Full Text of HB0122 101st General Assembly
HB0122ham001 101ST GENERAL ASSEMBLY | Rep. Yehiel M. Kalish Filed: 3/19/2019
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| 1 | | AMENDMENT TO HOUSE BILL 122
| 2 | | AMENDMENT NO. ______. Amend House Bill 122 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Substance Use Disorder Act is amended by | 5 | | adding Article 7 as follows: | 6 | | (20 ILCS 301/Art. 7 heading new) | 7 | | ARTICLE 7. BEHAVIORAL HEALTH ACCESS TO CARE OMBUDSMAN | 8 | | (20 ILCS 301/7-5 new) | 9 | | Sec. 7-5. Definitions. As used in this Article: | 10 | | (a) "Health care provider" or "provider" means: | 11 | | (1) a physician licensed under the Medical Practice Act | 12 | | of 1987 to practice medicine in all of its branches; a | 13 | | clinical psychologist licensed under the Clinical | 14 | | Psychologist Licensing Act; | 15 | | (2) a mental health professional who is licensed or |
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| 1 | | registered to provide mental health services by the | 2 | | Department of Financial and Professional Regulation; | 3 | | (3) any other health care provider regulated by the | 4 | | State when engaged in assisting consumers with behavioral | 5 | | health care access and coverage issues; or | 6 | | (4) a health care facility licensed or regulated by the | 7 | | State, when the facility is engaged in assisting consumers | 8 | | with behavioral health care access and coverage issues. | 9 | | (b) "Office" means the Office of the Ombudsman for | 10 | | Behavioral Health Access to Care created in Section 7-10. | 11 | | (c) "Ombudsman" means the individual designated under | 12 | | Section 7-10 as the Ombudsman for Behavioral Health Access to | 13 | | Care. | 14 | | (20 ILCS 301/7-10 new) | 15 | | Sec. 7-10. Office of the Ombudsman for Behavioral Health | 16 | | Access to Care; appointment; duties. | 17 | | (a) There is created in the Department of Human Services | 18 | | the Office of the Ombudsman for Behavioral Health Access to | 19 | | Care for the purpose of assisting residents of Illinois in | 20 | | accessing behavioral health care. | 21 | | (b) The Office and the Department shall operate in | 22 | | accordance with a memorandum of understanding between the 2 | 23 | | entities. The memorandum of understanding shall contain, at a | 24 | | minimum: | 25 | | (1) a requirement that the Office has its own personnel |
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| 1 | | rules; | 2 | | (2) a requirement that the Ombudsman has independent | 3 | | hiring and termination authority over Office employees; | 4 | | (3) a requirement that the Office must follow State | 5 | | fiscal rules; | 6 | | (4) a requirement that the Department of Human | 7 | | Services' Division of Mental Health shall offer the Office | 8 | | limited support with respect to: | 9 | | (A) personnel matters; | 10 | | (B) recruitment; | 11 | | (C) payroll; | 12 | | (D) benefits; | 13 | | (E) budget submission, as needed; | 14 | | (F) accounting; | 15 | | (G) office space, facilities, and technical | 16 | | support; and | 17 | | (H) other provisions regarding administrative | 18 | | support that will help maintain the independence of the | 19 | | Office. | 20 | | (c) The Office shall operate with full independence and has | 21 | | complete autonomy, control, and authority over operations, | 22 | | budget, and personnel decisions related to the Office and the | 23 | | Ombudsman. | 24 | | (d) By November 1, 2019, the Governor shall designate an | 25 | | Ombudsman for Behavioral Health Access to Care, who shall serve | 26 | | as Director of the Office. The Ombudsman shall serve as a |
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| 1 | | neutral party to help consumers, including consumers who are | 2 | | uninsured or have public or private health benefit coverage, | 3 | | including coverage that is not subject to State regulation, and | 4 | | health care providers, acting on their own behalf, on behalf of | 5 | | a consumer with the consumer's written permission, or on behalf | 6 | | of a group of health care providers, navigate and resolve | 7 | | issues related to consumer access to behavioral health care, | 8 | | including care for mental health conditions and substance use | 9 | | disorders. | 10 | | (e) The Ombudsman shall: | 11 | | (1) interact with consumers and health care providers | 12 | | with concerns or complaints to help the consumers and | 13 | | providers resolve behavioral health care access and | 14 | | coverage issues; | 15 | | (2) identify, track, and report to the appropriate | 16 | | regulatory or oversight agency concerns, complaints, and | 17 | | potential violations of State or federal rules, | 18 | | regulations, or statutes concerning the availability of, | 19 | | and terms and conditions of, benefits for mental health | 20 | | conditions or substance use disorders, including potential | 21 | | violations related to quantitative and non-quantitative | 22 | | treatment limitations; | 23 | | (3) receive and assist consumers and providers in | 24 | | reporting concerns and filing complaints with appropriate | 25 | | regulatory or oversight agencies relating to inappropriate | 26 | | care or involuntary admissions or judicial admissions |
