HB4785ham001 104TH GENERAL ASSEMBLY

Rep. Lindsey LaPointe

Filed: 3/16/2026

10400HB4785ham001 LRB104 18498 BAB 35041 a

AMENDMENT TO HOUSE BILL 4785

AMENDMENT NO. ______. Amend House Bill 4785 by replacing everything after the enacting clause with the following:

"Section 5. The State Finance Act is amended by changing Section 6z-134 as follows:

(30 ILCS 105/6z-134)

Sec. 6z-134. Statewide 9-8-8 Trust Fund.

(a) The Statewide 9-8-8 Trust Fund is created as a special fund in the State treasury. This Fund is administered by the Department of Human Services. Moneys in the Fund shall be used by the Department of Human Services for the purposes of establishing and maintaining a statewide 9-8-8 suicide prevention and mental health crisis system pursuant to the National Suicide Hotline Designation Act of 2020 as codified in 47 U.S.C. 251 and 251a and any subsequent amendments, the Federal Communication Commission's rules adopted to administer the National Suicide Hotline Designation Act of 2020 as codified in 47 U.S.C. 251 and 251a and any subsequent amendments, and national guidelines for crisis care. The Fund shall consist of:

(1) appropriations by the General Assembly;

(2) grants and gifts intended for deposit in the Fund;

(3) interest, premiums, gains, or other earnings on the Fund;

(3.1) proceeds from the statewide 9-8-8 surcharge imposed under Sections 3 and 4 of the Telecommunication Excise Tax Act; and

(4) moneys received from any other source that are deposited in or transferred into the Fund.

(b) Moneys in the Fund:

(1) do not revert at the end of any State fiscal year but remain available for the purposes of the Fund in subsequent State fiscal years;

(2) are not subject to transfer to any other Fund or to transfer, assignment, or reassignment for any other use or purpose outside of those specified in this Section; and

(3) shall be used by the Department of Human Services to pay expenses pursuant to 47 U.S.C. 251a.

(c) An annual report of Fund deposits and expenditures shall be made to the General Assembly and the Federal Communications Commission by the Department of Human Services pursuant to 47 U.S.C. 251a.

(d) (Blank).

(e) For the purposes of this Section, "statewide 9-8-8 suicide prevention and mental health crisis system" means the core elements or pillars of the crisis system, as described by the Substance Abuse and Mental Health Services Administration, and includes Illinois' 9-8-8 Lifeline Contact Centers, community crisis response services, including mobile crisis teams, and crisis receiving and stabilization facilities and programs, including Living Room Programs.

(f) In addition to the purposes specified in subsection (a), there is created as a special account within the Statewide 9-8-8 Trust Fund to be known as the Behavioral Health Emergency Services Assessment Account. Moneys deposited into this Account shall consist of assessments, interest, and civil penalties collected pursuant to Section 417 of the Illinois Insurance Code.

(g) Moneys in the Behavioral Health Emergency Services Assessment Account shall be used solely, consistent with the purposes described in subsection (a), for behavioral health emergency services, including mobile crisis response services and crisis receiving and stabilization services, refunds of erroneous or excessive payments, and administrative costs related to implementation of Section 417 of the Illinois Insurance Code, including all reasonable administrative costs incurred by the Department of Insurance in implementing, administering, collecting, and enforcing the assessment established under that Section.

(h) Moneys in the Behavioral Health Emergency Services Assessment Account shall not be used:

(1) to reimburse services provided to individuals enrolled in medical assistance programs under Title XIX or Title XXI of the Social Security Act;

(2) for services that have been directly billed to and reimbursed by a covered entity;

(3) as the nonfederal share for purposes of drawing down federal matching funds under Title XIX or Title XXI of the Social Security Act; or

(4) to supplant existing State general revenue appropriations for behavioral health emergency services.

(i) A provider or entity receiving funds attributable to the assessment under Section 417 of the Illinois Insurance Code shall not bill a covered entity for the behavioral health emergency services described in subsection (g) of this Section for a covered life.

(j) The Department of Human Services shall submit an annual report to the Governor and the General Assembly on the receipts and expenditures of the Behavioral Health Emergency Services Assessment Account. The report s5hall include:

(1) total assessment revenue collected during the preceding fiscal year;

(2) amounts expended by service category; and

(3) a summary of supported behavioral health emergency service capacity.

(Source: P.A. 104-6, eff. 6-16-25.)

Section 10. The Illinois Insurance Code is amended by adding Sections 370c.5 and 417 as follows:

(215 ILCS 5/370c.5 new)

Sec. 370c.5. Behavioral health emergency services network adequacy.

(a) Notwithstanding any other provision of this Code relating to network adequacy, a health insurance issuer or health maintenance organization subject to this Code shall ensure reasonable access to behavioral health emergency services, including mobile crisis response teams, crisis receiving services, and crisis stabilization units.

(b) Beginning January 1, 2027, a health insurance issuer or health maintenance organization subject to this Code that is making complete and timely payment of the behavioral health emergency services covered lives assessment established under Section 417 of this Code shall be deemed to satisfy the network adequacy requirements of this Code with respect to behavioral health emergency services.

