104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB2353 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED: 215 ILCS 5/370c.1 Amends the Illinois Insurance Code. In a provision concerning coverage for the treatment of mental, emotional, nervous, or substance use disorders or conditions, requires certain insurers to ensure, prior to policy issuance, that there is no limit on the number of visits per week for outpatient mental health treatment. LRB104 10556 BAB 20632 b A BILL FOR 104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB2353 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED: 215 ILCS 5/370c.1 215 ILCS 5/370c.1 Amends the Illinois Insurance Code. In a provision concerning coverage for the treatment of mental, emotional, nervous, or substance use disorders or conditions, requires certain insurers to ensure, prior to policy issuance, that there is no limit on the number of visits per week for outpatient mental health treatment. LRB104 10556 BAB 20632 b LRB104 10556 BAB 20632 b A BILL FOR
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB2353 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED:
215 ILCS 5/370c.1 215 ILCS 5/370c.1
215 ILCS 5/370c.1
Amends the Illinois Insurance Code. In a provision concerning coverage for the treatment of mental, emotional, nervous, or substance use disorders or conditions, requires certain insurers to ensure, prior to policy issuance, that there is no limit on the number of visits per week for outpatient mental health treatment.
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A BILL FOR
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SB2353 LRB104 10556 BAB 20632 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Insurance Code is amended by
5 changing Section 370c.1 as follows:
6 (215 ILCS 5/370c.1)
7 Sec. 370c.1. Mental, emotional, nervous, or substance use
8 disorder or condition parity.
9 (a) On and after July 23, 2021 (the effective date of
10 Public Act 102-135), every insurer that amends, delivers,
11 issues, or renews a group or individual policy of accident and
12 health insurance or a qualified health plan offered through
13 the Health Insurance Marketplace in this State providing
14 coverage for hospital or medical treatment and for the
15 treatment of mental, emotional, nervous, or substance use
16 disorders or conditions shall ensure prior to policy issuance
17 that:
18 (1) the financial requirements applicable to such
19 mental, emotional, nervous, or substance use disorder or
20 condition benefits are no more restrictive than the
21 predominant financial requirements applied to
22 substantially all hospital and medical benefits covered by
23 the policy and that there are no separate cost-sharing
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB2353 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED:
215 ILCS 5/370c.1 215 ILCS 5/370c.1
215 ILCS 5/370c.1
Amends the Illinois Insurance Code. In a provision concerning coverage for the treatment of mental, emotional, nervous, or substance use disorders or conditions, requires certain insurers to ensure, prior to policy issuance, that there is no limit on the number of visits per week for outpatient mental health treatment.
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A BILL FOR
215 ILCS 5/370c.1
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1 requirements that are applicable only with respect to
2 mental, emotional, nervous, or substance use disorder or
3 condition benefits; and
4 (2) the treatment limitations applicable to such
5 mental, emotional, nervous, or substance use disorder or
6 condition benefits are no more restrictive than the
7 predominant treatment limitations applied to substantially
8 all hospital and medical benefits covered by the policy
9 and that there are no separate treatment limitations that
10 are applicable only with respect to mental, emotional,
11 nervous, or substance use disorder or condition benefits;
12 and .
13 (3) there is no limit on the number of visits per week
14 for outpatient mental health treatment.
15 (b) The following provisions shall apply concerning
16 aggregate lifetime limits:
17 (1) In the case of a group or individual policy of
18 accident and health insurance or a qualified health plan
19 offered through the Health Insurance Marketplace amended,
20 delivered, issued, or renewed in this State on or after
21 September 9, 2015 (the effective date of Public Act
22 99-480) that provides coverage for hospital or medical
23 treatment and for the treatment of mental, emotional,
24 nervous, or substance use disorders or conditions the
25 following provisions shall apply:
26 (A) if the policy does not include an aggregate
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1 lifetime limit on substantially all hospital and
2 medical benefits, then the policy may not impose any
3 aggregate lifetime limit on mental, emotional,
4 nervous, or substance use disorder or condition
5 benefits; or
6 (B) if the policy includes an aggregate lifetime
7 limit on substantially all hospital and medical
8 benefits (in this subsection referred to as the
9 "applicable lifetime limit"), then the policy shall
10 either:
11 (i) apply the applicable lifetime limit both
12 to the hospital and medical benefits to which it
13 otherwise would apply and to mental, emotional,
14 nervous, or substance use disorder or condition
15 benefits and not distinguish in the application of
16 the limit between the hospital and medical
17 benefits and mental, emotional, nervous, or
18 substance use disorder or condition benefits; or
19 (ii) not include any aggregate lifetime limit
20 on mental, emotional, nervous, or substance use
21 disorder or condition benefits that is less than
22 the applicable lifetime limit.
