Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1568 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0094
2	1		SB1568 EnrolledLRB103 28639 BMS 55020 b SB1568 Enrolled LRB103 28639 BMS 55020 b
3	2		SB1568 Enrolled LRB103 28639 BMS 55020 b
4		-	AN ACT concerning regulation.
5		-	Be it enacted by the People of the State of Illinois,
6		-	represented in the General Assembly:
7		-	Section 5. The Illinois Insurance Code is amended by
8		-	changing Section 370c.1 as follows:
9		-	(215 ILCS 5/370c.1)
10		-	Sec. 370c.1. Mental, emotional, nervous, or substance use
11		-	disorder or condition parity.
12		-	(a) On and after July 23, 2021 (the effective date of
13		-	Public Act 102-135), every insurer that amends, delivers,
14		-	issues, or renews a group or individual policy of accident and
15		-	health insurance or a qualified health plan offered through
16		-	the Health Insurance Marketplace in this State providing
17		-	coverage for hospital or medical treatment and for the
18		-	treatment of mental, emotional, nervous, or substance use
19		-	disorders or conditions shall ensure prior to policy issuance
20		-	that:
21		-	(1) the financial requirements applicable to such
22		-	mental, emotional, nervous, or substance use disorder or
23		-	condition benefits are no more restrictive than the
24		-	predominant financial requirements applied to
25		-	substantially all hospital and medical benefits covered by
26		-	the policy and that there are no separate cost-sharing
	3	+	1 AN ACT concerning regulation.
	4	+	2 Be it enacted by the People of the State of Illinois,
	5	+	3 represented in the General Assembly:
	6	+	4 Section 5. The Illinois Insurance Code is amended by
	7	+	5 changing Section 370c.1 as follows:
	8	+	6 (215 ILCS 5/370c.1)
	9	+	7 Sec. 370c.1. Mental, emotional, nervous, or substance use
	10	+	8 disorder or condition parity.
	11	+	9 (a) On and after July 23, 2021 (the effective date of
	12	+	10 Public Act 102-135), every insurer that amends, delivers,
	13	+	11 issues, or renews a group or individual policy of accident and
	14	+	12 health insurance or a qualified health plan offered through
	15	+	13 the Health Insurance Marketplace in this State providing
	16	+	14 coverage for hospital or medical treatment and for the
	17	+	15 treatment of mental, emotional, nervous, or substance use
	18	+	16 disorders or conditions shall ensure prior to policy issuance
	19	+	17 that:
	20	+	18 (1) the financial requirements applicable to such
	21	+	19 mental, emotional, nervous, or substance use disorder or
	22	+	20 condition benefits are no more restrictive than the
	23	+	21 predominant financial requirements applied to
	24	+	22 substantially all hospital and medical benefits covered by
	25	+	23 the policy and that there are no separate cost-sharing
27	26
28	27
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33		-	requirements that are applicable only with respect to
34		-	mental, emotional, nervous, or substance use disorder or
35		-	condition benefits; and
36		-	(2) the treatment limitations applicable to such
37		-	mental, emotional, nervous, or substance use disorder or
38		-	condition benefits are no more restrictive than the
39		-	predominant treatment limitations applied to substantially
40		-	all hospital and medical benefits covered by the policy
41		-	and that there are no separate treatment limitations that
42		-	are applicable only with respect to mental, emotional,
43		-	nervous, or substance use disorder or condition benefits.
44		-	(b) The following provisions shall apply concerning
45		-	aggregate lifetime limits:
46		-	(1) In the case of a group or individual policy of
47		-	accident and health insurance or a qualified health plan
48		-	offered through the Health Insurance Marketplace amended,
49		-	delivered, issued, or renewed in this State on or after
50		-	September 9, 2015 (the effective date of Public Act
51		-	99-480) that provides coverage for hospital or medical
52		-	treatment and for the treatment of mental, emotional,
53		-	nervous, or substance use disorders or conditions the
54		-	following provisions shall apply:
55		-	(A) if the policy does not include an aggregate
56		-	lifetime limit on substantially all hospital and
57		-	medical benefits, then the policy may not impose any
58		-	aggregate lifetime limit on mental, emotional,
	32	+	SB1568 Enrolled- 2 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 2 - LRB103 28639 BMS 55020 b
	33	+	SB1568 Enrolled - 2 - LRB103 28639 BMS 55020 b
	34	+	1 requirements that are applicable only with respect to
	35	+	2 mental, emotional, nervous, or substance use disorder or
	36	+	3 condition benefits; and
	37	+	4 (2) the treatment limitations applicable to such
	38	+	5 mental, emotional, nervous, or substance use disorder or
	39	+	6 condition benefits are no more restrictive than the
	40	+	7 predominant treatment limitations applied to substantially
	41	+	8 all hospital and medical benefits covered by the policy
	42	+	9 and that there are no separate treatment limitations that
	43	+	10 are applicable only with respect to mental, emotional,
	44	+	11 nervous, or substance use disorder or condition benefits.
	45	+	12 (b) The following provisions shall apply concerning
	46	+	13 aggregate lifetime limits:
	47	+	14 (1) In the case of a group or individual policy of
	48	+	15 accident and health insurance or a qualified health plan
	49	+	16 offered through the Health Insurance Marketplace amended,
	50	+	17 delivered, issued, or renewed in this State on or after
	51	+	18 September 9, 2015 (the effective date of Public Act
	52	+	19 99-480) that provides coverage for hospital or medical
	53	+	20 treatment and for the treatment of mental, emotional,
	54	+	21 nervous, or substance use disorders or conditions the
	55	+	22 following provisions shall apply:
	56	+	23 (A) if the policy does not include an aggregate
	57	+	24 lifetime limit on substantially all hospital and
	58	+	25 medical benefits, then the policy may not impose any
	59	+	26 aggregate lifetime limit on mental, emotional,
59	60
60	61
61		-	nervous, or substance use disorder or condition
62		-	benefits; or
63		-	(B) if the policy includes an aggregate lifetime
64		-	limit on substantially all hospital and medical
65		-	benefits (in this subsection referred to as the
66		-	"applicable lifetime limit"), then the policy shall
67		-	either:
68		-	(i) apply the applicable lifetime limit both
69		-	to the hospital and medical benefits to which it
70		-	otherwise would apply and to mental, emotional,
71		-	nervous, or substance use disorder or condition
72		-	benefits and not distinguish in the application of
73		-	the limit between the hospital and medical
74		-	benefits and mental, emotional, nervous, or
75		-	substance use disorder or condition benefits; or
76		-	(ii) not include any aggregate lifetime limit
77		-	on mental, emotional, nervous, or substance use
78		-	disorder or condition benefits that is less than
79		-	the applicable lifetime limit.
80		-	(2) In the case of a policy that is not described in
81		-	paragraph (1) of subsection (b) of this Section and that
82		-	includes no or different aggregate lifetime limits on
83		-	different categories of hospital and medical benefits, the
84		-	Director shall establish rules under which subparagraph
85		-	(B) of paragraph (1) of subsection (b) of this Section is
86		-	applied to such policy with respect to mental, emotional,
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88	63
89		-	nervous, or substance use disorder or condition benefits
90		-	by substituting for the applicable lifetime limit an
91		-	average aggregate lifetime limit that is computed taking
92		-	into account the weighted average of the aggregate
93		-	lifetime limits applicable to such categories.
