Bill Text: IL HB4475 | 2023-2024 | 103rd General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Reinserts the provisions of the bill, as amended by House Amendment No. 1, with the following changes. Provides that for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2026, or any contracted third party administering the behavioral health benefits for the insurer, reimbursement for in-network mental health and substance use disorder treatment services delivered by Illinois providers and facilities must be equal to or greater than 141% of the Medicare rate for the mental health or substance use disorder service delivered (rather than on average, at least as favorable as professional services provided by in-network primary care providers). Removes language providing that reimbursement rates for services paid to Illinois mental health and substance use disorder treatment providers and facilities do not meet the required standard unless the reimbursement rates are, on average, equal to or greater than 141% of the Medicare reimbursement rate for the same service. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 (rather than $5,000) for each violation. Excludes health care plans serving Medicaid populations that provide, arrange for, pay for, or reimburse the cost of any health care service for persons who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Makes other changes. Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 37-3)

Status: (Engrossed) 2024-05-21 - Added as Alternate Co-Sponsor Sen. Patrick J. Joyce [HB4475 Detail]

Download: Illinois-2023-HB4475-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4475 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
5 ILCS 100/5-45.55 new
215 ILCS 5/370c.3 new
Amends the Illinois Insurance Code. Provides that the amendatory Act may be referred to as the Strengthening Mental Health and Substance Use Parity Act. Provides that 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, or any third-party administrator administering the behavioral health benefits for the insurer, shall cover all out-of-network medically necessary mental health and substance use benefits and services (inpatient and outpatient) as if they were in-network for purposes of cost sharing for the insured. Provides that the insured has the right to select the provider or facility of their choice and the modality, whether the care is provided via in-person visit or telehealth, for medically necessary care. Sets forth minimum reimbursement rates for certain behavioral health benefits. Sets forth provisions concerning responsibility for compliance with parity requirements; coverage and payment for multiple covered mental health and substance use services, mental health or substance use services provided under the supervision of a licensed mental health or substance treatment provider, and 60-minute individual psychotherapy; timely credentialing of mental health and substance use providers; Department of Insurance enforcement and rulemaking; civil penalties; and other matters. Amends the Illinois Administrative Procedure Act to authorize emergency rulemaking. Effective immediately.
LRB103 36234 RPS 66329 b
A BILL FOR
HB4475 LRB103 36234 RPS 66329 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. This Act may be referred to as the
Strengthening Mental Health and Substance Use Parity Act.
Section 2. Purpose. The purpose of this Act is to improve
mental health and substance use parity, specifically
addressing network adequacy and nonquantitative treatment
limitations that restrict access to care.
Section 3. Findings. The General Assembly finds that:
(1) A 2021 U.S. Surgeon General Advisory, Protecting Youth
Mental Health, reported the COVID-19 pandemic's devastating
impact on youth and family mental health:
(A) One in 3 high school students reported persistent
feelings of hopelessness and sadness in 2019.
(B) Rates of depression and anxiety for youth doubled
during the pandemic.
(C) Black children under 13 are nearly twice as likely
to die by suicide than white children.
(2) According to a bipartisan U.S. Senate Finance
Committee report on Mental Health Care in the United States,
symptoms for depression and anxiety in adults increased nearly

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four-fold during the pandemic.
(3) In 2020, 2,944 Illinoisans lost their lives to an
opioid overdose according to the Illinois Department of Public
Health.
(4) Discriminatory commercial insurance practices that do
not live up to the federal Mental Health Parity and Addiction
Equity Act (MHPAEA) and Illinois' parity laws, specifically
regarding insurance network adequacy, severely limit access to
care.
(5) Commercial insurance practices disincentivize mental
health and substance use treatment providers from
participating in insurance networks by erecting significant
administrative barriers and by reimbursing providers far below
the reimbursement of other health care providers despite a
behavioral health workforce crisis.
(A) Such practices lead to restrictive, narrow
insurance networks that restrict access care.
(B) 26% of psychiatrists do not participate in
insurance networks, according to a report in JAMA
Psychiatry.
(C) 21% of psychologists do not participate in
insurance networks, according to a 2015 American
Psychological Association Survey.
(D) A significant percentage of behavioral health
providers do not contract with insurers, leaving patients
to see out-of-network providers.

