Full Text of HB0059 94th General Assembly
HB0059 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 HB0059
Introduced 1/6/2005, by Rep. Lou Lang SYNOPSIS AS INTRODUCED: |
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215 ILCS 5/370c |
from Ch. 73, par. 982c |
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Amends the Illinois Insurance Code. In provisions requiring an insurer that provides coverage for hospital or medical
expenses under a group policy of accident and health insurance or
health care plan to provide coverage
under the policy for treatment of serious mental illness under the same terms
and conditions as coverage for hospital or medical expenses related to other
illnesses and diseases (commonly referred to as "mental health parity"), eliminates the December 31, 2005 sunset date that applies to those provisions. Effective immediately.
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A BILL FOR
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HB0059 |
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LRB094 02525 DRJ 32526 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 370c as follows:
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| (215 ILCS 5/370c) (from Ch. 73, par. 982c)
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| Sec. 370c. Mental and emotional disorders.
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| (a) (1) On and after the effective date of this Section,
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| every insurer which delivers, issues for delivery or renews or | 10 |
| modifies
group A&H policies providing coverage for hospital or | 11 |
| medical treatment or
services for illness on an | 12 |
| expense-incurred basis shall offer to the
applicant or group | 13 |
| policyholder subject to the insurers standards of
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| insurability, coverage for reasonable and necessary treatment | 15 |
| and services
for mental, emotional or nervous disorders or | 16 |
| conditions, other than serious
mental illnesses as defined in | 17 |
| item (2) of subsection (b), up to the limits
provided in the | 18 |
| policy for other disorders or conditions, except (i) the
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| insured may be required to pay up to 50% of expenses incurred | 20 |
| as a result
of the treatment or services, and (ii) the annual | 21 |
| benefit limit may be
limited to the lesser of $10,000 or 25% of | 22 |
| the lifetime policy limit.
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| (2) Each insured that is covered for mental, emotional or | 24 |
| nervous
disorders or conditions shall be free to select the | 25 |
| physician licensed to
practice medicine in all its branches, | 26 |
| licensed clinical psychologist,
licensed clinical social | 27 |
| worker, or licensed clinical professional counselor of
his | 28 |
| choice to treat such disorders, and
the insurer shall pay the | 29 |
| covered charges of such physician licensed to
practice medicine | 30 |
| in all its branches, licensed clinical psychologist,
licensed | 31 |
| clinical social worker, or licensed clinical professional | 32 |
| counselor up
to the limits of coverage, provided (i)
the |
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HB0059 |
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LRB094 02525 DRJ 32526 b |
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| disorder or condition treated is covered by the policy, and | 2 |
| (ii) the
physician, licensed psychologist, licensed clinical | 3 |
| social worker, or licensed
clinical professional counselor is
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| authorized to provide said services under the statutes of this | 5 |
| State and in
accordance with accepted principles of his | 6 |
| profession.
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| (3) Insofar as this Section applies solely to licensed | 8 |
| clinical social
workers and licensed clinical professional | 9 |
| counselors, those persons who may
provide services to | 10 |
| individuals shall do so
after the licensed clinical social | 11 |
| worker or licensed clinical professional
counselor has | 12 |
| informed the patient of the
desirability of the patient | 13 |
| conferring with the patient's primary care
physician and the | 14 |
| licensed clinical social worker or licensed clinical
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| professional counselor has
provided written
notification to | 16 |
| the patient's primary care physician, if any, that services
are | 17 |
| being provided to the patient. That notification may, however, | 18 |
| be
waived by the patient on a written form. Those forms shall | 19 |
| be retained by
the licensed clinical social worker or licensed | 20 |
| clinical professional counselor
for a period of not less than 5 | 21 |
| years.
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| (b) (1) An insurer that provides coverage for hospital or | 23 |
| medical
expenses under a group policy of accident and health | 24 |
| insurance or
health care plan amended, delivered, issued, or | 25 |
| renewed after the effective
date of this amendatory Act of the | 26 |
| 92nd General Assembly shall provide coverage
under the policy | 27 |
| for treatment of serious mental illness under the same terms
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| and conditions as coverage for hospital or medical expenses | 29 |
| related to other
illnesses and diseases. The coverage required | 30 |
| under this Section must provide
for same durational limits, | 31 |
| amount limits, deductibles, and co-insurance
requirements for | 32 |
| serious mental illness as are provided for other illnesses
and | 33 |
| diseases. This subsection does not apply to coverage provided | 34 |
| to
employees by employers who have 50 or fewer employees.