23 (2) In the case of a policy that is not described in
24 paragraph (1) of subsection (b) of this Section and that
25 includes no or different aggregate lifetime limits on
26 different categories of hospital and medical benefits, the
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1 Director shall establish rules under which subparagraph
2 (B) of paragraph (1) of subsection (b) of this Section is
3 applied to such policy with respect to mental, emotional,
4 nervous, or substance use disorder or condition benefits
5 by substituting for the applicable lifetime limit an
6 average aggregate lifetime limit that is computed taking
7 into account the weighted average of the aggregate
8 lifetime limits applicable to such categories.
9 (c) The following provisions shall apply concerning annual
10 limits:
11 (1) In the case of a group or individual policy of
12 accident and health insurance or a qualified health plan
13 offered through the Health Insurance Marketplace amended,
14 delivered, issued, or renewed in this State on or after
15 September 9, 2015 (the effective date of Public Act
16 99-480) that provides coverage for hospital or medical
17 treatment and for the treatment of mental, emotional,
18 nervous, or substance use disorders or conditions the
19 following provisions shall apply:
20 (A) if the policy does not include an annual limit
21 on substantially all hospital and medical benefits,
22 then the policy may not impose any annual limits on
23 mental, emotional, nervous, or substance use disorder
24 or condition benefits; or
25 (B) if the policy includes an annual limit on
26 substantially all hospital and medical benefits (in
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1 this subsection referred to as the "applicable annual
2 limit"), then the policy shall either:
3 (i) apply the applicable annual limit both to
4 the hospital and medical benefits to which it
5 otherwise would apply and to mental, emotional,
6 nervous, or substance use disorder or condition
7 benefits and not distinguish in the application of
8 the limit between the hospital and medical
9 benefits and mental, emotional, nervous, or
10 substance use disorder or condition benefits; or
11 (ii) not include any annual limit on mental,
12 emotional, nervous, or substance use disorder or
13 condition benefits that is less than the
14 applicable annual limit.
15 (2) In the case of a policy that is not described in
16 paragraph (1) of subsection (c) of this Section and that
17 includes no or different annual limits on different
18 categories of hospital and medical benefits, the Director
19 shall establish rules under which subparagraph (B) of
20 paragraph (1) of subsection (c) of this Section is applied
21 to such policy with respect to mental, emotional, nervous,
22 or substance use disorder or condition benefits by
23 substituting for the applicable annual limit an average
24 annual limit that is computed taking into account the
25 weighted average of the annual limits applicable to such
26 categories.
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1 (d) With respect to mental, emotional, nervous, or
2 substance use disorders or conditions, an insurer shall use
3 policies and procedures for the election and placement of
4 mental, emotional, nervous, or substance use disorder or
5 condition treatment drugs on their formulary that are no less
6 favorable to the insured as those policies and procedures the
7 insurer uses for the selection and placement of drugs for
8 medical or surgical conditions and shall follow the expedited
9 coverage determination requirements for substance abuse
10 treatment drugs set forth in Section 45.2 of the Managed Care
11 Reform and Patient Rights Act.
12 (e) This Section shall be interpreted in a manner
13 consistent with all applicable federal parity regulations
14 including, but not limited to, the Paul Wellstone and Pete
15 Domenici Mental Health Parity and Addiction Equity Act of
16 2008, final regulations issued under the Paul Wellstone and
17 Pete Domenici Mental Health Parity and Addiction Equity Act of
18 2008 and final regulations applying the Paul Wellstone and
19 Pete Domenici Mental Health Parity and Addiction Equity Act of
20 2008 to Medicaid managed care organizations, the Children's
21 Health Insurance Program, and alternative benefit plans.
22 (f) The provisions of subsections (b) and (c) of this
23 Section shall not be interpreted to allow the use of lifetime
24 or annual limits otherwise prohibited by State or federal law.
25 (g) As used in this Section:
26 "Financial requirement" includes deductibles, copayments,
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1 coinsurance, and out-of-pocket maximums, but does not include
2 an aggregate lifetime limit or an annual limit subject to
3 subsections (b) and (c).
