Full Text of HB1364 103rd General Assembly
HB1364enr 103RD GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Short title. This Act may be cited as the 9-8-8 | 5 | | Suicide and Crisis Lifeline Workgroup Act. | 6 | | Section 5. Findings. The General Assembly finds that: | 7 | | (1) In the summer of 2022, 31% of Illinois adults | 8 | | experienced symptoms of anxiety or depression more than half | 9 | | of the days of each week, which is an increase of 20% since | 10 | | 2019. | 11 | | (2) Suicide is the third leading cause of death in | 12 | | Illinois for young adults who are 15 to 34 years of age, and it | 13 | | is the 11th leading cause of death for all Illinoisans. In | 14 | | 2021, 1,488 Illinois lives were lost to suicide, and an | 15 | | estimated 376,000 adults had thoughts of suicide. | 16 | | (3) Historically, people in Illinois and nationwide have | 17 | | had few and fragmented options to call upon during a mental | 18 | | health crisis and have relied upon 9-1-1 and various privately | 19 | | funded crisis lines for help. | 20 | | (4) In July 2022, Illinois joined the nation in launching | 21 | | the 9-8-8 Suicide and Crisis Lifeline, a universal 3-digit | 22 | | dialing code for a national suicide prevention and mental | 23 | | health hotline, meant to offer 24-hour-a-day, 7-day-a-week |
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| 1 | | access to trained counselors who can help people experiencing | 2 | | mental health-related distress. | 3 | | (5) Congress delegated to the states significant | 4 | | decision-making responsibility for structuring and funding the | 5 | | states' 9-8-8 call center networks. | 6 | | (6) States had limited data on which to base their initial | 7 | | decisions because the Substance Abuse and Mental Health | 8 | | Services Administration's projections of future increases in | 9 | | call volumes varied widely, and there was no national | 10 | | best-practice model for the number and organization of 9-8-8 | 11 | | call centers. | 12 | | (7) The Substance Abuse and Mental Health Services | 13 | | Administration described the 2022 launch of 9-8-8 as being | 14 | | just the first step toward reimagining our country's mental | 15 | | health crisis system and stipulated that long-term | 16 | | transformation will rely on the willingness of states and | 17 | | territories to build and invest strategically in every level | 18 | | of the continuum of mental health crisis care over the next | 19 | | several years. | 20 | | (8) In 2023, the General Assembly and other State leaders | 21 | | can assess the first year of operations of the 9-8-8 call | 22 | | center system, identify legislative solutions to any funding | 23 | | and programmatic gaps that are emerging, and set the course | 24 | | for Illinois to eventually lead the country in providing | 25 | | quality and accessible 9-8-8 care and in connecting | 26 | | individuals with the mental health resources necessary to |
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| 1 | | sustain long-term recovery. | 2 | | (9) The launch of the 9-8-8 Suicide and Crisis Lifeline | 3 | | has created a once-in-a-generation opportunity to improve | 4 | | mental health crisis care in Illinois. | 5 | | (10) Illinois' success or failure in building a | 6 | | high-quality call center network in the initial years will be | 7 | | an important factor in determining whether 9-8-8 is perceived | 8 | | as a trusted resource in the State. | 9 | | (11) Illinois' success or failure in building a | 10 | | high-quality 9-8-8 call center network will disproportionately | 11 | | affect Black, Brown, and other marginalized residents who are | 12 | | most likely to rely on crisis services to access mental health | 13 | | care and are most likely to be criminalized or harmed by the | 14 | | existing crisis response system. | 15 | | Section 10. Suicide and Crisis Lifeline Workgroup. | 16 | | (a) The Department of Human Services, Division of Mental | 17 | | Health, shall convene a workgroup that includes: | 18 | | (1) bicameral, bipartisan members of the General | 19 | | Assembly; | 20 | | (2) at least one representative from the Department of | 21 | | Human Services, Division of Substance Use Prevention and | 22 | | Recovery; the Department of Public Health; the Department | 23 | | of Healthcare and Family Services; and the Department of | 24 | | Insurance; | 25 | | (3) the State's Chief Behavioral Health Officer; |
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| 1 | | (4) the Director of the Children's Behavioral Health | 2 | | Transformation Initiative; | 3 | | (5) service providers from the regional and statewide | 4 | | 9-8-8 call centers; | 5 | | (6) representatives of organizations that represent | 6 | | people with mental health conditions or substance use | 7 | | disorders; | 8 | | (7) representatives of organizations that operate an | 9 | | Illinois social services helpline or crisis line other | 10 | | than 9-8-8, including veterans' crisis services; | 11 | | (8) more than one individual with personal or family | 12 | | lived experience of a mental health condition or substance | 13 | | use disorder; | 14 | | (9) experts in research and operational evaluation; | 15 | | and | 16 | | (10) and any other person or persons as determined by | 17 | | the Department of Human Services, Division of Mental | 18 | | Health. | 19 | | (b) On or before December 31, 2023, the Department of | 20 | | Human Services, Division of Mental Health, shall submit a | 21 | | report to the General Assembly regarding the Workgroup's | 22 | | findings under Section 15 related to the 9-8-8 call system.
| 23 | | Section 15. Responsibilities; action plan. | 24 | | (a) The Workgroup has the following responsibilities: | 25 | | (1) to review existing information about the first |
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| 1 | | year of 9-8-8 call center operations in Illinois, | 2 | | including, but not limited to, state-level and | 3 | | county-level use data, progress around the federal | 4 | | measures of success determined by the Substance Abuse and | 5 | | Mental Health Services Administration, and research | 6 | | conducted by any State-contracted partners around cost | 7 | | projections, best-practice standards, and geographic | 8 | | needs; | 9 | | (2) to review other states' models and emerging best | 10 | | practices around structuring 9-8-8 call center networks, | 11 | | with an emphasis on promoting high-quality phone | 12 | | interventions, coordination with other crisis lines and | 13 | | crisis services, and connection to community-based support | 14 | | for those in need; | 15 | | (3) to review governmental infrastructures created in | 16 | | other states to promote sustainability and quality in | 17 | | 9-8-8 call centers and crisis system operations; | 18 | | (4) to review changes and new initiatives that have | 19 | | been advanced by the Substance Abuse and Mental Health | 20 | | Services Administration and Vibrant Emotional Health since | 21 | | Vibrant transitioned to 9-8-8 in July 2022, such as new | 22 | | training curricula for call takers and new technology | 23 | | platforms; | 24 | | (5) to consider input from call center personnel, | 25 | | providers, and advocates about strengths, weaknesses, and | 26 | | service gaps in Illinois; and |
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| 1 | | (6) to develop an action plan with recommendations to | 2 | | the General Assembly that include the following: | 3 | | (A) a future structure for a network of 9-8-8 call | 4 | | centers in Illinois that will best promote equity, | 5 | | quality, and connection to care; | 6 | | (B) metrics that Illinois should use to measure | 7 | | the success of our statewide system in promoting | 8 | | equity, quality, and connection to care and a system | 9 | | to measure those metrics, considering the metrics | 10 | | imposed by the Substance Abuse and Mental Health | 11 | | Services Administration as only a starting point for | 12 | | measurement of success in Illinois; | 13 | | (C) recommendations to further fund and strengthen | 14 | | the rest of Illinois' behavioral health services and | 15 | | crisis assistance programs based on lessons learned | 16 | | from 9-8-8 use; and | 17 | | (D) recommendations on a long-term governmental | 18 | | infrastructure to provide advice and recommendations | 19 | | necessary to sustainably implement and monitor the | 20 | | progress of the 9-8-8 Suicide and Crisis Lifeline in | 21 | | Illinois and to make recommendations for the statewide | 22 | | improvement of behavioral health crisis response and | 23 | | suicide prevention services in the State. | 24 | | The action plan shall be approved by a majority of | 25 | | Workgroup members. | 26 | | (b) Nothing in the action plan filed under this Section |
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| 1 | | shall be construed to supersede the recommendations of the | 2 | | Statewide Advisory Committee or Regional Advisory Committees | 3 | | created by the Community Emergency Services and Support Act. | 4 | | Section 20. Repeal. This Act is repealed on January 1, | 5 | | 2025. | 6 | | Section 85. The Community Emergency Services and Support | 7 | | Act is amended by changing Sections 5, 15, 20, 25, 30, 35, 40, | 8 | | 45, 50, and 65 and by adding Section 70 as follows: | 9 | | (50 ILCS 754/5)
| 10 | | Sec. 5. Findings. The General Assembly recognizes that the | 11 | | Illinois Department of Human Services Division of Mental | 12 | | Health is preparing to provide mobile mental and behavioral | 13 | | health services to all Illinoisans as part of the federally | 14 | | mandated adoption of the 9-8-8 phone number. The General | 15 | | Assembly also recognizes that many cities and some states have | 16 | | successfully established mobile emergency mental and | 17 | | behavioral health services as part of their emergency response | 18 | | system to support people who need such support and do not | 19 | | present a threat of physical violence to the mobile mental | 20 | | health relief providers responders . In light of that | 21 | | experience, the General Assembly finds that in order to | 22 | | promote and protect the health, safety, and welfare of the | 23 | | public, it is necessary and in the public interest to provide |
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| 1 | | emergency response, with or without medical transportation, to | 2 | | individuals requiring mental health or behavioral health | 3 | | services in a manner that is substantially equivalent to the | 4 | | response already provided to individuals who require emergency | 5 | | physical health care.
