Full Text of SB2085 101st General Assembly
SB2085enr 101ST GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by adding | 5 | | Section 356z.33 as follows: | 6 | | (215 ILCS 5/356z.33 new) | 7 | | Sec. 356z.33. Coverage of the psychiatric Collaborative | 8 | | Care Model. | 9 | | (a) As used in this Section, "psychiatric Collaborative | 10 | | Care Model" means the evidence-based, integrated behavioral | 11 | | health service delivery method, which includes a formal | 12 | | collaborative arrangement among a primary care team consisting | 13 | | of a primary care provider, a care manager, and a psychiatric | 14 | | consultant, and includes, but is not limited to, the following | 15 | | elements: | 16 | | (1) care directed by the primary care team; | 17 | | (2) structured care management; | 18 | | (3) regular assessments of clinical status using | 19 | | validated tools; and | 20 | | (4) modification of treatment as appropriate. | 21 | | (b) An individual or group policy of accident and health | 22 | | insurance amended, delivered, issued, or renewed on or after | 23 | | the effective date of this amendatory Act of the 101st General |
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| 1 | | Assembly or managed care organization that provides mental | 2 | | health benefits shall provide reimbursement for benefits that | 3 | | are delivered through the psychiatric Collaborative Care | 4 | | Model. The following American Medical Association 2018 current | 5 | | procedural terminology codes and Healthcare Common Procedure | 6 | | Coding System code shall be used to bill for benefits delivered | 7 | | through the psychiatric Collaborative Care Model: | 8 | | (1) 99492; | 9 | | (2) 99493; | 10 | | (3) 99494; and | 11 | | (4) G0512. | 12 | | (c) The Director of Insurance shall update the billing | 13 | | codes in subsection (b) if there are any alterations or | 14 | | additions to the billing codes for the psychiatric | 15 | | Collaborative Care Model. | 16 | | (d) An individual or group policy or managed care | 17 | | organization that provides benefits under this Section may deny | 18 | | reimbursement of any billing code listed in this Section on the | 19 | | grounds of medical necessity if such medical necessity | 20 | | determinations are in compliance with the Paul Wellstone and | 21 | | Pete Domenici Mental Health Parity and Addiction Equity Act of | 22 | | 2008 and its implementing and related regulations and that such | 23 | | determinations are made in accordance with the utilization | 24 | | review requirements under Section 85 of the Managed Care Reform | 25 | | and Patient Rights Act. |
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| 1 | | Section 10. The Illinois Public Aid Code is amended by | 2 | | changing Section 5-16.8 as follows:
| 3 | | (305 ILCS 5/5-16.8)
| 4 | | Sec. 5-16.8. Required health benefits. The medical | 5 | | assistance program
shall
(i) provide the post-mastectomy care | 6 | | benefits required to be covered by a policy of
accident and | 7 | | health insurance under Section 356t and the coverage required
| 8 | | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and | 9 | | 356z.29 , 356z.32, and 356z.33 of the Illinois
Insurance Code | 10 | | and (ii) be subject to the provisions of Sections 356z.19, | 11 | | 364.01, 370c, and 370c.1 of the Illinois
Insurance Code.
| 12 | | On and after July 1, 2012, the Department shall reduce any | 13 | | rate of reimbursement for services or other payments or alter | 14 | | any methodologies authorized by this Code to reduce any rate of | 15 | | reimbursement for services or other payments in accordance with | 16 | | Section 5-5e. | 17 | | To ensure full access to the benefits set forth in this | 18 | | Section, on and after January 1, 2016, the Department shall | 19 | | ensure that provider and hospital reimbursement for | 20 | | post-mastectomy care benefits required under this Section are | 21 | | no lower than the Medicare reimbursement rate. | 22 | | (Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; | 23 | | 99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff. | 24 | | 8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 25 | | 10-4-18.)
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| 1 | | Section 99. Effective date. This Act takes effect January | 2 | | 1, 2020.
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