Full Text of SB1568 103rd General Assembly
SB1568sam002 103RD GENERAL ASSEMBLY | Sen. Julie A. Morrison Filed: 3/21/2023
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| 1 | | AMENDMENT TO SENATE BILL 1568
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1568, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Insurance Code is amended by | 6 | | changing Section 370c.1 as follows: | 7 | | (215 ILCS 5/370c.1) | 8 | | Sec. 370c.1. Mental, emotional, nervous, or substance use | 9 | | disorder or condition parity. | 10 | | (a) On and after July 23, 2021 (the effective date of | 11 | | Public Act 102-135), every insurer that amends, delivers, | 12 | | issues, or renews a group or individual policy of accident and | 13 | | health insurance or a qualified health plan offered through | 14 | | the Health Insurance Marketplace in this State providing | 15 | | coverage for hospital or medical treatment and for the | 16 | | treatment of mental, emotional, nervous, or substance use |
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| 1 | | disorders or conditions shall ensure prior to policy issuance | 2 | | that: | 3 | | (1) the financial requirements applicable to such | 4 | | mental, emotional, nervous, or substance use disorder or | 5 | | condition benefits are no more restrictive than the | 6 | | predominant financial requirements applied to | 7 | | substantially all hospital and medical benefits covered by | 8 | | the policy and that there are no separate cost-sharing | 9 | | requirements that are applicable only with respect to | 10 | | mental, emotional, nervous, or substance use disorder or | 11 | | condition benefits; and | 12 | | (2) the treatment limitations applicable to such | 13 | | mental, emotional, nervous, or substance use disorder or | 14 | | condition benefits are no more restrictive than the | 15 | | predominant treatment limitations applied to substantially | 16 | | all hospital and medical benefits covered by the policy | 17 | | and that there are no separate treatment limitations that | 18 | | are applicable only with respect to mental, emotional, | 19 | | nervous, or substance use disorder or condition benefits. | 20 | | (b) The following provisions shall apply concerning | 21 | | aggregate lifetime limits: | 22 | | (1) In the case of a group or individual policy of | 23 | | accident and health insurance or a qualified health plan | 24 | | offered through the Health Insurance Marketplace amended, | 25 | | delivered, issued, or renewed in this State on or after | 26 | | September 9, 2015 (the effective date of Public Act |
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| 1 | | 99-480) that provides coverage for hospital or medical | 2 | | treatment and for the treatment of mental, emotional, | 3 | | nervous, or substance use disorders or conditions the | 4 | | following provisions shall apply: | 5 | | (A) if the policy does not include an aggregate | 6 | | lifetime limit on substantially all hospital and | 7 | | medical benefits, then the policy may not impose any | 8 | | aggregate lifetime limit on mental, emotional, | 9 | | nervous, or substance use disorder or condition | 10 | | benefits; or | 11 | | (B) if the policy includes an aggregate lifetime | 12 | | limit on substantially all hospital and medical | 13 | | benefits (in this subsection referred to as the | 14 | | "applicable lifetime limit"), then the policy shall | 15 | | either: | 16 | | (i) apply the applicable lifetime limit both | 17 | | to the hospital and medical benefits to which it | 18 | | otherwise would apply and to mental, emotional, | 19 | | nervous, or substance use disorder or condition | 20 | | benefits and not distinguish in the application of | 21 | | the limit between the hospital and medical | 22 | | benefits and mental, emotional, nervous, or | 23 | | substance use disorder or condition benefits; or | 24 | | (ii) not include any aggregate lifetime limit | 25 | | on mental, emotional, nervous, or substance use | 26 | | disorder or condition benefits that is less than |
