Illinois General Assembly - Bill Status for HB5395
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 Bill Status of HB5395  103rd General Assembly


Short Description:  NETWORK ADEQUACY-STANDARDS

House Sponsors
Rep. Anna Moeller - Robyn Gabel - Eva-Dina Delgado - Bob Morgan - Camille Y. Lilly, William E Hauter, Jenn Ladisch Douglass, Yolonda Morris, Sue Scherer, Kelly M. Cassidy, Marcus C. Evans, Jr., Sonya M. Harper, Mark L. Walker, Mary Beth Canty, Will Guzzardi, Ann M. Williams, Nabeela Syed, Natalie A. Manley, Nicholas K. Smith, Elizabeth "Lisa" Hernandez, Lindsey LaPointe, Dagmara Avelar, Suzanne M. Ness, Matt Hanson, Terra Costa Howard, Katie Stuart, Jaime M. Andrade, Jr., Joyce Mason, Jehan Gordon-Booth, Martin J. Moylan, Diane Blair-Sherlock, Maura Hirschauer, Maurice A. West, II, Michael J. Kelly, Tracy Katz Muhl, Margaret Croke, Kimberly Du Buclet, Theresa Mah, Rita Mayfield, Michelle Mussman, Kevin John Olickal, Abdelnasser Rashid, Robert "Bob" Rita, Sharon Chung, Kam Buckner, La Shawn K. Ford, Emanuel "Chris" Welch, Stephanie A. Kifowit and Janet Yang Rohr

Hearings
Human Services Committee Hearing Apr 18 2024 10:30AM Capitol Building Room 118 Springfield, IL - House Floor Amendment 2 - House Floor Amendment 3 - House Floor Amendment 4


Last Action
DateChamber Action
  4/16/2024HouseHeld on Calendar Order of Second Reading - Short Debate

Statutes Amended In Order of Appearance
5 ILCS 100/5-45.55 new
215 ILCS 124/3
215 ILCS 124/5
215 ILCS 124/10
215 ILCS 124/15
215 ILCS 124/20
215 ILCS 124/25
215 ILCS 124/30
215 ILCS 124/35 new
215 ILCS 124/40 new
215 ILCS 124/50 new
215 ILCS 134/20
215 ILCS 134/25


Synopsis As Introduced
Amends the Network Adequacy and Transparency Act. Adds definitions. Provides that the minimum ratio for each provider type shall be no less than any such ratio established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Provides that the maximum travel time and distance standards and appointment wait time standards shall be no greater than any such standards established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Makes changes to provisions concerning network adequacy, notice of nonrenewal or termination, transition of services, network transparency, administration and enforcement, provider requirements, and provider directory information. Amends the Managed Care Reform and Patient Rights Act. Makes changes to provisions concerning notice of nonrenewal or termination and transition of services. Amends the Illinois Administrative Procedure Act to authorize the Department of Insurance to adopt emergency rules implementing federal standards for provider ratios, time and distance, or appointment wait times when such standards apply to health insurance coverage regulated by the Department of Insurance and are more stringent than the State standards extant at the time the final federal standards are published. Amends the Illinois Administrative Procedure Act to make a conforming change. Effective immediately.

House Committee Amendment No. 1
Adds reference to:
215 ILCS 5/355from Ch. 73, par. 967
215 ILCS 125/4-12from Ch. 111 1/2, par. 1409.5
215 ILCS 130/3006from Ch. 73, par. 1503-6
215 ILCS 5/121-2.05from Ch. 73, par. 733-2.05
215 ILCS 5/352c new
215 ILCS 5/356z.18
215 ILCS 5/367.3from Ch. 73, par. 979.3
215 ILCS 5/367afrom Ch. 73, par. 979a
215 ILCS 5/368f
215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003from Ch. 73, par. 1504-3
215 ILCS 190/Act rep.
215 ILCS 5/155.36
215 ILCS 5/155.37
215 ILCS 5/356z.40
215 ILCS 5/370cfrom Ch. 73, par. 982c
215 ILCS 134/10
215 ILCS 134/45.1
215 ILCS 134/85
215 ILCS 134/87 new
215 ILCS 180/10
215 ILCS 200/20

Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Provides that the amendatory Act may be referred to as the Health Care Consumer Access and Protection Act. Amends the Illinois Insurance Code. Provides that, unless prohibited under federal law, for plan year 2026 and thereafter, for each insurer proposing to offer a qualified health plan issued in the individual market through the Illinois Health Benefits Exchange, the insurer's rate filing must apply a cost-sharing reduction defunding adjustment factor within a range that is uniform across all insurers; is consistent with the total adjustment expected to be needed to cover actual cost-sharing reduction costs across all silver plans on the Illinois Health Benefits Exchange statewide; and makes certain assumptions. Provides that the rate filing must apply an induced demand factor based on a specified formula. Provides that certain provisions concerning filing of premium rates for group accident and health insurance for approval by the Department of Insurance do not apply to group policies issued to large employers. Removes language providing that certain provisions do not apply to the large group market. Provides that for large employer group policies issued, delivered, amended, or renewed on or after January 1, 2026, the premium rates and risk classifications must be filed with the Department annually for approval. Amends the Limited Health Service Organization Act to provide that pharmaceutical policies are subject to the provisions of the amendatory Act. Sets forth provisions concerning short-term, limited-duration insurance. Provides that no company shall issue, deliver, amend, or renew short-term, limited-duration insurance. Provides that the Department may adopt rules as deemed necessary that prescribe specific standards for or restrictions on policy provisions, benefit design, disclosures, and sales and marketing practices for excepted benefits. Provides that the Director of Insurance's authority under specified provisions is extended to group and blanket excepted benefits. Makes conforming changes in the Health Maintenance Organization Act. Repeals the Short-Term, Limited-Duration Health Insurance Coverage Act. Provides that no later than July 1, 2025, insurance companies that use a drug formulary shall post the formulary on their websites. Makes changes concerning utilization reviews and step therapy requirements. Provides that beginning January 1, 2026, coverage for inpatient mental health treatment at participating hospitals or other licensed facilities shall comply with specified requirements concerning prior authorization, coverage, and concurrent review. Makes other changes. Further amends the Managed Care Reform and Patient Rights Act. Removes provisions concerning step therapy. Provides that only a clinical peer may make an adverse determination. Sets forth certain requirements for utilization review programs. Provides that no utilization review program or any policy, contract, certificate, evidence of coverage, or formulary shall impose step therapy requirements for any health care service, including prescription drugs. Amends the Health Carrier External Review Act. Requires a health insurance issuer to publish on its public website a list of services for which prior authorization is required. Effective January 1, 2025.

 Balanced Budget Note (Office of Management and Budget)
 Please be advised that the Balanced Budget Note Act does not apply to House Bill 5395, as amended by House Amendment 1, as it is not a supplemental appropriation that increases or decreases appropriations. Under the Act, a balanced budget note must be prepared only for bills that change a general funds appropriation for the fiscal year in which the new bill is enacted.

 Fiscal Note (Dept. of Healthcare & Family Services)
 Expected expenditures for the Illinois Department of Healthcare and Family Services, based on the provisions in HB 5395, are estimated at approximately $30 million per year, beginning January 1, 2026 (the anticipated effective date of the provisions regarding prior approval for inpatient treatment). This estimate assumes a static number of inpatient mental health admissions and does not account for any fluctuations in admissions that may result from changes in provider behavior or from the implementation of other, less-intensive interventions.

