Full Text of HB2847 103rd General Assembly
HB2847ham001 103RD GENERAL ASSEMBLY | Rep. Lindsey LaPointe Filed: 3/21/2023
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| 1 | | AMENDMENT TO HOUSE BILL 2847
| 2 | | AMENDMENT NO. ______. Amend House Bill 2847 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. References to Act; purpose. | 5 | | (a) References to Act. This Act may be referred to as the | 6 | | Mental Health Equity Access and Prevention Act. | 7 | | (b) Purpose. This Act is intended to address Illinois' | 8 | | skyrocketing mental health
needs for children, youth, and | 9 | | adults following the COVID-19 pandemic, cover preventive
| 10 | | mental health care to address symptoms early, increase access | 11 | | to affordable care, and
maximize the full mental health | 12 | | workforce. | 13 | | Section 5. Findings. The General Assembly finds that: | 14 | | (1) According to a recent U.S. Surgeon General's | 15 | | Advisory on Protecting Youth Mental Health, the proportion | 16 | | of high school students reporting persistent feelings of |
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| 1 | | hopelessness and
sadness increased by 40% between 2009 and | 2 | | 2019, and rates of depression and anxiety
doubled during | 3 | | the COVID-19 pandemic. | 4 | | (2) Death by suicide is alarmingly high, particularly | 5 | | among Black children. Black children
under 13 are now | 6 | | nearly twice as likely to die by suicide than White | 7 | | children. | 8 | | (3) According to a bipartisan United States Senate | 9 | | Finance Committee report on Mental Health Care in the | 10 | | United States, symptoms for depression and anxiety in | 11 | | adults increased nearly fourfold during the COVID-19 | 12 | | pandemic. | 13 | | (4) At the same time of unprecedented demand for | 14 | | treatment and support, the mental health workforce crisis | 15 | | is causing severe mental health care access challenges. | 16 | | (5) Private insurance does not cover preventive mental | 17 | | health care. Preventive mental health care can address | 18 | | mental health issues before symptoms worsen or before a
| 19 | | mental health crisis occurs. | 20 | | (6) Commercial insurance networks that include mental | 21 | | health providers are severely
restrictive, meaning a small | 22 | | percentage of the mental health workforce is contracted as
| 23 | | in-network providers. This forces individuals and patients | 24 | | to seek costly treatment
through out-of-network care. | 25 | | (7) The cost of mental health treatment is | 26 | | inaccessible and unaffordable for many
Illinoisans for |
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| 1 | | these reasons. | 2 | | (8) A recent Milliman research report that analyzed | 3 | | insurance claims for 37 million Americans, including | 4 | | Illinois residents, found major disparities in insurance | 5 | | contracting with in-network mental health providers and | 6 | | contracting with medical/surgical providers. The report's | 7 | | findings include the following: | 8 | | (A) Illinois out-of-network mental health | 9 | | utilization was 18.2% for outpatient
services in 2017 | 10 | | compared to just 3.9% for medical/surgical services. | 11 | | (B) Illinois out-of-network mental health | 12 | | utilization was 12.1% in 2017 for
inpatient care | 13 | | compared to just 2.8% for medical/surgical services. | 14 | | (C) The disparity between out-of-network usage for | 15 | | mental health compared to medical/surgical services | 16 | | grew significantly between 2013 and 2017: | 17 | | out-of-network
mental health utilization for | 18 | | outpatient visits grew by 44% while out-of-network | 19 | | utilization for medical/surgical services decreased by | 20 | | 42% over the same period in Illinois. | 21 | | (D) Nearly 14% of mental health office visits for | 22 | | individuals with a PPO plan were out-of-network in | 23 | | Illinois. | 24 | | (9) According to a report in JAMA Psychiatry, 26% of | 25 | | psychiatrists see patients who do not use their insurance | 26 | | to pay for their visit because it is an out-of-network |
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| 1 | | visit; according to a 2015 American Psychological | 2 | | Association Survey of Psychology Health Service Providers, | 3 | | 21% of psychologists report that most of their patients | 4 | | pay out-of-pocket because their visit is out-of-network. | 5 | | (10) Illinois must maximize its full mental health | 6 | | workforce to address the mental health crisis the state is | 7 | | experiencing post-COVID-19 and improve access to | 8 | | affordable, timely care. | 9 | | Section 10. The Department of Public Health Powers and | 10 | | Duties Law of the