| 6 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 7 | | (50 ILCS 754/15)
| 8 | | Sec. 15. Definitions. As used in this Act: | 9 | | "Division of Mental Health" means the Division of Mental | 10 | | Health of the Department of Human Services. | 11 | | "Emergency" means an emergent circumstance caused by a | 12 | | health condition, regardless of whether it is perceived as | 13 | | physical, mental, or behavioral in nature, for which an | 14 | | individual may require prompt care, support, or assessment at | 15 | | the individual's location. | 16 | | "Mental or behavioral health" means any health condition | 17 | | involving changes in thinking, emotion, or behavior, and that | 18 | | the medical community treats as distinct from physical health | 19 | | care. | 20 | | "Mobile mental health relief provider" means a person | 21 | | engaging with a member of the public to provide the mobile | 22 | | mental and behavioral service established in conjunction with | 23 | | the Division of Mental Health establishing the 9-8-8 emergency | 24 | | number. "Mobile mental health relief provider" does not | 25 | | include a Paramedic (EMT-P) or EMT, as those terms are defined |
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| 1 | | in the Emergency Medical Services (EMS) Systems Act, unless | 2 | | that responding agency has agreed to provide a specialized | 3 | | response in accordance with the Division of Mental Health's | 4 | | services offered through its 9-8-8 number and has met all the | 5 | | requirements to offer that service through that system. | 6 | | "Physical health" means a health condition that the | 7 | | medical community treats as distinct from mental or behavioral | 8 | | health care. | 9 | | "PSAP" means a Public Safety Answering Point | 10 | | tele-communicator. | 11 | | "Community services" and "community-based mental or | 12 | | behavioral health services" may include both public and | 13 | | private settings. | 14 | | "Treatment relationship" means an active association with | 15 | | a mental or behavioral care provider able to respond in an | 16 | | appropriate amount of time to requests for care. | 17 | | "Responder" is any person engaging with a member of the | 18 | | public to provide the mobile mental and behavioral service | 19 | | established in conjunction with the Division of Mental Health | 20 | | establishing the 9-8-8 emergency number. A responder is not an | 21 | | EMS Paramedic or EMT as defined in the Emergency Medical | 22 | | Services (EMS) Systems Act unless that responding agency has | 23 | | agreed to provide a specialized response in accordance with | 24 | | the Division of Mental Health's services offered through its | 25 | | 9-8-8 number and has met all the requirements to offer that | 26 | | service through that system.
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| 1 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 2 | | (50 ILCS 754/20)
| 3 | | Sec. 20. Coordination with Division of Mental Health. | 4 | | Each 9-1-1 PSAP and provider of emergency services dispatched | 5 | | through a 9-1-1 system must coordinate with the mobile mental | 6 | | and behavioral health services established by the Division of | 7 | | Mental Health so that the following State goals and State | 8 | | prohibitions are met whenever a person interacts with one of | 9 | | these entities for the purpose of seeking emergency mental and | 10 | | behavioral health care or when one of these entities | 11 | | recognizes the appropriateness of providing mobile mental or | 12 | | behavioral health care to an individual with whom they have | 13 | | engaged. The Division of Mental Health is also directed to | 14 | | provide guidance regarding whether and how these entities | 15 | | should coordinate with mobile mental and behavioral health | 16 | | services when responding to individuals who appear to be in a | 17 | | mental or behavioral health emergency while engaged in conduct | 18 | | alleged to constitute a non-violent misdemeanor.