Actions 
DateChamber Action
  2/9/2024HouseFiled with the Clerk by Rep. Anna Moeller
  2/9/2024HouseFirst Reading
  2/9/2024HouseReferred to Rules Committee
  2/20/2024HouseAdded Chief Co-Sponsor Rep. Robyn Gabel
  2/22/2024HouseAdded Co-Sponsor Rep. Jenn Ladisch Douglass
  2/22/2024HouseAdded Co-Sponsor Rep. Yolonda Morris
  2/22/2024HouseAdded Chief Co-Sponsor Rep. Eva-Dina Delgado
  2/22/2024HouseAdded Co-Sponsor Rep. Sue Scherer
  2/22/2024HouseAdded Co-Sponsor Rep. Kelly M. Cassidy
  2/22/2024HouseAdded Co-Sponsor Rep. Marcus C. Evans, Jr.
  2/22/2024HouseAdded Co-Sponsor Rep. Sonya M. Harper
  2/22/2024HouseAdded Co-Sponsor Rep. Mark L. Walker
  2/22/2024HouseAdded Co-Sponsor Rep. Mary Beth Canty
  2/22/2024HouseAdded Co-Sponsor Rep. Will Guzzardi
  2/22/2024HouseAdded Co-Sponsor Rep. Bob Morgan
  2/22/2024HouseAdded Co-Sponsor Rep. Ann M. Williams
  2/22/2024HouseAdded Co-Sponsor Rep. Nabeela Syed
  2/22/2024HouseAdded Co-Sponsor Rep. Natalie A. Manley
  2/22/2024HouseAdded Co-Sponsor Rep. Nicholas K. Smith
  2/22/2024HouseAdded Co-Sponsor Rep. Elizabeth "Lisa" Hernandez
  2/22/2024HouseAdded Co-Sponsor Rep. Lindsey LaPointe
  2/22/2024HouseAdded Co-Sponsor Rep. Dagmara Avelar
  2/22/2024HouseAdded Co-Sponsor Rep. Suzanne M. Ness
  2/22/2024HouseAdded Co-Sponsor Rep. Matt Hanson
  2/22/2024HouseAdded Co-Sponsor Rep. Terra Costa Howard
  2/22/2024HouseAdded Co-Sponsor Rep. Katie Stuart
  2/22/2024HouseAdded Co-Sponsor Rep. Jaime M. Andrade, Jr.
  2/22/2024HouseAdded Co-Sponsor Rep. Joyce Mason
  2/22/2024HouseRemoved Co-Sponsor Rep. Bob Morgan
  2/23/2024HouseAdded Chief Co-Sponsor Rep. Camille Y. Lilly
  2/23/2024HouseChief Co-Sponsor Changed to Rep. Camille Y. Lilly
  2/23/2024HouseAdded Chief Co-Sponsor Rep. Bob Morgan
  2/23/2024HouseChief Co-Sponsor Changed to Rep. Bob Morgan
  2/23/2024HouseChief Co-Sponsor Changed to Rep. Camille Y. Lilly
  2/23/2024HouseAdded Co-Sponsor Rep. Jehan Gordon-Booth
  2/23/2024HouseAdded Co-Sponsor Rep. Martin J. Moylan
  2/23/2024HouseAdded Co-Sponsor Rep. Michelle Mussman
  2/23/2024HouseAdded Co-Sponsor Rep. Maura Hirschauer
  3/4/2024HouseAdded Co-Sponsor Rep. Maurice A. West, II
  3/4/2024HouseAdded Co-Sponsor Rep. Michael J. Kelly
  3/4/2024HouseAdded Co-Sponsor Rep. Tracy Katz Muhl
  3/5/2024HouseAssigned to Human Services Committee
  3/6/2024HouseHouse Committee Amendment No. 1 Filed with Clerk by Rep. Anna Moeller
  3/6/2024HouseHouse Committee Amendment No. 1 Referred to Rules Committee
  3/7/2024HouseAdded Co-Sponsor Rep. Margaret Croke
  3/7/2024HouseAdded Co-Sponsor Rep. Kimberly Du Buclet
  3/7/2024HouseAdded Co-Sponsor Rep. Theresa Mah
  3/7/2024HouseAdded Co-Sponsor Rep. Rita Mayfield
  3/7/2024HouseAdded Co-Sponsor Rep. Michelle Mussman