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| 1 | | the applicable lifetime limit. | 2 | | (2) In the case of a policy that is not described in | 3 | | paragraph (1) of subsection (b) of this Section and that | 4 | | includes no or different aggregate lifetime limits on | 5 | | different categories of hospital and medical benefits, the | 6 | | Director shall establish rules under which subparagraph | 7 | | (B) of paragraph (1) of subsection (b) of this Section is | 8 | | applied to such policy with respect to mental, emotional, | 9 | | nervous, or substance use disorder or condition benefits | 10 | | by substituting for the applicable lifetime limit an | 11 | | average aggregate lifetime limit that is computed taking | 12 | | into account the weighted average of the aggregate | 13 | | lifetime limits applicable to such categories. | 14 | | (c) The following provisions shall apply concerning annual | 15 | | limits: | 16 | | (1) In the case of a group or individual policy of | 17 | | accident and health insurance or a qualified health plan | 18 | | offered through the Health Insurance Marketplace amended, | 19 | | delivered, issued, or renewed in this State on or after | 20 | | September 9, 2015 (the effective date of Public Act | 21 | | 99-480) that provides coverage for hospital or medical | 22 | | treatment and for the treatment of mental, emotional, | 23 | | nervous, or substance use disorders or conditions the | 24 | | following provisions shall apply: | 25 | | (A) if the policy does not include an annual limit | 26 | | on substantially all hospital and medical benefits, |
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| 1 | | then the policy may not impose any annual limits on | 2 | | mental, emotional, nervous, or substance use disorder | 3 | | or condition benefits; or | 4 | | (B) if the policy includes an annual limit on | 5 | | substantially all hospital and medical benefits (in | 6 | | this subsection referred to as the "applicable annual | 7 | | limit"), then the policy shall either: | 8 | | (i) apply the applicable annual limit both to | 9 | | the hospital and medical benefits to which it | 10 | | otherwise would apply and to mental, emotional, | 11 | | nervous, or substance use disorder or condition | 12 | | benefits and not distinguish in the application of | 13 | | the limit between the hospital and medical | 14 | | benefits and mental, emotional, nervous, or | 15 | | substance use disorder or condition benefits; or | 16 | | (ii) not include any annual limit on mental, | 17 | | emotional, nervous, or substance use disorder or | 18 | | condition benefits that is less than the | 19 | | applicable annual limit. | 20 | | (2) In the case of a policy that is not described in | 21 | | paragraph (1) of subsection (c) of this Section and that | 22 | | includes no or different annual limits on different | 23 | | categories of hospital and medical benefits, the Director | 24 | | shall establish rules under which subparagraph (B) of | 25 | | paragraph (1) of subsection (c) of this Section is applied | 26 | | to such policy with respect to mental, emotional, nervous, |
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| 1 | | or substance use disorder or condition benefits by | 2 | | substituting for the applicable annual limit an average | 3 | | annual limit that is computed taking into account the | 4 | | weighted average of the annual limits applicable to such | 5 | | categories. | 6 | | (d) With respect to mental, emotional, nervous, or | 7 | | substance use disorders or conditions, an insurer shall use | 8 | | policies and procedures for the election and placement of | 9 | | mental, emotional, nervous, or substance use disorder or | 10 | | condition treatment drugs on their formulary that are no less | 11 | | favorable to the insured as those policies and procedures the | 12 | | insurer uses for the selection and placement of drugs for | 13 | | medical or surgical conditions and shall follow the expedited | 14 | | coverage determination requirements for substance abuse | 15 | | treatment drugs set forth in Section 45.2 of the Managed Care | 16 | | Reform and Patient Rights Act. | 17 | | (e) This Section shall be interpreted in a manner | 18 | | consistent with all applicable federal parity regulations | 19 | | including, but not limited to, the Paul Wellstone and Pete | 20 | | Domenici Mental Health Parity and Addiction Equity Act of | 21 | | 2008, final regulations issued under the Paul Wellstone and | 22 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 23 | | 2008 and final regulations applying the Paul Wellstone and | 24 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 25 | | 2008 to Medicaid managed care organizations, the Children's | 26 | | Health Insurance Program, and alternative benefit plans. |
