HB0122ham002 101ST GENERAL ASSEMBLY

Rep. Yehiel M. Kalish

Filed: 4/2/2019

10100HB0122ham002 LRB101 02888 KTG 59034 a

AMENDMENT TO HOUSE BILL 122

AMENDMENT NO. ______. Amend House Bill 122 by replacing everything after the enacting clause with the following:

"Section 5. The Substance Use Disorder Act is amended by adding Article 7 as follows:

(20 ILCS 301/Art. 7 heading new)

ARTICLE 7. BEHAVIORAL HEALTH ACCESS TO CARE OMBUDSMAN

(20 ILCS 301/7-5 new)

Sec. 7-5. Definitions. As used in this Article:

(a) "Health care provider" or "provider" means:

(1) a physician licensed under the Medical Practice Act of 1987 to practice medicine in all of its branches; a clinical psychologist licensed under the Clinical Psychologist Licensing Act;

(2) a mental health professional who is licensed or registered to provide mental health services by the Department of Financial and Professional Regulation;

(3) any other health care provider regulated by the State when engaged in assisting consumers with behavioral health care access and coverage issues; or

(4) a health care facility licensed or regulated by the State, when the facility is engaged in assisting consumers with behavioral health care access and coverage issues, excluding any facility that is listed under subsection (b) of Section 4.04 of the Illinois Act on the Aging.

(b) "Office" means the Office of the Ombudsman for Behavioral Health Access to Care created in Section 7-10.

(c) "Ombudsman" means the individual designated under Section 7-10 as the Ombudsman for Behavioral Health Access to Care.

(20 ILCS 301/7-10 new)

Sec. 7-10. Office of the Ombudsman for Behavioral Health Access to Care; appointment; duties.

(a) There is created in the Department of Human Services the Office of the Ombudsman for Behavioral Health Access to Care for the purpose of assisting residents of Illinois in accessing behavioral health care.

(b) The Office and the Department shall operate in accordance with a memorandum of understanding between the 2 entities. The memorandum of understanding shall contain, at a minimum:

(1) a requirement that the Office has its own personnel rules;

(2) a requirement that the Ombudsman has independent hiring and termination authority over Office employees;

(3) a requirement that the Office must follow State fiscal rules;

(4) a requirement that the Department of Human Services' Division of Mental Health shall offer the Office limited support with respect to:

(A) personnel matters;

(B) recruitment;

(C) payroll;

(D) benefits;

(E) budget submission, as needed;

(F) accounting;

(G) office space, facilities, and technical support; and

(H) other provisions regarding administrative support that will help maintain the independence of the Office.

(c) The Office shall operate with full independence and has complete autonomy, control, and authority over operations, budget, and personnel decisions related to the Office and the Ombudsman.

(d) By November 1, 2019, the Governor shall designate an Ombudsman for Behavioral Health Access to Care, who shall serve as Director of the Office. The Ombudsman shall serve as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, including coverage that is not subject to State regulation, and health care providers, acting on their own behalf, on behalf of a consumer with the consumer's written permission, or on behalf of a group of health care providers, navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders.

(e) The Ombudsman shall:

(1) interact with consumers and health care providers with concerns or complaints to help the consumers and providers resolve behavioral health care access and coverage issues;

(2) identify, track, and report to the appropriate regulatory or oversight agency concerns, complaints, and potential violations of State or federal rules, regulations, or statutes concerning the availability of, and terms and conditions of, benefits for mental health conditions or substance use disorders, including potential violations related to quantitative and non-quantitative treatment limitations;

(3) receive and assist consumers and providers in reporting concerns and filing complaints with appropriate regulatory or oversight agencies relating to inappropriate care or involuntary admissions or judicial admissions under the Mental Health and Developmental Disabilities Code;

(4) provide appropriate information to help consumers obtain behavioral health care;

(5) develop appropriate points of contact for referrals to other State and federal agencies; and

(6) provide appropriate information to help consumers or health care providers file appeals or complaints with the appropriate entities, including insurers and other State and federal agencies.

(f) The Ombudsman, employees of the Office, and any persons acting on behalf of the Office shall comply with all State and federal confidentiality laws that govern the Department of Human Services with respect to the treatment of confidential information or records and the disclosure of such information and records.

(g) In the performance of his or her duties, the Ombudsman shall act independently of the Department of Human Services' Division of Mental Health. Any recommendations made or positions taken by the Ombudsman do not reflect those of the Department of Human Services or the Division of Mental Health.

(20 ILCS 301/7-15 new)

Sec. 7-15. Liaisons. The Director of Insurance and the Secretary of Human Services shall each appoint a liaison to the Ombudsman to receive reports of concerns, complaints, and potential violations described in paragraph (2) of subsection (e) of Section 7-10 from the Ombudsman, consumers, or health care providers.

(20 ILCS 301/7-20 new)

Sec. 7-20. Qualified immunity. The Ombudsman and employees or persons acting on behalf of the Office are immune from suit and liability, either personally or in their official capacities, for any claim for damage to or loss of property, or for personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred within the scope of employment, duties, or responsibilities pertaining to the Office, including issuing reports or recommendations; except that nothing in this Section protects those persons from suit or liability for damage, loss, injury, or liability caused by the intentional or willful and wanton misconduct of the person.

(20 ILCS 301/7-25 new)

Sec. 7-25. Annual report.

(a) On or before September 1, 2021, and on or before September 1 of each year thereafter, the Ombudsman shall prepare and submit, in accordance with subsection (b), a written report that includes information from the preceding fiscal year concerning actions taken by the Ombudsman relating to the duties of the Office set forth in Section 7-10.

(b) The Ombudsman shall submit the report required by this Section to the Governor, the Secretary of Human Services, the Director of Insurance, the Senate Human Services Committee or any successor committee, and the House Committees on Human Services, Insurance, Energy & Environment, and Mental Health or any successor committees.

(c) The Ombudsman shall post the annual report on the Department of Human Services' website.

(d) The Ombudsman shall not include in the report required by this Section any personally identifying information about an individual consumer or health care provider or identifying information about a health care facility licensed by the State or an emergency medical services system as defined in Section 3.20 of the Emergency Medical Services (EMS) Systems Act.

Section 10. The Illinois Insurance Code is amended by adding Section 370c.2 as follows:

(215 ILCS 5/370c.2 new)

Sec. 370c.2. Parity reporting.

(a) By March 1, 2020, and every other March 1 thereafter, the Director shall submit a written report and provide a presentation of the report to the General Assembly that:

(1) specifies the methodology the Director uses to verify that insurance carriers are complying with Section 370c and rules adopted under that Section and with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Public Law 110-343, as amended, any regulations adopted in accordance with that Act, or guidance related to compliance with and oversight of that Act;

(2) identifies market conduct examinations initiated, conducted, or completed during the preceding 12 months regarding compliance with Section 370c and rules adopted under that Section and with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and regulations adopted under that Act and summarizes the outcomes of those market conduct examinations; and

(3) details any educational or corrective actions the Director has taken to ensure insurance carrier compliance with Section 370c and rules adopted under that Section and with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and regulations adopted under that Act.

(b) The Director shall ensure that the report is written in plain language and is made available to the public by, at a minimum, posting the report on the Department's website.

Section 99. Effective date. This Act takes effect upon becoming law.".