SB1480 104TH GENERAL ASSEMBLY

LRB104 06841 KTG 16877 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB1480

Introduced 1/31/2025, by Sen. Laura Fine

SYNOPSIS AS INTRODUCED:

5 ILCS 375/6.17 new
65 ILCS 5/10-4-2.9 new
105 ILCS 5/10-22.3g new
215 ILCS 5/370c.3 new
215 ILCS 125/5-3	from Ch. 111 1/2, par. 1411.2
225 ILCS 150/20 new
305 ILCS 5/5-65 new
405 ILCS 160/1
405 ILCS 160/35 new

Amends the Illinois Insurance Code. Provides that all group and individual health insurance policies issued, delivered, amended, or renewed in Illinois that provide coverage for medical or surgical conditions shall also provide coverage for crisis services, regardless of any difference in billing codes used for such services. Provides that coverage for crisis services may not be denied or restricted based on the modality or setting of the services; and that crisis services shall be covered whether delivered in person, through telehealth, or in a residential or outpatient setting, to the extent that such services are covered in other settings or modalities under the policy. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Telehealth Act, and the Illinois Public Aid Code. Amends the Strengthening and Transforming Behavioral Health Crisis Care in Illinois Act. Renames the Act the Crisis Continuum Sustainability Act. Provides that on or before December 31, 2028, and every 5 years thereafter, the Department of Human Services shall, subject to available funding and in collaboration with relevant stakeholders and State bodies, develop and submit a Statewide Crisis Continuum Strategic Plan to the Office of the Governor and the General Assembly, with the goal of ensuring every Illinoisan has timely access to appropriate and supportive behavioral health response during a behavioral health crisis. Requires the strategic plan to identify statewide goals, key stakeholders, and performance metrics for expanding access to behavioral health crisis continuum services across Illinois; address gaps in service delivery; and other matters.

A BILL FOR

AN ACT concerning insurance.

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

Section 5. The State Employees Group Insurance Act of 1971 is amended by adding Section 6.17 as follows:

(5 ILCS 375/6.17 new)

Sec. 6.17. Behavioral health services; required crisis coverage. The program of health benefits is subject to the provisions of Section 370c.3 of the Illinois Insurance Code requiring coverage of crisis services as defined in 89 Ill. Adm. Code 140.453(d)(3).

Section 10. The Illinois Municipal Code is amended by adding Section 10-4-2.9 as follows:

(65 ILCS 5/10-4-2.9 new)

Sec. 10-4-2.9. Behavioral health services; required crisis coverage. The corporate authorities of all municipalities are subject to the provisions of Section 370c.3 of the Illinois Insurance Code requiring coverage of crisis services as defined in 89 Ill. Adm. Code 140.453(d)(3).

Section 15. The School Code is amended by adding Section 10-22.3g as follows:

(105 ILCS 5/10-22.3g new)

Sec. 10-22.3g. Behavioral health services; no utilization or prior approval mandates. Insurance protection and benefits for employees shall be subject to the provisions of Section 370c.3 of the Illinois Insurance Code requiring coverage of crisis services as defined in 89 Ill. Adm. Code 140.453(d)(3).

Section 20. The Illinois Insurance Code is amended by adding Section 370c.3 as follows:

(215 ILCS 5/370c.3 new)

Sec. 370c.3. Mandatory coverage for crisis services.

(a) All group and individual health insurance policies issued, delivered, amended, or renewed in Illinois that provide coverage for medical or surgical conditions shall also provide coverage for crisis services, regardless of any difference in billing codes used for such services.

(b) Coverage for crisis services may not be denied or restricted based on the modality or setting of the services. Crisis services shall be covered whether delivered in person, through telehealth, or in a residential or outpatient setting, to the extent that such services are covered in other settings or modalities under the policy.

(c) For the purposes of this Section, "crisis services" refers to any and all services defined under 89 Ill. Adm. Code 140.453(d)(3), including, but not limited to, the following:

(i) Crisis Intervention.

(ii) Mobile Crisis Response.

(iii) Crisis Stabilization.

Section 25. The Health Maintenance Organization Act is amended by changing Section 5-3 as follows:

(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)

Sec. 5-3. Insurance Code provisions.