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| 1 | | (f) The provisions of subsections (b) and (c) of this | 2 | | Section shall not be interpreted to allow the use of lifetime | 3 | | or annual limits otherwise prohibited by State or federal law. | 4 | | (g) As used in this Section: | 5 | | "Financial requirement" includes deductibles, copayments, | 6 | | coinsurance, and out-of-pocket maximums, but does not include | 7 | | an aggregate lifetime limit or an annual limit subject to | 8 | | subsections (b) and (c). | 9 | | "Mental, emotional, nervous, or substance use disorder or | 10 | | condition" means a condition or disorder that involves a | 11 | | mental health condition or substance use disorder that falls | 12 | | under any of the diagnostic categories listed in the mental | 13 | | and behavioral disorders chapter of the current edition of the | 14 | | International Classification of Disease or that is listed in | 15 | | the most recent version of the Diagnostic and Statistical | 16 | | Manual of Mental Disorders. | 17 | | "Treatment limitation" includes limits on benefits based | 18 | | on the frequency of treatment, number of visits, days of | 19 | | coverage, days in a waiting period, or other similar limits on | 20 | | the scope or duration of treatment. "Treatment limitation" | 21 | | includes both quantitative treatment limitations, which are | 22 | | expressed numerically (such as 50 outpatient visits per year), | 23 | | and nonquantitative treatment limitations, which otherwise | 24 | | limit the scope or duration of treatment. A permanent | 25 | | exclusion of all benefits for a particular condition or | 26 | | disorder shall not be considered a treatment limitation. |
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| 1 | | "Nonquantitative treatment" means those limitations as | 2 | | described under federal regulations (26 CFR 54.9812-1). | 3 | | "Nonquantitative treatment limitations" include, but are not | 4 | | limited to, those limitations described under federal | 5 | | regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR | 6 | | 146.136.
| 7 | | (h) The Department of Insurance shall implement the | 8 | | following education initiatives: | 9 | | (1) By January 1, 2016, the Department shall develop a | 10 | | plan for a Consumer Education Campaign on parity. The | 11 | | Consumer Education Campaign shall focus its efforts | 12 | | throughout the State and include trainings in the | 13 | | northern, southern, and central regions of the State, as | 14 | | defined by the Department, as well as each of the 5 managed | 15 | | care regions of the State as identified by the Department | 16 | | of Healthcare and Family Services. Under this Consumer | 17 | | Education Campaign, the Department shall: (1) by January | 18 | | 1, 2017, provide at least one live training in each region | 19 | | on parity for consumers and providers and one webinar | 20 | | training to be posted on the Department website and (2) | 21 | | establish a consumer hotline to assist consumers in | 22 | | navigating the parity process by March 1, 2017. By January | 23 | | 1, 2018 the Department shall issue a report to the General | 24 | | Assembly on the success of the Consumer Education | 25 | | Campaign, which shall indicate whether additional training | 26 | | is necessary or would be recommended. |
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| 1 | | (2) The Department, in coordination with the | 2 | | Department of Human Services and the Department of | 3 | | Healthcare and Family Services, shall convene a working | 4 | | group of health care insurance carriers, mental health | 5 | | advocacy groups, substance abuse patient advocacy groups, | 6 | | and mental health physician groups for the purpose of | 7 | | discussing issues related to the treatment and coverage of | 8 | | mental, emotional, nervous, or substance use disorders or | 9 | | conditions and compliance with parity obligations under | 10 | | State and federal law. Compliance shall be measured, | 11 | | tracked, and shared during the meetings of the working | 12 | | group. The working group shall meet once before January 1, | 13 | | 2016 and shall meet semiannually thereafter. The | 14 | | Department shall issue an annual report to the General | 15 | | Assembly that includes a list of the health care insurance | 16 | | carriers, mental health advocacy groups, substance abuse | 17 | | patient advocacy groups, and mental health physician | 18 | | groups that participated in the working group meetings, | 19 | | details on the issues and topics covered, and any | 20 | | legislative recommendations developed by the working | 21 | | group. | 22 | | (3) Not later than January 1 of each year, the | 23 | | Department, in conjunction with the Department of | 24 | | Healthcare and Family Services, shall issue a joint report | 25 | | to the General Assembly and provide an educational | 26 | | presentation to the General Assembly. The report and |