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(E) Out-of-network treatment is far more expensive for
the patient than in-network care.
(F) Mental health and substance use treatment is
inaccessible and unaffordable for millions of Illinoisans
for these reasons.
(6) A recent Milliman report analyzing insurance claims
for 37,000,000 Americans, including Illinois residents, found
major disparities in out-of-network utilization for behavioral
health compared to other health care. The report's findings
include:
(A) Illinois out-of-network behavioral health
utilization was 18.2% for outpatient services in 2017
compared to just 3.9% for medical/surgical services.
(B) Illinois out-of-network behavioral health
utilization was 12.1% in 2017 for inpatient care compared
to just 2.8% for medical/surgical.
(C) The disparity between out-of-network usage for
behavioral health compared to medical/surgical services
grew significantly between 2013 and 2017: Out-of-network
behavioral health utilization for outpatient visits grew
by 44%, while out-of-network utilization for
medical/surgical services decreased by 42% over the same
period in Illinois.
(D) Nearly 14% of behavioral health office visits for
individuals with a preferred provider organization plan
were out-of-network in Illinois.

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(7) Mental health and substance use care, which represents
just 5.2% of all health care spending, does not drive up
premiums.
(8) Improved access to behavioral health care is expected
to reduce overall health care spending because:
(A) spending on physical health care is 2 to 3 times
higher for patients with ongoing mental health and
substance use diagnoses, according to a 2018 Milliman
research report; and
(B) improved utilization of mental health services has
been demonstrated empirically to reduce overall health
care spending (Biu, Yoon, & Hines, 2021).
(9) Illinois must strengthen its parity laws to prevent
insurance practices that restrict access to mental health and
substance use care.
Section 5. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.55 as follows:
(5 ILCS 100/5-45.55 new)
Sec. 5-45.55. Emergency rulemaking; this amendatory Act of
the 103rd General Assembly. To provide for the expeditious and
timely implementation of this amendatory Act of the 103rd
General Assembly, emergency rules implementing Section 370c.3
of the Illinois Insurance Code may be adopted in accordance
with Section 5-45 by the Department of Insurance. The adoption

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of emergency rules authorized by Section 5-45 and this Section
is deemed to be necessary for the public interest, safety, and
welfare.
This Section is repealed one year after the effective date
of this amendatory Act of the 103rd General Assembly.
Section 10. The Illinois Insurance Code is amended by
adding Section 370c.3 as follows:
(215 ILCS 5/370c.3 new)
Sec. 370c.3. Mental health and substance use parity.
(a) Definitions. In this Section:
"Applicant" means a psychiatrist licensed to practice
medicine in all its branches, licensed clinical psychologist,
licensed clinical social worker, licensed clinical
professional counselor, licensed marriage and family
therapist, licensed speech-language pathologist, or other
licensed or certified professional at a program licensed
pursuant to the Substance Use Disorder Act who is engaged in
treating mental, emotional, nervous, or substance use
disorders or conditions and who submits an application to
become a participating provider in the insurer's network.
"Applicant" includes a person who is provisionally licensed.
"Application" means an applicant's application to become
credentialed by an insurer as a participating provider in at
least one of the insurer's provider networks.

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"Credentialing" or "credential" means the process by which
an insurer, a third-party administrator administering the
behavioral health benefits for the insurer, or a designee
collects information concerning an applicant; assesses whether
the applicant satisfies the relevant licensing, education, and
training requirements to become a participating provider;
verifies the assessment; approves or disapproves the
applicant's application; and, for purposes of a group
practice, rosters providers.
"Designee" means a third party to which an insurer, or a
third-party administrator administering the behavioral health
benefits for the insurer, delegates or contracts for
activities for responsibilities pertaining to credentialing.
"Participating provider" means a psychiatrist licensed to
practice medicine in all its branches, licensed clinical
psychologist, licensed clinical social worker, licensed
clinical professional counselor, licensed marriage and family
therapist, licensed speech-language pathologist, other
licensed or certified professional at a program licensed
pursuant to the Substance Use Disorder Act engaged in treating
mental, emotional, nervous, or substance use disorders or
conditions, or is provisionally licensed as such, and who is
credentialed by an insurer, or any third-party administrator
administering the behavioral health benefits for the insurer
or a designee to provide health care services to covered
persons in at least one of the insurer's provider networks.