| 19 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 20 | | (50 ILCS 754/25)
| 21 | | Sec. 25. State goals. | 22 | | (a) 9-1-1 PSAPs, emergency services dispatched through | 23 | | 9-1-1 PSAPs, and the mobile mental and behavioral health | 24 | | service established by the Division of Mental Health must |
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| 1 | | coordinate their services so that the State goals listed in | 2 | | this Section are achieved. Appropriate mobile response service | 3 | | for mental and behavioral health emergencies shall be | 4 | | available regardless of whether the initial contact was with | 5 | | 9-8-8, 9-1-1 or directly with an emergency service dispatched | 6 | | through 9-1-1. Appropriate mobile response services must: | 7 | | (1) whenever possible, ensure that individuals | 8 | | experiencing mental or behavioral health crises are | 9 | | diverted from hospitalization or incarceration whenever | 10 | | possible, and are instead linked with available | 11 | | appropriate community services;
| 12 | | (2) include the option of on-site care if that type of | 13 | | care is appropriate and does not override the care | 14 | | decisions of the individual receiving care. Providing care | 15 | | in the community, through methods like mobile crisis | 16 | | units, is encouraged. If effective care is provided on | 17 | | site, and if it is consistent with the care decisions of | 18 | | the individual receiving the care, further transportation | 19 | | to other medical providers is not required by this Act; | 20 | | (3) recommend appropriate referrals for available | 21 | | community services if the individual receiving on-site | 22 | | care is not already in a treatment relationship with a | 23 | | service provider or is unsatisfied with their current | 24 | | service providers. The referrals shall take into | 25 | | consideration waiting lists and copayments, which may | 26 | | present barriers to access; and
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| 1 | | (4) subject to the care decisions of the individual | 2 | | receiving care, provide transportation for any individual | 3 | | experiencing a mental or behavioral health emergency. | 4 | | Transportation shall be to the most integrated and least | 5 | | restrictive setting appropriate in the community, such as | 6 | | to the individual's home or chosen location, community | 7 | | crisis respite centers, clinic settings, behavioral health | 8 | | centers, or the offices of particular medical care | 9 | | providers with existing treatment relationships to the | 10 | | individual seeking care. | 11 | | (b) Prioritize requests for emergency assistance. 9-1-1 | 12 | | PSAPs, emergency services dispatched through 9-1-1 PSAPs, and | 13 | | the mobile mental and behavioral health service established by | 14 | | the Division of Mental Health must provide guidance for | 15 | | prioritizing calls for assistance and maximum response time in | 16 | | relation to the type of emergency reported. | 17 | | (c) Provide appropriate response times. From the time of | 18 | | first notification, 9-1-1 PSAPs, emergency services dispatched | 19 | | through 9-1-1 PSAPs, and the mobile mental and behavioral | 20 | | health service established by the Division of Mental Health | 21 | | must provide the response within response time appropriate to | 22 | | the care requirements of the individual with an emergency. | 23 | | (d) Require appropriate mobile mental health relief | 24 | | provider responder training. Mobile mental health relief | 25 | | providers Responders must have adequate training to address | 26 | | the needs of individuals experiencing a mental or behavioral |
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| 1 | | health emergency. Adequate training at least includes: | 2 | | (1) training in de-escalation techniques; | 3 | | (2) knowledge of local community services and | 4 | | supports; and
| 5 | | (3) training in respectful interaction with people | 6 | | experiencing mental or behavioral health crises, including | 7 | | the concepts of stigma and respectful language. | 8 | | (e) Require minimum team staffing. The Division of Mental | 9 | | Health, in consultation with the Regional Advisory Committees | 10 | | created in Section 40, shall determine the appropriate | 11 | | credentials for the mental health providers responding to | 12 | | calls, including to what extent the mobile mental health | 13 | | relief providers responders must have certain credentials and | 14 | | licensing, and to what extent the mobile mental health relief | 15 | | providers responders can be peer support professionals. | 16 | | (f) Require training from individuals with lived | 17 | | experience. Training shall be provided by individuals with | 18 | | lived experience to the extent available. | 19 | | (g) Adopt guidelines directing referral to restrictive | 20 | | care settings. Mobile mental health relief providers | 21 | | Responders must have guidelines to follow when considering | 22 | | whether to refer an individual to more restrictive forms of | 23 | | care, like emergency room or hospital settings. | 24 | | (h) Specify regional best practices. Mobile mental health | 25 | | relief providers Responders providing these services must do | 26 | | so consistently with best practices, which include respecting |
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| 1 | | the care choices of the individuals receiving assistance. | 2 | | Regional best practices may be broken down into sub-regions, | 3 | | as appropriate to reflect local resources and conditions. With | 4 | | the agreement of the impacted EMS Regions, providers of | 5 | | emergency response to physical emergencies may participate in | 6 | | another EMS Region for mental and behavioral response, if that | 7 | | participation shall provide a better service to individuals | 8 | | experiencing a mental or behavioral health emergency. | 9 | | (i) Adopt system for directing care in advance of an | 10 | | emergency. The Division of Mental Health shall select and | 11 | | publicly identify a system that allows individuals who | 12 | | voluntarily chose to do so to provide confidential advanced | 13 | | care directions to individuals providing services under this | 14 | | Act. No system for providing advanced care direction may be | 15 | | implemented unless the Division of Mental Health approves it | 16 | | as confidential, available to individuals at all economic | 17 | | levels, and non-stigmatizing. The Division of Mental Health | 18 | | may defer this requirement for providing a system for advanced | 19 | | care direction if it determines that no existing systems can | 20 | | currently meet these requirements. | 21 | | (j) Train dispatching staff. The personnel staffing 9-1-1, | 22 | | 3-1-1, or other emergency response intake systems must be | 23 | | provided with adequate training to assess whether coordinating | 24 | | with 9-8-8 is appropriate. | 25 | | (k) Establish protocol for emergency responder | 26 | | coordination. The Division of Mental Health shall establish a |
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| 1 | | protocol for mobile mental health relief providers responders , | 2 | | law enforcement, and fire and ambulance services to request | 3 | | assistance from each other, and train these groups on the | 4 | | protocol. | 5 | | (l) Integrate law enforcement. The Division of Mental | 6 | | Health shall provide for law enforcement to request mobile | 7 | | mental health relief provider responder assistance whenever | 8 | | law enforcement engages an individual appropriate for services | 9 | | under this Act. If law enforcement would typically request EMS | 10 | | assistance when it encounters an individual with a physical | 11 | | health emergency, law enforcement shall similarly dispatch | 12 | | mental or behavioral health personnel or medical | 13 | | transportation when it encounters an individual in a mental or | 14 | | behavioral health emergency.
| 15 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 16 | | (50 ILCS 754/30)
| 17 | | Sec. 30. State prohibitions. 9-1-1 PSAPs, emergency | 18 | | services dispatched through 9-1-1 PSAPs, and the mobile mental | 19 | | and behavioral health service established by the Division of | 20 | | Mental Health must coordinate their services so that, based on | 21 | | the information provided to them, the following State | 22 | | prohibitions are avoided: | 23 | | (a) Law enforcement responsibility for providing mental | 24 | | and behavioral health care. In any area where mobile mental | 25 | | health relief providers responders are available for dispatch, |
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| 1 | | law enforcement shall not be dispatched to respond to an | 2 | | individual requiring mental or behavioral health care unless | 3 | | that individual is (i) involved in a suspected violation of | 4 | | the criminal laws of this State, or (ii) presents a threat of | 5 | | physical injury to self or others. Mobile mental health relief | 6 | | providers Responders are not considered available for dispatch | 7 | | under this Section if 9-8-8 reports that it cannot dispatch | 8 | | appropriate service within the maximum response times | 9 | | established by each Regional Advisory Committee under Section | 10 | | 45. | 11 | | (1) Standing on its own or in combination with each | 12 | | other, the fact that an individual is experiencing a | 13 | | mental or behavioral health emergency, or has a mental | 14 | | health, behavioral health, or other diagnosis, is not | 15 | | sufficient to justify an assessment that the individual is | 16 | | a threat of physical injury to self or others, or requires | 17 | | a law enforcement response to a request for emergency | 18 | | response or medical transportation. | 19 | | (2) If, based on its assessment of the threat to | 20 | | public safety, law enforcement would not accompany medical | 21 | | transportation responding to a physical health emergency, | 22 | | unless requested by mobile mental health relief providers | 23 | | responders , law enforcement may not accompany emergency | 24 | | response or medical transportation personnel responding to | 25 | | a mental or behavioral health emergency that presents an | 26 | | equivalent level of threat to self or public safety. |
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| 1 | | (3) Without regard to an assessment of threat to self | 2 | | or threat to public safety, law enforcement may station | 3 | | personnel so that they can rapidly respond to requests for | 4 | | assistance from mobile mental health relief providers | 5 | | responders if law enforcement does not interfere with the | 6 | | provision of emergency response or transportation | 7 | | services. To the extent practical, not interfering with | 8 | | services includes remaining sufficiently distant from or | 9 | | out of sight of the individual receiving care so that law | 10 | | enforcement presence is unlikely to escalate the | 11 | | emergency. | 12 | | (b) Mobile mental health relief provider Responder | 13 | | involvement in involuntary commitment. In order to maintain | 14 | | the appropriate care relationship, mobile mental health relief | 15 | | providers responders shall not in any way assist in the | 16 | | involuntary commitment of an individual beyond (i) reporting | 17 | | to their dispatching entity or to law enforcement that they | 18 | | believe the situation requires assistance the mobile mental | 19 | | health relief providers responders are not permitted to | 20 | | provide under this Section; (ii) providing witness statements; | 21 | | and (iii) fulfilling reporting requirements the mobile mental | 22 | | health relief providers responders may have under their | 23 | | professional ethical obligations or laws of this state. This | 24 | | prohibition shall not interfere with any mobile mental health | 25 | | relief provider's responder's ability to provide physical or | 26 | | mental health care. |
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| 1 | | (c) Use of law enforcement for transportation. In any area | 2 | | where mobile mental health relief providers responders are | 3 | | available for dispatch, unless requested by mobile mental | 4 | | health relief providers responders , law enforcement shall not | 5 | | be used to provide transportation to access mental or | 6 | | behavioral health care, or travel between mental or behavioral | 7 | | health care providers, except where no alternative is | 8 | | available. | 9 | | (d) Reduction of educational institution obligations. The | 10 | | services coordinated under this Act may not be used to replace | 11 | | any service an educational institution is required to provide | 12 | | to a student. It shall not substitute for appropriate special | 13 | | education and related services that schools are required to | 14 | | provide by any law.