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| 1 | | presentation shall: | 2 | | (A) Cover the methodology the Departments use to | 3 | | check for compliance with the federal Paul Wellstone | 4 | | and Pete Domenici Mental Health Parity and Addiction | 5 | | Equity Act of 2008, 42 U.S.C. 18031(j), and any | 6 | | federal regulations or guidance relating to the | 7 | | compliance and oversight of the federal Paul Wellstone | 8 | | and Pete Domenici Mental Health Parity and Addiction | 9 | | Equity Act of 2008 and 42 U.S.C. 18031(j). | 10 | | (B) Cover the methodology the Departments use to | 11 | | check for compliance with this Section and Sections | 12 | | 356z.23 and 370c of this Code. | 13 | | (C) Identify market conduct examinations or, in | 14 | | the case of the Department of Healthcare and Family | 15 | | Services, audits conducted or completed during the | 16 | | preceding 12-month period regarding compliance with | 17 | | parity in mental, emotional, nervous, and substance | 18 | | use disorder or condition benefits under State and | 19 | | federal laws and summarize the results of such market | 20 | | conduct examinations and audits. This shall include: | 21 | | (i) the number of market conduct examinations | 22 | | and audits initiated and completed; | 23 | | (ii) the benefit classifications examined by | 24 | | each market conduct examination and audit; | 25 | | (iii) the subject matter of each market | 26 | | conduct examination and audit, including |
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| 1 | | quantitative and nonquantitative treatment | 2 | | limitations; and | 3 | | (iv) a summary of the basis for the final | 4 | | decision rendered in each market conduct | 5 | | examination and audit. | 6 | | Individually identifiable information shall be | 7 | | excluded from the reports consistent with federal | 8 | | privacy protections. | 9 | | (D) Detail any educational or corrective actions | 10 | | the Departments have taken to ensure compliance with | 11 | | the federal Paul Wellstone and Pete Domenici Mental | 12 | | Health Parity and Addiction Equity Act of 2008, 42 | 13 | | U.S.C. 18031(j), this Section, and Sections 356z.23 | 14 | | and 370c of this Code. | 15 | | (E) The report must be written in non-technical, | 16 | | readily understandable language and shall be made | 17 | | available to the public by, among such other means as | 18 | | the Departments find appropriate, posting the report | 19 | | on the Departments' websites. | 20 | | (i) The Parity Advancement Fund is created as a special | 21 | | fund in the State treasury. Moneys from fines and penalties | 22 | | collected from insurers for violations of this Section shall | 23 | | be deposited into the Fund. Moneys deposited into the Fund for | 24 | | appropriation by the General Assembly to the Department shall | 25 | | be used for the purpose of providing financial support of the | 26 | | Consumer Education Campaign, parity compliance advocacy, and |
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| 1 | | other initiatives that support parity implementation and | 2 | | enforcement on behalf of consumers. | 3 | | (j) The Department of Insurance and the Department of | 4 | | Healthcare and Family Services shall convene and provide | 5 | | technical support to a workgroup of 11 members that shall be | 6 | | comprised of 3 mental health parity experts recommended by an | 7 | | organization advocating on behalf of mental health parity | 8 | | appointed by the President of the Senate; 3 behavioral health | 9 | | providers recommended by an organization that represents | 10 | | behavioral health providers appointed by the Speaker of the | 11 | | House of Representatives; 2 representing Medicaid managed care | 12 | | organizations recommended by an organization that represents | 13 | | Medicaid managed care plans appointed by the Minority Leader | 14 | | of the House of Representatives; 2 representing commercial | 15 | | insurers recommended by an organization that represents | 16 | | insurers appointed by the Minority Leader of the Senate; and a | 17 | | representative of an organization that represents Medicaid | 18 | | managed care plans appointed by the Governor. | 19 | | The workgroup shall provide recommendations to the General | 20 | | Assembly on health plan data reporting requirements that | 21 | | separately break out data on mental, emotional, nervous, or | 22 | | substance use disorder or condition benefits and data on other | 23 | | medical benefits, including physical health and related health | 24 | | services no later than December 31, 2019. The recommendations | 25 | | to the General Assembly shall be filed with the Clerk of the | 26 | | House of Representatives and the Secretary of the Senate in |
