | subparagraph (A) and for each nonquantitative treatment | 7 | | limitation identified in subparagraph (B), as written and | 8 | | in operation, the processes, strategies, evidentiary | 9 | | standards, or other factors used in applying the medical | 10 | | necessity criteria and each nonquantitative treatment | 11 | | limitation to mental, emotional, nervous, or substance use | 12 | | disorder or condition benefits within each classification | 13 | | of benefits are comparable to, and are applied no more | 14 | | stringently than, the processes, strategies, evidentiary | 15 | | standards, or other factors used in applying the medical | 16 | | necessity criteria and each nonquantitative treatment | 17 | | limitation to medical and surgical benefits within the | 18 | | corresponding classification of benefits; at a minimum, | 19 | | the results of the analysis shall: | 20 | | (A) identify the factors used to determine that a | 21 | | nonquantitative treatment limitation applies to a | 22 | | benefit, including factors that were considered but | 23 | | rejected; | 24 | | (B) identify and define the specific evidentiary | 25 | | standards used to define the factors and any other | 26 | | evidence relied upon in designing each nonquantitative |
| | | HB1957 Enrolled | - 21 - | LRB102 10644 BMS 15973 b |
|
| 1 | | treatment limitation; | 2 | | (C) provide the comparative analyses, including | 3 | | the results of the analyses, performed to determine | 4 | | that the processes and strategies used to design each | 5 | | nonquantitative treatment limitation, as written, for | 6 | | mental, emotional, nervous, or substance use disorder | 7 | | or condition benefits are comparable to, and are | 8 | | applied no more stringently than, the processes and | 9 | | strategies used to design each nonquantitative | 10 | | treatment limitation, as written, for medical and | 11 | | surgical benefits; | 12 | | (D) provide the comparative analyses, including | 13 | | the results of the analyses, performed to determine | 14 | | that the processes and strategies used to apply each | 15 | | nonquantitative treatment limitation, in operation, | 16 | | for mental, emotional, nervous, or substance use | 17 | | disorder or condition benefits are comparable to, and | 18 | | applied no more stringently than, the processes or | 19 | | strategies used to apply each nonquantitative | 20 | | treatment limitation, in operation, for medical and | 21 | | surgical benefits; and | 22 | | (E) disclose the specific findings and conclusions | 23 | | reached by the insurer that the results of the | 24 | | analyses described in subparagraphs (C) and (D) | 25 | | indicate that the insurer is in compliance with this | 26 | | Section and the Mental Health Parity and Addiction |
| | | HB1957 Enrolled | - 22 - | LRB102 10644 BMS 15973 b |
|
| 1 | | Equity Act of 2008 and its implementing regulations, | 2 | | which includes 42 CFR Parts 438, 440, and 457 and 45 | 3 | | CFR 146.136 and any other related federal regulations | 4 | | found in the Code of Federal Regulations. | 5 | | (7) Any other information necessary to clarify data | 6 | | provided in accordance with this Section requested by the | 7 | | Director, including information that may be proprietary or | 8 | | have commercial value, under the requirements of Section | 9 | | 30 of the Viatical Settlements Act of 2009. | 10 | | (l) An insurer that amends, delivers, issues, or renews a | 11 | | group or individual policy of accident and health insurance or | 12 | | a qualified health plan offered through the health insurance | 13 | | marketplace in this State providing coverage for hospital or | 14 | | medical treatment and for the treatment of mental, emotional, | 15 | | nervous, or substance use disorders or conditions on or after | 16 | | the effective date of this amendatory Act of the 100th General | 17 | | Assembly shall, in advance of the plan year, make available to | 18 | | the Department or, with respect to medical assistance, the | 19 | | Department of Healthcare and Family Services and to all plan | 20 | | participants and beneficiaries the information required in | 21 | | subparagraphs (C) through (E) of paragraph (6) of subsection | 22 | | (k). For plan participants and medical assistance | 23 | | beneficiaries, the information required in subparagraphs (C) | 24 | | through (E) of paragraph (6) of subsection (k) shall be made | 25 | | available on a publicly-available website whose web address is | 26 | | prominently displayed in plan and managed care organization |
| | | HB1957 Enrolled | - 23 - | LRB102 10644 BMS 15973 b |
|
| 1 | | informational and marketing materials. | 2 | | (m) In conjunction with its compliance examination program | 3 | | conducted in accordance with the Illinois State Auditing Act, | 4 | | the Auditor General shall undertake a review of
compliance by | 5 | | the Department and the Department of Healthcare and Family | 6 | | Services with Section 370c and this Section. Any
findings | 7 | | resulting from the review conducted under this Section shall | 8 | | be included in the applicable State agency's compliance | 9 | | examination report. Each compliance examination report shall | 10 | | be issued in accordance with Section 3-14 of the Illinois | 11 | | State
Auditing Act. A copy of each report shall also be | 12 | | delivered to
the head of the applicable State agency and | 13 | | posted on the Auditor General's website. | 14 | | (Source: P.A. 99-480, eff. 9-9-15; 100-1024, eff. 1-1-19 .)