94		-	(c) The following provisions shall apply concerning annual
95		-	limits:
96		-	(1) In the case of a group or individual policy of
97		-	accident and health insurance or a qualified health plan
98		-	offered through the Health Insurance Marketplace amended,
99		-	delivered, issued, or renewed in this State on or after
100		-	September 9, 2015 (the effective date of Public Act
101		-	99-480) that provides coverage for hospital or medical
102		-	treatment and for the treatment of mental, emotional,
103		-	nervous, or substance use disorders or conditions the
104		-	following provisions shall apply:
105		-	(A) if the policy does not include an annual limit
106		-	on substantially all hospital and medical benefits,
107		-	then the policy may not impose any annual limits on
108		-	mental, emotional, nervous, or substance use disorder
109		-	or condition benefits; or
110		-	(B) if the policy includes an annual limit on
111		-	substantially all hospital and medical benefits (in
112		-	this subsection referred to as the "applicable annual
113		-	limit"), then the policy shall either:
114		-	(i) apply the applicable annual limit both to
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117		-	the hospital and medical benefits to which it
118		-	otherwise would apply and to mental, emotional,
119		-	nervous, or substance use disorder or condition
120		-	benefits and not distinguish in the application of
121		-	the limit between the hospital and medical
122		-	benefits and mental, emotional, nervous, or
123		-	substance use disorder or condition benefits; or
124		-	(ii) not include any annual limit on mental,
125		-	emotional, nervous, or substance use disorder or
126		-	condition benefits that is less than the
127		-	applicable annual limit.
128		-	(2) In the case of a policy that is not described in
129		-	paragraph (1) of subsection (c) of this Section and that
130		-	includes no or different annual limits on different
131		-	categories of hospital and medical benefits, the Director
132		-	shall establish rules under which subparagraph (B) of
133		-	paragraph (1) of subsection (c) of this Section is applied
134		-	to such policy with respect to mental, emotional, nervous,
135		-	or substance use disorder or condition benefits by
136		-	substituting for the applicable annual limit an average
137		-	annual limit that is computed taking into account the
138		-	weighted average of the annual limits applicable to such
139		-	categories.
140		-	(d) With respect to mental, emotional, nervous, or
141		-	substance use disorders or conditions, an insurer shall use
142		-	policies and procedures for the election and placement of
	68	+	SB1568 Enrolled- 3 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 3 - LRB103 28639 BMS 55020 b
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	70	+	1 nervous, or substance use disorder or condition
	71	+	2 benefits; or
	72	+	3 (B) if the policy includes an aggregate lifetime
	73	+	4 limit on substantially all hospital and medical
	74	+	5 benefits (in this subsection referred to as the
	75	+	6 "applicable lifetime limit"), then the policy shall
	76	+	7 either:
	77	+	8 (i) apply the applicable lifetime limit both
	78	+	9 to the hospital and medical benefits to which it
	79	+	10 otherwise would apply and to mental, emotional,
	80	+	11 nervous, or substance use disorder or condition
	81	+	12 benefits and not distinguish in the application of
	82	+	13 the limit between the hospital and medical
	83	+	14 benefits and mental, emotional, nervous, or
	84	+	15 substance use disorder or condition benefits; or
	85	+	16 (ii) not include any aggregate lifetime limit
	86	+	17 on mental, emotional, nervous, or substance use
	87	+	18 disorder or condition benefits that is less than
	88	+	19 the applicable lifetime limit.
	89	+	20 (2) In the case of a policy that is not described in
	90	+	21 paragraph (1) of subsection (b) of this Section and that
	91	+	22 includes no or different aggregate lifetime limits on
	92	+	23 different categories of hospital and medical benefits, the
	93	+	24 Director shall establish rules under which subparagraph
	94	+	25 (B) of paragraph (1) of subsection (b) of this Section is
	95	+	26 applied to such policy with respect to mental, emotional,
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145		-	mental, emotional, nervous, or substance use disorder or
146		-	condition treatment drugs on their formulary that are no less
147		-	favorable to the insured as those policies and procedures the
148		-	insurer uses for the selection and placement of drugs for
149		-	medical or surgical conditions and shall follow the expedited
150		-	coverage determination requirements for substance abuse
151		-	treatment drugs set forth in Section 45.2 of the Managed Care
152		-	Reform and Patient Rights Act.
153		-	(e) This Section shall be interpreted in a manner
154		-	consistent with all applicable federal parity regulations
155		-	including, but not limited to, the Paul Wellstone and Pete
156		-	Domenici Mental Health Parity and Addiction Equity Act of
157		-	2008, final regulations issued under the Paul Wellstone and
158		-	Pete Domenici Mental Health Parity and Addiction Equity Act of
159		-	2008 and final regulations applying the Paul Wellstone and
160		-	Pete Domenici Mental Health Parity and Addiction Equity Act of
161		-	2008 to Medicaid managed care organizations, the Children's
162		-	Health Insurance Program, and alternative benefit plans.
163		-	(f) The provisions of subsections (b) and (c) of this
164		-	Section shall not be interpreted to allow the use of lifetime
165		-	or annual limits otherwise prohibited by State or federal law.
166		-	(g) As used in this Section:
167		-	"Financial requirement" includes deductibles, copayments,
168		-	coinsurance, and out-of-pocket maximums, but does not include
169		-	an aggregate lifetime limit or an annual limit subject to
170		-	subsections (b) and (c).
171	98
172	99
173		-	"Mental, emotional, nervous, or substance use disorder or
174		-	condition" means a condition or disorder that involves a
175		-	mental health condition or substance use disorder that falls
176		-	under any of the diagnostic categories listed in the mental
177		-	and behavioral disorders chapter of the current edition of the
178		-	International Classification of Disease or that is listed in
179		-	the most recent version of the Diagnostic and Statistical
180		-	Manual of Mental Disorders.
181		-	"Treatment limitation" includes limits on benefits based
182		-	on the frequency of treatment, number of visits, days of
183		-	coverage, days in a waiting period, or other similar limits on
184		-	the scope or duration of treatment. "Treatment limitation"
185		-	includes both quantitative treatment limitations, which are
186		-	expressed numerically (such as 50 outpatient visits per year),
187		-	and nonquantitative treatment limitations, which otherwise
188		-	limit the scope or duration of treatment. A permanent
189		-	exclusion of all benefits for a particular condition or
190		-	disorder shall not be considered a treatment limitation.
191		-	"Nonquantitative treatment" means those limitations as
192		-	described under federal regulations (26 CFR 54.9812-1).
193		-	"Nonquantitative treatment limitations" include, but are not
194		-	limited to, those limitations described under federal
195		-	regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR
196		-	146.136.
197		-	(h) The Department of Insurance shall implement the
198		-	following education initiatives:
	100	+
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201		-	(1) By January 1, 2016, the Department shall develop a
202		-	plan for a Consumer Education Campaign on parity. The
203		-	Consumer Education Campaign shall focus its efforts
204		-	throughout the State and include trainings in the
205		-	northern, southern, and central regions of the State, as
206		-	defined by the Department, as well as each of the 5 managed
207		-	care regions of the State as identified by the Department
208		-	of Healthcare and Family Services. Under this Consumer
209		-	Education Campaign, the Department shall: (1) by January
210		-	1, 2017, provide at least one live training in each region
211		-	on parity for consumers and providers and one webinar
212		-	training to be posted on the Department website and (2)
213		-	establish a consumer hotline to assist consumers in
214		-	navigating the parity process by March 1, 2017. By January
215		-	1, 2018 the Department shall issue a report to the General
216		-	Assembly on the success of the Consumer Education
217		-	Campaign, which shall indicate whether additional training
218		-	is necessary or would be recommended.
