100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB0070

 

Introduced , by Rep. Lou Lang

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/370c.1

    Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.


LRB100 03761 RPS 13766 b

 

 

A BILL FOR

 

HB0070LRB100 03761 RPS 13766 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 370c.1 as follows:
 
6    (215 ILCS 5/370c.1)
7    Sec. 370c.1. Mental health and addiction parity.
8    (a) On and after the the effective date of this amendatory
9Act of the 99th General Assembly, every insurer that amends,
10delivers, issues, or renews a group or individual policy of
11accident and health insurance or a qualified health plan
12offered through the Health Insurance Marketplace in this State
13providing coverage for hospital or medical treatment and for
14the treatment of mental, emotional, nervous, or substance use
15disorders or conditions shall ensure that:
16        (1) the financial requirements applicable to such
17    mental, emotional, nervous, or substance use disorder or
18    condition benefits are no more restrictive than the
19    predominant financial requirements applied to
20    substantially all hospital and medical benefits covered by
21    the policy and that there are no separate cost-sharing
22    requirements that are applicable only with respect to
23    mental, emotional, nervous, or substance use disorder or

 

 

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1    condition benefits; and
2        (2) the treatment limitations applicable to such
3    mental, emotional, nervous, or substance use disorder or
4    condition benefits are no more restrictive than the
5    predominant treatment limitations applied to substantially
6    all hospital and medical benefits covered by the policy and
7    that there are no separate treatment limitations that are
8    applicable only with respect to mental, emotional,
9    nervous, or substance use disorder or condition benefits.
10    (b) The following provisions shall apply concerning
11aggregate lifetime limits:
12        (1) In the case of a group or individual policy of
13    accident and health insurance or a qualified health plan
14    offered through the Health Insurance Marketplace amended,
15    delivered, issued, or renewed in this State on or after the
16    effective date of this amendatory Act of the 99th General
17    Assembly that provides coverage for hospital or medical
18    treatment and for the treatment of mental, emotional,
19    nervous, or substance use disorders or conditions the
20    following provisions shall apply:
21            (A) if the policy does not include an aggregate
22        lifetime limit on substantially all hospital and
23        medical benefits, then the policy may not impose any
24        aggregate lifetime limit on mental, emotional,
25        nervous, or substance use disorder or condition
26        benefits; or

 

 

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

 

 

HB0070- 4 -LRB100 03761 RPS 13766 b

1    aggregate lifetime limit that is computed taking into
2    account the weighted average of the aggregate lifetime
3    limits applicable to such categories.
4    (c) The following provisions shall apply concerning annual
5limits:
6        (1) In the case of a group or individual policy of
7    accident and health insurance or a qualified health plan
8    offered through the Health Insurance Marketplace amended,
9    delivered, issued, or renewed in this State on or after the
10    effective date of this amendatory Act of the 99th General
11    Assembly that provides coverage for hospital or medical
12    treatment and for the treatment of mental, emotional,
13    nervous, or substance use disorders or conditions the
14    following provisions shall apply:
15            (A) if the policy does not include an annual limit
16        on substantially all hospital and medical benefits,
17        then the policy may not impose any annual limits on
18        mental, emotional, nervous, or substance use disorder
19        or condition benefits; or
20            (B) if the policy includes an annual limit on
21        substantially all hospital and medical benefits (in
22        this subsection referred to as the "applicable annual
23        limit"), then the policy shall either:
24                (i) apply the applicable annual limit both to
25            the hospital and medical benefits to which it
26            otherwise would apply and to mental, emotional,

 

 