| 15 | | (e) Subsections (a), (c), and (d) are operative beginning | 16 | | on the date the 3 conditions in Section 65 are met or July 1, | 17 | | 2024, whichever is earlier. Subsection (b) is operative | 18 | | beginning on July 1, 2024. | 19 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 20 | | (50 ILCS 754/35)
| 21 | | Sec. 35. Non-violent misdemeanors. The Division of Mental | 22 | | Health's Guidance for 9-1-1 PSAPs and emergency services | 23 | | dispatched through 9-1-1 PSAPs for coordinating the response | 24 | | to individuals who appear to be in a mental or behavioral | 25 | | health emergency while engaging in conduct alleged to |
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| 1 | | constitute a non-violent misdemeanor shall promote the | 2 | | following: | 3 | | (a) Prioritization of Health Care. To the greatest | 4 | | extent practicable, community-based mental or behavioral | 5 | | health services should be provided before addressing law | 6 | | enforcement objectives. | 7 | | (b) Diversion from Further Criminal Justice | 8 | | Involvement. To the greatest extent practicable, | 9 | | individuals should be referred to health care services | 10 | | with the potential to reduce the likelihood of further law | 11 | | enforcement engagement and referral to a pre-arrest or | 12 | | pre-booking case management unit should be prioritized in | 13 | | any areas served by pre-arrest or pre-booking case | 14 | | management .
| 15 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 16 | | (50 ILCS 754/40)
| 17 | | Sec. 40. Statewide Advisory Committee. | 18 | | (a) The Division of Mental Health shall establish a | 19 | | Statewide Advisory Committee to review and make | 20 | | recommendations for aspects of coordinating 9-1-1 and the | 21 | | 9-8-8 mobile mental health response system most appropriately | 22 | | addressed on a State level. | 23 | | (b) Issues to be addressed by the Statewide Advisory | 24 | | Committee include, but are not limited to, addressing changes | 25 | | necessary in 9-1-1 call taking protocols and scripts used in |
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| 1 | | 9-1-1 PSAPs where those protocols and scripts are based on or | 2 | | otherwise dependent on national providers for their operation.
| 3 | | (c) The Statewide Advisory Committee shall recommend a | 4 | | system for gathering data related to the coordination of the | 5 | | 9-1-1 and 9-8-8 systems for purposes of allowing the parties | 6 | | to make ongoing improvements in that system. As practical, the | 7 | | system shall attempt to determine issues including, but not | 8 | | limited to: | 9 | | (1) the volume of calls coordinated between 9-1-1 and | 10 | | 9-8-8; | 11 | | (2) the volume of referrals from other first | 12 | | responders to 9-8-8; | 13 | | (3) the volume and type of calls deemed appropriate | 14 | | for referral to 9-8-8 but could not be served by 9-8-8 | 15 | | because of capacity restrictions or other reasons; | 16 | | (4) the appropriate information to improve | 17 | | coordination between 9-1-1 and 9-8-8; and | 18 | | (5) the appropriate information to improve the 9-8-8 | 19 | | system, if the information is most appropriately gathered | 20 | | at the 9-1-1 PSAPs. | 21 | | (d) The Statewide Advisory Committee shall consist of: | 22 | | (1) the Statewide 9-1-1 Administrator, ex officio; | 23 | | (2) one representative designated by the Illinois | 24 | | Chapter of National Emergency Number Association (NENA); | 25 | | (3) one representative designated by the Illinois | 26 | | Chapter of Association of Public Safety Communications |
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| 1 | | Officials (APCO); | 2 | | (4) one representative of the Division of Mental | 3 | | Health; | 4 | | (5) one representative of the Illinois Department of | 5 | | Public Health; | 6 | | (6) one representative of a statewide organization of | 7 | | EMS responders; | 8 | | (7) one representative of a statewide organization of | 9 | | fire chiefs; | 10 | | (8) two representatives of statewide organizations of | 11 | | law enforcement; | 12 | | (9) two representatives of mental health, behavioral | 13 | | health, or substance abuse providers; and | 14 | | (10) four representatives of advocacy organizations | 15 | | either led by or consisting primarily of individuals with | 16 | | intellectual or developmental disabilities, individuals | 17 | | with behavioral disabilities, or individuals with lived | 18 | | experience. | 19 | | (e) The members of the Statewide Advisory Committee, other | 20 | | than the Statewide 9-1-1 Administrator, shall be appointed by | 21 | | the Secretary of Human Services.
| 22 | | (f) The Statewide Advisory Committee shall continue to | 23 | | meet until this Act has been fully implemented, as determined | 24 | | by the Division of Mental Health, and mobile mental health | 25 | | relief providers are available in all parts of Illinois. The | 26 | | Division of Mental Health may reconvene the Statewide Advisory |
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| 1 | | Committee at its discretion after full implementation of this | 2 | | Act. | 3 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 4 | | (50 ILCS 754/45)
| 5 | | Sec. 45. Regional Advisory Committees. | 6 | | (a) The Division of Mental Health shall establish Regional | 7 | | Advisory Committees in each EMS Region to advise on regional | 8 | | issues related to emergency response systems for mental and | 9 | | behavioral health. The Secretary of Human Services shall | 10 | | appoint the members of the Regional Advisory Committees. Each | 11 | | Regional Advisory Committee shall consist of: | 12 | | (1) representatives of the 9-1-1 PSAPs in the region; | 13 | | (2) representatives of the EMS Medical Directors | 14 | | Committee, as constituted under the Emergency Medical | 15 | | Services (EMS) Systems Act, or other similar committee | 16 | | serving the medical needs of the jurisdiction; | 17 | | (3) representatives of law enforcement officials with | 18 | | jurisdiction in the Emergency Medical Services (EMS) | 19 | | Regions; | 20 | | (4) representatives of both the EMS providers and the | 21 | | unions representing EMS or emergency mental and behavioral | 22 | | health responders, or both; and | 23 | | (5) advocates from the mental health, behavioral | 24 | | health, intellectual disability, and developmental | 25 | | disability communities. |
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| 1 | | If no person is willing or available to fill a member's | 2 | | seat for one of the required areas of representation on a | 3 | | Regional Advisory Committee under paragraphs (1) through (5), | 4 | | the Secretary of Human Services shall adopt procedures to | 5 | | ensure that a missing area of representation is filled once a | 6 | | person becomes willing and available to fill that seat. | 7 | | (b) The majority of advocates on the Regional Advisory | 8 | | Emergency Response Equity Committee must either be individuals | 9 | | with a lived experience of a condition commonly regarded as a | 10 | | mental health or behavioral health disability, developmental | 11 | | disability, or intellectual disability , or be from | 12 | | organizations primarily composed of such individuals. The | 13 | | members of the Committee shall also reflect the racial | 14 | | demographics of the jurisdiction served. To achieve the | 15 | | requirements of this subsection, the Division of Mental Health | 16 | | must establish a clear plan and regular course of action to | 17 | | engage, recruit, and sustain areas of established | 18 | | participation. The plan and actions taken must be shared with | 19 | | the general public. | 20 | | (c) Subject to the oversight of the Department of Human | 21 | | Services Division of Mental Health, the EMS Medical Directors | 22 | | Committee is responsible for convening the meetings of the | 23 | | committee. Impacted units of local government may also have | 24 | | representatives on the committee subject to approval by the | 25 | | Division of Mental Health, if this participation is structured | 26 | | in such a way that it does not give undue weight to any of the |
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| 1 | | groups represented.