Civil Administrative Code of Illinois is | 11 | | amended by adding Section 2310-720 as follows: | 12 | | (20 ILCS 2310/2310-720 new) | 13 | | Sec. 2310-720. Public educational effort on mental health | 14 | | and wellness. Subject to appropriation, the Department shall | 15 | | undertake a public educational campaign to bring broad public | 16 | | awareness to communities across this State on the importance | 17 | | of mental health and wellness, including the expanded coverage | 18 | | of mental health treatment, and consistent with the | 19 | | recommendations of the Illinois Children's Mental Health | 20 | | Partnership's Children's Mental Health Plan of 2022 and Public | 21 | | Act 102-899. The Department shall look to other successful | 22 | | public educational campaigns to guide this effort, such as the | 23 | | public educational campaign related to Get Covered Illinois. | 24 | | Additionally, the Department shall work with the Department of |
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| 1 | | Insurance, the Illinois State Board of Education, the | 2 | | Department of Human Services, the Department of Healthcare and | 3 | | Family Services, the Department of Juvenile Justice, the | 4 | | Department of Children and Family Services, and other State | 5 | | agencies as necessary to promote consistency in messaging and | 6 | | distribution methods between this campaign and other | 7 | | concurrent public educational campaigns related to mental | 8 | | health and mental wellness. Public messaging for this campaign | 9 | | shall be simple, easy to understand, and shall include | 10 | | culturally competent messaging for different communities and | 11 | | regions throughout this State. | 12 | | Section 15. The Illinois Insurance Code is amended by | 13 | | adding Sections 356z.61 and 356z.62 as follows: | 14 | | (215 ILCS 5/356z.61 new) | 15 | | Sec. 356z.61. Coverage of out-of-network mental health | 16 | | care. | 17 | | (a) As used in this Section: | 18 | | "Grandfathered health plan" has the meaning given to that | 19 | | term in 42 U.S.C. 18011. | 20 | | "Individual market" has the meaning given to that term in | 21 | | Section 5 of the Illinois Health Insurance Portability and | 22 | | Accountability Act. "Individual market" includes student | 23 | | health insurance coverage. | 24 | | "Large group market" has the meaning given to that term in |
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| 1 | | Section 5 of the Illinois Health Insurance Portability and | 2 | | Accountability Act. | 3 | | "Market" means the individual, small group, or large group | 4 | | market. "Market" includes grandfathered and transitional | 5 | | health plans pertaining to the policyholder to which the plan | 6 | | is issued or renewed. | 7 | | "Network plan" has the meaning given to that term in | 8 | | Section 5 of the Network Adequacy and Transparency Act. | 9 | | "Small group market" has the meaning given to that term in | 10 | | Section 5 of the Illinois Health Insurance Portability and | 11 | | Accountability Act. | 12 | | "Student health insurance coverage" has the meaning given | 13 | | to that term in 45 CFR 147.145. | 14 | | "Transitional health plan" means a plan subject to the | 15 | | limited non-enforcement policy regarding the federal Patient | 16 | | Protection and Affordable Care Act for certain | 17 | | non-grandfathered health plans in the individual and small | 18 | | group markets that the federal Centers for Medicare and | 19 | | Medicaid Services announced in a letter to state insurance | 20 | | commissioners, dated November 14, 2013, to the extent that the | 21 | | limited non-enforcement policy has been renewed annually by | 22 | | the federal Centers for Medicare and Medicaid Services and | 23 | | ratified by the Department. | 24 | | (b) Notwithstanding the provisions of the Network Adequacy | 25 | | and Transparency Act, a group or individual policy of accident | 26 | | and health insurance or a managed care plan
that is amended, |
