HB2595ham001 102ND GENERAL ASSEMBLY

Rep. Deb Conroy

Filed: 4/19/2021

10200HB2595ham001 LRB102 10633 BMS 25207 a

AMENDMENT TO HOUSE BILL 2595

AMENDMENT NO. ______. Amend House Bill 2595 by replacing lines 11 through 21 on page 11 with the following: "Manual of Mental Disorders. "Mental,"; and

on page 27, by replacing lines 17 through 20 with the following:

"(2) An insurer shall not set a specific limit on the duration of benefits or coverage of medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions or limit coverage only to alleviation of the insured's current symptoms; insurers shall base the duration of treatment on the insured's individual needs, including treating the insured's underlying mental, emotional, nervous, or substance use disorders or conditions and comorbidities."; and

on page 28, lines 6 and 7, by replacing "rescission, cancellation, or modification" with "cancellation or modification"; and

on page 28, line 8, after "eligibility.", by inserting "Nothing in this Section shall require the insurer to cover a treatment when the authorization was granted based on a material misrepresentation by the insured, the policyholder, or the provider. As used in this paragraph, "material" means a fact or situation that is not merely technical in nature and results in or could result in a substantial change in the situation."; and

on page 29, line 7, after "apply", by inserting "without modification"; and

on page 29, line 8, by replacing "versions" with "version"; and

on page 29, line 9, by replacing "the nonprofit" with "an unaffiliated nonprofit"; and

on page 30, immediately below line 4, by inserting the following:

"This subsection does not prohibit an insurer from applying utilization review criteria that were developed in accordance with subsection (k) to health care services and benefits for mental, emotional, and nervous disorders or conditions that:

(1) are outside the scope of the criteria and guidelines set forth in the sources specified in subsection (l); or

(2) relate to advancements in technology or types of care that are not covered in the most recent versions of the sources specified in subsection (l)."; and

on page 32, lines 22 and 23, by deleting "in accordance with Section 1016 of this Code"; and

on page 32, line 24, by replacing "$5,000 and $20,000" with "$1,000 and $5,000"; and

on page 48, lines 25 and 26, by replacing "This Act takes effect upon becoming law" with "This Act takes effect January 1, 2022".