Rep. Lindsey LaPointe

Filed: 3/21/2023





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2    AMENDMENT NO. ______. Amend House Bill 2847 by replacing
3everything after the enacting clause with the following:
4    "Section 1. References to Act; purpose.
5    (a) References to Act. This Act may be referred to as the
6Mental Health Equity Access and Prevention Act.
7    (b) Purpose. This Act is intended to address Illinois'
8skyrocketing mental health needs for children, youth, and
9adults following the COVID-19 pandemic, cover preventive
10mental health care to address symptoms early, increase access
11to affordable care, and maximize the full mental health
13    Section 5. Findings. The General Assembly finds that:
14        (1) According to a recent U.S. Surgeon General's
15    Advisory on Protecting Youth Mental Health, the proportion
16    of high school students reporting persistent feelings of



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1    hopelessness and sadness increased by 40% between 2009 and
2    2019, and rates of depression and anxiety doubled during
3    the COVID-19 pandemic.
4        (2) Death by suicide is alarmingly high, particularly
5    among Black children. Black children under 13 are now
6    nearly twice as likely to die by suicide than White
7    children.
8        (3) According to a bipartisan United States Senate
9    Finance Committee report on Mental Health Care in the
10    United States, symptoms for depression and anxiety in
11    adults increased nearly fourfold during the COVID-19
12    pandemic.
13        (4) At the same time of unprecedented demand for
14    treatment and support, the mental health workforce crisis
15    is causing severe mental health care access challenges.
16        (5) Private insurance does not cover preventive mental
17    health care. Preventive mental health care can address
18    mental health issues before symptoms worsen or before a
19    mental health crisis occurs.
20        (6) Commercial insurance networks that include mental
21    health providers are severely restrictive, meaning a small
22    percentage of the mental health workforce is contracted as
23    in-network providers. This forces individuals and patients
24    to seek costly treatment through out-of-network care.
25        (7) The cost of mental health treatment is
26    inaccessible and unaffordable for many Illinoisans for



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1    these reasons.
2        (8) A recent Milliman research report that analyzed
3    insurance claims for 37 million Americans, including
4    Illinois residents, found major disparities in insurance
5    contracting with in-network mental health providers and
6    contracting with medical/surgical providers. The report's
7    findings include the following:
8            (A) Illinois out-of-network mental health
9        utilization was 18.2% for outpatient services in 2017
10        compared to just 3.9% for medical/surgical services.
11            (B) Illinois out-of-network mental health
12        utilization was 12.1% in 2017 for inpatient care
13        compared to just 2.8% for medical/surgical services.
14            (C) The disparity between out-of-network usage for
15        mental health compared to medical/surgical services
16        grew significantly between 2013 and 2017:
17        out-of-network mental health utilization for
18        outpatient visits grew by 44% while out-of-network
19        utilization for medical/surgical services decreased by
20        42% over the same period in Illinois.
21            (D) Nearly 14% of mental health office visits for
22        individuals with a PPO plan were out-of-network in
23        Illinois.
24        (9) According to a report in JAMA Psychiatry, 26% of
25    psychiatrists see patients who do not use their insurance
26    to pay for their visit because it is an out-of-network



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1    visit; according to a 2015 American Psychological
2    Association Survey of Psychology Health Service Providers,
3    21% of psychologists report that most of their patients
4    pay out-of-pocket because their visit is out-of-network.
5        (10) Illinois must maximize its full mental health
6    workforce to address the mental health crisis the state is
7    experiencing post-COVID-19 and improve access to
8    affordable, timely care.
9    Section 10. The Department of Public Health Powers and
10Duties Law of the Civil Administrative Code of Illinois is
11amended by adding Section 2310-720 as follows:
12    (20 ILCS 2310/2310-720 new)
13    Sec. 2310-720. Public educational effort on mental health
14and wellness. Subject to appropriation, the Department shall
15undertake a public educational campaign to bring broad public
16awareness to communities across this State on the importance
17of mental health and wellness, including the expanded coverage
18of mental health treatment, and consistent with the
19recommendations of the Illinois Children's Mental Health
20Partnership's Children's Mental Health Plan of 2022 and Public
21Act 102-899. The Department shall look to other successful
22public educational campaigns to guide this effort, such as the
23public educational campaign related to Get Covered Illinois.
24Additionally, the Department shall work with the Department of



