Public Act 101-0574
 
SB2085 EnrolledLRB101 08661 RAB 53745 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Illinois Insurance Code is amended  by adding 
Section 356z.33 as follows:
 
    (215 ILCS 5/356z.33  new)
    Sec. 356z.33. Coverage of the psychiatric Collaborative 
Care Model. 
    (a) As used in this Section, "psychiatric Collaborative 
Care Model" means the evidence-based, integrated behavioral 
health service delivery method, which includes a formal 
collaborative arrangement among a primary care team consisting 
of a primary care provider, a care manager, and a psychiatric 
consultant, and includes, but is not limited to, the following 
elements:
        (1) care directed by the primary care team; 
        (2) structured care management; 
        (3) regular assessments of clinical status using 
    validated tools; and 
        (4) modification of treatment as appropriate. 
    (b) An individual or group policy of accident and health 
insurance amended, delivered, issued, or renewed on or after 
the effective date of this amendatory Act of the 101st General 
Assembly or managed care organization that provides mental 
health benefits shall provide reimbursement for benefits that 
are delivered through the psychiatric Collaborative Care 
Model. The following American Medical Association 2018 current 
procedural terminology codes and Healthcare Common Procedure 
Coding System code shall be used to bill for benefits delivered 
through the psychiatric Collaborative Care Model:
        (1) 99492;
        (2) 99493;
        (3) 99494; and
        (4) G0512.
    (c) The Director of Insurance shall update the billing 
codes in subsection (b) if there are any alterations or 
additions to the billing codes for the psychiatric  
Collaborative Care Model.
    (d) An individual or group policy or managed care 
organization that provides benefits under this Section may deny 
reimbursement of any billing  code listed in this Section on the 
grounds of medical necessity if such medical necessity 
determinations are in compliance with the Paul Wellstone and 
Pete Domenici Mental Health Parity and Addiction Equity Act of 
2008 and its implementing and related regulations and that such 
determinations are made in accordance with the utilization 
review requirements under Section 85 of the Managed Care Reform 
and Patient Rights Act.
 
    Section 10. The Illinois Public Aid Code is amended by 
changing Section 5-16.8 as follows:
 


    (305 ILCS 5/5-16.8)



    Sec. 5-16.8. Required health benefits. The medical 
assistance program
shall
(i) provide the post-mastectomy care 
benefits required to be covered by a policy of
accident and 
health insurance under Section 356t and the coverage required

under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and 
356z.29, 356z.32, and 356z.33 of the Illinois
Insurance Code 
and (ii) be subject to the provisions of Sections 356z.19, 
364.01, 370c, and 370c.1 of the Illinois
Insurance Code.

    On and after July 1, 2012, the Department shall reduce any 
rate of reimbursement for services or other payments or alter 
any methodologies authorized by this Code to reduce any rate of 
reimbursement for services or other payments in accordance with 
Section 5-5e. 
    To ensure full access to the benefits set forth in this 
Section, on and after January 1, 2016, the Department shall 
ensure that provider and hospital reimbursement  for 
post-mastectomy care benefits required under this Section are 
no lower than the Medicare reimbursement rate. 
(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; 
99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff. 
8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised 
10-4-18.)


 
 
    Section 99. Effective date. This Act takes effect January 
1, 2020.