HB2847ham001 103RD GENERAL ASSEMBLY

Rep. Lindsey LaPointe

Filed: 3/21/2023

10300HB2847ham001 LRB103 26943 BMS 59563 a

AMENDMENT TO HOUSE BILL 2847

AMENDMENT NO. ______. Amend House Bill 2847 by replacing everything after the enacting clause with the following:

"Section 1. References to Act; purpose.

(a) References to Act. This Act may be referred to as the Mental Health Equity Access and Prevention Act.

(b) Purpose. This Act is intended to address Illinois' skyrocketing mental health needs for children, youth, and adults following the COVID-19 pandemic, cover preventive mental health care to address symptoms early, increase access to affordable care, and maximize the full mental health workforce.

Section 5. Findings. The General Assembly finds that:

(1) According to a recent U.S. Surgeon General's Advisory on Protecting Youth Mental Health, the proportion of high school students reporting persistent feelings of hopelessness and sadness increased by 40% between 2009 and 2019, and rates of depression and anxiety doubled during the COVID-19 pandemic.

(2) Death by suicide is alarmingly high, particularly among Black children. Black children under 13 are now nearly twice as likely to die by suicide than White children.

(3) According to a bipartisan United States Senate Finance Committee report on Mental Health Care in the United States, symptoms for depression and anxiety in adults increased nearly fourfold during the COVID-19 pandemic.

(4) At the same time of unprecedented demand for treatment and support, the mental health workforce crisis is causing severe mental health care access challenges.

(5) Private insurance does not cover preventive mental health care. Preventive mental health care can address mental health issues before symptoms worsen or before a mental health crisis occurs.

(6) Commercial insurance networks that include mental health providers are severely restrictive, meaning a small percentage of the mental health workforce is contracted as in-network providers. This forces individuals and patients to seek costly treatment through out-of-network care.

(7) The cost of mental health treatment is inaccessible and unaffordable for many Illinoisans for these reasons.

(8) A recent Milliman research report that analyzed insurance claims for 37 million Americans, including Illinois residents, found major disparities in insurance contracting with in-network mental health providers and contracting with medical/surgical providers. The report's findings include the following:

(A) Illinois out-of-network mental health utilization was 18.2% for outpatient services in 2017 compared to just 3.9% for medical/surgical services.

(B) Illinois out-of-network mental health utilization was 12.1% in 2017 for inpatient care compared to just 2.8% for medical/surgical services.

(C) The disparity between out-of-network usage for mental health compared to medical/surgical services grew significantly between 2013 and 2017: out-of-network mental health utilization for outpatient visits grew by 44% while out-of-network utilization for medical/surgical services decreased by 42% over the same period in Illinois.

(D) Nearly 14% of mental health office visits for individuals with a PPO plan were out-of-network in Illinois.

(9) According to a report in JAMA Psychiatry, 26% of psychiatrists see patients who do not use their insurance to pay for their visit because it is an out-of-network visit; according to a 2015 American Psychological Association Survey of Psychology Health Service Providers, 21% of psychologists report that most of their patients pay out-of-pocket because their visit is out-of-network.

(10) Illinois must maximize its full mental health workforce to address the mental health crisis the state is experiencing post-COVID-19 and improve access to affordable, timely care.

Section 10. The Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois is amended by adding Section 2310-720 as follows:

(20 ILCS 2310/2310-720 new)

Sec. 2310-720. Public educational effort on mental health and wellness. Subject to appropriation, the Department shall undertake a public educational campaign to bring broad public awareness to communities across this State on the importance of mental health and wellness, including the expanded coverage of mental health treatment, and consistent with the recommendations of the Illinois Children's Mental Health Partnership's Children's Mental Health Plan of 2022 and Public Act 102-899. The Department shall look to other successful public educational campaigns to guide this effort, such as the public educational campaign related to Get Covered Illinois. Additionally, the Department shall work with the Department of Insurance, the Illinois State Board of Education, the Department of Human Services, the Department of Healthcare and Family Services, the Department of Juvenile Justice, the Department of Children and Family Services, and other State agencies as necessary to promote consistency in messaging and distribution methods between this campaign and other concurrent public educational campaigns related to mental health and mental wellness. Public messaging for this campaign shall be simple, easy to understand, and shall include culturally competent messaging for different communities and regions throughout this State.

Section 15. The Illinois Insurance Code is amended by adding Sections 356z.61 and 356z.62 as follows:

(215 ILCS 5/356z.61 new)

Sec. 356z.61. Coverage of out-of-network mental health care.

(a) As used in this Section:

"Grandfathered health plan" has the meaning given to that term in 42 U.S.C. 18011.

"Individual market" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act. "Individual market" includes student health insurance coverage.

"Large group market" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act.

"Market" means the individual, small group, or large group market. "Market" includes grandfathered and transitional health plans pertaining to the policyholder to which the plan is issued or renewed.

"Network plan" has the meaning given to that term in Section 5 of the Network Adequacy and Transparency Act.

"Small group market" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act.

"Student health insurance coverage" has the meaning given to that term in 45 CFR 147.145.

"Transitional health plan" means a plan subject to the limited non-enforcement policy regarding the federal Patient Protection and Affordable Care Act for certain non-grandfathered health plans in the individual and small group markets that the federal Centers for Medicare and Medicaid Services announced in a letter to state insurance commissioners, dated November 14, 2013, to the extent that the limited non-enforcement policy has been renewed annually by the federal Centers for Medicare and Medicaid Services and ratified by the Department.