219		-	(2) The Department, in coordination with the
220		-	Department of Human Services and the Department of
221		-	Healthcare and Family Services, shall convene a working
222		-	group of health care insurance carriers, mental health
223		-	advocacy groups, substance abuse patient advocacy groups,
224		-	and mental health physician groups for the purpose of
225		-	discussing issues related to the treatment and coverage of
226		-	mental, emotional, nervous, or substance use disorders or
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	106	+	1 nervous, or substance use disorder or condition benefits
	107	+	2 by substituting for the applicable lifetime limit an
	108	+	3 average aggregate lifetime limit that is computed taking
	109	+	4 into account the weighted average of the aggregate
	110	+	5 lifetime limits applicable to such categories.
	111	+	6 (c) The following provisions shall apply concerning annual
	112	+	7 limits:
	113	+	8 (1) In the case of a group or individual policy of
	114	+	9 accident and health insurance or a qualified health plan
	115	+	10 offered through the Health Insurance Marketplace amended,
	116	+	11 delivered, issued, or renewed in this State on or after
	117	+	12 September 9, 2015 (the effective date of Public Act
	118	+	13 99-480) that provides coverage for hospital or medical
	119	+	14 treatment and for the treatment of mental, emotional,
	120	+	15 nervous, or substance use disorders or conditions the
	121	+	16 following provisions shall apply:
	122	+	17 (A) if the policy does not include an annual limit
	123	+	18 on substantially all hospital and medical benefits,
	124	+	19 then the policy may not impose any annual limits on
	125	+	20 mental, emotional, nervous, or substance use disorder
	126	+	21 or condition benefits; or
	127	+	22 (B) if the policy includes an annual limit on
	128	+	23 substantially all hospital and medical benefits (in
	129	+	24 this subsection referred to as the "applicable annual
	130	+	25 limit"), then the policy shall either:
	131	+	26 (i) apply the applicable annual limit both to
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229		-	conditions and compliance with parity obligations under
230		-	State and federal law. Compliance shall be measured,
231		-	tracked, and shared during the meetings of the working
232		-	group. The working group shall meet once before January 1,
233		-	2016 and shall meet semiannually thereafter. The
234		-	Department shall issue an annual report to the General
235		-	Assembly that includes a list of the health care insurance
236		-	carriers, mental health advocacy groups, substance abuse
237		-	patient advocacy groups, and mental health physician
238		-	groups that participated in the working group meetings,
239		-	details on the issues and topics covered, and any
240		-	legislative recommendations developed by the working
241		-	group.
242		-	(3) Not later than January 1 of each year, the
243		-	Department, in conjunction with the Department of
244		-	Healthcare and Family Services, shall issue a joint report
245		-	to the General Assembly and provide an educational
246		-	presentation to the General Assembly. The report and
247		-	presentation shall:
248		-	(A) Cover the methodology the Departments use to
249		-	check for compliance with the federal Paul Wellstone
250		-	and Pete Domenici Mental Health Parity and Addiction
251		-	Equity Act of 2008, 42 U.S.C. 18031(j), and any
252		-	federal regulations or guidance relating to the
253		-	compliance and oversight of the federal Paul Wellstone
254		-	and Pete Domenici Mental Health Parity and Addiction
255	134
256	135
257		-	Equity Act of 2008 and 42 U.S.C. 18031(j).
258		-	(B) Cover the methodology the Departments use to
259		-	check for compliance with this Section and Sections
260		-	356z.23 and 370c of this Code.
261		-	(C) Identify market conduct examinations or, in
262		-	the case of the Department of Healthcare and Family
263		-	Services, audits conducted or completed during the
264		-	preceding 12-month period regarding compliance with
265		-	parity in mental, emotional, nervous, and substance
266		-	use disorder or condition benefits under State and
267		-	federal laws and summarize the results of such market
268		-	conduct examinations and audits. This shall include:
269		-	(i) the number of market conduct examinations
270		-	and audits initiated and completed;
271		-	(ii) the benefit classifications examined by
272		-	each market conduct examination and audit;
273		-	(iii) the subject matter of each market
274		-	conduct examination and audit, including
275		-	quantitative and nonquantitative treatment
276		-	limitations; and
277		-	(iv) a summary of the basis for the final
278		-	decision rendered in each market conduct
279		-	examination and audit.
280		-	Individually identifiable information shall be
281		-	excluded from the reports consistent with federal
282		-	privacy protections.
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284	139
285		-	(D) Detail any educational or corrective actions
286		-	the Departments have taken to ensure compliance with
287		-	the federal Paul Wellstone and Pete Domenici Mental
288		-	Health Parity and Addiction Equity Act of 2008, 42
289		-	U.S.C. 18031(j), this Section, and Sections 356z.23
290		-	and 370c of this Code.
291		-	(E) The report must be written in non-technical,
292		-	readily understandable language and shall be made
293		-	available to the public by, among such other means as
294		-	the Departments find appropriate, posting the report
295		-	on the Departments' websites.
296		-	(i) The Parity Advancement Fund is created as a special
297		-	fund in the State treasury. Moneys from fines and penalties
298		-	collected from insurers for violations of this Section shall
299		-	be deposited into the Fund. Moneys deposited into the Fund for
300		-	appropriation by the General Assembly to the Department shall
301		-	be used for the purpose of providing financial support of the
302		-	Consumer Education Campaign, parity compliance advocacy, and
303		-	other initiatives that support parity implementation and
304		-	enforcement on behalf of consumers.
305		-	(j) The Department of Insurance and the Department of
306		-	Healthcare and Family Services shall convene and provide
307		-	technical support to a workgroup of 11 members that shall be
308		-	comprised of 3 mental health parity experts recommended by an
309		-	organization advocating on behalf of mental health parity
310		-	appointed by the President of the Senate; 3 behavioral health
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	142	+	1 the hospital and medical benefits to which it
	143	+	2 otherwise would apply and to mental, emotional,
	144	+	3 nervous, or substance use disorder or condition
	145	+	4 benefits and not distinguish in the application of
	146	+	5 the limit between the hospital and medical
	147	+	6 benefits and mental, emotional, nervous, or
	148	+	7 substance use disorder or condition benefits; or
	149	+	8 (ii) not include any annual limit on mental,
	150	+	9 emotional, nervous, or substance use disorder or
	151	+	10 condition benefits that is less than the
	152	+	11 applicable annual limit.
	153	+	12 (2) In the case of a policy that is not described in
	154	+	13 paragraph (1) of subsection (c) of this Section and that
	155	+	14 includes no or different annual limits on different
	156	+	15 categories of hospital and medical benefits, the Director
	157	+	16 shall establish rules under which subparagraph (B) of
	158	+	17 paragraph (1) of subsection (c) of this Section is applied
	159	+	18 to such policy with respect to mental, emotional, nervous,
	160	+	19 or substance use disorder or condition benefits by
	161	+	20 substituting for the applicable annual limit an average
	162	+	21 annual limit that is computed taking into account the
	163	+	22 weighted average of the annual limits applicable to such
	164	+	23 categories.
	165	+	24 (d) With respect to mental, emotional, nervous, or
	166	+	25 substance use disorders or conditions, an insurer shall use
	167	+	26 policies and procedures for the election and placement of
311	168
312	169
313		-	providers recommended by an organization that represents
314		-	behavioral health providers appointed by the Speaker of the
315		-	House of Representatives; 2 representing Medicaid managed care
316		-	organizations recommended by an organization that represents
317		-	Medicaid managed care plans appointed by the Minority Leader
318		-	of the House of Representatives; 2 representing commercial
319		-	insurers recommended by an organization that represents
320		-	insurers appointed by the Minority Leader of the Senate; and a
321		-	representative of an organization that represents Medicaid
322		-	managed care plans appointed by the Governor.