4 "Mental, emotional, nervous, or substance use disorder or
5 condition" means a condition or disorder that involves a
6 mental health condition or substance use disorder that falls
7 under any of the diagnostic categories listed in the mental
8 and behavioral disorders chapter of the current edition of the
9 International Classification of Disease or that is listed in
10 the most recent version of the Diagnostic and Statistical
11 Manual of Mental Disorders.
12 "Treatment limitation" includes limits on benefits based
13 on the frequency of treatment, number of visits, days of
14 coverage, days in a waiting period, or other similar limits on
15 the scope or duration of treatment. "Treatment limitation"
16 includes both quantitative treatment limitations, which are
17 expressed numerically (such as 50 outpatient visits per year),
18 and nonquantitative treatment limitations, which otherwise
19 limit the scope or duration of treatment. A permanent
20 exclusion of all benefits for a particular condition or
21 disorder shall not be considered a treatment limitation.
22 "Nonquantitative treatment" means those limitations as
23 described under federal regulations (26 CFR 54.9812-1).
24 "Nonquantitative treatment limitations" include, but are not
25 limited to, those limitations described under federal
26 regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR
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1 146.136.
2 (h) The Department of Insurance shall implement the
3 following education initiatives:
4 (1) By January 1, 2016, the Department shall develop a
5 plan for a Consumer Education Campaign on parity. The
6 Consumer Education Campaign shall focus its efforts
7 throughout the State and include trainings in the
8 northern, southern, and central regions of the State, as
9 defined by the Department, as well as each of the 5 managed
10 care regions of the State as identified by the Department
11 of Healthcare and Family Services. Under this Consumer
12 Education Campaign, the Department shall: (1) by January
13 1, 2017, provide at least one live training in each region
14 on parity for consumers and providers and one webinar
15 training to be posted on the Department website and (2)
16 establish a consumer hotline to assist consumers in
17 navigating the parity process by March 1, 2017. By January
18 1, 2018 the Department shall issue a report to the General
19 Assembly on the success of the Consumer Education
20 Campaign, which shall indicate whether additional training
21 is necessary or would be recommended.
22 (2) The Department, in coordination with the
23 Department of Human Services and the Department of
24 Healthcare and Family Services, shall convene a working
25 group of health care insurance carriers, mental health
26 advocacy groups, substance abuse patient advocacy groups,
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1 and mental health physician groups for the purpose of
2 discussing issues related to the treatment and coverage of
3 mental, emotional, nervous, or substance use disorders or
4 conditions and compliance with parity obligations under
5 State and federal law. Compliance shall be measured,
6 tracked, and shared during the meetings of the working
7 group. The working group shall meet once before January 1,
8 2016 and shall meet semiannually thereafter. The
9 Department shall issue an annual report to the General
10 Assembly that includes a list of the health care insurance
11 carriers, mental health advocacy groups, substance abuse
12 patient advocacy groups, and mental health physician
13 groups that participated in the working group meetings,
14 details on the issues and topics covered, and any
15 legislative recommendations developed by the working
16 group.
17 (3) Not later than January 1 of each year, the
18 Department, in conjunction with the Department of
19 Healthcare and Family Services, shall issue a joint report
20 to the General Assembly and provide an educational
21 presentation to the General Assembly. The report and
22 presentation shall:
23 (A) Cover the methodology the Departments use to
24 check for compliance with the federal Paul Wellstone
25 and Pete Domenici Mental Health Parity and Addiction
26 Equity Act of 2008, 42 U.S.C. 18031(j), and any
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1 federal regulations or guidance relating to the
2 compliance and oversight of the federal Paul Wellstone
3 and Pete Domenici Mental Health Parity and Addiction
4 Equity Act of 2008 and 42 U.S.C. 18031(j).
5 (B) Cover the methodology the Departments use to
6 check for compliance with this Section and Sections
7 356z.23 and 370c of this Code.
8 (C) Identify market conduct examinations or, in
9 the case of the Department of Healthcare and Family
10 Services, audits conducted or completed during the
11 preceding 12-month period regarding compliance with
12 parity in mental, emotional, nervous, and substance
13 use disorder or condition benefits under State and
14 federal laws and summarize the results of such market
15 conduct examinations and audits. This shall include:
16 (i) the number of market conduct examinations
17 and audits initiated and completed;
18 (ii) the benefit classifications examined by
19 each market conduct examination and audit;
20 (iii) the subject matter of each market
21 conduct examination and audit, including
22 quantitative and nonquantitative treatment
23 limitations; and
24 (iv) a summary of the basis for the final
25 decision rendered in each market conduct
26 examination and audit.
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1 Individually identifiable information shall be
2 excluded from the reports consistent with federal
3 privacy protections.