(b) Notwithstanding the provisions of the Network Adequacy and Transparency Act, a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover all medically necessary out-of-network mental health visits, including prevention and wellness visits, mental health treatment, and mental health services provided by a mental health provider or facility.

(c) For purposes of insured cost sharing, the insured shall pay no more for the out-of-network services and visits than the insured would have paid for in-network services and visits.

(d) No action shall be required by the insured to use out-of-network mental health services covered pursuant to this Section. The insured has the right to select the provider of their choice and the modality, in-person visit or telehealth, for medically necessary care.

(e) The insurer shall reimburse the out-of-network mental health provider or facility at the provider's usual and customary charges for out-of-network medically necessary patient care.

(f) This Section shall apply to each market in which the insurer offers or provides any network plan until the insurer's network plans in that market reduce by 50% the annual disparity between out-of-network mental health utilization and out-of-network medical/surgical utilization for both outpatient mental health visits and inpatient mental health visits from the Base Year by increasing the number of in-network mental health providers and facilities. Outpatient mental health visits and inpatient mental health visits shall be measured separately. The Base Year shall be calendar year 2022 for purposes of measuring the disparity against future years. The Department may require an insurer to file utilization data to establish the disparity level in a market for the Base Year as needed. If and only if an insurer did not have network plans in a market in this State in 2022, the Department shall allow an insurer entering that market to use alternative data to establish a Base Year to simulate 2022 utilization, subject to the Department's approval of the sources of data. An insurer's network plans in a market are exempt from this Section for inpatient care or outpatient care, or both, once the 50% reduction in the disparity between mental health and medical/surgical out-of-network utilization is met. The exemption does not extend to the annual filing requirement under subsection (g).

(g) An insurer shall file annually the metrics established in this Section for each market in which the insurer issued or renewed any network plan during the preceding calendar year. An insurer may request a review from the Department, and the Department shall undertake such a review, in any given year if the insurer believes it has reduced the disparity described in this Section for inpatient or outpatient care, or both, by the end of the preceding calendar year for one or more markets to qualify for an exemption. If the Department determines that the insurer has not reduced the disparity, the insurer may not request another exemption review for 3 years. If an insurer becomes exempt from this Section for a market in a given year but fails to maintain the 50% reduction in the disparity between mental health and medical/surgical out-of-network utilization in a future calendar year based on a Department review, the exemption lapses for the following plan year. An insurer may not submit a request to reinstate a lapsed exemption at least until the second calendar year after the year the lapse takes effect. Plan beneficiaries shall be notified at least 60 days before renewal when there will be any change in benefit coverage based on an exemption or lapse of exemption.

(h) The Department shall adopt any rules necessary to implement this Section by no later than October 31, 2024.

(i) This Section is subject to appropriation to the Department of Insurance.

(215 ILCS 5/356z.62 new)

Sec. 356z.62. Coverage of no-cost mental health prevention and wellness visits.

(a) A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for 2 annual mental health prevention and wellness visits for children and for adults.

(b) Mental health prevention and wellness visits shall include any age-appropriate screening recommended by the United States Preventive Services Task Force or by the American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents for purposes of identifying a mental health issue, condition, or disorder; discussing mental health symptoms that might be present, including symptoms of a previously diagnosed mental health condition or disorder; performing an evaluation of adverse childhood experiences; and discussing mental health and wellness.

(c) A mental health prevention and wellness visit shall be covered for up to 60 minutes and may be performed by a physician licensed to practice medicine in all of its branches, a licensed clinical psychologist, a licensed clinical social worker, a licensed clinical professional counselor, a licensed marriage and family therapist, a licensed social worker, or a licensed professional counselor.

(d) A policy subject to this Section shall not impose a deductible, coinsurance, copayment, or other cost-sharing requirement for mental health and wellness visits, and no prior authorization shall be required for the visits. The cost-sharing prohibition in this subsection (d) does not apply to coverage of mental health prevention and wellness visits to the extent such coverage would disqualify a high-deductible health plan from eligibility from a health savings account pursuant to Section 223 of the Internal Revenue Code.

(e) A mental health prevention and wellness visit shall not replace a Well Child visit or a general health or medical visit.

(f) A mental health prevention and wellness visit shall be reimbursed through the following American Medical Association current procedural terminology codes and at the same rate that current procedural terminology codes are reimbursed for the provision of other medical care: 99381-99387 and 99391-99397.

(g) Reimbursement of any of the current procedural terminology codes listed in this Section shall comply with the following:

(1) Reimbursement may be adjusted for payment of claims that are billed by a nonphysician clinician so long as the methodology to determine the adjustments are comparable to and applied no more stringently than the methodology for adjustments made for reimbursement of claims billed by nonphysician clinicians for other medical care, in accordance with 45 CFR 146.136(c)(4);

(2) for the purpose of covering a mental health prevention and wellness visit, reimbursement shall not be denied because the code was already reimbursed for the purpose of covering a service other than such visit;

(3) for the purpose of covering a service other than a mental health prevention and wellness visit, reimbursement shall not be denied because the code was already reimbursed for the purpose of covering a mental health prevention and wellness visit; and

(4) for a mental health prevention and wellness visit and for a service other than a mental health prevention and wellness visit, reimbursement shall not be denied if they occur on the same date by the same provider and the provider is a primary care provider.

(i) The Department shall adopt any rules necessary to implement this Section by no later than October 31, 2024.

Section 99. Effective date. This Act takes effect July 1, 2024.".