| 2 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 3 | | (50 ILCS 754/50)
| 4 | | Sec. 50. Regional Advisory Committee responsibilities. | 5 | | Each Regional Advisory Committee is responsible for designing | 6 | | the local protocol to allow its region's 9-1-1 call center and | 7 | | emergency responders to coordinate their activities with 9-8-8 | 8 | | as required by this Act and monitoring current operation to | 9 | | advise on ongoing adjustments to the local protocol. Included | 10 | | in this responsibility, each Regional Advisory Committee must: | 11 | | (1) negotiate the appropriate amendment of each 9-1-1 | 12 | | PSAP emergency dispatch protocols, in consultation with | 13 | | each 9-1-1 PSAP in the EMS Region and consistent with | 14 | | national certification requirements; | 15 | | (2) set maximum response times for 9-8-8 to provide | 16 | | service when an in-person response is required, based on | 17 | | type of mental or behavioral health emergency, which, if | 18 | | exceeded, constitute grounds for sending other emergency | 19 | | responders through the 9-1-1 system; | 20 | | (3) report, geographically by police district if | 21 | | practical, the data collected through the direction | 22 | | provided by the Statewide Advisory Committee in | 23 | | aggregated, non-individualized monthly reports. These | 24 | | reports shall be available to the Regional Advisory | 25 | | Committee members, the Department of Human Service |
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| 1 | | Division of Mental Health, the Administrator of the 9-1-1 | 2 | | Authority, and to the public upon request; and | 3 | | (4) convene, after the initial regional policies are | 4 | | established, at least every 2 years to consider amendment | 5 | | of the regional policies, if any, and also convene | 6 | | whenever a member of the Committee requests that the | 7 | | Committee consider an amendment ; and .
| 8 | | (5) identify regional resources and supports for use | 9 | | by the mobile mental health relief providers as they | 10 | | respond to the requests for services. | 11 | | (Source: P.A. 102-580, eff. 1-1-22 .) | 12 | | (50 ILCS 754/65)
| 13 | | Sec. 65. PSAP and emergency service dispatched through a | 14 | | 9-1-1 PSAP; coordination of activities with mobile and | 15 | | behavioral health services. Each 9-1-1 PSAP and emergency | 16 | | service dispatched through a 9-1-1 PSAP must begin | 17 | | coordinating its activities with the mobile mental and | 18 | | behavioral health services established by the Division of | 19 | | Mental Health once all 3 of the following conditions are met, | 20 | | but not later than July 1, 2024 2023 : | 21 | | (1) the Statewide Committee has negotiated useful | 22 | | protocol and 9-1-1 operator script adjustments with the | 23 | | contracted services providing these tools to 9-1-1 PSAPs | 24 | | operating in Illinois; | 25 | | (2) the appropriate Regional Advisory Committee has |
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| 1 | | completed design of the specific 9-1-1 PSAP's process for | 2 | | coordinating activities with the mobile mental and | 3 | | behavioral health service; and | 4 | | (3) the mobile mental and behavioral health service is | 5 | | available in their jurisdiction.
| 6 | | (Source: P.A. 102-580, eff. 1-1-22; 102-1109, eff. 12-21-22.) | 7 | | (50 ILCS 754/70 new) | 8 | | Sec. 70. Report. On or before July 1, 2023 and on a | 9 | | quarterly basis thereafter, the Division of Mental Health | 10 | | shall submit a report to the General Assembly on its progress | 11 | | in implementing this Act, which shall include, but not be | 12 | | limited to, a strategic assessment that evaluates the success | 13 | | toward current strategy, identification of future targets for | 14 | | implementation that help estimate the potential for success | 15 | | and provides a basis for assessing future performance, and key | 16 | | benchmarks to provide a comparison to set in context and help | 17 | | stakeholders understand their positions. | 18 | | Section 90. The Illinois Insurance Code is amended by | 19 | | changing Section 370c.1 as follows: | 20 | | (215 ILCS 5/370c.1) | 21 | | Sec. 370c.1. Mental, emotional, nervous, or substance use | 22 | | disorder or condition parity. | 23 | | (a) On and after July 23, 2021 (the effective date of |
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| 1 | | Public Act 102-135), every insurer that amends, delivers, | 2 | | issues, or renews a group or individual policy of accident and | 3 | | health insurance or a qualified health plan offered through | 4 | | the Health Insurance Marketplace in this State providing | 5 | | coverage for hospital or medical treatment and for the | 6 | | treatment of mental, emotional, nervous, or substance use | 7 | | disorders or conditions shall ensure prior to policy issuance | 8 | | that: | 9 | | (1) the financial requirements applicable to such | 10 | | mental, emotional, nervous, or substance use disorder or | 11 | | condition benefits are no more restrictive than the | 12 | | predominant financial requirements applied to | 13 | | substantially all hospital and medical benefits covered by | 14 | | the policy and that there are no separate cost-sharing | 15 | | requirements that are applicable only with respect to | 16 | | mental, emotional, nervous, or substance use disorder or | 17 | | condition benefits; and | 18 | | (2) the treatment limitations applicable to such | 19 | | mental, emotional, nervous, or substance use disorder or | 20 | | condition benefits are no more restrictive than the | 21 | | predominant treatment limitations applied to substantially | 22 | | all hospital and medical benefits covered by the policy | 23 | | and that there are no separate treatment limitations that | 24 | | are applicable only with respect to mental, emotional, | 25 | | nervous, or substance use disorder or condition benefits. | 26 | | (b) The following provisions shall apply concerning |
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| 1 | | aggregate lifetime limits: | 2 | | (1) In the case of a group or individual policy of | 3 | | accident and health insurance or a qualified health plan | 4 | | offered through the Health Insurance Marketplace amended, | 5 | | delivered, issued, or renewed in this State on or after | 6 | | September 9, 2015 (the effective date of Public Act | 7 | | 99-480) that provides coverage for hospital or medical | 8 | | treatment and for the treatment of mental, emotional, | 9 | | nervous, or substance use disorders or conditions the | 10 | | following provisions shall apply: | 11 | | (A) if the policy does not include an aggregate | 12 | | lifetime limit on substantially all hospital and | 13 | | medical benefits, then the policy may not impose any | 14 | | aggregate lifetime limit on mental, emotional, | 15 | | nervous, or substance use disorder or condition | 16 | | benefits; or | 17 | | (B) if the policy includes an aggregate lifetime | 18 | | limit on substantially all hospital and medical | 19 | | benefits (in this subsection referred to as the | 20 | | "applicable lifetime limit"), then the policy shall | 21 | | either: | 22 | | (i) apply the applicable lifetime limit both | 23 | | to the hospital and medical benefits to which it | 24 | | otherwise would apply and to mental, emotional, | 25 | | nervous, or substance use disorder or condition | 26 | | benefits and not distinguish in the application of |
