Sen. Julie A. Morrison
Filed: 3/6/2018
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1 | AMENDMENT TO SENATE BILL 338
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2 | AMENDMENT NO. ______. Amend Senate Bill 338 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 370c.1 as follows: | ||||||
6 | (215 ILCS 5/370c.1) | ||||||
7 | Sec. 370c.1. Mental health and addiction parity. | ||||||
8 | (a) On and after the effective date of this amendatory Act | ||||||
9 | of the 99th General Assembly, every insurer that amends, | ||||||
10 | delivers, issues, or renews a group or individual policy of | ||||||
11 | accident and health insurance or a qualified health plan | ||||||
12 | offered through the Health Insurance Marketplace in this State | ||||||
13 | providing coverage for hospital or medical treatment and for | ||||||
14 | the treatment of mental, emotional, nervous, or substance use | ||||||
15 | disorders or conditions shall ensure that: | ||||||
16 | (1) the financial requirements applicable to such |
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1 | mental, emotional, nervous, or substance use disorder or | ||||||
2 | condition benefits are no more restrictive than the | ||||||
3 | predominant financial requirements applied to | ||||||
4 | substantially all hospital and medical benefits covered by | ||||||
5 | the policy and that there are no separate cost-sharing | ||||||
6 | requirements that are applicable only with respect to | ||||||
7 | mental, emotional, nervous, or substance use disorder or | ||||||
8 | condition benefits; and | ||||||
9 | (2) the treatment limitations applicable to such | ||||||
10 | mental, emotional, nervous, or substance use disorder or | ||||||
11 | condition benefits are no more restrictive than the | ||||||
12 | predominant treatment limitations applied to substantially | ||||||
13 | all hospital and medical benefits covered by the policy and | ||||||
14 | that there are no separate treatment limitations that are | ||||||
15 | applicable only with respect to mental, emotional, | ||||||
16 | nervous, or substance use disorder or condition benefits. | ||||||
17 | (a-5) On and after the effective date of this amendatory | ||||||
18 | Act of the 100th General Assembly, every insurer that amends, | ||||||
19 | delivers, issues, or renews a group or individual policy or | ||||||
20 | certificate of disability insurance or disability income | ||||||
21 | insurance in or to any person in this State shall ensure that: | ||||||
22 | (1) the benefits applicable to such mental, emotional, | ||||||
23 | nervous, or substance use disorders or conditions are no | ||||||
24 | more restrictive than the benefits available for all other | ||||||
25 | medical conditions covered by the policy or certificate and | ||||||
26 | that there are no separate requirements that are applicable |
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1 | only with respect to mental, emotional, nervous, or | ||||||
2 | substance use disorder or condition benefits; and | ||||||
3 | (2) the treatment limitations or other coverage | ||||||
4 | limitations applicable to such
mental, emotional, nervous, | ||||||
5 | or substance use disorder or condition benefits are no more | ||||||
6 | restrictive than the benefits available for other | ||||||
7 | physiologic conditions covered by the policy and that there | ||||||
8 | are no separate payment limitations that may be applied | ||||||
9 | specifically with respect to mental, emotional, nervous, | ||||||
10 | or substance use disorder or condition benefits. | ||||||
11 | (b) The following provisions shall apply concerning | ||||||
12 | aggregate lifetime limits: | ||||||
13 | (1) In the case of a group or individual policy of | ||||||
14 | accident and health insurance or a qualified health plan | ||||||
15 | offered through the Health Insurance Marketplace amended, | ||||||
16 | delivered, issued, or renewed in this State on or after the | ||||||
17 | effective date of this amendatory Act of the 99th General | ||||||
18 | Assembly that provides coverage for hospital or medical | ||||||
19 | treatment and for the treatment of mental, emotional, | ||||||
20 | nervous, or substance use disorders or conditions the | ||||||
21 | following provisions shall apply: | ||||||
22 | (A) if the policy does not include an aggregate | ||||||
23 | lifetime limit on substantially all hospital and | ||||||
24 | medical benefits, then the policy may not impose any | ||||||
25 | aggregate lifetime limit on mental, emotional, | ||||||
26 | nervous, or substance use disorder or condition |
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1 | benefits; or | ||||||
2 | (B) if the policy includes an aggregate lifetime | ||||||
3 | limit on substantially all hospital and medical | ||||||
4 | benefits (in this subsection referred to as the | ||||||
5 | "applicable lifetime limit"), then the policy shall | ||||||
6 | either: | ||||||
7 | (i) apply the applicable lifetime limit both | ||||||