| 15 | | (215 ILCS 5/500-30)
| 16 | | (Section scheduled to be repealed on January 1, 2027)
| 17 | | Sec. 500-30. Application for license.
| 18 | | (a) An individual applying for a resident insurance | 19 | | producer license must
make
application on a form specified by | 20 | | the Director and declare under penalty of
refusal, suspension,
| 21 | | or revocation of the license that the statements made in the | 22 | | application are
true, correct, and
complete to the best of the | 23 | | individual's knowledge and belief. Before
approving the | 24 | | application,
the Director must find that the individual:
| 25 | | (1) is at least 18 years of age;
|
| | | HB1957 Enrolled | - 24 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (2) is sufficiently rehabilitated in cases in which | 2 | | the applicant has committed any act that is a ground for | 3 | | denial, suspension, or
revocation set forth in Section | 4 | | 500-70, other than convictions set forth in paragraph (6) | 5 | | of subsection (a) of Section 500-70; with respect to | 6 | | applicants with convictions set forth in paragraph (6) of | 7 | | subsection (a) of Section 500-70, the Director shall | 8 | | determine in accordance with Section 500-76 that the | 9 | | conviction will not impair the ability of the applicant to | 10 | | engage in the position for which a license is sought;
| 11 | | (3) has completed, if required by the Director, a | 12 | | pre-licensing course
of
study before the insurance exam | 13 | | for the lines of authority for which the individual has | 14 | | applied (an
individual who
successfully completes the Fire | 15 | | and Casualty pre-licensing courses also meets
the
| 16 | | requirements for Personal Lines-Property and Casualty);
| 17 | | (4) has paid the fees set forth in Section 500-135; | 18 | | and
| 19 | | (5) has successfully passed the examinations for the | 20 | | lines of authority
for
which the person has applied.
| 21 | | (b) A pre-licensing course of study for each class of | 22 | | insurance for which
an insurance
producer license is requested | 23 | | must be established in accordance with rules
prescribed by the
| 24 | | Director and must consist of the following minimum hours:
|
|
25 | | Class of Insurance |
Number of |
|
26 | | |
Hours |
|
|
| | | HB1957 Enrolled | - 25 - | LRB102 10644 BMS 15973 b |
|
| 1 | | Life (Class 1(a)) |
20 |
|
2 | | Accident and Health (Class 1(b) or 2(a)) |
20 |
|
3 | | Fire (Class 3) |
20 |
|
4 | | Casualty (Class 2) |
20 |
|
5 | | Personal Lines-Property Casualty |
20 |
|
6 | | Motor Vehicle (Class 2(b) or 3(e)) |
12.5 |
|
7 | | 7.5 hours of each pre-licensing course must be completed | 8 | | in a classroom or webinar setting, except Motor Vehicle, which | 9 | | would require 5 hours in a classroom or webinar setting. | 10 | | (c) A business entity acting as an insurance producer must | 11 | | obtain an
insurance
producer license. Application must be made | 12 | | using the Uniform Business Entity
Application.
Before | 13 | | approving the application, the Director must find that:
| 14 | | (1) the business entity has paid the fees set forth in | 15 | | Section 500-135;
and
| 16 | | (2) the business entity has designated a licensed | 17 | | producer responsible for
the
business entity's compliance | 18 | | with the insurance laws and rules of this State.
| 19 | | (d) The Director may require any documents reasonably | 20 | | necessary to verify
the
information contained in an | 21 | | application.
| 22 | | (Source: P.A. 100-286, eff. 1-1-18 .)
| 23 | | (215 ILCS 5/500-130)
| 24 | | (Section scheduled to be repealed on January 1, 2027)
| 25 | | Sec. 500-130. Bond required of insurance producers.