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| 1 | | the limit between the hospital and medical | 2 | | benefits and mental, emotional, nervous, or | 3 | | substance use disorder or condition benefits; or | 4 | | (ii) not include any aggregate lifetime limit | 5 | | on mental, emotional, nervous, or substance use | 6 | | disorder or condition benefits that is less than | 7 | | the applicable lifetime limit. | 8 | | (2) In the case of a policy that is not described in | 9 | | paragraph (1) of subsection (b) of this Section and that | 10 | | includes no or different aggregate lifetime limits on | 11 | | different categories of hospital and medical benefits, the | 12 | | Director shall establish rules under which subparagraph | 13 | | (B) of paragraph (1) of subsection (b) of this Section is | 14 | | applied to such policy with respect to mental, emotional, | 15 | | nervous, or substance use disorder or condition benefits | 16 | | by substituting for the applicable lifetime limit an | 17 | | average aggregate lifetime limit that is computed taking | 18 | | into account the weighted average of the aggregate | 19 | | lifetime limits applicable to such categories. | 20 | | (c) The following provisions shall apply concerning annual | 21 | | 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 annual limit | 6 | | on substantially all hospital and medical benefits, | 7 | | then the policy may not impose any annual limits on | 8 | | mental, emotional, nervous, or substance use disorder | 9 | | or condition benefits; or | 10 | | (B) if the policy includes an annual limit on | 11 | | substantially all hospital and medical benefits (in | 12 | | this subsection referred to as the "applicable annual | 13 | | limit"), then the policy shall either: | 14 | | (i) apply the applicable annual limit both to | 15 | | the hospital and medical benefits to which it | 16 | | otherwise would apply and to mental, emotional, | 17 | | nervous, or substance use disorder or condition | 18 | | benefits and not distinguish in the application of | 19 | | the limit between the hospital and medical | 20 | | benefits and mental, emotional, nervous, or | 21 | | substance use disorder or condition benefits; or | 22 | | (ii) not include any annual limit on mental, | 23 | | emotional, nervous, or substance use disorder or | 24 | | condition benefits that is less than the | 25 | | applicable annual limit. | 26 | | (2) In the case of a policy that is not described in |
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| 1 | | paragraph (1) of subsection (c) of this Section and that | 2 | | includes no or different annual limits on different | 3 | | categories of hospital and medical benefits, the Director | 4 | | shall establish rules under which subparagraph (B) of | 5 | | paragraph (1) of subsection (c) of this Section is applied | 6 | | to such policy with respect to mental, emotional, nervous, | 7 | | or substance use disorder or condition benefits by | 8 | | substituting for the applicable annual limit an average | 9 | | annual limit that is computed taking into account the | 10 | | weighted average of the annual limits applicable to such | 11 | | categories. | 12 | | (d) With respect to mental, emotional, nervous, or | 13 | | substance use disorders or conditions, an insurer shall use | 14 | | policies and procedures for the election and placement of | 15 | | mental, emotional, nervous, or substance use disorder or | 16 | | condition treatment drugs on their formulary that are no less | 17 | | favorable to the insured as those policies and procedures the | 18 | | insurer uses for the selection and placement of drugs for | 19 | | medical or surgical conditions and shall follow the expedited | 20 | | coverage determination requirements for substance abuse | 21 | | treatment drugs set forth in Section 45.2 of the Managed Care | 22 | | Reform and Patient Rights Act. | 23 | | (e) This Section shall be interpreted in a manner | 24 | | consistent with all applicable federal parity regulations | 25 | | including, but not limited to, the Paul Wellstone and Pete | 26 | | Domenici Mental Health Parity and Addiction Equity Act of |
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| 1 | | 2008, final regulations issued under the Paul Wellstone and | 2 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 3 | | 2008 and final regulations applying the Paul Wellstone and | 4 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 5 | | 2008 to Medicaid managed care organizations, the Children's | 6 | | Health Insurance Program, and alternative benefit plans. | 7 | | (f) The provisions of subsections (b) and (c) of this | 8 | | Section shall not be interpreted to allow the use of lifetime | 9 | | or annual limits otherwise prohibited by State or federal law. | 10 | | (g) As used in this Section: | 11 | | "Financial requirement" includes deductibles, copayments, | 12 | | coinsurance, and out-of-pocket maximums, but does not include | 13 | | an aggregate lifetime limit or an annual limit subject to | 14 | | subsections (b) and (c). | 15 | | "Mental, emotional, nervous, or substance use disorder or | 16 | | condition" means a condition or disorder that involves a | 17 | | mental health condition or substance use disorder that falls | 18 | | under any of the diagnostic categories listed in the mental | 19 | | and behavioral disorders chapter of the current edition of the | 20 | | International Classification of Disease or that is listed in | 21 | | the most recent version of the Diagnostic and Statistical | 22 | | Manual of Mental Disorders. | 23 | | "Treatment limitation" includes limits on benefits based | 24 | | on the frequency of treatment, number of visits, days of | 25 | | coverage, days in a waiting period, or other similar limits on | 26 | | the scope or duration of treatment. "Treatment limitation" |
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| 1 | | includes both quantitative treatment limitations, which are | 2 | | expressed numerically (such as 50 outpatient visits per year), | 3 | | and nonquantitative treatment limitations, which otherwise | 4 | | limit the scope or duration of treatment. A permanent | 5 | | exclusion of all benefits for a particular condition or | 6 | | disorder shall not be considered a treatment limitation. | 7 | | "Nonquantitative treatment" means those limitations as | 8 | | described under federal regulations (26 CFR 54.9812-1). | 9 | | "Nonquantitative treatment limitations" include, but are not | 10 | | limited to, those limitations described under federal | 11 | | regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR | 12 | | 146.136.