8 | to the hospital and medical benefits to which it | ||||||
9 | otherwise would apply and to mental, emotional, | ||||||
10 | nervous, or substance use disorder or condition | ||||||
11 | benefits and not distinguish in the application of | ||||||
12 | the limit between the hospital and medical | ||||||
13 | benefits and mental, emotional, nervous, or | ||||||
14 | substance use disorder or condition benefits; or | ||||||
15 | (ii) not include any aggregate lifetime limit | ||||||
16 | on mental, emotional, nervous, or substance use | ||||||
17 | disorder or condition benefits that is less than | ||||||
18 | the applicable lifetime limit. | ||||||
19 | (2) In the case of a policy that is not described in | ||||||
20 | paragraph (1) of subsection (b) of this Section and that | ||||||
21 | includes no or different aggregate lifetime limits on | ||||||
22 | different categories of hospital and medical benefits, the | ||||||
23 | Director shall establish rules under which subparagraph | ||||||
24 | (B) of paragraph (1) of subsection (b) of this Section is | ||||||
25 | applied to such policy with respect to mental, emotional, | ||||||
26 | nervous, or substance use disorder or condition benefits by |
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1 | substituting for the applicable lifetime limit an average | ||||||
2 | aggregate lifetime limit that is computed taking into | ||||||
3 | account the weighted average of the aggregate lifetime | ||||||
4 | limits applicable to such categories. | ||||||
5 | (c) The following provisions shall apply concerning annual | ||||||
6 | limits: | ||||||
7 | (1) In the case of a group or individual policy of | ||||||
8 | accident and health insurance or a qualified health plan | ||||||
9 | offered through the Health Insurance Marketplace amended, | ||||||
10 | delivered, issued, or renewed in this State on or after the | ||||||
11 | effective date of this amendatory Act of the 99th General | ||||||
12 | Assembly that provides coverage for hospital or medical | ||||||
13 | treatment and for the treatment of mental, emotional, | ||||||
14 | nervous, or substance use disorders or conditions the | ||||||
15 | following provisions shall apply: | ||||||
16 | (A) if the policy does not include an annual limit | ||||||
17 | on substantially all hospital and medical benefits, | ||||||
18 | then the policy may not impose any annual limits on | ||||||
19 | mental, emotional, nervous, or substance use disorder | ||||||
20 | or condition benefits; or | ||||||
21 | (B) if the policy includes an annual limit on | ||||||
22 | substantially all hospital and medical benefits (in | ||||||
23 | this subsection referred to as the "applicable annual | ||||||
24 | limit"), then the policy shall either: | ||||||
25 | (i) apply the applicable annual limit both to | ||||||
26 | the hospital and medical benefits to which it |
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1 | otherwise would apply and to mental, emotional, | ||||||
2 | nervous, or substance use disorder or condition | ||||||
3 | benefits and not distinguish in the application of | ||||||
4 | the limit between the hospital and medical | ||||||
5 | benefits and mental, emotional, nervous, or | ||||||
6 | substance use disorder or condition benefits; or | ||||||
7 | (ii) not include any annual limit on mental, | ||||||
8 | emotional, nervous, or substance use disorder or | ||||||
9 | condition benefits that is less than the | ||||||
10 | applicable annual limit. | ||||||
11 | (2) In the case of a policy that is not described in | ||||||
12 | paragraph (1) of subsection (c) of this Section and that | ||||||
13 | includes no or different annual limits on different | ||||||
14 | categories of hospital and medical benefits, the Director | ||||||
15 | shall establish rules under which subparagraph (B) of | ||||||
16 | paragraph (1) of subsection (c) of this Section is applied | ||||||
17 | to such policy with respect to mental, emotional, nervous, | ||||||
18 | or substance use disorder or condition benefits by | ||||||
19 | substituting for the applicable annual limit an average | ||||||
20 | annual limit that is computed taking into account the | ||||||
21 | weighted average of the annual limits applicable to such | ||||||
22 | categories. | ||||||
23 | (d) With respect to substance use disorders, an insurer | ||||||
24 | shall use policies and procedures for the election and | ||||||
25 | placement of substance abuse treatment drugs on their formulary | ||||||
26 | that are no less favorable to the insured as those policies and |
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1 | procedures the insurer uses for the selection and placement of | ||||||
2 | other drugs and shall follow the expedited coverage | ||||||
3 | determination requirements for substance abuse treatment drugs | ||||||
4 | set forth in Section 45.2 of the Managed Care Reform and | ||||||
5 | Patient Rights Act. | ||||||