(a) Health Maintenance Organizations shall be subject to the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 370c.3, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance Code.

(b) For purposes of the Illinois Insurance Code, except for Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health Maintenance Organizations in the following categories are deemed to be "domestic companies":

(1) a corporation authorized under the Dental Service Plan Act or the Voluntary Health Services Plans Act;

(2) a corporation organized under the laws of this State; or

(3) a corporation organized under the laws of another state, 30% or more of the enrollees of which are residents of this State, except a corporation subject to substantially the same requirements in its state of organization as is a "domestic company" under Article VIII 1/2 of the Illinois Insurance Code.

(c) In considering the merger, consolidation, or other acquisition of control of a Health Maintenance Organization pursuant to Article VIII 1/2 of the Illinois Insurance Code,

(1) the Director shall give primary consideration to the continuation of benefits to enrollees and the financial conditions of the acquired Health Maintenance Organization after the merger, consolidation, or other acquisition of control takes effect;

(2)(i) the criteria specified in subsection (1)(b) of Section 131.8 of the Illinois Insurance Code shall not apply and (ii) the Director, in making his determination with respect to the merger, consolidation, or other acquisition of control, need not take into account the effect on competition of the merger, consolidation, or other acquisition of control;

(3) the Director shall have the power to require the following information:

(A) certification by an independent actuary of the adequacy of the reserves of the Health Maintenance Organization sought to be acquired;

(B) pro forma financial statements reflecting the combined balance sheets of the acquiring company and the Health Maintenance Organization sought to be acquired as of the end of the preceding year and as of a date 90 days prior to the acquisition, as well as pro forma financial statements reflecting projected combined operation for a period of 2 years;

(C) a pro forma business plan detailing an acquiring party's plans with respect to the operation of the Health Maintenance Organization sought to be acquired for a period of not less than 3 years; and

(D) such other information as the Director shall require.

(d) The provisions of Article VIII 1/2 of the Illinois Insurance Code and this Section 5-3 shall apply to the sale by any health maintenance organization of greater than 10% of its enrollee population (including, without limitation, the health maintenance organization's right, title, and interest in and to its health care certificates).

(e) In considering any management contract or service agreement subject to Section 141.1 of the Illinois Insurance Code, the Director (i) shall, in addition to the criteria specified in Section 141.2 of the Illinois Insurance Code, take into account the effect of the management contract or service agreement on the continuation of benefits to enrollees and the financial condition of the health maintenance organization to be managed or serviced, and (ii) need not take into account the effect of the management contract or service agreement on competition.

(f) Except for small employer groups as defined in the Small Employer Rating, Renewability and Portability Health Insurance Act and except for medicare supplement policies as defined in Section 363 of the Illinois Insurance Code, a Health Maintenance Organization may by contract agree with a group or other enrollment unit to effect refunds or charge additional premiums under the following terms and conditions:

(i) the amount of, and other terms and conditions with respect to, the refund or additional premium are set forth in the group or enrollment unit contract agreed in advance of the period for which a refund is to be paid or additional premium is to be charged (which period shall not be less than one year); and

(ii) the amount of the refund or additional premium shall not exceed 20% of the Health Maintenance Organization's profitable or unprofitable experience with respect to the group or other enrollment unit for the period (and, for purposes of a refund or additional premium, the profitable or unprofitable experience shall be calculated taking into account a pro rata share of the Health Maintenance Organization's administrative and marketing expenses, but shall not include any refund to be made or additional premium to be paid pursuant to this subsection (f)). The Health Maintenance Organization and the group or enrollment unit may agree that the profitable or unprofitable experience may be calculated taking into account the refund period and the immediately preceding 2 plan years.

The Health Maintenance Organization shall include a statement in the evidence of coverage issued to each enrollee describing the possibility of a refund or additional premium, and upon request of any group or enrollment unit, provide to the group or enrollment unit a description of the method used to calculate (1) the Health Maintenance Organization's profitable experience with respect to the group or enrollment unit and the resulting refund to the group or enrollment unit or (2) the Health Maintenance Organization's unprofitable experience with respect to the group or enrollment unit and the resulting additional premium to be paid by the group or enrollment unit.