| 13 | | (h) The Department of Insurance shall implement the | 14 | | following education initiatives: | 15 | | (1) By January 1, 2016, the Department shall develop a | 16 | | plan for a Consumer Education Campaign on parity. The | 17 | | Consumer Education Campaign shall focus its efforts | 18 | | throughout the State and include trainings in the | 19 | | northern, southern, and central regions of the State, as | 20 | | defined by the Department, as well as each of the 5 managed | 21 | | care regions of the State as identified by the Department | 22 | | of Healthcare and Family Services. Under this Consumer | 23 | | Education Campaign, the Department shall: (1) by January | 24 | | 1, 2017, provide at least one live training in each region | 25 | | on parity for consumers and providers and one webinar | 26 | | training to be posted on the Department website and (2) |
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| 1 | | establish a consumer hotline to assist consumers in | 2 | | navigating the parity process by March 1, 2017. By January | 3 | | 1, 2018 the Department shall issue a report to the General | 4 | | Assembly on the success of the Consumer Education | 5 | | Campaign, which shall indicate whether additional training | 6 | | is necessary or would be recommended. | 7 | | (2) The Department, in coordination with the | 8 | | Department of Human Services and the Department of | 9 | | Healthcare and Family Services, shall convene a working | 10 | | group of health care insurance carriers, mental health | 11 | | advocacy groups, substance abuse patient advocacy groups, | 12 | | and mental health physician groups for the purpose of | 13 | | discussing issues related to the treatment and coverage of | 14 | | mental, emotional, nervous, or substance use disorders or | 15 | | conditions and compliance with parity obligations under | 16 | | State and federal law. Compliance shall be measured, | 17 | | tracked, and shared during the meetings of the working | 18 | | group. The working group shall meet once before January 1, | 19 | | 2016 and shall meet semiannually thereafter. The | 20 | | Department shall issue an annual report to the General | 21 | | Assembly that includes a list of the health care insurance | 22 | | carriers, mental health advocacy groups, substance abuse | 23 | | patient advocacy groups, and mental health physician | 24 | | groups that participated in the working group meetings, | 25 | | details on the issues and topics covered, and any | 26 | | legislative recommendations developed by the working |
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| 1 | | group. | 2 | | (3) Not later than January 1 of each year, the | 3 | | Department, in conjunction with the Department of | 4 | | Healthcare and Family Services, shall issue a joint report | 5 | | to the General Assembly and provide an educational | 6 | | presentation to the General Assembly. The report and | 7 | | presentation shall: | 8 | | (A) Cover the methodology the Departments use to | 9 | | check for compliance with the federal Paul Wellstone | 10 | | and Pete Domenici Mental Health Parity and Addiction | 11 | | Equity Act of 2008, 42 U.S.C. 18031(j), and any | 12 | | federal regulations or guidance relating to the | 13 | | compliance and oversight of the federal Paul Wellstone | 14 | | and Pete Domenici Mental Health Parity and Addiction | 15 | | Equity Act of 2008 and 42 U.S.C. 18031(j). | 16 | | (B) Cover the methodology the Departments use to | 17 | | check for compliance with this Section and Sections | 18 | | 356z.23 and 370c of this Code. | 19 | | (C) Identify market conduct examinations or, in | 20 | | the case of the Department of Healthcare and Family | 21 | | Services, audits conducted or completed during the | 22 | | preceding 12-month period regarding compliance with | 23 | | parity in mental, emotional, nervous, and substance | 24 | | use disorder or condition benefits under State and | 25 | | federal laws and summarize the results of such market | 26 | | conduct examinations and audits. This shall include: |
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| 1 | | (i) the number of market conduct examinations | 2 | | and audits initiated and completed; | 3 | | (ii) the benefit classifications examined by | 4 | | each market conduct examination and audit; | 5 | | (iii) the subject matter of each market | 6 | | conduct examination and audit, including | 7 | | quantitative and nonquantitative treatment | 8 | | limitations; and | 9 | | (iv) a summary of the basis for the final | 10 | | decision rendered in each market conduct | 11 | | examination and audit. | 12 | | Individually identifiable information shall be | 13 | | excluded from the reports consistent with federal | 14 | | privacy protections. | 15 | | (D) Detail any educational or corrective actions | 16 | | the Departments have taken to ensure compliance with | 17 | | the federal Paul Wellstone and Pete Domenici Mental | 18 | | Health Parity and Addiction Equity Act of 2008, 42 | 19 | | U.S.C. 18031(j), this Section, and Sections 356z.23 | 20 | | and 370c of this Code. | 21 | | (E) The report must be written in non-technical, | 22 | | readily understandable language and shall be made | 23 | | available to the public by, among such other means as | 24 | | the Departments find appropriate, posting the report | 25 | | on the Departments' websites. | 26 | | (i) The Parity Advancement Fund is created as a special |
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| 1 | | fund in the State treasury. Moneys from fines and penalties | 2 | | collected from insurers for violations of this Section shall | 3 | | be deposited into the Fund. Moneys deposited into the Fund for | 4 | | appropriation by the General Assembly to the Department shall | 5 | | be used for the purpose of providing financial support of the | 6 | | Consumer Education Campaign, parity compliance advocacy, and | 7 | | other initiatives that support parity implementation and | 8 | | enforcement on behalf of consumers. | 9 | | (j) (Blank). The Department of Insurance and the | 10 | | Department of Healthcare and Family Services shall convene and | 11 | | provide technical support to a workgroup of 11 members that | 12 | | shall be comprised of 3 mental health parity experts | 13 | | recommended by an organization advocating on behalf of mental | 14 | | health parity appointed by the President of the Senate; 3 | 15 | | behavioral health providers recommended by an organization | 16 | | that represents behavioral health providers appointed by the | 17 | | Speaker of the House of Representatives; 2 representing | 18 | | Medicaid managed care organizations recommended by an | 19 | | organization that represents Medicaid managed care plans | 20 | | appointed by the Minority Leader of the House of | 21 | | Representatives; 2 representing commercial insurers | 22 | | recommended by an organization that represents insurers | 23 | | appointed by the Minority Leader of the Senate; and a | 24 | | representative of an organization that represents Medicaid | 25 | | managed care plans appointed by the Governor. | 26 | | The workgroup shall provide recommendations to the General |
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| 1 | | Assembly on health plan data reporting requirements that | 2 | | separately break out data on mental, emotional, nervous, or | 3 | | substance use disorder or condition benefits and data on other | 4 | | medical benefits, including physical health and related health | 5 | | services no later than December 31, 2019. The recommendations | 6 | | to the General Assembly shall be filed with the Clerk of the | 7 | | House of Representatives and the Secretary of the Senate in | 8 | | electronic form only, in the manner that the Clerk and the | 9 | | Secretary shall direct. This workgroup shall take into account | 10 | | federal requirements and recommendations on mental health | 11 | | parity reporting for the Medicaid program. This workgroup | 12 | | shall also develop the format and provide any needed | 13 | | definitions for reporting requirements in subsection (k). The | 14 | | research and evaluation of the working group shall include, | 15 | | but not be limited to: | 16 | | (1) claims denials due to benefit limits, if | 17 | | applicable; | 18 | | (2) administrative denials for no prior authorization; | 19 | | (3) denials due to not meeting medical necessity; | 20 | | (4) denials that went to external review and whether | 21 | | they were upheld or overturned for medical necessity; | 22 | | (5) out-of-network claims; | 23 | | (6) emergency care claims; | 24 | | (7) network directory providers in the outpatient | 25 | | benefits classification who filed no claims in the last 6 | 26 | | months, if applicable; |