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1            nervous, or substance use disorder or condition
2            benefits and not distinguish in the application of
3            the limit between the hospital and medical
4            benefits and mental, emotional, nervous, or
5            substance use disorder or condition benefits; or
6                (ii) not include any annual limit on mental,
7            emotional, nervous, or substance use disorder or
8            condition benefits that is less than the
9            applicable annual limit.
10        (2) In the case of a policy that is not described in
11    paragraph (1) of subsection (c) of this Section and that
12    includes no or different annual limits on different
13    categories of hospital and medical benefits, the Director
14    shall establish rules under which subparagraph (B) of
15    paragraph (1) of subsection (c) of this Section is applied
16    to such policy with respect to mental, emotional, nervous,
17    or substance use disorder or condition benefits by
18    substituting for the applicable annual limit an average
19    annual limit that is computed taking into account the
20    weighted average of the annual limits applicable to such
21    categories.
22    (d) With respect to substance use disorders, an insurer
23shall use policies and procedures for the election and
24placement of substance abuse treatment drugs on their formulary
25that are no less favorable to the insured as those policies and
26procedures the insurer uses for the selection and placement of

 

 

HB0070- 6 -LRB100 03761 RPS 13766 b

1other drugs and shall follow the expedited coverage
2determination requirements for substance abuse treatment drugs
3set forth in Section 45.2 of the Managed Care Reform and
4Patient Rights Act.
5    (e) This Section shall be interpreted in a manner
6consistent with all applicable federal parity regulations
7including, but not limited to, the Mental Health Parity and
8Addiction Equity Act of 2008 at 78 FR 68240.
9    (f) 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    (g) As used in this Section:
13    "Financial requirement" includes deductibles, copayments,
14coinsurance, and out-of-pocket maximums, but does not include
15an aggregate lifetime limit or an annual limit subject to
16subsections (b) and (c).
17    "Treatment limitation" includes limits on benefits based
18on the frequency of treatment, number of visits, days of
19coverage, days in a waiting period, or other similar limits on
20the scope or duration of treatment. "Treatment limitation"
21includes both quantitative treatment limitations, which are
22expressed numerically (such as 50 outpatient visits per year),
23and nonquantitative treatment limitations, which otherwise
24limit the scope or duration of treatment. A permanent exclusion
25of all benefits for a particular condition or disorder shall
26not be considered a treatment limitation. "Nonquantitative

 

 

HB0070- 7 -LRB100 03761 RPS 13766 b

1treatment" means those limitations as described under federal
2regulations (26 CFR 54.9812-1).
3    (h) The Department of Insurance shall implement the
4following education initiatives:
5        (1) By January 1, 2016, the Department shall develop a
6    plan for a Consumer Education Campaign on parity. The
7    Consumer Education Campaign shall focus its efforts
8    throughout the State and include trainings in the northern,
9    southern, and central regions of the State, as defined by
10    the Department, as well as each of the 5 managed care
11    regions of the State as identified by the Department of
12    Healthcare and Family Services. Under this Consumer
13    Education Campaign, the Department shall: (1) by January 1,
14    2017, provide at least one live training in each region on
15    parity for consumers and providers and one webinar training
16    to be posted on the Department website and (2) establish a
17    consumer hotline to assist consumers in navigating the
18    parity process by March 1, 2016. By January 1, 2018 the
19    Department shall issue a report to the General Assembly on
20    the success of the Consumer Education Campaign, which shall
21    indicate whether additional training is necessary or would
22    be recommended.
23        (2) The Department, in coordination with the
24    Department of Human Services and the Department of
25    Healthcare and Family Services, shall convene a working
26    group of health care insurance carriers, mental health

 

 

HB0070- 8 -LRB100 03761 RPS 13766 b

1    advocacy groups, substance abuse patient advocacy groups,
2    and mental health physician groups for the purpose of
3    discussing issues related to the treatment and coverage of
4    substance abuse disorders and mental illness. The working
5    group shall meet once before January 1, 2016 and shall meet
6    semiannually thereafter. The Department shall issue an
7    annual report to the General Assembly that includes a list
8    of the health care insurance carriers, mental health
9    advocacy groups, substance abuse patient advocacy groups,
10    and mental health physician groups that participated in the
11    working group meetings, details on the issues and topics
12    covered, and any legislative recommendations.
13    (i) The Parity Education Fund is created as a special fund
14in the State treasury. Moneys deposited into the Fund for
15appropriation by the General Assembly to the Department of
16Insurance shall be used for the purpose of providing financial
17support of the Consumer Education Campaign.
18(Source: P.A. 99-480, eff. 9-9-15.)