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"Provisionally licensed" means a person seeking to be a
psychiatrist licensed to practice medicine in all its
branches, licensed clinical psychologist, licensed clinical
social worker, licensed clinical professional counselor,
licensed marriage and family therapist, licensed
speech-language pathologist, or other licensed or certified
professional at a program licensed pursuant to the Substance
Use Disorder Act engaged in treating mental, emotional,
nervous, or substance use disorders or conditions, who has a
license to practice under the supervision of a licensed mental
health or substance use provider and is in the process of
meeting additional licensure requirements.
"Recredentialing" or "recredential" means the process by
which an insurer or its designee confirms that a participating
provider is in good standing and continues to satisfy the
insurer's requirements for participating providers.
"Supervisee" means an individual who is:
(1) a master's or doctoral level degree-seeking
student in an accredited medical, clinical mental health,
substance use, or counseling program working toward
graduation, or has completed a masters or doctoral degree
from such a program, and is seeking full licensure as a
psychiatrist licensed to practice medicine in all its
branches, licensed clinical psychologist, licensed
clinical social worker, licensed clinical professional
counselor, licensed marriage and family therapist,

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licensed speech-language pathologist, or other licensed or
certified professional at a program licensed pursuant to
the Substance Use Disorder Act engaged in treating mental,
emotional, nervous, or substance use disorders or
conditions; or
(2) provisionally licensed as a psychiatrist licensed
to practice medicine in all its branches, licensed
clinical psychologist, licensed clinical social worker,
licensed clinical professional counselor, licensed
marriage and family therapist, licensed speech-language
pathologist, or other licensed or certified professional
at a program licensed pursuant to the Substance Use
Disorder Act engaged in treating mental, emotional,
nervous, or substance use disorders or conditions, and
such individual is under the supervision of a psychiatrist
licensed to practice medicine in all its branches,
licensed clinical psychologist, licensed clinical social
worker, licensed clinical professional counselor, licensed
marriage and family therapist, licensed speech-language
pathologist, or other licensed or certified professional
at a program licensed pursuant to the Substance Use
Disorder Act engaged in treating mental, emotional,
nervous, or substance use disorders.
"Supervisory billing" means the process of billing for
medically necessary mental health or substance use services
provided by a mental health or substance use provider that is a

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supervisee under the supervision of a licensed behavioral
health (mental health or substance use) provider, including a
psychiatrist licensed to practice medicine in all its
branches, licensed clinical psychologist, licensed clinical
social worker, licensed clinical professional counselor,
licensed marriage and family therapist, licensed
speech-language pathologist, or other licensed or certified
professional at a program licensed pursuant to the Substance
Use Disorder Act.
"Third-party administrator" means an administrator, as
defined in subsection (a) of Section 511.101, that administers
any behavioral health (mental health or substance use)
benefits on behalf of a plan sponsor or insurer. "Third-party
administrator" includes any entity, subcontractor, or person
who performs administrative or operational functions related
to the insured's behavioral health benefits.
(b) Expanding mental health and substance use network
participation to improve access to care; third-party
administrators administering behavioral health benefits
subject to parity. Notwithstanding the provisions of the
Network Adequacy and Transparency Act, 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, or any third-party administrator
administering the behavioral health benefits for the insurer,
shall cover all out-of-network medically necessary mental

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health and substance use benefits and services (inpatient and
outpatient) as if they were in-network for purposes of cost
sharing for the insured. The insured has the right to select
the provider or facility of the insured's choice and the
modality, including whether the care is provided via an
in-person visit or telehealth, for medically necessary care.
No action shall be required by the insured to treat an
out-of-network mental health or substance use service as an
in-network service pursuant to this Section.
(1) The insurer, or any third-party administrator
administering the behavioral health benefits for the
insurer, shall reimburse Illinois-based mental health or
substance use treatment providers and facilities for
out-of-network medically necessary services provided at a
reimbursement rate for such services at least equal to
116% of the most recently published Medicare Fee Schedule
published by the Centers for Medicare and Medicaid
Services for the specific service delivered, or at an
agreed upon rate that is no lower. For any mental health or
substance use service that is not covered by Medicare, the
reimbursement rate for such service shall be at least
equal to 119% of the standard in-network reimbursement
rate for such service, or at an agreed upon rate that is no
lower. This paragraph applies to all medically necessary
outpatient and inpatient mental health and substance use
services and includes all mental health and substance use

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CPT Codes, add-ons, and modifiers.
(2) The insurer, or any third-party administrator
administering the behavioral health benefits for the
insurer, shall reimburse Illinois-based mental health or
substance use treatment providers and facilities for
in-network medically necessary services provided at a
reimbursement rate for such services at least equal to
141% of the most recently published Medicare Fee Schedule
published by the Centers for Medicare and Medicaid
Services for the specific service delivered, or at an
agreed upon rate that is no lower. For any mental health or
substance use service that is not covered by Medicare, the
reimbursement rate for such service shall be at least
equal to 144% of the standard in-network reimbursement
rate for such service, or at an agreed upon rate that is no
lower. This paragraph applies to medically necessary
outpatient and inpatient mental health and substance use
services and shall include all mental health and substance
use CPT Codes, add-ons, and modifiers.
(3) A health care plan that is created and operated
under the Health Maintenance Organization Act and is
administered by the health maintenance organization, as
defined in the Section 1-2 of the Health Maintenance
Organization Act, or any third-party administrator
administering the behavioral health benefits for the
health maintenance organization, shall reimburse