323		-	The workgroup shall provide recommendations to the General
324		-	Assembly on health plan data reporting requirements that
325		-	separately break out data on mental, emotional, nervous, or
326		-	substance use disorder or condition benefits and data on other
327		-	medical benefits, including physical health and related health
328		-	services no later than December 31, 2019. The recommendations
329		-	to the General Assembly shall be filed with the Clerk of the
330		-	House of Representatives and the Secretary of the Senate in
331		-	electronic form only, in the manner that the Clerk and the
332		-	Secretary shall direct. This workgroup shall take into account
333		-	federal requirements and recommendations on mental health
334		-	parity reporting for the Medicaid program. This workgroup
335		-	shall also develop the format and provide any needed
336		-	definitions for reporting requirements in subsection (k). The
337		-	research and evaluation of the working group shall include,
338		-	but not be limited to:
339	170
340	171
341		-	(1) claims denials due to benefit limits, if
342		-	applicable;
343		-	(2) administrative denials for no prior authorization;
344		-	(3) denials due to not meeting medical necessity;
345		-	(4) denials that went to external review and whether
346		-	they were upheld or overturned for medical necessity;
347		-	(5) out-of-network claims;
348		-	(6) emergency care claims;
349		-	(7) network directory providers in the outpatient
350		-	benefits classification who filed no claims in the last 6
351		-	months, if applicable;
352		-	(8) the impact of existing and pertinent limitations
353		-	and restrictions related to approved services, licensed
354		-	providers, reimbursement levels, and reimbursement
355		-	methodologies within the Division of Mental Health, the
356		-	Division of Substance Use Prevention and Recovery
357		-	programs, the Department of Healthcare and Family
358		-	Services, and, to the extent possible, federal regulations
359		-	and law; and
360		-	(9) when reporting and publishing should begin.
361		-	Representatives from the Department of Healthcare and
362		-	Family Services, representatives from the Division of Mental
363		-	Health, and representatives from the Division of Substance Use
364		-	Prevention and Recovery shall provide technical advice to the
365		-	workgroup.
366		-	(j-5) The Department of Insurance shall collect the
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367	174
368	175
369		-	following information:
370		-	(1) The number of employment disability insurance
371		-	plans offered in this State, including, but not limited
372		-	to:
373		-	(A) individual short-term policies;
374		-	(B) individual long-term policies;
375		-	(C) group short-term policies; and
376		-	(D) group long-term policies.
377		-	(2) The number of policies referenced in paragraph (1)
378		-	of this subsection that limit mental health and substance
379		-	use disorder benefits.
380		-	(3) The average defined benefit period for the
381		-	policies referenced in paragraph (1) of this subsection,
382		-	both for those policies that limit and those policies that
383		-	have no limitation on mental health and substance use
384		-	disorder benefits.
385		-	(4) Whether the policies referenced in paragraph (1)
386		-	of this subsection are purchased on a voluntary or
387		-	non-voluntary basis.
388		-	(5) The identities of the individuals, entities, or a
389		-	combination of the 2, that assume the cost associated with
390		-	covering the policies referenced in paragraph (1) of this
391		-	subsection.
392		-	(6) The average defined benefit period for plans that
393		-	cover physical disability and mental health and substance
394		-	abuse without limitation, including, but not limited to:
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	178	+	1 mental, emotional, nervous, or substance use disorder or
	179	+	2 condition treatment drugs on their formulary that are no less
	180	+	3 favorable to the insured as those policies and procedures the
	181	+	4 insurer uses for the selection and placement of drugs for
	182	+	5 medical or surgical conditions and shall follow the expedited
	183	+	6 coverage determination requirements for substance abuse
	184	+	7 treatment drugs set forth in Section 45.2 of the Managed Care
	185	+	8 Reform and Patient Rights Act.
	186	+	9 (e) This Section shall be interpreted in a manner
	187	+	10 consistent with all applicable federal parity regulations
	188	+	11 including, but not limited to, the Paul Wellstone and Pete
	189	+	12 Domenici Mental Health Parity and Addiction Equity Act of
	190	+	13 2008, final regulations issued under the Paul Wellstone and
	191	+	14 Pete Domenici Mental Health Parity and Addiction Equity Act of
	192	+	15 2008 and final regulations applying the Paul Wellstone and
	193	+	16 Pete Domenici Mental Health Parity and Addiction Equity Act of
	194	+	17 2008 to Medicaid managed care organizations, the Children's
	195	+	18 Health Insurance Program, and alternative benefit plans.
	196	+	19 (f) The provisions of subsections (b) and (c) of this
	197	+	20 Section shall not be interpreted to allow the use of lifetime
	198	+	21 or annual limits otherwise prohibited by State or federal law.
	199	+	22 (g) As used in this Section:
	200	+	23 "Financial requirement" includes deductibles, copayments,
	201	+	24 coinsurance, and out-of-pocket maximums, but does not include
	202	+	25 an aggregate lifetime limit or an annual limit subject to
	203	+	26 subsections (b) and (c).
395	204
396	205
397		-	(A) individual short-term policies;
398		-	(B) individual long-term policies;
399		-	(C) group short-term policies; and
400		-	(D) group long-term policies.
401		-	(7) The average premiums for disability income
402		-	insurance issued in this State for:
403		-	(A) individual short-term policies that limit
404		-	mental health and substance use disorder benefits;
405		-	(B) individual long-term policies that limit
406		-	mental health and substance use disorder benefits;
407		-	(C) group short-term policies that limit mental
408		-	health and substance use disorder benefits;
409		-	(D) group long-term policies that limit mental
410		-	health and substance use disorder benefits;
411		-	(E) individual short-term policies that include
412		-	mental health and substance use disorder benefits
413		-	without limitation;
414		-	(F) individual long-term policies that include
415		-	mental health and substance use disorder benefits
416		-	without limitation;
417		-	(G) group short-term policies that include mental
418		-	health and substance use disorder benefits without
419		-	limitation; and
420		-	(H) group long-term policies that include mental
421		-	health and substance use disorder benefits without
422		-	limitation.
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424	207
425		-	The Department shall present its findings regarding
426		-	information collected under this subsection (j-5) to the
427		-	General Assembly no later than April 30, 2024. Information
428		-	regarding a specific insurance provider's contributions to the
429		-	Department's report shall be exempt from disclosure under
430		-	paragraph (t) of subsection (1) of Section 7 of the Freedom of
431		-	Information Act. The aggregated information gathered by the
432		-	Department shall not be exempt from disclosure under paragraph
433		-	(t) of subsection (1) of Section 7 of the Freedom of
434		-	Information Act.
435		-	(k) An insurer that amends, delivers, issues, or renews a
436		-	group or individual policy of accident and health insurance or
437		-	a qualified health plan offered through the health insurance
438		-	marketplace in this State providing coverage for hospital or
439		-	medical treatment and for the treatment of mental, emotional,
440		-	nervous, or substance use disorders or conditions shall submit
441		-	an annual report, the format and definitions for which will be
442		-	developed by the workgroup in subsection (j), to the
443		-	Department, or, with respect to medical assistance, the
444		-	Department of Healthcare and Family Services starting on or
445		-	before July 1, 2020 that contains the following information
446		-	separately for inpatient in-network benefits, inpatient
447		-	out-of-network benefits, outpatient in-network benefits,
448		-	outpatient out-of-network benefits, emergency care benefits,
449		-	and prescription drug benefits in the case of accident and
450		-	health insurance or qualified health plans, or inpatient,
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452	211
453		-	outpatient, emergency care, and prescription drug benefits in
454		-	the case of medical assistance:
455		-	(1) A summary of the plan's pharmacy management
456		-	processes for mental, emotional, nervous, or substance use
457		-	disorder or condition benefits compared to those for other
458		-	medical benefits.