4 (D) Detail any educational or corrective actions
5 the Departments have taken to ensure compliance with
6 the federal Paul Wellstone and Pete Domenici Mental
7 Health Parity and Addiction Equity Act of 2008, 42
8 U.S.C. 18031(j), this Section, and Sections 356z.23
9 and 370c of this Code.
10 (E) The report must be written in non-technical,
11 readily understandable language and shall be made
12 available to the public by, among such other means as
13 the Departments find appropriate, posting the report
14 on the Departments' websites.
15 (i) The Parity Advancement Fund is created as a special
16 fund in the State treasury. Moneys from fines and penalties
17 collected from insurers for violations of this Section shall
18 be deposited into the Fund. Moneys deposited into the Fund for
19 appropriation by the General Assembly to the Department shall
20 be used for the purpose of providing financial support of the
21 Consumer Education Campaign, parity compliance advocacy, and
22 other initiatives that support parity implementation and
23 enforcement on behalf of consumers.
24 (j) (Blank).
25 (j-5) The Department of Insurance shall collect the
26 following information:
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1 (1) The number of employment disability insurance
2 plans offered in this State, including, but not limited
3 to:
4 (A) individual short-term policies;
5 (B) individual long-term policies;
6 (C) group short-term policies; and
7 (D) group long-term policies.
8 (2) The number of policies referenced in paragraph (1)
9 of this subsection that limit mental health and substance
10 use disorder benefits.
11 (3) The average defined benefit period for the
12 policies referenced in paragraph (1) of this subsection,
13 both for those policies that limit and those policies that
14 have no limitation on mental health and substance use
15 disorder benefits.
16 (4) Whether the policies referenced in paragraph (1)
17 of this subsection are purchased on a voluntary or
18 non-voluntary basis.
19 (5) The identities of the individuals, entities, or a
20 combination of the 2 that assume the cost associated with
21 covering the policies referenced in paragraph (1) of this
22 subsection.
23 (6) The average defined benefit period for plans that
24 cover physical disability and mental health and substance
25 abuse without limitation, including, but not limited to:
26 (A) individual short-term policies;
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1 (B) individual long-term policies;
2 (C) group short-term policies; and
3 (D) group long-term policies.
4 (7) The average premiums for disability income
5 insurance issued in this State for:
6 (A) individual short-term policies that limit
7 mental health and substance use disorder benefits;
8 (B) individual long-term policies that limit
9 mental health and substance use disorder benefits;
10 (C) group short-term policies that limit mental
11 health and substance use disorder benefits;
12 (D) group long-term policies that limit mental
13 health and substance use disorder benefits;
14 (E) individual short-term policies that include
15 mental health and substance use disorder benefits
16 without limitation;
17 (F) individual long-term policies that include
18 mental health and substance use disorder benefits
19 without limitation;
20 (G) group short-term policies that include mental
21 health and substance use disorder benefits without
22 limitation; and
23 (H) group long-term policies that include mental
24 health and substance use disorder benefits without
25 limitation.
26 The Department shall present its findings regarding
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1 information collected under this subsection (j-5) to the
2 General Assembly no later than April 30, 2024. Information
3 regarding a specific insurance provider's contributions to the
4 Department's report shall be exempt from disclosure under
5 paragraph (t) of subsection (1) of Section 7 of the Freedom of
6 Information Act. The aggregated information gathered by the
7 Department shall not be exempt from disclosure under paragraph
8 (t) of subsection (1) of Section 7 of the Freedom of
9 Information Act.
10 (k) An insurer that amends, delivers, issues, or renews a
11 group or individual policy of accident and health insurance or
12 a qualified health plan offered through the health insurance
13 marketplace in this State providing coverage for hospital or
14 medical treatment and for the treatment of mental, emotional,
15 nervous, or substance use disorders or conditions shall submit
16 an annual report, the format and definitions for which will be
17 determined by the Department and the Department of Healthcare
18 and Family Services and posted on their respective websites,
19 starting on September 1, 2023 and annually thereafter, that
20 contains the following information separately for inpatient
21 in-network benefits, inpatient out-of-network benefits,
22 outpatient in-network benefits, outpatient out-of-network
23 benefits, emergency care benefits, and prescription drug
24 benefits in the case of accident and health insurance or
25 qualified health plans, or inpatient, outpatient, emergency
26 care, and prescription drug benefits in the case of medical
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1 assistance:
2 (1) A summary of the plan's pharmacy management
3 processes for mental, emotional, nervous, or substance use
4 disorder or condition benefits compared to those for other
5 medical benefits.