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1Insurance, the Illinois State Board of Education, the
2Department of Human Services, the Department of Healthcare and
3Family Services, the Department of Juvenile Justice, the
4Department of Children and Family Services, and other State
5agencies as necessary to promote consistency in messaging and
6distribution methods between this campaign and other
7concurrent public educational campaigns related to mental
8health and mental wellness. Public messaging for this campaign
9shall be simple, easy to understand, and shall include
10culturally competent messaging for different communities and
11regions throughout this State.
12    Section 15. The Illinois Insurance Code is amended by
13adding Sections 356z.61 and 356z.62 as follows:
14    (215 ILCS 5/356z.61 new)
15    Sec. 356z.61. Coverage of out-of-network mental health
17    (a) As used in this Section:
18    "Grandfathered health plan" has the meaning given to that
19term in 42 U.S.C. 18011.
20    "Individual market" has the meaning given to that term in
21Section 5 of the Illinois Health Insurance Portability and
22Accountability Act. "Individual market" includes student
23health insurance coverage.
24    "Large group market" has the meaning given to that term in



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1Section 5 of the Illinois Health Insurance Portability and
2Accountability Act.
3    "Market" means the individual, small group, or large group
4market. "Market" includes grandfathered and transitional
5health plans pertaining to the policyholder to which the plan
6is issued or renewed.
7    "Network plan" has the meaning given to that term in
8Section 5 of the Network Adequacy and Transparency Act.
9    "Small group market" has the meaning given to that term in
10Section 5 of the Illinois Health Insurance Portability and
11Accountability Act.
12    "Student health insurance coverage" has the meaning given
13to that term in 45 CFR 147.145.
14    "Transitional health plan" means a plan subject to the
15limited non-enforcement policy regarding the federal Patient
16Protection and Affordable Care Act for certain
17non-grandfathered health plans in the individual and small
18group markets that the federal Centers for Medicare and
19Medicaid Services announced in a letter to state insurance
20commissioners, dated November 14, 2013, to the extent that the
21limited non-enforcement policy has been renewed annually by
22the federal Centers for Medicare and Medicaid Services and
23ratified by the Department.
24    (b) Notwithstanding the provisions of the Network Adequacy
25and Transparency Act, a group or individual policy of accident
26and health insurance or a managed care plan that is amended,



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1delivered, issued, or renewed on or after January 1, 2025
2shall cover all medically necessary out-of-network mental
3health visits, including prevention and wellness visits,
4mental health treatment, and mental health services provided
5by a mental health provider or facility.
6    (c) For purposes of insured cost sharing, the insured
7shall pay no more for the out-of-network services and visits
8than the insured would have paid for in-network services and
10    (d) No action shall be required by the insured to use
11out-of-network mental health services covered pursuant to this
12Section. The insured has the right to select the provider of
13their choice and the modality, in-person visit or telehealth,
14for medically necessary care.
15    (e) The insurer shall reimburse the out-of-network mental
16health provider or facility at the provider's usual and
17customary charges for out-of-network medically necessary
18patient care.
19    (f) This Section shall apply to each market in which the
20insurer offers or provides any network plan until the
21insurer's network plans in that market reduce by 50% the
22annual disparity between out-of-network mental health
23utilization and out-of-network medical/surgical utilization
24for both outpatient mental health visits and inpatient mental
25health visits from the Base Year by increasing the number of
26in-network mental health providers and facilities. Outpatient



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1mental health visits and inpatient mental health visits shall
2be measured separately. The Base Year shall be calendar year
32022 for purposes of measuring the disparity against future
4years. The Department may require an insurer to file
5utilization data to establish the disparity level in a market
6for the Base Year as needed. If and only if an insurer did not
7have network plans in a market in this State in 2022, the
8Department shall allow an insurer entering that market to use
9alternative data to establish a Base Year to simulate 2022
10utilization, subject to the Department's approval of the
11sources of data. An insurer's network plans in a market are
12exempt from this Section for inpatient care or outpatient
13care, or both, once the 50% reduction in the disparity between
14mental health and medical/surgical out-of-network utilization
15is met. The exemption does not extend to the annual filing
16requirement under subsection (g).
17    (g) An insurer shall file annually the metrics established
18in this Section for each market in which the insurer issued or
19renewed any network plan during the preceding calendar year.
20An insurer may request a review from the Department, and the
21Department shall undertake such a review, in any given year if
22the insurer believes it has reduced the disparity described in
23this Section for inpatient or outpatient care, or both, by the
24end of the preceding calendar year for one or more markets to
25qualify for an exemption. If the Department determines that
26the insurer has not reduced the disparity, the insurer may not