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Illinois-based mental health or substance use treatment
providers and facilities that are contracted with the
health maintenance organization for medically necessary
services provided at a reimbursement rate for such
services at least equal to 141% of the most recently
published Medicare Fee Schedule published by the Centers
for Medicare and Medicaid Services for the specific
service delivered, or at an agreed upon rate that is no
lower. For any mental health or substance use service that
is not covered by Medicare, the reimbursement rate for
such service shall be at least equal to 144% of the
standard contracted reimbursement rate for such service,
or at an agreed upon rate that is no lower. This paragraph
applies to all medically necessary outpatient and
inpatient mental health and substance use services and
includes all mental health and substance use CPT Codes,
add-ons, and modifiers.
(4) A health care plan that is created and operated
under the Health Maintenance Organization Act and is
administered by the health maintenance organization, as
defined in Section 1-2 of the Health Maintenance
Organization Act, or any third-party administrator
administering the behavioral health benefits for the
health maintenance organization, shall reimburse
Illinois-based mental health or substance use treatment
providers and facilities that are not contracted with the

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health maintenance organization, for medically necessary
services provided to the insured at a reimbursement rate
for such services at least equal to 116% of the most
recently published Medicare Fee Schedule published by the
Centers for Medicare and Medicaid Services for the
specific service delivered, or at an agreed upon rate that
is no lower. For any mental health or substance use
service that is not covered by Medicare, the reimbursement
rate for such service shall be at least equal to 119% of
the standard contracted reimbursement rate for such
service, or at an agreed upon rate that is no lower. This
paragraph applies to all medically necessary outpatient
and inpatient mental health and substance use services and
includes all mental health and substance use CPT Codes,
add-ons, and modifiers.
(c) Third-party administrators of behavioral health
benefits are responsible for mental health and substance use
services parity compliance. 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, or any third-party administrator administering the
behavioral health (mental health or substance use) benefits
for the insurer shall be subject to Section 370c and the parity
requirements of Section 370c.1. The Department has the same
authority to enforce this Section as it has to enforce
compliance with Sections 370c and 370c.1.

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(1) If an insured receives a medically necessary
mental health or substance use service from a mental
health or substance use treatment provider or facility
that is in-network with their insurer, or for purposes of
a health maintenance organization, from a contracted
mental health or substance use provider or facility, the
service shall be treated as an in-network, or as a service
with a contracted provider or facility with a health
maintenance organization, with any third-party
administrator for the insurer for purposes of cost
sharing. The mental health or substance use provider or
facility that renders such service that is treated as
in-network or as a contracted provider or facility under
this Section, shall be reimbursed by the third-party
administrator at the reimbursement rate that is no less
than the in-network or contracted rate for such service in
accordance with this Section.
(2) Insurers shall require contractual language with
any third-party administrator or entity administering the
behavioral health benefits for the insurer that expressly
obligates any third-party administrator that administers
such benefits to comply with this Section, Section 370c,
and the parity requirements of Section 370c.1 and shall be
required to assist the insurer with compliance with those
provisions.
(d) Coverage and payment for multiple covered mental

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health and substance use services on the same day. Mental
health and substance use services received by an insured on
the same day shall be fully covered and fully reimbursed. 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, or any third-party
administrator administering the behavioral health benefits for
the insurer, shall cover all medically necessary mental health
or substance use services received by the same insured on the
same day from the same or different mental health or substance
use provider or facility for both outpatient and inpatient
care. The insurer, or any third-party administrator
administering the behavioral health benefits for the insurer,
shall fully reimburse a mental health or substance use
provider or facility for each medically necessary service,
whether inpatient or outpatient, delivered to the same insured
on the same day by the same or different provider or facility.
(e) Coverage of mental health or substance use services
provided under the supervision of a licensed mental health or
substance use treatment provider shall be covered and
reimbursed. 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, or
any third-party administrator administering the behavioral
health benefits for the insurer, shall accept and reimburse
for supervisory billing for any medically necessary mental