459		-	(2) A summary of the internal processes of review for
460		-	experimental benefits and unproven technology for mental,
461		-	emotional, nervous, or substance use disorder or condition
462		-	benefits and those for other medical benefits.
463		-	(3) A summary of how the plan's policies and
464		-	procedures for utilization management for mental,
465		-	emotional, nervous, or substance use disorder or condition
466		-	benefits compare to those for other medical benefits.
467		-	(4) A description of the process used to develop or
468		-	select the medical necessity criteria for mental,
469		-	emotional, nervous, or substance use disorder or condition
470		-	benefits and the process used to develop or select the
471		-	medical necessity criteria for medical and surgical
472		-	benefits.
473		-	(5) Identification of all nonquantitative treatment
474		-	limitations that are applied to both mental, emotional,
475		-	nervous, or substance use disorder or condition benefits
476		-	and medical and surgical benefits within each
477		-	classification of benefits.
478		-	(6) The results of an analysis that demonstrates that
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	214	+	1 "Mental, emotional, nervous, or substance use disorder or
	215	+	2 condition" means a condition or disorder that involves a
	216	+	3 mental health condition or substance use disorder that falls
	217	+	4 under any of the diagnostic categories listed in the mental
	218	+	5 and behavioral disorders chapter of the current edition of the
	219	+	6 International Classification of Disease or that is listed in
	220	+	7 the most recent version of the Diagnostic and Statistical
	221	+	8 Manual of Mental Disorders.
	222	+	9 "Treatment limitation" includes limits on benefits based
	223	+	10 on the frequency of treatment, number of visits, days of
	224	+	11 coverage, days in a waiting period, or other similar limits on
	225	+	12 the scope or duration of treatment. "Treatment limitation"
	226	+	13 includes both quantitative treatment limitations, which are
	227	+	14 expressed numerically (such as 50 outpatient visits per year),
	228	+	15 and nonquantitative treatment limitations, which otherwise
	229	+	16 limit the scope or duration of treatment. A permanent
	230	+	17 exclusion of all benefits for a particular condition or
	231	+	18 disorder shall not be considered a treatment limitation.
	232	+	19 "Nonquantitative treatment" means those limitations as
	233	+	20 described under federal regulations (26 CFR 54.9812-1).
	234	+	21 "Nonquantitative treatment limitations" include, but are not
	235	+	22 limited to, those limitations described under federal
	236	+	23 regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR
	237	+	24 146.136.
	238	+	25 (h) The Department of Insurance shall implement the
	239	+	26 following education initiatives:
479	240
480	241
481		-	for the medical necessity criteria described in
482		-	subparagraph (A) and for each nonquantitative treatment
483		-	limitation identified in subparagraph (B), as written and
484		-	in operation, the processes, strategies, evidentiary
485		-	standards, or other factors used in applying the medical
486		-	necessity criteria and each nonquantitative treatment
487		-	limitation to mental, emotional, nervous, or substance use
488		-	disorder or condition benefits within each classification
489		-	of benefits are comparable to, and are applied no more
490		-	stringently than, the processes, strategies, evidentiary
491		-	standards, or other factors used in applying the medical
492		-	necessity criteria and each nonquantitative treatment
493		-	limitation to medical and surgical benefits within the
494		-	corresponding classification of benefits; at a minimum,
495		-	the results of the analysis shall:
496		-	(A) identify the factors used to determine that a
497		-	nonquantitative treatment limitation applies to a
498		-	benefit, including factors that were considered but
499		-	rejected;
500		-	(B) identify and define the specific evidentiary
501		-	standards used to define the factors and any other
502		-	evidence relied upon in designing each nonquantitative
503		-	treatment limitation;
504		-	(C) provide the comparative analyses, including
505		-	the results of the analyses, performed to determine
506		-	that the processes and strategies used to design each
507	242
508	243
509		-	nonquantitative treatment limitation, as written, for
510		-	mental, emotional, nervous, or substance use disorder
511		-	or condition benefits are comparable to, and are
512		-	applied no more stringently than, the processes and
513		-	strategies used to design each nonquantitative
514		-	treatment limitation, as written, for medical and
515		-	surgical benefits;
516		-	(D) provide the comparative analyses, including
517		-	the results of the analyses, performed to determine
518		-	that the processes and strategies used to apply each
519		-	nonquantitative treatment limitation, in operation,
520		-	for mental, emotional, nervous, or substance use
521		-	disorder or condition benefits are comparable to, and
522		-	applied no more stringently than, the processes or
523		-	strategies used to apply each nonquantitative
524		-	treatment limitation, in operation, for medical and
525		-	surgical benefits; and
526		-	(E) disclose the specific findings and conclusions
527		-	reached by the insurer that the results of the
528		-	analyses described in subparagraphs (C) and (D)
529		-	indicate that the insurer is in compliance with this
530		-	Section and the Mental Health Parity and Addiction
531		-	Equity Act of 2008 and its implementing regulations,
532		-	which includes 42 CFR Parts 438, 440, and 457 and 45
533		-	CFR 146.136 and any other related federal regulations
534		-	found in the Code of Federal Regulations.
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536	247
537		-	(7) Any other information necessary to clarify data
538		-	provided in accordance with this Section requested by the
539		-	Director, including information that may be proprietary or
540		-	have commercial value, under the requirements of Section
541		-	30 of the Viatical Settlements Act of 2009.
542		-	(l) An insurer that amends, delivers, issues, or renews a
543		-	group or individual policy of accident and health insurance or
544		-	a qualified health plan offered through the health insurance
545		-	marketplace in this State providing coverage for hospital or
546		-	medical treatment and for the treatment of mental, emotional,
547		-	nervous, or substance use disorders or conditions on or after
548		-	January 1, 2019 (the effective date of Public Act 100-1024)
549		-	shall, in advance of the plan year, make available to the
550		-	Department or, with respect to medical assistance, the
551		-	Department of Healthcare and Family Services and to all plan
552		-	participants and beneficiaries the information required in
553		-	subparagraphs (C) through (E) of paragraph (6) of subsection
554		-	(k). For plan participants and medical assistance
555		-	beneficiaries, the information required in subparagraphs (C)
556		-	through (E) of paragraph (6) of subsection (k) shall be made
557		-	available on a publicly-available website whose web address is
558		-	prominently displayed in plan and managed care organization
559		-	informational and marketing materials.
560		-	(m) In conjunction with its compliance examination program
561		-	conducted in accordance with the Illinois State Auditing Act,
562		-	the Auditor General shall undertake a review of compliance by
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	250	+	1 (1) By January 1, 2016, the Department shall develop a
	251	+	2 plan for a Consumer Education Campaign on parity. The
	252	+	3 Consumer Education Campaign shall focus its efforts
	253	+	4 throughout the State and include trainings in the
	254	+	5 northern, southern, and central regions of the State, as
	255	+	6 defined by the Department, as well as each of the 5 managed
	256	+	7 care regions of the State as identified by the Department
	257	+	8 of Healthcare and Family Services. Under this Consumer
	258	+	9 Education Campaign, the Department shall: (1) by January
	259	+	10 1, 2017, provide at least one live training in each region
	260	+	11 on parity for consumers and providers and one webinar
	261	+	12 training to be posted on the Department website and (2)
	262	+	13 establish a consumer hotline to assist consumers in
	263	+	14 navigating the parity process by March 1, 2017. By January
	264	+	15 1, 2018 the Department shall issue a report to the General
	265	+	16 Assembly on the success of the Consumer Education
	266	+	17 Campaign, which shall indicate whether additional training
	267	+	18 is necessary or would be recommended.
