Illinois General Assembly - Full Text of SB2085
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Full Text of SB2085  101st General Assembly




SB2085 EnrolledLRB101 08661 RAB 53745 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Insurance Code is amended by adding
5Section 356z.33 as follows:
6    (215 ILCS 5/356z.33 new)
7    Sec. 356z.33. Coverage of the psychiatric Collaborative
8Care Model.
9    (a) As used in this Section, "psychiatric Collaborative
10Care Model" means the evidence-based, integrated behavioral
11health service delivery method, which includes a formal
12collaborative arrangement among a primary care team consisting
13of a primary care provider, a care manager, and a psychiatric
14consultant, and includes, but is not limited to, the following
16        (1) care directed by the primary care team;
17        (2) structured care management;
18        (3) regular assessments of clinical status using
19    validated tools; and
20        (4) modification of treatment as appropriate.
21    (b) An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed on or after
23the effective date of this amendatory Act of the 101st General



SB2085 Enrolled- 2 -LRB101 08661 RAB 53745 b

1Assembly or managed care organization that provides mental
2health benefits shall provide reimbursement for benefits that
3are delivered through the psychiatric Collaborative Care
4Model. The following American Medical Association 2018 current
5procedural terminology codes and Healthcare Common Procedure
6Coding System code shall be used to bill for benefits delivered
7through the psychiatric Collaborative Care Model:
8        (1) 99492;
9        (2) 99493;
10        (3) 99494; and
11        (4) G0512.
12    (c) The Director of Insurance shall update the billing
13codes in subsection (b) if there are any alterations or
14additions to the billing codes for the psychiatric
15Collaborative Care Model.
16    (d) An individual or group policy or managed care
17organization that provides benefits under this Section may deny
18reimbursement of any billing code listed in this Section on the
19grounds of medical necessity if such medical necessity
20determinations are in compliance with the Paul Wellstone and
21Pete Domenici Mental Health Parity and Addiction Equity Act of
222008 and its implementing and related regulations and that such
23determinations are made in accordance with the utilization
24review requirements under Section 85 of the Managed Care Reform
25and Patient Rights Act.



SB2085 Enrolled- 3 -LRB101 08661 RAB 53745 b

1    Section 10. The Illinois Public Aid Code is amended by
2changing Section 5-16.8 as follows:
3    (305 ILCS 5/5-16.8)
4    Sec. 5-16.8. Required health benefits. The medical
5assistance program shall (i) provide the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
9356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code
10and (ii) be subject to the provisions of Sections 356z.19,
11364.01, 370c, and 370c.1 of the Illinois Insurance Code.
12    On and after July 1, 2012, the Department shall reduce any
13rate of reimbursement for services or other payments or alter
14any methodologies authorized by this Code to reduce any rate of
15reimbursement for services or other payments in accordance with
16Section 5-5e.
17    To ensure full access to the benefits set forth in this
18Section, on and after January 1, 2016, the Department shall
19ensure that provider and hospital reimbursement for
20post-mastectomy care benefits required under this Section are
21no lower than the Medicare reimbursement rate.
22(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
2399-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
248-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised



SB2085 Enrolled- 4 -LRB101 08661 RAB 53745 b

1    Section 99. Effective date. This Act takes effect January
21, 2020.