HB5497 104TH GENERAL ASSEMBLY

LRB104 20224 BAB 33675 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5497

Introduced 2/13/2026, by Rep. Laura Faver Dias

SYNOPSIS AS INTRODUCED:

215 ILCS 5/370c.5 new
215 ILCS 124/25.5 new

Amends the Illinois Insurance Code. Provides that any policy of insurance amended, delivered, issued, or renewed on or after January 1, 2027 that provides coverage for emergency services for medical or surgical conditions shall also provide coverage for behavioral health emergency services on coverage terms no more restrictive than those applied to emergency services for medical or surgical conditions. Requires coverage for post-stabilization services. Sets forth provisions concerning behavioral health emergency services parity; coverage of services provided by nonlicensed staff performing under direct supervision; restrictions on prior authorization, utilization review, and cost sharing; reimbursement rates; and rulemaking. Amends the Network Adequacy and Transparency Act. Includes behavioral health emergency services providers in network adequacy determinations under the Act. Establishes provisions concerning rulemaking for the Department of Insurance; behavioral health emergency services requirements for health insurance issuers; and enforcement coordination with specified federal law. Effective January 1, 2027.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Findings. The General Assembly finds that:

(1) Individuals experiencing behavioral health emergencies, including mental health and substance use challenges, may face urgent situations that require immediate support to promote safety, stability, and overall well-being for themselves, their families, and their communities.

(2) Timely access to a full continuum of behavioral health emergency services, including crisis intervention, stabilization, mobile crisis response, and post-stabilization care, is essential to support recovery, reduce harm, and prevent unnecessary hospitalizations or interactions with law enforcement.

(3) Commercial health insurance policies in Illinois generally do not provide coverage for behavioral health emergency services, resulting in the costs of these services being covered primarily by State and federal funds.

(4) Evidence demonstrates that mobile crisis response services are more cost-effective than hospitalization and provide more timely, person-centered care by stabilizing individuals in their communities, reducing unnecessary emergency department visits and inpatient admissions, and improving connections to ongoing behavioral health supports.

(5) Disparities in coverage, prior authorization requirements, and cost-sharing obligations create barriers that prevent individuals from accessing necessary, life-saving behavioral health services.

(6) Commercial insurance policies that provide coverage for emergency medical or surgical services should provide equivalent coverage for behavioral health emergency services to ensure parity and compliance with the Mental Health Parity and Addiction Equity Act.

(7) Under widely recognized mobile crisis response models, behavioral health crisis teams often include nonlicensed staff, including peer specialists and individuals with lived experience, working under the direct supervision of licensed clinicians, enabling the team to deliver timely, effective, and community-based crisis services without unnecessary administrative or financial barriers.

(8) Ensuring network adequacy, including travel time, distance, and mobile crisis response times consistent with standards established by the Illinois Division of Behavioral Health and Recovery and the Department of Healthcare and Family Services under the Mobile Response and Stabilization Services program, is critical to providing rapid access to behavioral health emergency services.

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

(215 ILCS 5/370c.5 new)

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

(a) This Section applies to all policies of insurance amended, delivered, issued, or renewed on and after January 1, 2027.

(b) In this Section, "behavioral health emergency services" means the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs of those experiencing a mental health or substance use disorder crisis that are wellness, resilience, and recovery oriented.

"Behavioral health emergency services" includes, but is not limited to, crisis intervention, including counseling provided by 9-8-8 Suicide and Crisis Lifeline centers, mobile crisis response, crisis de-escalation, crisis receiving and stabilization services, and coordination with health, social, and other services and supports year-round 24-hour availability for up to a 72-hour crisis period.

(c) Any policy that provides coverage for emergency services for medical or surgical conditions shall also provide coverage for behavioral health emergency services, on coverage terms no more restrictive than those applied to emergency services for medical or surgical conditions, if any of the following conditions are met:

(1) the insured has acute symptoms or distress that would cause a prudent layperson experiencing them to reasonably seek immediate care;

(2) a clinical assessment of the insured indicates a behavioral health crisis requiring immediate evaluation or intervention; or

(3) the insured is referred, transported, or directed to behavioral health emergency services by a 9-8-8 Suicide and Crisis Lifeline center, emergency medical services, law enforcement, or other crisis responder.

Coverage shall not be denied solely because the enrollee is unable to recognize or communicate the need for emergency care.

(d) A policy subject to this Section shall provide coverage and reimbursement for post-stabilization services, as required by 42 U.S.C. 300gg-111(a)(3)(C)(ii), and those services shall be covered as behavioral health emergency services under this Section.

(e) A health insurance issuer shall cover behavioral health emergency services provided by nonlicensed staff who are performing services under the direct supervision of a fully licensed mental health clinician. Services delivered by such supervised nonlicensed staff shall be billed under the supervising clinician's rendering National Provider Identifier, in accordance with the issuer's credentialing and billing policies and applicable law.

(f) Coverage under this Section shall not be conditioned on prior authorization, utilization review, or plan notification and shall not vary based on whether services are provided by a participating or nonparticipating provider or facility, on the licensure category of the provider or facility, or on the location where services are delivered, so long as the services are within the scope of practice under Illinois law.

(g) Reimbursement for behavioral health emergency services under this Section shall not be made in an amount less than the applicable reimbursement rate floor established under Section 370c.4 of this Code, regardless of network status, and shall adopt applicable Medicaid procedure codes, modifiers, and fee schedules where available to streamline billing and ensure consistency.

(h) Notwithstanding any other provision of this Code, a policy subject to this Section shall not impose any deductible, copayment, coinsurance, or other cost-sharing requirement on behavioral health emergency services, including post-stabilization services covered under subsection (d).

(i) The Department may adopt rules to implement this Section, including rules regarding enforcement and coordination with federal requirements.

Section 10. The Network Adequacy and Transparency Act is amended by adding Section 25.5 as follows:

(215 ILCS 124/25.5 new)

Sec. 25.5. Behavioral health emergency services network adequacy.

(a) This Section applies to an individual or group policy of health insurance coverage with a network plan amended, delivered, issued, or renewed in this State on and after January 1, 2027.

(b) For purposes of this Section, "behavioral health emergency services" has the meaning given to that term in Section 370c.4 of the Illinois Insurance Code.

(c) Behavioral health emergency services providers, including, but not limited to, mobile crisis response teams and crisis receiving and stabilization providers, shall be included in network adequacy determinations under this Act.

(d) The Department shall adopt maximum travel time and distance standards for enrollees to access in-network, facility-based behavioral health emergency services and shall establish maximum response time standards for mobile crisis response teams to reach enrollees in the community. All travel, distance, and response time standards shall be no less stringent than the requirements established by the Illinois Division of Behavioral Health and Recovery and the Department of Healthcare and Family Services under the Mobile Response and Stabilization Services program.

(e) A health insurance issuer offering a network plan shall ensure 24-hour-a-day, 7-day-a-week timely access to behavioral health emergency services in each geographic region served by the plan.

(f) Enforcement of this Section shall be coordinated with federal requirements under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the No Surprises Act.

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