	268	+	19 (2) The Department, in coordination with the
	269	+	20 Department of Human Services and the Department of
	270	+	21 Healthcare and Family Services, shall convene a working
	271	+	22 group of health care insurance carriers, mental health
	272	+	23 advocacy groups, substance abuse patient advocacy groups,
	273	+	24 and mental health physician groups for the purpose of
	274	+	25 discussing issues related to the treatment and coverage of
	275	+	26 mental, emotional, nervous, or substance use disorders or
563	276
564	277
565		-	the Department and the Department of Healthcare and Family
566		-	Services with Section 370c and this Section. Any findings
567		-	resulting from the review conducted under this Section shall
568		-	be included in the applicable State agency's compliance
569		-	examination report. Each compliance examination report shall
570		-	be issued in accordance with Section 3-14 of the Illinois
571		-	State Auditing Act. A copy of each report shall also be
572		-	delivered to the head of the applicable State agency and
573		-	posted on the Auditor General's website.
574		-	(Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21;
575		-	102-813, eff. 5-13-22.)
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	286	+	1 conditions and compliance with parity obligations under
	287	+	2 State and federal law. Compliance shall be measured,
	288	+	3 tracked, and shared during the meetings of the working
	289	+	4 group. The working group shall meet once before January 1,
	290	+	5 2016 and shall meet semiannually thereafter. The
	291	+	6 Department shall issue an annual report to the General
	292	+	7 Assembly that includes a list of the health care insurance
	293	+	8 carriers, mental health advocacy groups, substance abuse
	294	+	9 patient advocacy groups, and mental health physician
	295	+	10 groups that participated in the working group meetings,
	296	+	11 details on the issues and topics covered, and any
	297	+	12 legislative recommendations developed by the working
	298	+	13 group.
	299	+	14 (3) Not later than January 1 of each year, the
	300	+	15 Department, in conjunction with the Department of
	301	+	16 Healthcare and Family Services, shall issue a joint report
	302	+	17 to the General Assembly and provide an educational
	303	+	18 presentation to the General Assembly. The report and
	304	+	19 presentation shall:
	305	+	20 (A) Cover the methodology the Departments use to
	306	+	21 check for compliance with the federal Paul Wellstone
	307	+	22 and Pete Domenici Mental Health Parity and Addiction
	308	+	23 Equity Act of 2008, 42 U.S.C. 18031(j), and any
	309	+	24 federal regulations or guidance relating to the
	310	+	25 compliance and oversight of the federal Paul Wellstone
	311	+	26 and Pete Domenici Mental Health Parity and Addiction
	312	+
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	322	+	1 Equity Act of 2008 and 42 U.S.C. 18031(j).
	323	+	2 (B) Cover the methodology the Departments use to
	324	+	3 check for compliance with this Section and Sections
	325	+	4 356z.23 and 370c of this Code.
	326	+	5 (C) Identify market conduct examinations or, in
	327	+	6 the case of the Department of Healthcare and Family
	328	+	7 Services, audits conducted or completed during the
	329	+	8 preceding 12-month period regarding compliance with
	330	+	9 parity in mental, emotional, nervous, and substance
	331	+	10 use disorder or condition benefits under State and
	332	+	11 federal laws and summarize the results of such market
	333	+	12 conduct examinations and audits. This shall include:
	334	+	13 (i) the number of market conduct examinations
	335	+	14 and audits initiated and completed;
	336	+	15 (ii) the benefit classifications examined by
	337	+	16 each market conduct examination and audit;
	338	+	17 (iii) the subject matter of each market
	339	+	18 conduct examination and audit, including
	340	+	19 quantitative and nonquantitative treatment
	341	+	20 limitations; and
	342	+	21 (iv) a summary of the basis for the final
	343	+	22 decision rendered in each market conduct
	344	+	23 examination and audit.
	345	+	24 Individually identifiable information shall be
	346	+	25 excluded from the reports consistent with federal
	347	+	26 privacy protections.
	348	+
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	358	+	1 (D) Detail any educational or corrective actions
	359	+	2 the Departments have taken to ensure compliance with
	360	+	3 the federal Paul Wellstone and Pete Domenici Mental
	361	+	4 Health Parity and Addiction Equity Act of 2008, 42
	362	+	5 U.S.C. 18031(j), this Section, and Sections 356z.23
	363	+	6 and 370c of this Code.
	364	+	7 (E) The report must be written in non-technical,
	365	+	8 readily understandable language and shall be made
	366	+	9 available to the public by, among such other means as
	367	+	10 the Departments find appropriate, posting the report
	368	+	11 on the Departments' websites.
	369	+	12 (i) The Parity Advancement Fund is created as a special
	370	+	13 fund in the State treasury. Moneys from fines and penalties
	371	+	14 collected from insurers for violations of this Section shall
	372	+	15 be deposited into the Fund. Moneys deposited into the Fund for
	373	+	16 appropriation by the General Assembly to the Department shall
	374	+	17 be used for the purpose of providing financial support of the
	375	+	18 Consumer Education Campaign, parity compliance advocacy, and
	376	+	19 other initiatives that support parity implementation and
	377	+	20 enforcement on behalf of consumers.
	378	+	21 (j) The Department of Insurance and the Department of
	379	+	22 Healthcare and Family Services shall convene and provide
	380	+	23 technical support to a workgroup of 11 members that shall be
	381	+	24 comprised of 3 mental health parity experts recommended by an
	382	+	25 organization advocating on behalf of mental health parity
	383	+	26 appointed by the President of the Senate; 3 behavioral health
	384	+
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	394	+	1 providers recommended by an organization that represents
	395	+	2 behavioral health providers appointed by the Speaker of the
	396	+	3 House of Representatives; 2 representing Medicaid managed care
	397	+	4 organizations recommended by an organization that represents
	398	+	5 Medicaid managed care plans appointed by the Minority Leader
	399	+	6 of the House of Representatives; 2 representing commercial
	400	+	7 insurers recommended by an organization that represents
	401	+	8 insurers appointed by the Minority Leader of the Senate; and a
	402	+	9 representative of an organization that represents Medicaid
	403	+	10 managed care plans appointed by the Governor.
	404	+	11 The workgroup shall provide recommendations to the General
	405	+	12 Assembly on health plan data reporting requirements that
	406	+	13 separately break out data on mental, emotional, nervous, or
	407	+	14 substance use disorder or condition benefits and data on other
	408	+	15 medical benefits, including physical health and related health
	409	+	16 services no later than December 31, 2019. The recommendations
	410	+	17 to the General Assembly shall be filed with the Clerk of the
	411	+	18 House of Representatives and the Secretary of the Senate in
	412	+	19 electronic form only, in the manner that the Clerk and the
	413	+	20 Secretary shall direct. This workgroup shall take into account
	414	+	21 federal requirements and recommendations on mental health
	415	+	22 parity reporting for the Medicaid program. This workgroup
	416	+	23 shall also develop the format and provide any needed
	417	+	24 definitions for reporting requirements in subsection (k). The
	418	+	25 research and evaluation of the working group shall include,
	419	+	26 but not be limited to:
	420	+
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	430	+	1 (1) claims denials due to benefit limits, if
	431	+	2 applicable;
	432	+	3 (2) administrative denials for no prior authorization;
	433	+	4 (3) denials due to not meeting medical necessity;
	434	+	5 (4) denials that went to external review and whether
	435	+	6 they were upheld or overturned for medical necessity;
	436	+	7 (5) out-of-network claims;
	437	+	8 (6) emergency care claims;
	438	+	9 (7) network directory providers in the outpatient
	439	+	10 benefits classification who filed no claims in the last 6
	440	+	11 months, if applicable;
	441	+	12 (8) the impact of existing and pertinent limitations
	442	+	13 and restrictions related to approved services, licensed
	443	+	14 providers, reimbursement levels, and reimbursement
	444	+	15 methodologies within the Division of Mental Health, the
	445	+	16 Division of Substance Use Prevention and Recovery
	446	+	17 programs, the Department of Healthcare and Family
	447	+	18 Services, and, to the extent possible, federal regulations
	448	+	19 and law; and
	449	+	20 (9) when reporting and publishing should begin.
