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Public Act 101-0574
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| SB2085 Enrolled | LRB101 08661 RAB 53745 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by adding |
Section 356z.33 as follows:
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(215 ILCS 5/356z.33 new) |
Sec. 356z.33. Coverage of the psychiatric Collaborative |
Care Model. |
(a) As used in this Section, "psychiatric Collaborative |
Care Model" means the evidence-based, integrated behavioral |
health service delivery method, which includes a formal |
collaborative arrangement among a primary care team consisting |
of a primary care provider, a care manager, and a psychiatric |
consultant, and includes, but is not limited to, the following |
elements: |
(1) care directed by the primary care team; |
(2) structured care management; |
(3) regular assessments of clinical status using |
validated tools; and |
(4) modification of treatment as appropriate. |
(b) An individual or group policy of accident and health |
insurance amended, delivered, issued, or renewed on or after |
the effective date of this amendatory Act of the 101st General |
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Assembly or managed care organization that provides mental |
health benefits shall provide reimbursement for benefits that |
are delivered through the psychiatric Collaborative Care |
Model. The following American Medical Association 2018 current |
procedural terminology codes and Healthcare Common Procedure |
Coding System code shall be used to bill for benefits delivered |
through the psychiatric Collaborative Care Model: |
(1) 99492; |
(2) 99493; |
(3) 99494; and |
(4) G0512. |
(c) The Director of Insurance shall update the billing |
codes in subsection (b) if there are any alterations or |
additions to the billing codes for the psychiatric |
Collaborative Care Model. |
(d) An individual or group policy or managed care |
organization that provides benefits under this Section may deny |
reimbursement of any billing code listed in this Section on the |
grounds of medical necessity if such medical necessity |
determinations are in compliance with the Paul Wellstone and |
Pete Domenici Mental Health Parity and Addiction Equity Act of |
2008 and its implementing and related regulations and that such |
determinations are made in accordance with the utilization |
review requirements under Section 85 of the Managed Care Reform |
and Patient Rights Act.
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Section 10. The Illinois Public Aid Code is amended by |
changing Section 5-16.8 as follows:
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(305 ILCS 5/5-16.8)
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Sec. 5-16.8. Required health benefits. The medical |
assistance program
shall
(i) provide the post-mastectomy care |
benefits required to be covered by a policy of
accident and |
health insurance under Section 356t and the coverage required
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under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and |
356z.29, 356z.32, and 356z.33 of the Illinois
Insurance Code |
and (ii) be subject to the provisions of Sections 356z.19, |
364.01, 370c, and 370c.1 of the Illinois
Insurance Code.
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On and after July 1, 2012, the Department shall reduce any |
rate of reimbursement for services or other payments or alter |
any methodologies authorized by this Code to reduce any rate of |
reimbursement for services or other payments in accordance with |
Section 5-5e. |
To ensure full access to the benefits set forth in this |
Section, on and after January 1, 2016, the Department shall |
ensure that provider and hospital reimbursement for |
post-mastectomy care benefits required under this Section are |
no lower than the Medicare reimbursement rate. |
(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; |
99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff. |
8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised |
10-4-18.)
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