6 (2) A summary of the internal processes of review for
7 experimental benefits and unproven technology for mental,
8 emotional, nervous, or substance use disorder or condition
9 benefits and those for other medical benefits.
10 (3) A summary of how the plan's policies and
11 procedures for utilization management for mental,
12 emotional, nervous, or substance use disorder or condition
13 benefits compare to those for other medical benefits.
14 (4) A description of the process used to develop or
15 select the medical necessity criteria for mental,
16 emotional, nervous, or substance use disorder or condition
17 benefits and the process used to develop or select the
18 medical necessity criteria for medical and surgical
19 benefits.
20 (5) Identification of all nonquantitative treatment
21 limitations that are applied to both mental, emotional,
22 nervous, or substance use disorder or condition benefits
23 and medical and surgical benefits within each
24 classification of benefits.
25 (6) The results of an analysis that demonstrates that
26 for the medical necessity criteria described in
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1 subparagraph (A) and for each nonquantitative treatment
2 limitation identified in subparagraph (B), as written and
3 in operation, the processes, strategies, evidentiary
4 standards, or other factors used in applying the medical
5 necessity criteria and each nonquantitative treatment
6 limitation to mental, emotional, nervous, or substance use
7 disorder or condition benefits within each classification
8 of benefits are comparable to, and are applied no more
9 stringently than, the processes, strategies, evidentiary
10 standards, or other factors used in applying the medical
11 necessity criteria and each nonquantitative treatment
12 limitation to medical and surgical benefits within the
13 corresponding classification of benefits; at a minimum,
14 the results of the analysis shall:
15 (A) identify the factors used to determine that a
16 nonquantitative treatment limitation applies to a
17 benefit, including factors that were considered but
18 rejected;
19 (B) identify and define the specific evidentiary
20 standards used to define the factors and any other
21 evidence relied upon in designing each nonquantitative
22 treatment limitation;
23 (C) provide the comparative analyses, including
24 the results of the analyses, performed to determine
25 that the processes and strategies used to design each
26 nonquantitative treatment limitation, as written, for
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1 mental, emotional, nervous, or substance use disorder
2 or condition benefits are comparable to, and are
3 applied no more stringently than, the processes and
4 strategies used to design each nonquantitative
5 treatment limitation, as written, for medical and
6 surgical benefits;
7 (D) provide the comparative analyses, including
8 the results of the analyses, performed to determine
9 that the processes and strategies used to apply each
10 nonquantitative treatment limitation, in operation,
11 for mental, emotional, nervous, or substance use
12 disorder or condition benefits are comparable to, and
13 applied no more stringently than, the processes or
14 strategies used to apply each nonquantitative
15 treatment limitation, in operation, for medical and
16 surgical benefits; and
17 (E) disclose the specific findings and conclusions
18 reached by the insurer that the results of the
19 analyses described in subparagraphs (C) and (D)
20 indicate that the insurer is in compliance with this
21 Section and the Mental Health Parity and Addiction
22 Equity Act of 2008 and its implementing regulations,
23 which includes 42 CFR Parts 438, 440, and 457 and 45
24 CFR 146.136 and any other related federal regulations
25 found in the Code of Federal Regulations.
26 (7) Any other information necessary to clarify data
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1 provided in accordance with this Section requested by the
2 Director, including information that may be proprietary or
3 have commercial value, under the requirements of Section
4 30 of the Viatical Settlements Act of 2009.
5 (l) An insurer that amends, delivers, issues, or renews a
6 group or individual policy of accident and health insurance or
7 a qualified health plan offered through the health insurance
8 marketplace in this State providing coverage for hospital or
9 medical treatment and for the treatment of mental, emotional,
10 nervous, or substance use disorders or conditions on or after
11 January 1, 2019 (the effective date of Public Act 100-1024)
12 shall, in advance of the plan year, make available to the
13 Department or, with respect to medical assistance, the
14 Department of Healthcare and Family Services and to all plan
15 participants and beneficiaries the information required in
16 subparagraphs (C) through (E) of paragraph (6) of subsection
17 (k). For plan participants and medical assistance
18 beneficiaries, the information required in subparagraphs (C)
19 through (E) of paragraph (6) of subsection (k) shall be made
20 available on a publicly available website whose web address is
21 prominently displayed in plan and managed care organization
22 informational and marketing materials.
23 (m) In conjunction with its compliance examination program
24 conducted in accordance with the Illinois State Auditing Act,
25 the Auditor General shall undertake a review of compliance by
26 the Department and the Department of Healthcare and Family
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