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| 1 | | electronic form only, in the manner that the Clerk and the | 2 | | Secretary shall direct. This workgroup shall take into account | 3 | | federal requirements and recommendations on mental health | 4 | | parity reporting for the Medicaid program. This workgroup | 5 | | shall also develop the format and provide any needed | 6 | | definitions for reporting requirements in subsection (k). The | 7 | | research and evaluation of the working group shall include, | 8 | | but not be limited to: | 9 | | (1) claims denials due to benefit limits, if | 10 | | applicable; | 11 | | (2) administrative denials for no prior authorization; | 12 | | (3) denials due to not meeting medical necessity; | 13 | | (4) denials that went to external review and whether | 14 | | they were upheld or overturned for medical necessity; | 15 | | (5) out-of-network claims; | 16 | | (6) emergency care claims; | 17 | | (7) network directory providers in the outpatient | 18 | | benefits classification who filed no claims in the last 6 | 19 | | months, if applicable; | 20 | | (8) the impact of existing and pertinent limitations | 21 | | and restrictions related to approved services, licensed | 22 | | providers, reimbursement levels, and reimbursement | 23 | | methodologies within the Division of Mental Health, the | 24 | | Division of Substance Use Prevention and Recovery | 25 | | programs, the Department of Healthcare and Family | 26 | | Services, and, to the extent possible, federal regulations |
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| 1 | | and law; and | 2 | | (9) when reporting and publishing should begin. | 3 | | Representatives from the Department of Healthcare and | 4 | | Family Services, representatives from the Division of Mental | 5 | | Health, and representatives from the Division of Substance Use | 6 | | Prevention and Recovery shall provide technical advice to the | 7 | | workgroup. | 8 | | (j-5) The Department of Insurance shall collect the | 9 | | following information: | 10 | | (1) The number of employment disability insurance | 11 | | plans offered in this State, including, but not limited | 12 | | to: | 13 | | (A) individual short-term policies; | 14 | | (B) individual long-term policies; | 15 | | (C) group short-term policies; and | 16 | | (D) group long-term policies. | 17 | | (2) The number of policies referenced in paragraph (1) | 18 | | of this subsection that limit mental health and substance | 19 | | use disorder benefits. | 20 | | (3) The average defined benefit period for the | 21 | | policies referenced in paragraph (1) of this subsection, | 22 | | both for those policies that limit and those policies that | 23 | | have no limitation on mental health and substance use | 24 | | disorder benefits. | 25 | | (4) Whether the policies referenced in paragraph (1) | 26 | | of this subsection are purchased on a voluntary or |
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| 1 | | non-voluntary basis. | 2 | | (5) The identities of the individuals, entities, or a | 3 | | combination of the 2, that assume the cost associated with | 4 | | covering the policies referenced in paragraph (1) of this | 5 | | subsection. | 6 | | (6) The average defined benefit period for plans that | 7 | | cover physical disability and mental health and substance | 8 | | abuse without limitation, including, but not limited to: | 9 | | (A) individual short-term policies; | 10 | | (B) individual long-term policies; | 11 | | (C) group short-term policies; and | 12 | | (D) group long-term policies. | 13 | | (7) The average premiums for disability income | 14 | | insurance issued in this State for: | 15 | | (A) individual short-term policies that limit | 16 | | mental health and substance use disorder benefits; | 17 | | (B) individual long-term policies that limit | 18 | | mental health and substance use disorder benefits; | 19 | | (C) group short-term policies that limit mental | 20 | | health and substance use disorder benefits; | 21 | | (D) group long-term policies that limit mental | 22 | | health and substance use disorder benefits; | 23 | | (E) individual short-term policies that include | 24 | | mental health and substance use disorder benefits | 25 | | without limitation; | 26 | | (F) individual long-term policies that include |