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health or substance use service delivered. An insurer or
third-party administrator administering the behavioral health
benefits for an insurer shall accept and reimburse claims
submitted for supervisory billing for medically necessary
mental health or substance use services when such claims are
submitted by the supervising licensed mental health or
substance use provider, as the rendering provider, using such
provider's National Provider Identifier. A modifier shall be
used to specify the supervisee's degree level.
(f) Coverage of and payment for 60-minute individual
psychotherapy. 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, or
any third-party administrator administering the behavioral
health benefits for the insurer shall:
(1) accept and reimburse for a medically necessary
60-minute psychotherapy visit billed using the CPT Code
90837 for Individual Therapy;
(2) not impose more onerous documentation requirements
than is required for other psychotherapy CPT Codes; and
(3) not audit the use of CPT Code 90837 any more
frequently than audits for the use of other psychotherapy
CPT Codes.
(g) Timely credentialing of mental health and substance
use providers. A group or individual policy of accident and
health insurance or managed care plan that is amended,

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delivered, issued, or renewed on or after January 1, 2025, or
any third-party administrator administering the behavioral
health benefits for the insurer, shall comply with this
subsection to ensure timely credentialing with the insurer or
third-party administrator. All notices required by this
subsection shall come directly from the insurer.
(1) An insurer shall provide the applicant a written
or electronic receipt within 5 calendar days after the
insurer receives the applicant's credentialing
application.
(2) If an insurer determines an application is
incomplete, the insurer shall notify the applicant in
writing or electronically that the application is
incomplete within 10 calendar days from the date the
insurer received the application. The notice shall specify
what specific information is required to complete the
application.
(3) An insurer shall conclude the process of
credentialing an applicant within 30 calendar days
following receipt of an applicant's completed application
and shall provide each applicant written or electronic
notice of the outcome of the applicant's credentialing
application within such 30-day timeframe.
(4) If an insurer fails to provide the applicant
notice of a completed application or the outcome of the
applicant's completed application as required under this

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Section, the insurer shall consider the applicant a
participating provider effective no later than 30 days
following the insurer's receipt of the applicant's
completed application. The applicant shall be reimbursed
for all medically necessary mental health or substance use
services delivered at the standard in-network rate for
services provided in compliance with this Section.
(5) An insurer, or the third-party administrator
administering the behavioral health benefits for the
insurer, shall post the following nonproprietary
information on its website and make it available to all
applicants:
(A) the insurer's and any third-party
administrator's credentialing policies and procedures,
consistent with this Section;
(B) a list of the information required to be
included in an application;
(C) a checklist of the materials that must be
submitted in the credentialing process;
(D) designated contact information, including a
designated point of contact, an email address, and a
telephone number, to which an applicant may address
any credentialing inquiries; and
(6) An insurer, third-party administrator, or a
designee may recredential a participating provider if the
recredentialing is required by federal or State law or by

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the insurer's accreditation standards or is permitted by
the insurer's or third-party administrator's contract with
the participating provider. An insurer or third-party
administrator shall not require a participating provider
to submit an application or participate in a contracting
process in order to be recredentialed.
(7) Except as provided in paragraph (6) of subsection
(g), an insurer, or third-party administrator, shall allow
a participating provider to remain credentialed and
include the participating provider in the insurer's or
third-party administrator's provider network unless the
insurer or third-party administrator discovers information
indicating that the provider no longer satisfies the
insurer's guidelines for participation, in which case the
insurer, or the third-party administrator, shall notify
the participating provider in writing or electronically at
least 60 days before the termination of the participating
provider from the insurer's, or third-party
administrator's, network. The insurer, or third-party
administrator, shall provide written notice to all covered
persons seen by that provider within 15 business days
after issuance of a notice of termination to that provider
that such provider will no longer be a participating
provider in the insurer's, or third-party administrator's,
plan network by a certain specified date.
(8) Nothing in this Section affects the contract

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termination rights of an insurer or a participating
provider.
(h) Enforcement. The Department has the same authority to
enforce this Section as it has to enforce compliance with
Sections 370c and 370c.1. Additionally, if the Department
determines that an insurer or any third-party administrator
administering the behavioral health benefits for the insurer
has violated this Section, including denying medically
necessary services, failing to reimburse in accordance with
this Section, failing to meet the specified timelines and
notice requirements, treating in-network or contracted
services as out-of-network or noncontracted services, or
failing to meet any other requirement pursuant to this
Section, the Department shall, after appropriate notice and
opportunity for hearing in accordance with Section 1016, by
order assess a civil penalty of $20,000 for each violation.
The Department shall establish any processes or procedures
necessary to monitor compliance with this Section, including
the ability to receive complaints from mental health and
substance use providers impacted by an insurer's or
third-party administrator's failure to comply, while ensuring
adherence to all federal and State privacy and confidentiality
laws.
(i) Rulemaking. The Department shall adopt any rules,
including emergency rules, necessary to implement this Section
by no later than November 1, 2024.

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