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| 1 | | (8) the impact of existing and pertinent limitations | 2 | | and restrictions related to approved services, licensed | 3 | | providers, reimbursement levels, and reimbursement | 4 | | methodologies within the Division of Mental Health, the | 5 | | Division of Substance Use Prevention and Recovery | 6 | | programs, the Department of Healthcare and Family | 7 | | Services, and, to the extent possible, federal regulations | 8 | | and law; and | 9 | | (9) when reporting and publishing should begin. | 10 | | Representatives from the Department of Healthcare and | 11 | | Family Services, representatives from the Division of Mental | 12 | | Health, and representatives from the Division of Substance Use | 13 | | Prevention and Recovery shall provide technical advice to the | 14 | | workgroup. | 15 | | (k) An insurer that amends, delivers, issues, or renews a | 16 | | group or individual policy of accident and health insurance or | 17 | | a qualified health plan offered through the health insurance | 18 | | marketplace in this State providing coverage for hospital or | 19 | | medical treatment and for the treatment of mental, emotional, | 20 | | nervous, or substance use disorders or conditions shall submit | 21 | | an annual report, the format and definitions for which will be | 22 | | determined developed by the workgroup in subsection (j), to | 23 | | the Department and , or, with respect to medical assistance, | 24 | | the Department of Healthcare and Family Services and posted on | 25 | | their respective websites, starting on September 1, 2023 and | 26 | | annually thereafter, or before July 1, 2020 that contains the |
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| 1 | | following information separately for inpatient in-network | 2 | | benefits, inpatient out-of-network benefits, outpatient | 3 | | in-network benefits, outpatient out-of-network benefits, | 4 | | emergency care benefits, and prescription drug benefits in the | 5 | | case of accident and health insurance or qualified health | 6 | | plans, or inpatient, outpatient, emergency care, and | 7 | | prescription drug benefits in the case of medical assistance: | 8 | | (1) A summary of the plan's pharmacy management | 9 | | processes for mental, emotional, nervous, or substance use | 10 | | disorder or condition benefits compared to those for other | 11 | | medical benefits. | 12 | | (2) A summary of the internal processes of review for | 13 | | experimental benefits and unproven technology for mental, | 14 | | emotional, nervous, or substance use disorder or condition | 15 | | benefits and those for
other medical benefits. | 16 | | (3) A summary of how the plan's policies and | 17 | | procedures for utilization management for mental, | 18 | | emotional, nervous, or substance use disorder or condition | 19 | | benefits compare to those for other medical benefits. | 20 | | (4) A description of the process used to develop or | 21 | | select the medical necessity criteria for mental, | 22 | | emotional, nervous, or substance use disorder or condition | 23 | | benefits and the process used to develop or select the | 24 | | medical necessity criteria for medical and surgical | 25 | | benefits. | 26 | | (5) Identification of all nonquantitative treatment |
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| 1 | | limitations that are applied to both mental, emotional, | 2 | | nervous, or substance use disorder or condition benefits | 3 | | and medical and surgical benefits within each | 4 | | classification of benefits. | 5 | | (6) The results of an analysis that demonstrates that | 6 | | for the medical necessity criteria described in | 7 | | subparagraph (A) and for each nonquantitative treatment | 8 | | limitation identified in subparagraph (B), as written and | 9 | | in operation, the processes, strategies, evidentiary | 10 | | standards, or other factors used in applying the medical | 11 | | necessity criteria and each nonquantitative treatment | 12 | | limitation to mental, emotional, nervous, or substance use | 13 | | disorder or condition benefits within each classification | 14 | | of benefits are comparable to, and are applied no more | 15 | | stringently than, the processes, strategies, evidentiary | 16 | | standards, or other factors used in applying the medical | 17 | | necessity criteria and each nonquantitative treatment | 18 | | limitation to medical and surgical benefits within the | 19 | | corresponding classification of benefits; at a minimum, | 20 | | the results of the analysis shall: | 21 | | (A) identify the factors used to determine that a | 22 | | nonquantitative treatment limitation applies to a | 23 | | benefit, including factors that were considered but | 24 | | rejected; | 25 | | (B) identify and define the specific evidentiary | 26 | | standards used to define the factors and any other |
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| 1 | | evidence relied upon in designing each nonquantitative | 2 | | treatment limitation; | 3 | | (C) provide the comparative analyses, including | 4 | | the results of the analyses, performed to determine | 5 | | that the processes and strategies used to design each | 6 | | nonquantitative treatment limitation, as written, for | 7 | | mental, emotional, nervous, or substance use disorder | 8 | | or condition benefits are comparable to, and are | 9 | | applied no more stringently than, the processes and | 10 | | strategies used to design each nonquantitative | 11 | | treatment limitation, as written, for medical and | 12 | | surgical benefits; | 13 | | (D) provide the comparative analyses, including | 14 | | the results of the analyses, performed to determine | 15 | | that the processes and strategies used to apply each | 16 | | nonquantitative treatment limitation, in operation, | 17 | | for mental, emotional, nervous, or substance use | 18 | | disorder or condition benefits are comparable to, and | 19 | | applied no more stringently than, the processes or | 20 | | strategies used to apply each nonquantitative | 21 | | treatment limitation, in operation, for medical and | 22 | | surgical benefits; and | 23 | | (E) disclose the specific findings and conclusions | 24 | | reached by the insurer that the results of the | 25 | | analyses described in subparagraphs (C) and (D) | 26 | | indicate that the insurer is in compliance with this |
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| 1 | | Section and the Mental Health Parity and Addiction | 2 | | Equity Act of 2008 and its implementing regulations, | 3 | | which includes 42 CFR Parts 438, 440, and 457 and 45 | 4 | | CFR 146.136 and any other related federal regulations | 5 | | found in the Code of Federal Regulations. | 6 | | (7) Any other information necessary to clarify data | 7 | | provided in accordance with this Section requested by the | 8 | | Director, including information that may be proprietary or | 9 | | have commercial value, under the requirements of Section | 10 | | 30 of the Viatical Settlements Act of 2009. | 11 | | (l) An insurer that amends, delivers, issues, or renews a | 12 | | group or individual policy of accident and health insurance or | 13 | | a qualified health plan offered through the health insurance | 14 | | marketplace in this State providing coverage for hospital or | 15 | | medical treatment and for the treatment of mental, emotional, | 16 | | nervous, or substance use disorders or conditions on or after | 17 | | January 1, 2019 (the effective date of Public Act 100-1024) | 18 | | shall, in advance of the plan year, make available to the | 19 | | Department or, with respect to medical assistance, the | 20 | | Department of Healthcare and Family Services and to all plan | 21 | | participants and beneficiaries the information required in | 22 | | subparagraphs (C) through (E) of paragraph (6) of subsection | 23 | | (k). For plan participants and medical assistance | 24 | | beneficiaries, the information required in subparagraphs (C) | 25 | | through (E) of paragraph (6) of subsection (k) shall be made | 26 | | available on a publicly-available website whose web address is |
| | | HB1364 Enrolled | - 44 - | LRB103 24835 AWJ 51167 b |
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| 1 | | prominently displayed in plan and managed care organization | 2 | | informational and marketing materials. | 3 | | (m) In conjunction with its compliance examination program | 4 | | conducted in accordance with the Illinois State Auditing Act, | 5 | | the Auditor General shall undertake a review of
compliance by | 6 | | the Department and the Department of Healthcare and Family | 7 | | Services with Section 370c and this Section. Any
findings | 8 | | resulting from the review conducted under this Section shall | 9 | | be included in the applicable State agency's compliance | 10 | | examination report. Each compliance examination report shall | 11 | | be issued in accordance with Section 3-14 of the Illinois | 12 | | State
Auditing Act. A copy of each report shall also be | 13 | | delivered to
the head of the applicable State agency and | 14 | | posted on the Auditor General's website. | 15 | | (Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21; | 16 | | 102-813, eff. 5-13-22.) | 17 | | Section 99. Effective date. This Act takes effect upon | 18 | | becoming law. |
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