	450	+	21 Representatives from the Department of Healthcare and
	451	+	22 Family Services, representatives from the Division of Mental
	452	+	23 Health, and representatives from the Division of Substance Use
	453	+	24 Prevention and Recovery shall provide technical advice to the
	454	+	25 workgroup.
	455	+	26 (j-5) The Department of Insurance shall collect the
	456	+
	457	+
	458	+
	459	+
	460	+
	461	+	SB1568 Enrolled - 13 - LRB103 28639 BMS 55020 b
	462	+
	463	+
	464	+	SB1568 Enrolled- 14 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 14 - LRB103 28639 BMS 55020 b
	465	+	SB1568 Enrolled - 14 - LRB103 28639 BMS 55020 b
	466	+	1 following information:
	467	+	2 (1) The number of employment disability insurance
	468	+	3 plans offered in this State, including, but not limited
	469	+	4 to:
	470	+	5 (A) individual short-term policies;
	471	+	6 (B) individual long-term policies;
	472	+	7 (C) group short-term policies; and
	473	+	8 (D) group long-term policies.
	474	+	9 (2) The number of policies referenced in paragraph (1)
	475	+	10 of this subsection that limit mental health and substance
	476	+	11 use disorder benefits.
	477	+	12 (3) The average defined benefit period for the
	478	+	13 policies referenced in paragraph (1) of this subsection,
	479	+	14 both for those policies that limit and those policies that
	480	+	15 have no limitation on mental health and substance use
	481	+	16 disorder benefits.
	482	+	17 (4) Whether the policies referenced in paragraph (1)
	483	+	18 of this subsection are purchased on a voluntary or
	484	+	19 non-voluntary basis.
	485	+	20 (5) The identities of the individuals, entities, or a
	486	+	21 combination of the 2, that assume the cost associated with
	487	+	22 covering the policies referenced in paragraph (1) of this
	488	+	23 subsection.
	489	+	24 (6) The average defined benefit period for plans that
	490	+	25 cover physical disability and mental health and substance
	491	+	26 abuse without limitation, including, but not limited to:
	492	+
	493	+
	494	+
	495	+
	496	+
	497	+	SB1568 Enrolled - 14 - LRB103 28639 BMS 55020 b
	498	+
	499	+
	500	+	SB1568 Enrolled- 15 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 15 - LRB103 28639 BMS 55020 b
	501	+	SB1568 Enrolled - 15 - LRB103 28639 BMS 55020 b
	502	+	1 (A) individual short-term policies;
	503	+	2 (B) individual long-term policies;
	504	+	3 (C) group short-term policies; and
	505	+	4 (D) group long-term policies.
	506	+	5 (7) The average premiums for disability income
	507	+	6 insurance issued in this State for:
	508	+	7 (A) individual short-term policies that limit
	509	+	8 mental health and substance use disorder benefits;
	510	+	9 (B) individual long-term policies that limit
	511	+	10 mental health and substance use disorder benefits;
	512	+	11 (C) group short-term policies that limit mental
	513	+	12 health and substance use disorder benefits;
	514	+	13 (D) group long-term policies that limit mental
	515	+	14 health and substance use disorder benefits;
	516	+	15 (E) individual short-term policies that include
	517	+	16 mental health and substance use disorder benefits
	518	+	17 without limitation;
	519	+	18 (F) individual long-term policies that include
	520	+	19 mental health and substance use disorder benefits
	521	+	20 without limitation;
	522	+	21 (G) group short-term policies that include mental
	523	+	22 health and substance use disorder benefits without
	524	+	23 limitation; and
	525	+	24 (H) group long-term policies that include mental
	526	+	25 health and substance use disorder benefits without
	527	+	26 limitation.
	528	+
	529	+
	530	+
	531	+
	532	+
	533	+	SB1568 Enrolled - 15 - LRB103 28639 BMS 55020 b
	534	+
	535	+
	536	+	SB1568 Enrolled- 16 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 16 - LRB103 28639 BMS 55020 b
	537	+	SB1568 Enrolled - 16 - LRB103 28639 BMS 55020 b
	538	+	1 The Department shall present its findings regarding
	539	+	2 information collected under this subsection (j-5) to the
	540	+	3 General Assembly no later than April 30, 2024. Information
	541	+	4 regarding a specific insurance provider's contributions to the
	542	+	5 Department's report shall be exempt from disclosure under
	543	+	6 paragraph (t) of subsection (1) of Section 7 of the Freedom of
	544	+	7 Information Act. The aggregated information gathered by the
	545	+	8 Department shall not be exempt from disclosure under paragraph
	546	+	9 (t) of subsection (1) of Section 7 of the Freedom of
	547	+	10 Information Act.
	548	+	11 (k) An insurer that amends, delivers, issues, or renews a
	549	+	12 group or individual policy of accident and health insurance or
	550	+	13 a qualified health plan offered through the health insurance
	551	+	14 marketplace in this State providing coverage for hospital or
	552	+	15 medical treatment and for the treatment of mental, emotional,
	553	+	16 nervous, or substance use disorders or conditions shall submit
	554	+	17 an annual report, the format and definitions for which will be
	555	+	18 developed by the workgroup in subsection (j), to the
	556	+	19 Department, or, with respect to medical assistance, the
	557	+	20 Department of Healthcare and Family Services starting on or
	558	+	21 before July 1, 2020 that contains the following information
	559	+	22 separately for inpatient in-network benefits, inpatient
	560	+	23 out-of-network benefits, outpatient in-network benefits,
	561	+	24 outpatient out-of-network benefits, emergency care benefits,
	562	+	25 and prescription drug benefits in the case of accident and
	563	+	26 health insurance or qualified health plans, or inpatient,
	564	+
	565	+
	566	+
	567	+
	568	+
	569	+	SB1568 Enrolled - 16 - LRB103 28639 BMS 55020 b
	570	+
	571	+
	572	+	SB1568 Enrolled- 17 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 17 - LRB103 28639 BMS 55020 b
	573	+	SB1568 Enrolled - 17 - LRB103 28639 BMS 55020 b
	574	+	1 outpatient, emergency care, and prescription drug benefits in
	575	+	2 the case of medical assistance:
	576	+	3 (1) A summary of the plan's pharmacy management
	577	+	4 processes for mental, emotional, nervous, or substance use
	578	+	5 disorder or condition benefits compared to those for other
	579	+	6 medical benefits.
	580	+	7 (2) A summary of the internal processes of review for
	581	+	8 experimental benefits and unproven technology for mental,
	582	+	9 emotional, nervous, or substance use disorder or condition
	583	+	10 benefits and those for other medical benefits.
	584	+	11 (3) A summary of how the plan's policies and
	585	+	12 procedures for utilization management for mental,
	586	+	13 emotional, nervous, or substance use disorder or condition
	587	+	14 benefits compare to those for other medical benefits.