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1request another exemption review for 3 years. If an insurer
2becomes exempt from this Section for a market in a given year
3but fails to maintain the 50% reduction in the disparity
4between mental health and medical/surgical out-of-network
5utilization in a future calendar year based on a Department
6review, the exemption lapses for the following plan year. An
7insurer may not submit a request to reinstate a lapsed
8exemption at least until the second calendar year after the
9year the lapse takes effect. Plan beneficiaries shall be
10notified at least 60 days before renewal when there will be any
11change in benefit coverage based on an exemption or lapse of
13    (h) The Department shall adopt any rules necessary to
14implement this Section by no later than October 31, 2024.
15    (i) This Section is subject to appropriation to the
16Department of Insurance.
17    (215 ILCS 5/356z.62 new)
18    Sec. 356z.62. Coverage of no-cost mental health prevention
19and wellness visits.
20    (a) A group or individual policy of accident and health
21insurance or managed care plan that is amended, delivered,
22issued, or renewed on or after January 1, 2025 shall provide
23coverage for 2 annual mental health prevention and wellness
24visits for children and for adults.
25    (b) Mental health prevention and wellness visits shall



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1include any age-appropriate screening recommended by the
2United States Preventive Services Task Force or by the
3American Academy of Pediatrics' Bright Futures: Guidelines for
4Health Supervision of Infants, Children, and Adolescents for
5purposes of identifying a mental health issue, condition, or
6disorder; discussing mental health symptoms that might be
7present, including symptoms of a previously diagnosed mental
8health condition or disorder; performing an evaluation of
9adverse childhood experiences; and discussing mental health
10and wellness.
11    (c) A mental health prevention and wellness visit shall be
12covered for up to 60 minutes and may be performed by a
13physician licensed to practice medicine in all of its
14branches, a licensed clinical psychologist, a licensed
15clinical social worker, a licensed clinical professional
16counselor, a licensed marriage and family therapist, a
17licensed social worker, or a licensed professional counselor.
18    (d) A policy subject to this Section shall not impose a
19deductible, coinsurance, copayment, or other cost-sharing
20requirement for mental health and wellness visits, and no
21prior authorization shall be required for the visits. The
22cost-sharing prohibition in this subsection (d) does not apply
23to coverage of mental health prevention and wellness visits to
24the extent such coverage would disqualify a high-deductible
25health plan from eligibility from a health savings account
26pursuant to Section 223 of the Internal Revenue Code.



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1    (e) A mental health prevention and wellness visit shall
2not replace a Well Child visit or a general health or medical
4    (f) A mental health prevention and wellness visit shall be
5reimbursed through the following American Medical Association
6current procedural terminology codes and at the same rate that
7current procedural terminology codes are reimbursed for the
8provision of other medical care: 99381-99387 and 99391-99397.
9    (g) Reimbursement of any of the current procedural
10terminology codes listed in this Section shall comply with the
12        (1) Reimbursement may be adjusted for payment of
13    claims that are billed by a nonphysician clinician so long
14    as the methodology to determine the adjustments are
15    comparable to and applied no more stringently than the
16    methodology for adjustments made for reimbursement of
17    claims billed by nonphysician clinicians for other medical
18    care, in accordance with 45 CFR 146.136(c)(4);
19        (2) for the purpose of covering a mental health
20    prevention and wellness visit, reimbursement shall not be
21    denied because the code was already reimbursed for the
22    purpose of covering a service other than such visit;
23        (3) for the purpose of covering a service other than a
24    mental health prevention and wellness visit, reimbursement
25    shall not be denied because the code was already
26    reimbursed for the purpose of covering a mental health



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1    prevention and wellness visit; and
2        (4) for a mental health prevention and wellness visit
3    and for a service other than a mental health prevention
4    and wellness visit, reimbursement shall not be denied if
5    they occur on the same date by the same provider and the
6    provider is a primary care provider.
7    (i) The Department shall adopt any rules necessary to
8implement this Section by no later than October 31, 2024.
9    Section 99. Effective date. This Act takes effect July 1,