|
| | | HB1957 Enrolled | - 26 - | LRB102 10644 BMS 15973 b |
|
| 1 | | (a) An insurance producer who places insurance either | 2 | | directly or indirectly
with an
insurer with which the | 3 | | insurance producer does not have an agency contract agent | 4 | | contact must
maintain in force
while licensed a bond in favor | 5 | | of the people of the
State of Illinois executed by an | 6 | | authorized
surety company and payable to any party injured | 7 | | under
the terms of the bond. The bond shall be
continuous in | 8 | | form and in the amount of $2,500 or 5% of
the premiums brokered | 9 | | in the previous
calendar year, whichever is greater, but not | 10 | | to exceed
$50,000 total aggregate liability. The bond
shall be | 11 | | conditioned upon full accounting and due payment
to the person | 12 | | or company entitled
thereto, of funds coming into the | 13 | | insurance producer's
possession as an incident to insurance
| 14 | | transactions under the license or surplus line insurance
| 15 | | transactions under the license as a surplus
line producer.
| 16 | | (b) Authorized insurance producers of a business entity | 17 | | may
meet the requirements of this
Section with a bond in the | 18 | | name of the business entity,
continuous in form, and in the | 19 | | amounts
set forth in subsection (a) of this Section. Insurance
| 20 | | producers may meet the requirements of this
Section with a | 21 | | bond in the name of an association. An
individual producer | 22 | | remains responsible
for assuring that a producer bond is in | 23 | | effect and is for
the correct amount. The association must
| 24 | | have been in existence for 5 years, have common membership,
| 25 | | and been formed for a purpose
other than obtaining a bond.
| 26 | | (c) The surety may cancel the bond and be released from |
| | | HB1957 Enrolled | - 27 - | LRB102 10644 BMS 15973 b |
|
| 1 | | further
liability thereunder upon
30 days' written notice in | 2 | | advance to the principal. The
cancellation does not affect any | 3 | | liability
incurred or accrued under the bond before the | 4 | | termination
of the 30-day period.
| 5 | | (d) The producer's license may be revoked if the producer | 6 | | acts without a
bond that is
required under this Section.
| 7 | | (e) If a party injured under the terms of the bond requests | 8 | | the producer to
provide the
name of the surety and the bond | 9 | | number, the producer must provide the
information within 3
| 10 | | working days after receiving the request.
| 11 | | (f) An association may meet the requirements of this | 12 | | Section for all of its
members with a
bond in the name of the | 13 | | association that is continuous in form and in the
amounts set | 14 | | forth in
subsection (a) of this Section.
| 15 | | (Source: P.A. 92-386, eff. 1-1-02 .)
| 16 | | (215 ILCS 5/1510)
| 17 | | Sec. 1510. Definitions. In this Article: | 18 | | "Adjusting a claim for loss or damage covered by an | 19 | | insurance contract" means negotiating values, damages, or | 20 | | depreciation or applying the loss circumstances to insurance | 21 | | policy provisions. | 22 | | "Business entity" means a corporation, association, | 23 | | partnership, limited liability company, limited liability | 24 | | partnership, or other legal entity. | 25 | | "Department" means the Department of Insurance. |
| | | HB1957 Enrolled | - 28 - | LRB102 10644 BMS 15973 b |
|
| 1 | | "Director" means the Director of Insurance. | 2 | | "Fingerprints" means an impression of the lines on the | 3 | | finger taken for the purpose of identification. The impression | 4 | | may be electronic or in ink converted to electronic format. | 5 | | "Home state" means the District of Columbia and any state | 6 | | or territory of the United States where the public adjuster's | 7 | | principal place of residence or principal place of business is | 8 | | located. If neither the state in which the public adjuster | 9 | | maintains the principal place of residence nor the state in | 10 | | which the public adjuster maintains the principal place of | 11 | | business has a substantially similar law governing public | 12 | | adjusters, the public adjuster may declare another state in | 13 | | which it becomes licensed and acts as a public adjuster to be | 14 | | the home state. | 15 | | "Individual" means a natural person. | 16 | | "Person" means an individual or a business entity. | 17 | | "Public adjuster" means any person who, for compensation | 18 | | or any other thing of value on behalf of the insured: | 19 | | (i) acts or aids, solely in relation to first party | 20 | | claims arising under insurance contracts that insure the | 21 | | real or personal property of the insured, on behalf of an | 22 | | insured in adjusting a claim for loss or damage covered by | 23 | | an insurance contract; | 24 | | (ii) advertises for employment as a public adjuster of | 25 | | insurance claims or solicits business or represents | 26 | | himself or herself to the public as a public adjuster of |
| | | HB1957 Enrolled | - 29 - | LRB102 10644 BMS 15973 b |
|
| 1 | | first party insurance claims for losses or damages arising | 2 | | out of policies of insurance that insure real or personal | 3 | | property; or | 4 | | (iii) directly or indirectly solicits business, | 5 | | investigates or adjusts losses, or advises an insured | 6 | | about first party claims for losses or damages arising out | 7 | | of policies of insurance that insure real or personal | 8 | | property for another person engaged in the business of | 9 | | adjusting losses or damages covered by an insurance policy | 10 | | for the insured. | 11 | | "Uniform individual application" means the current version | 12 | | of the National Association of Directors (NAIC) Uniform | 13 | | Individual Application for resident and nonresident | 14 | | individuals. | 15 | | "Uniform business entity application" means the current | 16 | | version of the National Association of Insurance Commissioners | 17 | | (NAIC) Uniform Business Entity Application for resident and | 18 | | nonresident business entities.
