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| Public Act 103-0535 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. References to Act; purpose. | ||||
(a) References to Act. This Act may be referred to as the | ||||
Mental Health and Wellness Act. | ||||
(b) Purpose. This Act is intended to address Illinois' | ||||
skyrocketing mental health
needs for children, youth, and | ||||
adults following the COVID-19 pandemic by covering preventive
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mental health care. | ||||
Section 5. Findings. The General Assembly finds that: | ||||
(1) According to a recent U.S. Surgeon General's | ||||
Advisory on Protecting Youth Mental Health, the proportion | ||||
of high school students reporting persistent feelings of | ||||
hopelessness and
sadness increased by 40% between 2009 and | ||||
2019, and rates of depression and anxiety
doubled during | ||||
the COVID-19 pandemic. | ||||
(2) Death by suicide is alarmingly high, particularly | ||||
among Black children. Black children
under 13 are now | ||||
nearly twice as likely to die by suicide than White | ||||
children. | ||||
(3) According to a bipartisan United States Senate | ||||
Finance Committee report on Mental Health Care in the | ||||
United States, symptoms for depression and anxiety in | ||
adults increased nearly fourfold during the COVID-19 | ||
pandemic. | ||
Section 10. The State Employees Group Insurance Act of | ||
1971 is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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(Text of Section before amendment by P.A. 102-768) | ||
Sec. 6.11. Required health benefits; Illinois Insurance | ||
Code
requirements. The program of health
benefits shall | ||
provide the post-mastectomy care benefits required to be | ||
covered
by a policy of accident and health insurance under | ||
Section 356t of the Illinois
Insurance Code. The program of | ||
health benefits shall provide the coverage
required under | ||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and | ||
356z.61 of the
Illinois Insurance Code.
The program of health | ||
benefits must comply with Sections 155.22a, 155.37, 355b, | ||
356z.19, 370c, and 370c.1 and Article XXXIIB of the
Illinois | ||
Insurance Code. The Department of Insurance shall enforce the | ||
requirements of this Section with respect to Sections 370c and | ||
370c.1 of the Illinois Insurance Code; all other requirements | ||
of this Section shall be enforced by the Department of Central | ||
Management Services.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
revised 12-13-22.) | ||
(Text of Section after amendment by P.A. 102-768) | ||
Sec. 6.11. Required health benefits; Illinois Insurance | ||
Code
requirements. The program of health
benefits shall | ||
provide the post-mastectomy care benefits required to be | ||
covered
by a policy of accident and health insurance under | ||
Section 356t of the Illinois
Insurance Code. The program of | ||
health benefits shall provide the coverage
required under | ||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and | ||
356z.60, and 356z.61 of the
Illinois Insurance Code.
The | ||
program of health benefits must comply with Sections 155.22a, | ||
155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of | ||
the
Illinois Insurance Code. The Department of Insurance shall | ||
enforce the requirements of this Section with respect to | ||
Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||
other requirements of this Section shall be enforced by the | ||
Department of Central Management Services.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||
1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, | ||
eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; | ||
102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||
Section 15. The Department of Public Health Powers and | ||
Duties Law of the
Civil Administrative Code of Illinois is | ||
amended by adding Section 2310-720 as follows: | ||
(20 ILCS 2310/2310-720 new) | ||
Sec. 2310-720. Public educational effort on mental health | ||
and wellness. Subject to appropriation, the Department shall | ||
undertake a public educational campaign to bring broad public | ||
awareness to communities across this State on the importance | ||
of mental health and wellness, including the expanded coverage | ||
of mental health treatment, and consistent with the | ||
recommendations of the Illinois Children's Mental Health | ||
Partnership's Children's Mental Health Plan of 2022 and Public | ||
Act 102-899. The Department shall look to other successful | ||
public educational campaigns to guide this effort, such as the | ||
public educational campaign related to Get Covered Illinois. | ||
Additionally, the Department shall work with the Department of | ||
Insurance, the Illinois State Board of Education, the | ||
Department of Human Services, the Department of Healthcare and | ||
Family Services, the Department of Juvenile Justice, the | ||
Department of Children and Family Services, and other State | ||
agencies as necessary to promote consistency in messaging and | ||
distribution methods between this campaign and other | ||
concurrent public educational campaigns related to mental | ||
health and mental wellness. Public messaging for this campaign | ||
shall be simple, be easy to understand, and include culturally | ||
competent messaging for different communities and regions | ||
throughout this State. | ||
Section 20. The Counties Code is amended by changing | ||
Section 5-1069.3 as follows: | ||
(55 ILCS 5/5-1069.3)
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Sec. 5-1069.3. Required health benefits. If a county, | ||
including a home
rule
county, is a self-insurer for purposes | ||
of providing health insurance coverage
for its employees, the | ||
coverage shall include coverage for 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, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, | ||
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | ||
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||
356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||
356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | ||
356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 | ||
of
the Illinois Insurance Code. The coverage shall comply with | ||
Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||
Insurance Code. The Department of Insurance shall enforce the | ||
requirements of this Section. The requirement that health | ||
benefits be covered
as provided in this Section is an
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exclusive power and function of the State and is a denial and | ||
limitation under
Article VII, Section 6, subsection (h) of the | ||
Illinois Constitution. A home
rule county to which this | ||
Section applies must comply with every provision of
this | ||
Section.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
102-1117, eff. 1-13-23.) | ||
Section 25. The Illinois Municipal Code is amended by | ||
changing Section 10-4-2.3 as follows: | ||
(65 ILCS 5/10-4-2.3)
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Sec. 10-4-2.3. Required health benefits. If a | ||
municipality, including a
home rule municipality, is a | ||
self-insurer for purposes of providing health
insurance | ||
coverage for its employees, the coverage shall include | ||
coverage for
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, | ||
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||
356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the | ||
Illinois
Insurance
Code. The coverage shall comply with | ||
Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||
Insurance Code. The Department of Insurance shall enforce the | ||
requirements of this Section. The requirement that health
| ||
benefits be covered as provided in this is an exclusive power | ||
and function of
the State and is a denial and limitation under | ||
Article VII, Section 6,
subsection (h) of the Illinois | ||
Constitution. A home rule municipality to which
this Section | ||
applies must comply with every provision of this Section.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
102-1117, eff. 1-13-23.) | ||
Section 30. The School Code is amended by changing Section | ||
10-22.3f as follows: | ||
(105 ILCS 5/10-22.3f)
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Sec. 10-22.3f. Required health benefits. Insurance | ||
protection and
benefits
for employees shall 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, 356g.5, 356g.5-1, | ||
356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, | ||
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and | ||
356z.61 of
the
Illinois Insurance Code.