6 | (e) This Section shall be interpreted in a manner | ||||||
7 | consistent with all applicable federal parity regulations | ||||||
8 | including, but not limited to, the Mental Health Parity and | ||||||
9 | Addiction Equity Act of 2008 at 78 FR 68240. | ||||||
10 | (f) The provisions of subsections (b) and (c) of this | ||||||
11 | Section shall not be interpreted to allow the use of lifetime | ||||||
12 | or annual limits otherwise prohibited by State or federal law. | ||||||
13 | (g) As used in this Section: | ||||||
14 | "Financial requirement" includes deductibles, copayments, | ||||||
15 | coinsurance, and out-of-pocket maximums, but does not include | ||||||
16 | an aggregate lifetime limit or an annual limit subject to | ||||||
17 | subsections (b) and (c). | ||||||
18 | "Treatment limitation" includes limits on benefits based | ||||||
19 | on the frequency of treatment, number of visits, days of | ||||||
20 | coverage, days in a waiting period, or other similar limits on | ||||||
21 | the scope or duration of treatment , and shall also include | ||||||
22 | benefit payments under disability insurance or disability | ||||||
23 | income insurance policies or certificates . "Treatment | ||||||
24 | limitation" includes both quantitative treatment limitations, | ||||||
25 | which are expressed numerically (such as 50 outpatient visits | ||||||
26 | per year), and nonquantitative treatment limitations, which |
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1 | otherwise limit the scope or duration of treatment , or the | ||||||
2 | duration of benefit payments under the terms of a disability | ||||||
3 | insurance policy or certificate or disability income insurance | ||||||
4 | policy or certificate . A permanent exclusion of all benefits | ||||||
5 | for a particular condition or disorder shall not be considered | ||||||
6 | a treatment limitation. "Nonquantitative treatment" means | ||||||
7 | those limitations as described under federal regulations (26 | ||||||
8 | CFR 54.9812-1).
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9 | (h) The Department of Insurance shall implement the | ||||||
10 | following education initiatives: | ||||||
11 | (1) By January 1, 2016, the Department shall develop a | ||||||
12 | plan for a Consumer Education Campaign on parity. The | ||||||
13 | Consumer Education Campaign shall focus its efforts | ||||||
14 | throughout the State and include trainings in the northern, | ||||||
15 | southern, and central regions of the State, as defined by | ||||||
16 | the Department, as well as each of the 5 managed care | ||||||
17 | regions of the State as identified by the Department of | ||||||
18 | Healthcare and Family Services. Under this Consumer | ||||||
19 | Education Campaign, the Department shall: (1) by January 1, | ||||||
20 | 2017, provide at least one live training in each region on | ||||||
21 | parity for consumers and providers and one webinar training | ||||||
22 | to be posted on the Department website and (2) establish a | ||||||
23 | consumer hotline to assist consumers in navigating the | ||||||
24 | parity process by March 1, 2016. By January 1, 2018 the | ||||||
25 | Department shall issue a report to the General Assembly on | ||||||
26 | the success of the Consumer Education Campaign, which shall |
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1 | indicate whether additional training is necessary or would | ||||||
2 | be recommended. | ||||||
3 | (2) The Department, in coordination with the | ||||||
4 | Department of Human Services and the Department of | ||||||
5 | Healthcare and Family Services, shall convene a working | ||||||
6 | group of health care insurance carriers, mental health | ||||||
7 | advocacy groups, substance abuse patient advocacy groups, | ||||||
8 | and mental health physician groups for the purpose of | ||||||
9 | discussing issues related to the treatment and coverage of | ||||||
10 | substance abuse disorders and mental illness. The working | ||||||
11 | group shall meet once before January 1, 2016 and shall meet | ||||||
12 | semiannually thereafter. The Department shall issue an | ||||||
13 | annual report to the General Assembly that includes a list | ||||||
14 | of the health care insurance carriers, mental health | ||||||
15 | advocacy groups, substance abuse patient advocacy groups, | ||||||
16 | and mental health physician groups that participated in the | ||||||
17 | working group meetings, details on the issues and topics | ||||||
18 | covered, and any legislative recommendations. | ||||||
19 | (i) The Parity Education Fund is created as a special fund | ||||||
20 | in the State treasury. Moneys deposited into the Fund for | ||||||
21 | appropriation by the General Assembly to the Department of | ||||||
22 | Insurance shall be used for the purpose of providing financial | ||||||
23 | support of the Consumer Education Campaign. | ||||||
24 | (Source: P.A. 99-480, eff. 9-9-15.)".
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