Illinois General Assembly - Bill Status for HB1085

Amends the Illinois Insurance Code. Establishes reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2027 or for any contracted third party administering the behavioral health benefits for the insurer. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 or any contracted third party administering the behavioral health benefits for the insurer to cover certain medically necessary mental health and substance use disorder treatment services. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 for each violation. Excludes certain health care plans serving Medicaid populations who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Requires the Department to review the impact of the proposed mental health and substance abuse mandate on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Permits the Department to examine out-of-network utilization and out-of-pocket costs for insureds for mental health and substance use treatment and services for all plans to compare with in-network utilization. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under those provisions. Effective immediately.

Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes: Removes provisions amending the State Employees Group Insurance Act of 1971. In provisions concerning mental health and substance abuse parity, removes provision limiting the applicability of parity requirements for mental health or substance use disorder services provided by a hospital when the hospital has a contract with the insurer that provides for reimbursement for such services based on achieving specified patient health outcomes and other quality measures and includes shared savings from lower health care costs. Makes conforming changes.

Replaces everything after the enacting clause with the provisions of the engrossed bill with the following changes. Replaces provisions concerning reimbursement for in-network mental health and substance use disorder treatment services. Provides that, consistent with the principles of the federal Mental Health Parity and Addiction Equity Act of 2008, and for the purposes of strengthening network adequacy for mental health and substance use disorder services and lowering out-of-network utilization, the Department of Human Services, by rule, shall determine a reimbursement rate floor for all in-network mental health and substance use disorder services, including inpatient services, outpatient services, office visits, and residential care, delivered by Illinois providers and facilities using the Illinois data in Research Triangle Institute International's study. Sets forth provisions concerning requirements for the reimbursement rate floor. Grants the Department of Insurance enforcement and monitoring authority over the reimbursement rate floor and requires the Department to publish the rate floor set by the Department of Human Services in Title 50 of the Illinois Administrative Code. Provides that, at the end of 2 years, 7 years, and 12 years (rather than 5 years, 10 years, and 15 years) following the implementation of provisions concerning the reimbursement rate floor, the Department of Insurance shall review the impact of provisions concerning mental health and substance use parity on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Requires the Department to submit a report to the General Assembly by no later than December 31, 2030, December 31, 2035, and December 31, 2040 (rather than by December 31, 2033, December 31, 2038, and December 31, 2043) that includes its analyses and findings following the Department's review. Makes changes in provisions granting the Department of Insurance the authority to examine out-of-network utilization and out-of-pocket costs. Provides that the Department of Insurance and the Department of Human Services (rather than only the Department of Insurance) shall adopt any rules necessary to implement provisions concerning mental health and substance use parity by no later than May 1, 2026. Removes provisions amending the Health Maintenance Organization Act. Effective immediately.

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