Insurance policies | ||
shall comply with Section 356z.19 of the Illinois Insurance | ||
Code. The coverage shall comply with Sections 155.22a, 355b, | ||
and 370c of
the Illinois Insurance Code. The Department of | ||
Insurance shall enforce the requirements of this Section.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||
eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; | ||
102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff. | ||
1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | ||
eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||
Section 35. The Illinois Insurance Code is amended by | ||
adding Section 356z.61 as follows: | ||
(215 ILCS 5/356z.61 new) | ||
Sec. 356z.61. Coverage of no-cost mental health prevention | ||
and wellness visits. | ||
(a) A group or individual policy of accident and health | ||
insurance or managed care plan that is amended, delivered, | ||
issued, or renewed on or after January 1, 2025 shall provide | ||
coverage for one annual mental health prevention and wellness | ||
visit for children and for adults. | ||
(b) Mental health prevention and wellness visits shall | ||
include any age-appropriate screening recommended by the | ||
United States Preventive Services Task Force or by the | ||
American Academy of Pediatrics' Bright Futures: Guidelines for | ||
Health Supervision of Infants, Children, and Adolescents for | ||
purposes of identifying a mental health issue, condition, or | ||
disorder; discussing mental health symptoms that might be | ||
present, including symptoms of a previously diagnosed mental | ||
health condition or disorder; performing an evaluation of | ||
adverse childhood experiences; and discussing mental health | ||
and wellness. | ||
(c) A mental health prevention and wellness visit shall be | ||
covered for up to 60 minutes and may be performed by a | ||
physician licensed to practice medicine in all of its | ||
branches, a licensed clinical psychologist, a licensed | ||
clinical social worker, a licensed clinical professional | ||
counselor, a licensed marriage and family therapist, a | ||
licensed social worker, or a licensed professional counselor. | ||
(d) A policy subject to this Section shall not impose a | ||
deductible, coinsurance, copayment, or other cost-sharing | ||
requirement for mental health prevention and wellness visits. | ||
The cost-sharing prohibition in this subsection (d) does not | ||
apply to coverage of mental health prevention and wellness | ||
visits to the extent such coverage would disqualify a | ||
high-deductible health plan from eligibility for a health | ||
savings account pursuant to Section 223 of the Internal | ||
Revenue Code. | ||
(e) A mental health prevention and wellness visit shall be | ||
in addition to an annual physical examination and shall not | ||
replace a well-child visit or a
general health or medical | ||
visit. | ||
(f) A mental health prevention and wellness visit shall be | ||
reimbursed through the following American Medical Association | ||
current procedural terminology codes and at the same rate that | ||
current procedural terminology codes are reimbursed for the | ||
provision of other medical care: 99381-99387 and 99391-99397. | ||
The Department shall update the current procedural terminology | ||
codes through adoption of rules if the codes listed in this | ||
subsection are altered, amended, changed, deleted, or | ||
supplemented. | ||
(g) Reimbursement of any of the current procedural | ||
terminology codes listed in this Section shall comply with the | ||
following: | ||
(1) reimbursement may be adjusted for payment of | ||
claims that are billed by a nonphysician clinician so long | ||
as the methodology to determine the adjustments are | ||
comparable to and applied no more stringently than the | ||
methodology for adjustments made for reimbursement of | ||
claims billed by nonphysician clinicians for other medical | ||
care, in accordance with 45 CFR 146.136(c)(4); and | ||
(2) for a mental health prevention and wellness visit | ||
and for a service other than a mental health prevention | ||
and wellness visit, reimbursement shall not be denied if | ||
they occur on the same date by the same provider and the | ||
provider is a primary care provider. | ||
(h) A mental health prevention and wellness visit may be | ||
incorporated into and reimbursed within any type of integrated | ||
primary care service delivery method, including, but not | ||
limited to, a psychiatric collaborative care model as provided | ||
for under this Code. | ||
(i) The Department shall adopt any rules necessary to | ||
implement this Section by no later than October 31, 2024. | ||
Section 95. No acceleration or delay. Where this Act makes | ||
changes in a statute that is represented in this Act by text | ||
that is not yet or no longer in effect (for example, a Section | ||
represented by multiple versions), the use of that text does | ||
not accelerate or delay the taking effect of (i) the changes | ||
made by this Act or (ii) provisions derived from any other | ||
Public Act.
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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