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| (2) "Serious mental illness" means the following | 36 |
| psychiatric illnesses as
defined in the most current edition of |
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LRB094 02525 DRJ 32526 b |
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| the Diagnostic and Statistical Manual
(DSM) published by the | 2 |
| American Psychiatric Association:
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| (A) schizophrenia;
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| (B) paranoid and other psychotic disorders;
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| (C) bipolar disorders (hypomanic, manic, depressive, | 6 |
| and mixed);
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| (D) major depressive disorders (single episode or | 8 |
| recurrent);
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| (E) schizoaffective disorders (bipolar or depressive);
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| (F) pervasive developmental disorders;
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| (G) obsessive-compulsive disorders;
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| (H) depression in childhood and adolescence; and
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| (I) panic disorder.
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| (3) Upon request of the reimbursing insurer, a provider of | 15 |
| treatment of
serious mental illness shall furnish medical | 16 |
| records or other necessary data
that substantiate that initial | 17 |
| or continued treatment is at all times medically
necessary. An | 18 |
| insurer shall provide a mechanism for the timely review by a
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| provider holding the same license and practicing in the same | 20 |
| specialty as the
patient's provider, who is unaffiliated with | 21 |
| the insurer, jointly selected by
the patient (or the patient's | 22 |
| next of kin or legal representative if the
patient is unable to | 23 |
| act for himself or herself), the patient's provider, and
the | 24 |
| insurer in the event of a dispute between the insurer and | 25 |
| patient's
provider regarding the medical necessity of a | 26 |
| treatment proposed by a patient's
provider. If the reviewing | 27 |
| provider determines the treatment to be medically
necessary, | 28 |
| the insurer shall provide reimbursement for the treatment. | 29 |
| Future
contractual or employment actions by the insurer | 30 |
| regarding the patient's
provider may not be based on the | 31 |
| provider's participation in this procedure.
Nothing prevents
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| the insured from agreeing in writing to continue treatment at | 33 |
| his or her
expense. When making a determination of the medical | 34 |
| necessity for a treatment
modality for serous mental illness, | 35 |
| an insurer must make the determination in a
manner that is | 36 |
| consistent with the manner used to make that determination with
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| respect to other diseases or illnesses covered under the | 2 |
| policy, including an
appeals process.
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| (4) A group health benefit plan:
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| (A) shall provide coverage based upon medical | 5 |
| necessity for the following
treatment of mental illness in | 6 |
| each calendar year;
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| (i) 45 days of inpatient treatment; and
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| (ii) 35 visits for outpatient treatment including | 9 |
| group and individual
outpatient treatment;
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| (B) may not include a lifetime limit on the number of | 11 |
| days of inpatient
treatment or the number of outpatient | 12 |
| visits covered under the plan; and
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| (C) shall include the same amount limits, deductibles, | 14 |
| copayments, and
coinsurance factors for serious mental | 15 |
| illness as for physical illness.
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| (5) An issuer of a group health benefit plan may not count | 17 |
| toward the number
of outpatient visits required to be covered | 18 |
| under this Section an outpatient
visit for the purpose of | 19 |
| medication management and shall cover the outpatient
visits | 20 |
| under the same terms and conditions as it covers outpatient | 21 |
| visits for
the treatment of physical illness.
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| (6) An issuer of a group health benefit
plan may provide or | 23 |
| offer coverage required under this Section through a
managed | 24 |
| care plan.
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| (7) This Section shall not be interpreted to require a | 26 |
| group health benefit
plan to provide coverage for treatment of:
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| (A) an addiction to a controlled substance or cannabis | 28 |
| that is used in
violation of law; or
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| (B) mental illness resulting from the use of a | 30 |
| controlled substance or
cannabis in violation of law.
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| (8) (Blank).
This subsection (b) is inoperative after | 32 |
| December 31, 2005.
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| (Source: P.A. 92-182, eff. 7-27-01; 92-185, eff. 1-1-02; | 34 |
| 92-651, eff.
7-11-02.)
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| Section 99. Effective date. This Act takes effect upon |
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LRB094 02525 DRJ 32526 b |
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| becoming law.
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