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| 1 | | mental health and substance use disorder benefits | 2 | | without limitation; | 3 | | (G) group short-term policies that include mental | 4 | | health and substance use disorder benefits without | 5 | | limitation; and | 6 | | (H) group long-term policies that include mental | 7 | | health and substance use disorder benefits without | 8 | | limitation. | 9 | | The Department shall present its findings regarding | 10 | | information collected under this subsection (j-5) to the | 11 | | General Assembly no later than April 30, 2024. Information | 12 | | regarding a specific insurance provider's contributions to the | 13 | | Department's report shall be exempt from disclosure under | 14 | | paragraph (t) of subsection (1) of Section 7 of the Freedom of | 15 | | Information Act. The aggregated information gathered by the | 16 | | Department shall not be exempt from disclosure under paragraph | 17 | | (t) of subsection (1) of Section 7 of the Freedom of | 18 | | Information Act. | 19 | | (k) An insurer that amends, delivers, issues, or renews a | 20 | | group or individual policy of accident and health insurance or | 21 | | a qualified health plan offered through the health insurance | 22 | | marketplace in this State providing coverage for hospital or | 23 | | medical treatment and for the treatment of mental, emotional, | 24 | | nervous, or substance use disorders or conditions shall submit | 25 | | an annual report, the format and definitions for which will be | 26 | | developed by the workgroup in subsection (j), to the |
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| 1 | | Department, or, with respect to medical assistance, the | 2 | | Department of Healthcare and Family Services starting on or | 3 | | before July 1, 2020 that contains the following information | 4 | | separately for inpatient in-network benefits, inpatient | 5 | | out-of-network benefits, outpatient in-network benefits, | 6 | | outpatient out-of-network benefits, emergency care benefits, | 7 | | and prescription drug benefits in the case of accident and | 8 | | health insurance or qualified health plans, or inpatient, | 9 | | outpatient, emergency care, and prescription drug benefits in | 10 | | the case of medical assistance: | 11 | | (1) A summary of the plan's pharmacy management | 12 | | processes for mental, emotional, nervous, or substance use | 13 | | disorder or condition benefits compared to those for other | 14 | | medical benefits. | 15 | | (2) A summary of the internal processes of review for | 16 | | experimental benefits and unproven technology for mental, | 17 | | emotional, nervous, or substance use disorder or condition | 18 | | benefits and those for
other medical benefits. | 19 | | (3) A summary of how the plan's policies and | 20 | | procedures for utilization management for mental, | 21 | | emotional, nervous, or substance use disorder or condition | 22 | | benefits compare to those for other medical benefits. | 23 | | (4) A description of the process used to develop or | 24 | | select the medical necessity criteria for mental, | 25 | | emotional, nervous, or substance use disorder or condition | 26 | | benefits and the process used to develop or select the |
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| 1 | | medical necessity criteria for medical and surgical | 2 | | benefits. | 3 | | (5) Identification of all nonquantitative treatment | 4 | | limitations that are applied to both mental, emotional, | 5 | | nervous, or substance use disorder or condition benefits | 6 | | and medical and surgical benefits within each | 7 | | classification of benefits. | 8 | | (6) The results of an analysis that demonstrates that | 9 | | for the medical necessity criteria described in | 10 | | subparagraph (A) and for each nonquantitative treatment | 11 | | limitation identified in subparagraph (B), as written and | 12 | | in operation, the processes, strategies, evidentiary | 13 | | standards, or other factors used in applying the medical | 14 | | necessity criteria and each nonquantitative treatment | 15 | | limitation to mental, emotional, nervous, or substance use | 16 | | disorder or condition benefits within each classification | 17 | | of benefits are comparable to, and are applied no more | 18 | | stringently than, the processes, strategies, evidentiary | 19 | | standards, or other factors used in applying the medical | 20 | | necessity criteria and each nonquantitative treatment | 21 | | limitation to medical and surgical benefits within the | 22 | | corresponding classification of benefits; at a minimum, | 23 | | the results of the analysis shall: | 24 | | (A) identify the factors used to determine that a | 25 | | nonquantitative treatment limitation applies to a | 26 | | benefit, including factors that were considered but |