	588	+	15 (4) A description of the process used to develop or
	589	+	16 select the medical necessity criteria for mental,
	590	+	17 emotional, nervous, or substance use disorder or condition
	591	+	18 benefits and the process used to develop or select the
	592	+	19 medical necessity criteria for medical and surgical
	593	+	20 benefits.
	594	+	21 (5) Identification of all nonquantitative treatment
	595	+	22 limitations that are applied to both mental, emotional,
	596	+	23 nervous, or substance use disorder or condition benefits
	597	+	24 and medical and surgical benefits within each
	598	+	25 classification of benefits.
	599	+	26 (6) The results of an analysis that demonstrates that
	600	+
	601	+
	602	+
	603	+
	604	+
	605	+	SB1568 Enrolled - 17 - LRB103 28639 BMS 55020 b
	606	+
	607	+
	608	+	SB1568 Enrolled- 18 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 18 - LRB103 28639 BMS 55020 b
	609	+	SB1568 Enrolled - 18 - LRB103 28639 BMS 55020 b
	610	+	1 for the medical necessity criteria described in
	611	+	2 subparagraph (A) and for each nonquantitative treatment
	612	+	3 limitation identified in subparagraph (B), as written and
	613	+	4 in operation, the processes, strategies, evidentiary
	614	+	5 standards, or other factors used in applying the medical
	615	+	6 necessity criteria and each nonquantitative treatment
	616	+	7 limitation to mental, emotional, nervous, or substance use
	617	+	8 disorder or condition benefits within each classification
	618	+	9 of benefits are comparable to, and are applied no more
	619	+	10 stringently than, the processes, strategies, evidentiary
	620	+	11 standards, or other factors used in applying the medical
	621	+	12 necessity criteria and each nonquantitative treatment
	622	+	13 limitation to medical and surgical benefits within the
	623	+	14 corresponding classification of benefits; at a minimum,
	624	+	15 the results of the analysis shall:
	625	+	16 (A) identify the factors used to determine that a
	626	+	17 nonquantitative treatment limitation applies to a
	627	+	18 benefit, including factors that were considered but
	628	+	19 rejected;
	629	+	20 (B) identify and define the specific evidentiary
	630	+	21 standards used to define the factors and any other
	631	+	22 evidence relied upon in designing each nonquantitative
	632	+	23 treatment limitation;
	633	+	24 (C) provide the comparative analyses, including
	634	+	25 the results of the analyses, performed to determine
	635	+	26 that the processes and strategies used to design each
	636	+
	637	+
	638	+
	639	+
	640	+
	641	+	SB1568 Enrolled - 18 - LRB103 28639 BMS 55020 b
	642	+
	643	+
	644	+	SB1568 Enrolled- 19 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 19 - LRB103 28639 BMS 55020 b
	645	+	SB1568 Enrolled - 19 - LRB103 28639 BMS 55020 b
	646	+	1 nonquantitative treatment limitation, as written, for
	647	+	2 mental, emotional, nervous, or substance use disorder
	648	+	3 or condition benefits are comparable to, and are
	649	+	4 applied no more stringently than, the processes and
	650	+	5 strategies used to design each nonquantitative
	651	+	6 treatment limitation, as written, for medical and
	652	+	7 surgical benefits;
	653	+	8 (D) provide the comparative analyses, including
	654	+	9 the results of the analyses, performed to determine
	655	+	10 that the processes and strategies used to apply each
	656	+	11 nonquantitative treatment limitation, in operation,
	657	+	12 for mental, emotional, nervous, or substance use
	658	+	13 disorder or condition benefits are comparable to, and
	659	+	14 applied no more stringently than, the processes or
	660	+	15 strategies used to apply each nonquantitative
	661	+	16 treatment limitation, in operation, for medical and
	662	+	17 surgical benefits; and
	663	+	18 (E) disclose the specific findings and conclusions
	664	+	19 reached by the insurer that the results of the
	665	+	20 analyses described in subparagraphs (C) and (D)
	666	+	21 indicate that the insurer is in compliance with this
	667	+	22 Section and the Mental Health Parity and Addiction
	668	+	23 Equity Act of 2008 and its implementing regulations,
	669	+	24 which includes 42 CFR Parts 438, 440, and 457 and 45
	670	+	25 CFR 146.136 and any other related federal regulations
	671	+	26 found in the Code of Federal Regulations.
	672	+
	673	+
	674	+
	675	+
	676	+
	677	+	SB1568 Enrolled - 19 - LRB103 28639 BMS 55020 b
	678	+
	679	+
	680	+	SB1568 Enrolled- 20 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 20 - LRB103 28639 BMS 55020 b
	681	+	SB1568 Enrolled - 20 - LRB103 28639 BMS 55020 b
	682	+	1 (7) Any other information necessary to clarify data
	683	+	2 provided in accordance with this Section requested by the
	684	+	3 Director, including information that may be proprietary or
	685	+	4 have commercial value, under the requirements of Section
	686	+	5 30 of the Viatical Settlements Act of 2009.
	687	+	6 (l) An insurer that amends, delivers, issues, or renews a
	688	+	7 group or individual policy of accident and health insurance or
	689	+	8 a qualified health plan offered through the health insurance
	690	+	9 marketplace in this State providing coverage for hospital or
	691	+	10 medical treatment and for the treatment of mental, emotional,
	692	+	11 nervous, or substance use disorders or conditions on or after
	693	+	12 January 1, 2019 (the effective date of Public Act 100-1024)
	694	+	13 shall, in advance of the plan year, make available to the
	695	+	14 Department or, with respect to medical assistance, the
	696	+	15 Department of Healthcare and Family Services and to all plan
	697	+	16 participants and beneficiaries the information required in
	698	+	17 subparagraphs (C) through (E) of paragraph (6) of subsection
	699	+	18 (k). For plan participants and medical assistance
	700	+	19 beneficiaries, the information required in subparagraphs (C)
	701	+	20 through (E) of paragraph (6) of subsection (k) shall be made
	702	+	21 available on a publicly-available website whose web address is
	703	+	22 prominently displayed in plan and managed care organization
	704	+	23 informational and marketing materials.
	705	+	24 (m) In conjunction with its compliance examination program
	706	+	25 conducted in accordance with the Illinois State Auditing Act,
	707	+	26 the Auditor General shall undertake a review of compliance by
	708	+
	709	+
	710	+
	711	+
	712	+
	713	+	SB1568 Enrolled - 20 - LRB103 28639 BMS 55020 b
	714	+
	715	+
	716	+	SB1568 Enrolled- 21 -LRB103 28639 BMS 55020 b SB1568 Enrolled - 21 - LRB103 28639 BMS 55020 b
	717	+	SB1568 Enrolled - 21 - LRB103 28639 BMS 55020 b
	718	+	1 the Department and the Department of Healthcare and Family
	719	+	2 Services with Section 370c and this Section. Any findings
	720	+	3 resulting from the review conducted under this Section shall
	721	+	4 be included in the applicable State agency's compliance
	722	+	5 examination report. Each compliance examination report shall
	723	+	6 be issued in accordance with Section 3-14 of the Illinois
	724	+	7 State Auditing Act. A copy of each report shall also be
	725	+	8 delivered to the head of the applicable State agency and
	726	+	9 posted on the Auditor General's website.
	727	+	10 (Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21;
	728	+	11 102-813, eff. 5-13-22.)
	729	+
	730	+
	731	+
	732	+
	733	+
	734	+	SB1568 Enrolled - 21 - LRB103 28639 BMS 55020 b