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| 1 | | delivered, issued, or renewed on or after January 1, 2025 | 2 | | shall cover all medically necessary out-of-network mental | 3 | | health visits, including prevention and wellness visits, | 4 | | mental health treatment, and mental health services provided | 5 | | by a mental health provider or facility. | 6 | | (c) For purposes of insured cost sharing, the insured | 7 | | shall pay no more for the out-of-network services and visits | 8 | | than the insured would have paid for in-network services and | 9 | | visits. | 10 | | (d) No action shall be required by the insured to use | 11 | | out-of-network mental health services covered pursuant to this | 12 | | Section. The insured has the right to select the provider of | 13 | | their choice and the modality, in-person visit or telehealth, | 14 | | for medically necessary care. | 15 | | (e) The insurer shall reimburse the out-of-network mental | 16 | | health provider or facility
at the provider's usual and | 17 | | customary charges for out-of-network medically necessary | 18 | | patient care. | 19 | | (f) This Section shall apply to each market in which the | 20 | | insurer offers or provides any network plan until the | 21 | | insurer's network plans in that market reduce by 50% the | 22 | | annual disparity between out-of-network mental health | 23 | | utilization and out-of-network medical/surgical utilization | 24 | | for both outpatient mental health visits and inpatient mental | 25 | | health visits from the Base Year by increasing the number of | 26 | | in-network mental health providers and facilities. Outpatient |
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| 1 | | mental health visits and inpatient mental health visits shall | 2 | | be measured separately. The Base Year shall be calendar year | 3 | | 2022 for purposes of measuring the disparity against future | 4 | | years. The Department may require an insurer to file | 5 | | utilization data to establish the disparity level in a market | 6 | | for the Base Year as needed. If and only if an insurer did not | 7 | | have network plans in a market in this State in 2022, the | 8 | | Department shall allow an insurer entering that market to use | 9 | | alternative data to establish a Base Year to simulate 2022 | 10 | | utilization, subject to the Department's approval of the | 11 | | sources of data. An insurer's network plans in a market are | 12 | | exempt from this Section for inpatient care or outpatient | 13 | | care, or both, once the 50% reduction in the disparity between | 14 | | mental health and medical/surgical out-of-network utilization | 15 | | is met. The exemption does not extend to the annual filing | 16 | | requirement under subsection (g). | 17 | | (g) An insurer shall file annually the metrics established | 18 | | in this Section for each market in which the insurer issued or | 19 | | renewed any network plan during the preceding calendar year. | 20 | | An insurer may request a review from the Department, and the | 21 | | Department shall undertake such a review, in any given year if | 22 | | the insurer believes it has reduced the disparity described in | 23 | | this Section for inpatient or outpatient care, or both, by the | 24 | | end of the preceding calendar year for one or more markets to | 25 | | qualify for an exemption. If the Department determines that | 26 | | the insurer has not reduced the disparity, the insurer may not |
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| 1 | | request another exemption review for 3 years. If an insurer | 2 | | becomes exempt from this Section for a market in a given year | 3 | | but fails to maintain the 50% reduction in the disparity | 4 | | between mental health and medical/surgical out-of-network | 5 | | utilization in a future calendar year based on a Department | 6 | | review, the exemption lapses for the following plan year. An | 7 | | insurer may not submit a request to reinstate a lapsed | 8 | | exemption at least until the second calendar year after the | 9 | | year the lapse takes effect. Plan beneficiaries shall be | 10 | | notified at least 60 days before renewal when there will be any | 11 | | change in benefit coverage based on an exemption or lapse of | 12 | | exemption. | 13 | | (h) The Department shall adopt any rules necessary to | 14 | | implement this Section by no later than October 31, 2024. | 15 | | (i) This Section is subject to appropriation to the | 16 | | Department of Insurance. | 17 | | (215 ILCS 5/356z.62 new) | 18 | | Sec. 356z.62. Coverage of no-cost mental health prevention | 19 | | and wellness visits. | 20 | | (a) A group or individual policy of accident and health | 21 | | insurance or managed care plan that is amended, delivered, | 22 | | issued, or renewed on or after January 1, 2025 shall provide | 23 | | coverage for 2 annual mental health prevention and wellness | 24 | | visits for children and for adults. | 25 | | (b) Mental health prevention and wellness visits shall |