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| 1 | | rejected; | 2 | | (B) identify and define the specific evidentiary | 3 | | standards used to define the factors and any other | 4 | | evidence relied upon in designing each nonquantitative | 5 | | treatment limitation; | 6 | | (C) provide the comparative analyses, including | 7 | | the results of the analyses, performed to determine | 8 | | that the processes and strategies used to design each | 9 | | nonquantitative treatment limitation, as written, for | 10 | | mental, emotional, nervous, or substance use disorder | 11 | | or condition benefits are comparable to, and are | 12 | | applied no more stringently than, the processes and | 13 | | strategies used to design each nonquantitative | 14 | | treatment limitation, as written, for medical and | 15 | | surgical benefits; | 16 | | (D) provide the comparative analyses, including | 17 | | the results of the analyses, performed to determine | 18 | | that the processes and strategies used to apply each | 19 | | nonquantitative treatment limitation, in operation, | 20 | | for mental, emotional, nervous, or substance use | 21 | | disorder or condition benefits are comparable to, and | 22 | | applied no more stringently than, the processes or | 23 | | strategies used to apply each nonquantitative | 24 | | treatment limitation, in operation, for medical and | 25 | | surgical benefits; and | 26 | | (E) disclose the specific findings and conclusions |
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| 1 | | reached by the insurer that the results of the | 2 | | analyses described in subparagraphs (C) and (D) | 3 | | indicate that the insurer is in compliance with this | 4 | | Section and the Mental Health Parity and Addiction | 5 | | Equity Act of 2008 and its implementing regulations, | 6 | | which includes 42 CFR Parts 438, 440, and 457 and 45 | 7 | | CFR 146.136 and any other related federal regulations | 8 | | found in the Code of Federal Regulations. | 9 | | (7) Any other information necessary to clarify data | 10 | | provided in accordance with this Section requested by the | 11 | | Director, including information that may be proprietary or | 12 | | have commercial value, under the requirements of Section | 13 | | 30 of the Viatical Settlements Act of 2009. | 14 | | (l) An insurer that amends, delivers, issues, or renews a | 15 | | group or individual policy of accident and health insurance or | 16 | | a qualified health plan offered through the health insurance | 17 | | marketplace in this State providing coverage for hospital or | 18 | | medical treatment and for the treatment of mental, emotional, | 19 | | nervous, or substance use disorders or conditions on or after | 20 | | January 1, 2019 (the effective date of Public Act 100-1024) | 21 | | shall, in advance of the plan year, make available to the | 22 | | Department or, with respect to medical assistance, the | 23 | | Department of Healthcare and Family Services and to all plan | 24 | | participants and beneficiaries the information required in | 25 | | subparagraphs (C) through (E) of paragraph (6) of subsection | 26 | | (k). For plan participants and medical assistance |
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| 1 | | beneficiaries, the information required in subparagraphs (C) | 2 | | through (E) of paragraph (6) of subsection (k) shall be made | 3 | | available on a publicly-available website whose web address is | 4 | | prominently displayed in plan and managed care organization | 5 | | informational and marketing materials. | 6 | | (m) In conjunction with its compliance examination program | 7 | | conducted in accordance with the Illinois State Auditing Act, | 8 | | the Auditor General shall undertake a review of
compliance by | 9 | | the Department and the Department of Healthcare and Family | 10 | | Services with Section 370c and this Section. Any
findings | 11 | | resulting from the review conducted under this Section shall | 12 | | be included in the applicable State agency's compliance | 13 | | examination report. Each compliance examination report shall | 14 | | be issued in accordance with Section 3-14 of the Illinois | 15 | | State
Auditing Act. A copy of each report shall also be | 16 | | delivered to
the head of the applicable State agency and | 17 | | posted on the Auditor General's website. | 18 | | (Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21; | 19 | | 102-813, eff. 5-13-22.)".
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