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| 1 | | under the Mental Health and Developmental Disabilities | 2 | | Code; | 3 | | (4) provide appropriate information to help consumers | 4 | | obtain behavioral health care; | 5 | | (5) develop appropriate points of contact for | 6 | | referrals to other State and federal agencies; and | 7 | | (6) provide appropriate information to help consumers | 8 | | or health care providers file appeals or complaints with | 9 | | the appropriate entities, including insurers and other | 10 | | State and federal agencies. | 11 | | (f) The Ombudsman, employees of the Office, and any persons | 12 | | acting on behalf of the Office shall comply with all State and | 13 | | federal confidentiality laws that govern the Department of | 14 | | Human Services with respect to the treatment of confidential | 15 | | information or records and the disclosure of such information | 16 | | and records. | 17 | | (g) In the performance of his or her duties, the Ombudsman | 18 | | shall act independently of the Department of Human Services' | 19 | | Division of Mental Health. Any recommendations made or | 20 | | positions taken by the Ombudsman do not reflect those of the | 21 | | Department of Human Services or the Division of Mental Health. | 22 | | (20 ILCS 301/7-15 new) | 23 | | Sec. 7-15. Liaisons. The Director of Insurance and the | 24 | | Secretary of Human Services shall each appoint a liaison to the | 25 | | Ombudsman to receive reports of concerns, complaints, and |
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| 1 | | potential violations described in paragraph (2) of subsection | 2 | | (e) of Section 7-10 from the Ombudsman, consumers, or health | 3 | | care providers. | 4 | | (20 ILCS 301/7-20 new) | 5 | | Sec. 7-20. Qualified immunity. The Ombudsman and employees | 6 | | or persons acting on behalf of the Office are immune from suit | 7 | | and liability, either personally or in their official | 8 | | capacities, for any claim for damage to or loss of property, or | 9 | | for personal injury or other civil liability caused by or | 10 | | arising out of any actual or alleged act, error, or omission | 11 | | that occurred within the scope of employment, duties, or | 12 | | responsibilities pertaining to the Office, including issuing | 13 | | reports or recommendations; except that nothing in this Section | 14 | | protects those persons from suit or liability for damage, loss, | 15 | | injury, or liability caused by the intentional or willful and | 16 | | wanton misconduct of the person. | 17 | | (20 ILCS 301/7-25 new) | 18 | | Sec. 7-25. Annual report. | 19 | | (a) On or before September 1, 2021, and on or before | 20 | | September 1 of each year thereafter, the Ombudsman shall | 21 | | prepare and submit, in accordance with subsection (b), a | 22 | | written report that includes information from the preceding | 23 | | fiscal year concerning actions taken by the Ombudsman relating | 24 | | to the duties of the Office set forth in Section 7-10. |
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| 1 | | (b) The Ombudsman shall submit the report required by this | 2 | | Section to the Governor, the Secretary of Human Services, the | 3 | | Director of Insurance, the Senate Human Services Committee or | 4 | | any successor committee, and the House Committees on Human | 5 | | Services, Insurance, Energy & Environment, and Mental Health or | 6 | | any successor committees. | 7 | | (c) The Ombudsman shall post the annual report on the | 8 | | Department of Human Services' website. | 9 | | (d) The Ombudsman shall not include in the report required | 10 | | by this Section any personally identifying information about an | 11 | | individual consumer or health care provider or identifying | 12 | | information about a health care facility licensed by the State | 13 | | or an emergency medical services system as defined in Section | 14 | | 3.20 of the Emergency Medical Services (EMS) Systems Act.
| 15 | | Section 10. The Illinois Insurance Code is amended by | 16 | | adding Section 370c.2 as follows: | 17 | | (215 ILCS 5/370c.2 new) | 18 | | Sec. 370c.2. Parity reporting. | 19 | | (a) By March 1, 2020, and every other March 1 thereafter, | 20 | | the Director shall submit a written report and provide a | 21 | | presentation of the report to the General Assembly that: | 22 | | (1) specifies the methodology the Director uses to | 23 | | verify that insurance carriers are complying with Section | 24 | | 370c and rules adopted under that Section and with the |
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| 1 | | federal Paul Wellstone and Pete Domenici Mental Health | 2 | | Parity and Addiction Equity Act of 2008, Public Law | 3 | | 110-343, as amended, any regulations adopted in accordance | 4 | | with that Act, or guidance related to compliance with and | 5 | | oversight of that Act; | 6 | | (2) identifies market conduct examinations initiated, | 7 | | conducted, or completed during the preceding 12 months | 8 | | regarding compliance with Section 370c and rules adopted | 9 | | under that Section and with the Paul Wellstone and Pete | 10 | | Domenici Mental Health Parity and Addiction Equity Act of | 11 | | 2008 and regulations adopted under that Act and summarizes | 12 | | the outcomes of those market conduct examinations; and | 13 | | (3) details any educational or corrective actions the | 14 | | Director has taken to ensure insurance carrier compliance | 15 | | with Section 370c and rules adopted under that Section and | 16 | | with the Paul Wellstone and Pete Domenici Mental Health | 17 | | Parity and Addiction Equity Act of 2008 and regulations | 18 | | adopted under that Act. | 19 | | (b) The Director shall ensure that the report is written in | 20 | | plain language and is made available to the public by, at a | 21 | | minimum, posting the report on the Department's website. | 22 | | Section 99. Effective date. This Act takes effect upon | 23 | | becoming law.".
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