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| 1 | | include any age-appropriate screening recommended by the | 2 | | United States Preventive Services Task Force or by the | 3 | | American Academy of Pediatrics' Bright Futures: Guidelines for | 4 | | Health Supervision of Infants, Children, and Adolescents for | 5 | | purposes of identifying a mental health issue, condition, or | 6 | | disorder; discussing mental health symptoms that might be | 7 | | present, including symptoms of a previously diagnosed mental | 8 | | health condition or disorder; performing an evaluation of | 9 | | adverse childhood experiences; and discussing mental health | 10 | | and wellness. | 11 | | (c) A mental health prevention and wellness visit shall be | 12 | | covered for up to 60 minutes and may be performed by a | 13 | | physician licensed to practice medicine in all of its | 14 | | branches, a licensed clinical psychologist, a licensed | 15 | | clinical social worker, a licensed clinical professional | 16 | | counselor, a licensed marriage and family therapist, a | 17 | | licensed social worker, or a licensed professional counselor. | 18 | | (d) A policy subject to this Section shall not impose a | 19 | | deductible, coinsurance, copayment, or other cost-sharing | 20 | | requirement for mental health and wellness visits, and no | 21 | | prior authorization shall be required for the visits. The | 22 | | cost-sharing prohibition in this subsection (d) does not apply | 23 | | to coverage of mental health prevention and wellness visits to | 24 | | the extent such coverage would disqualify a high-deductible | 25 | | health plan from eligibility from a health savings account | 26 | | pursuant to Section 223 of the Internal Revenue Code. |
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| 1 | | (e) A mental health prevention and wellness visit shall | 2 | | not replace a Well Child visit or a
general health or medical | 3 | | visit. | 4 | | (f) A mental health prevention and wellness visit shall be | 5 | | reimbursed through the following American Medical Association | 6 | | current procedural terminology codes and at the same rate that | 7 | | current procedural terminology codes are reimbursed for the | 8 | | provision of other medical care: 99381-99387 and 99391-99397. | 9 | | (g) Reimbursement of any of the current procedural | 10 | | terminology codes listed in this Section shall comply with the | 11 | | following: | 12 | | (1) Reimbursement may be adjusted for payment of | 13 | | claims that are billed by a nonphysician clinician so long | 14 | | as the methodology to determine the adjustments are | 15 | | comparable to and applied no more stringently than the | 16 | | methodology for adjustments made for reimbursement of | 17 | | claims billed by nonphysician clinicians for other medical | 18 | | care, in accordance with 45 CFR 146.136(c)(4); | 19 | | (2) for the purpose of covering a mental health | 20 | | prevention and wellness visit, reimbursement shall not be | 21 | | denied because the code was already reimbursed for the | 22 | | purpose of covering a service other than such visit; | 23 | | (3) for the purpose of covering a service other than a | 24 | | mental health prevention and wellness visit, reimbursement | 25 | | shall not be denied because the code was already | 26 | | reimbursed for the purpose of covering a mental health |
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| 1 | | prevention and wellness visit; and | 2 | | (4) for a mental health prevention and wellness visit | 3 | | and for a service other than a mental health prevention | 4 | | and wellness visit, reimbursement shall not be denied if | 5 | | they occur on the same date by the same provider and the | 6 | | provider is a primary care provider. | 7 | | (i) The Department shall adopt any rules necessary to | 8 | | implement this Section by no later than October 31, 2024.
| 9 | | Section 99. Effective date. This Act takes effect July 1, | 10 | | 2024.".
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