Illinois General Assembly - Full Text of Public Act 101-0574
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Public Act 101-0574


Public Act 0574 101ST GENERAL ASSEMBLY



Public Act 101-0574
SB2085 EnrolledLRB101 08661 RAB 53745 b

    AN ACT concerning regulation.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Insurance Code is amended by adding
Section 356z.33 as follows:
    (215 ILCS 5/356z.33 new)
    Sec. 356z.33. Coverage of the psychiatric Collaborative
Care Model.
    (a) As used in this Section, "psychiatric Collaborative
Care Model" means the evidence-based, integrated behavioral
health service delivery method, which includes a formal
collaborative arrangement among a primary care team consisting
of a primary care provider, a care manager, and a psychiatric
consultant, and includes, but is not limited to, the following
        (1) care directed by the primary care team;
        (2) structured care management;
        (3) regular assessments of clinical status using
    validated tools; and
        (4) modification of treatment as appropriate.
    (b) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed on or after
the effective date of this amendatory Act of the 101st General
Assembly or managed care organization that provides mental
health benefits shall provide reimbursement for benefits that
are delivered through the psychiatric Collaborative Care
Model. The following American Medical Association 2018 current
procedural terminology codes and Healthcare Common Procedure
Coding System code shall be used to bill for benefits delivered
through the psychiatric Collaborative Care Model:
        (1) 99492;
        (2) 99493;
        (3) 99494; and
        (4) G0512.
    (c) The Director of Insurance shall update the billing
codes in subsection (b) if there are any alterations or
additions to the billing codes for the psychiatric
Collaborative Care Model.
    (d) An individual or group policy or managed care
organization that provides benefits under this Section may deny
reimbursement of any billing code listed in this Section on the
grounds of medical necessity if such medical necessity
determinations are in compliance with the Paul Wellstone and
Pete Domenici Mental Health Parity and Addiction Equity Act of
2008 and its implementing and related regulations and that such
determinations are made in accordance with the utilization
review requirements under Section 85 of the Managed Care Reform
and Patient Rights Act.
    Section 10. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
    (305 ILCS 5/5-16.8)
    Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code
and (ii) be subject to the provisions of Sections 356z.19,
364.01, 370c, and 370c.1 of the Illinois Insurance Code.
    On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
    To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
    Section 99. Effective date. This Act takes effect January
1, 2020.

Effective Date: 1/1/2020