  3/7/2024HouseAdded Co-Sponsor Rep. Kevin John Olickal
  3/7/2024HouseAdded Co-Sponsor Rep. Abdelnasser Rashid
  3/7/2024HouseAdded Co-Sponsor Rep. Robert "Bob" Rita
  3/7/2024HouseAdded Co-Sponsor Rep. William E Hauter
  3/7/2024HouseAdded Co-Sponsor Rep. Sharon Chung
  3/12/2024HouseAdded Co-Sponsor Rep. Kam Buckner
  3/12/2024HouseAdded Co-Sponsor Rep. La Shawn K. Ford
  3/12/2024HouseHouse Committee Amendment No. 1 Rules Refers to Human Services Committee
  3/21/2024HouseHouse Committee Amendment No. 1 Adopted in Human Services Committee; by Voice Vote
  3/21/2024HouseDo Pass as Amended / Short Debate Human Services Committee; 006-003-000
  3/21/2024HouseFiscal Note Requested by Rep. Ryan Spain
  3/21/2024HouseState Mandates Fiscal Note Requested by Rep. Ryan Spain
  3/21/2024HouseBalanced Budget Note Requested by Rep. Ryan Spain
  3/21/2024HousePlaced on Calendar 2nd Reading - Short Debate
  3/22/2024HouseBalanced Budget Note Requested by Rep. Robyn Gabel
  3/22/2024HouseCorrectional Note Requested by Rep. Robyn Gabel
  3/22/2024HouseFiscal Note Requested by Rep. Robyn Gabel
  3/22/2024HouseHome Rule Note Requested by Rep. Robyn Gabel
  3/22/2024HouseHousing Affordability Impact Note Requested by Rep. Robyn Gabel
  3/22/2024HouseJudicial Note Requested by Rep. Robyn Gabel
  3/22/2024HouseLand Conveyance Appraisal Note Requested by Rep. Robyn Gabel
  3/22/2024HousePension Note Requested by Rep. Robyn Gabel
  3/22/2024HouseRacial Impact Note Requested by Rep. Robyn Gabel
  3/22/2024HouseState Debt Impact Note Requested by Rep. Robyn Gabel
  3/22/2024HouseState Mandates Fiscal Note Requested by Rep. Robyn Gabel
  3/22/2024HouseAdded Co-Sponsor Rep. Emanuel "Chris" Welch
  3/26/2024HouseBalanced Budget Note Filed
  4/1/2024HouseFiscal Note Filed
  4/5/2024HouseHouse Floor Amendment No. 2 Filed with Clerk by Rep. Anna Moeller
  4/5/2024HouseHouse Floor Amendment No. 2 Referred to Rules Committee
  4/15/2024HouseHouse Floor Amendment No. 2 Rules Refers to Human Services Committee
  4/15/2024HouseAdded Co-Sponsor Rep. Stephanie A. Kifowit
  4/16/2024HouseAdded Co-Sponsor Rep. Janet Yang Rohr
  4/16/2024HouseHouse Floor Amendment No. 3 Filed with Clerk by Rep. Anna Moeller
  4/16/2024HouseHouse Floor Amendment No. 3 Referred to Rules Committee
  4/16/2024HouseSecond Reading - Short Debate
  4/16/2024HouseHeld on Calendar Order of Second Reading - Short Debate
  4/17/2024HouseHouse Floor Amendment No. 4 Filed with Clerk by Rep. Anna Moeller
  4/17/2024HouseHouse Floor Amendment No. 4 Referred to Rules Committee
  4/17/2024HouseHouse Floor Amendment No. 3 Rules Refers to Human Services Committee
  4/17/2024HouseHouse Floor Amendment No. 4 Rules Refers to Human Services Committee

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