In no event shall the Illinois Health Maintenance Organization Guaranty Association be liable to pay any contractual obligation of an insolvent organization to pay any refund authorized under this Section.

(g) Rulemaking authority to implement Public Act 95-1045, if any, is conditioned on the rules being adopted in accordance with all provisions of the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules; any purported rule not so adopted, for whatever reason, is unauthorized.

(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)

Section 30. The Telehealth Act is amended by adding Section 20 as follows:

(225 ILCS 150/20 new)

Sec. 20. Behavioral health crisis services delivered via telehealth.

(a) Notwithstanding any existing regulation, to the fullest extent permitted by federal law, all crisis services listed under 89 Ill. Adm. Code 140.453(d)(3) of the Illinois Administrative Code shall be permitted to be delivered via telehealth where practical. This authorization shall apply to, at minimum, Crisis Intervention, Mobile Crisis Response (both Individual and Team), Crisis Stabilization, and Community Stabilization. The Department may elect to establish differential rates for telehealth services. The Department shall have rulemaking authority to implement this Section.

(b) To ensure services may be provided without administrative delay, no prior authorization or utilization management control requirement shall be placed on any crisis service delivered via telehealth under this Section.

Section 35. The Illinois Public Aid Code is amended by adding Section 5-65 as follows:

(305 ILCS 5/5-65 new)

Sec. 5-65. Reimbursement for crisis services.

(a) For the purposes of this Section, "crisis services" refers to any and all services defined under 89 Ill. Admin Code 140.453(d)(3), including, but not limited to, the following:

(1) Behavioral Health Hotline Services.

(2) Crisis Intervention.

(3) Mobile Crisis Response.

(4) Crisis Stabilization.

(5) 23-Hour Crisis Observation.

(6) Community Stabilization.

(7) Crisis Residential.

(8) Crisis Respite.

(b) Subject to federal approval and notwithstanding any other provision of this Code, for dates of service beginning on and after July 1, 2026, crisis services shall be covered and reimbursed under the medical assistance program for persons who are otherwise eligible for medical assistance under this Article.

(c) All crisis services listed under 89 Ill. Adm. Code 140.453(d)(3) of the Illinois Administrative Code shall be considered emergency services and shall not be subject to prior authorization or other utilization management controls.

(d) The Department shall, no later than July 1, 2026, ensure that all State-funded crisis services, including mobile crisis and crisis stabilization services, include reimbursement for services provided by Certified Recovery Support Specialists and other similar behavioral health professionals.

(e) The Department shall apply for any federal waiver or Title XIX State Plan amendment, if required, to implement this Section. The Department may adopt any rules, including standards and criteria, necessary to implement this Section.

Section 40. The Strengthening and Transforming Behavioral Health Crisis Care in Illinois Act is amended by changing Section 1 and by adding Section 35 as follows:

(405 ILCS 160/1)

Sec. 1. Short title. This Act may be cited as the Crisis Continuum Sustainability Strengthening and Transforming Behavioral Health Crisis Care in Illinois Act.

(Source: P.A. 103-337, eff. 7-28-23.)

(405 ILCS 160/35 new)

Sec. 35. Statewide Crisis Continuum Strategic Plan. On or before December 31, 2028, and every 5 years thereafter, the Department shall, subject to available funding and in collaboration with relevant stakeholders and state bodies, develop and submit a Statewide Crisis Continuum Strategic Plan to the Office of the Governor and the General Assembly, with the goal of ensuring every Illinoisan has timely access to appropriate and supportive behavioral health response during a behavioral health crisis. The strategic plan shall:

(1) identify statewide goals, key stakeholders, and performance metrics for expanding access to behavioral health crisis continuum services across Illinois;

(2) address gaps in service delivery, including geographic disparities in crisis intervention and access to services, and provide recommendations for addressing these gaps;

(3) present strategies for improving data collection, reporting, and analysis to better understand social and demographic factors contributing to suicide and crisis events in Illinois; and

(4) outline a sustainable funding framework to maintain and expand the 9-8-8 hotline and Illinois's crisis intervention infrastructure, including making recommendations for legislative or regulatory changes to streamline funding and reduce administrative burdens on providers and residents in need of services.