(c) Nothing in this Section shall be construed to alter or limit network adequacy requirements applicable to behavioral health services other than behavioral health emergency services.

(215 ILCS 5/417 new)

Sec. 417. Preventing Crisis Cost Shifting to Medicaid Law.

(a) References to this Section. This Section may be referred to as the Preventing Crisis Cost Shifting to Medicaid Law.

(b) Findings. The General Assembly finds that:

(1) individuals experiencing behavioral health emergencies, including mental health and substance use crises, require timely access to crisis services to promote safety, stability, and recovery for themselves, their families, and their communities;

(2) behavioral health crisis services, including crisis call centers, mobile crisis response teams, crisis receiving services, and crisis stabilization units, function as essential public health infrastructure and must be available statewide without regard to insurance status;

(3) commercial health insurance policies and health maintenance organization contracts issued or administered in this State generally do not provide comprehensive coverage for the full continuum of behavioral health crisis services, resulting in the cost of such services being disproportionately borne by Medicaid, local governments, and taxpayers;

(4) a predictable, multi-payer financing mechanism is necessary to prevent cost shifting from commercial payors to Medicaid and other publicly financed systems and to ensure the long-term availability and geographic equity of a statewide behavioral health crisis system; and

(5) the assessment established under this Section is intended to operate as a broad-based health financing mechanism to support behavioral health emergency services and does not regulate plan benefits, coverage determinations, or claims administration.

(c) Definitions. As used in this Section:

"Adjustment factor" means the sum of inflation change and population change for the biennium during which an adjustment increase under paragraph (10) of subsection (d) is calculated.

"Covered entity" means:

(1) an entity authorized to issue or administer accident and health insurance in this State, including individual and group coverage, providing coverage for hospital or medical treatment or services for illness or injury on an expense-incurred basis;

(2) a health maintenance organization authorized under the Health Maintenance Organization Act; or

(3) a private employer-sponsored self-funded employee welfare benefit plan providing coverage for hospital or medical treatment or services for illness or injury.

"Covered lives" means all persons residing in Illinois who are enrolled in health coverage offered by a covered entity. "Covered lives" does not include lives enrolled in Medicaid managed care organizations under contract with the Department of Healthcare and Family Services, lives enrolled in Medicare Advantage plans established under Medicare Part C, lives enrolled in outpatient prescription drug plans established under Medicare Part D, or lives enrolled in Federal Employee Health Benefit plans.

"Department" means the Department of Insurance.

"Director" means the Director of Insurance.

"Inflation change" means the percentage change in the Consumer Price Index for All Urban Consumers, or successor index, as published by the United States Bureau of Labor Statistics, for the biennium during which an adjustment increase under paragraph (10) of subsection (d) is calculated.

"Population change" means the percentage change in the population of this State as reported by the Governor's Office of Management and Budget, or successor entity, for the biennium during which an adjustment increase under paragraph (10) of subsection (d) is calculated.

(d) Behavioral health emergency services covered lives assessment.

(1) Beginning January 1, 2027, each covered entity shall pay to the Department a behavioral health emergency services covered lives assessment for deposit into the Behavioral Health Emergency Services Assessment Account within the Statewide 9-8-8 Trust Fund.

(2) The assessment shall be imposed at a rate of $1.25 per member per month per covered life. The Department shall collect the assessment on a quarterly basis. Each covered entity shall report covered lives in a form and manner to be determined by the Department by rule.

(3) The assessment imposed under this Section is a health care financing assessment and shall not be considered a premium tax under this Code.

(4) The assessment imposed under this Section is an obligation of the covered entity and shall not be construed to regulate plan benefits, cost sharing, claims administration, or the design of coverage for participants or beneficiaries.

(5) Payments are due within 45 days after notice from the Department of the amount owed. Interest begins to accrue on the 46th day on amounts received after the 45-day period, at a rate to be determined by the Department by rule consistent with State law.

(6) A covered entity that fails to pay the assessment within 90 days after notice shall be assessed a civil penalty equal to 150% of the assessment owed, in addition to interest. The assessment, penalty, and interest may be recovered by the Department in a civil action. The Director may suspend or revoke the certificate of authority of an entity regulated by the Department until all amounts due are paid.

(7) A covered entity that is unable to pay the full assessment when due may submit a payment plan to the Department for approval. A payment plan shall include an initial payment and a schedule for payment of the remaining balance. The Director may approve, modify, or deny a proposed payment plan and may require compliance with the terms of the approved plan as a condition of avoiding additional penalties.

(8) The Department may contract with a third party to obtain covered lives information, administer the assessment, and perform related audit or collection functions consistent with this Section.

(9) In the event of a merger, acquisition, or other transfer of ownership, liability for the assessment shall be assumed by the successor entity.

(10) Each June of even-numbered years, the Director shall calculate the assessment for the next 2 calendar years by increasing the current assessment by known changes in the adjustment factor, except that the increase shall not exceed 10%.

Section 97. Severability. The provisions of this Act are severable under Section 1.31 of the Statute on Statutes.

Section 99. Effective date. This Act takes effect January 1, 2027.".