| 19 | | "Webinar" means an online educational presentation during | 20 | | which a live and participating instructor and participating | 21 | | viewers, whose attendance is periodically verified throughout | 22 | | the presentation, actively engage in discussion and in the | 23 | | submission and answering of questions. | 24 | | (Source: P.A. 96-1332, eff. 1-1-11.) | 25 | | (215 ILCS 5/1565)
|
| | | HB1957 Enrolled | - 30 - | LRB102 10644 BMS 15973 b |
|
| 1 | | Sec. 1565. Continuing education. | 2 | | (a) An individual who holds a public adjuster license and | 3 | | who is not exempt under subsection (b) of this Section shall | 4 | | satisfactorily complete a minimum of 24 hours of continuing | 5 | | education courses, including 3 hours of classroom or webinar | 6 | | ethics instruction, reported on a biennial basis in | 7 | | conjunction with the license renewal cycle. | 8 | | The Director may not approve a course of study unless the | 9 | | course provides for
classroom, seminar, or self-study | 10 | | instruction methods. A course
given in a combination | 11 | | instruction method of classroom or seminar
and self-study | 12 | | shall be deemed to be a self-study course unless the
classroom | 13 | | or seminar certified hours meets or exceeds two-thirds of
the | 14 | | total hours certified for the course. The self-study material | 15 | | used
in the combination course must be directly related to and | 16 | | complement
the classroom portion of the course in order to be | 17 | | considered for
credit. An instruction method other than | 18 | | classroom or seminar shall
be considered as self-study | 19 | | methodology. Self-study credit hours
require the successful | 20 | | completion of an examination covering the
self-study material. | 21 | | The examination may not be self-evaluated.
However, if the | 22 | | self-study material is completed through the use of
an | 23 | | approved computerized interactive format whereby the computer
| 24 | | validates the successful completion of the self-study | 25 | | material, no
additional examination is required. The | 26 | | self-study credit hours
contained in a certified course shall |
| | | HB1957 Enrolled | - 31 - | LRB102 10644 BMS 15973 b |
|
| 1 | | be considered classroom hours
when at least two-thirds of the | 2 | | hours are given as classroom or
seminar instruction. | 3 | | The public adjuster must complete the course in advance of | 4 | | the renewal date to
allow the education provider time to | 5 | | report the credit to the
Department. | 6 | | (b) This Section shall not apply to: | 7 | | (1) licensees not licensed for one full year prior to | 8 | | the end of the applicable continuing education biennium; | 9 | | or | 10 | | (2) licensees holding nonresident public adjuster | 11 | | licenses who have met the continuing education | 12 | | requirements of their home state and whose home state | 13 | | gives credit to residents of this State on the same basis. | 14 | | (c) Only continuing education courses approved by the | 15 | | Director shall be used to satisfy the continuing education | 16 | | requirement of subsection (a) of this Section.
| 17 | | (Source: P.A. 96-1332, eff. 1-1-11.) | 18 | | (215 ILCS 5/Art. XXXI.75 rep.) | 19 | | Section 10. The Illinois Insurance Code is amended by | 20 | | repealing Article XXXI 3/4.
| 21 | | Section 99. Effective date. This Act takes effect upon | 22 | | becoming law, except that the changes to Section 107a.12 of | 23 | | the Illinois Insurance Code take effect January 1, 2022.
|
|