Kane County Reporter

Karina Villa introduced SB0055 in the Illinois Senate on Jan. 13, 2025, during the general assembly session 104, according to the Illinois General Assembly.

According to the Illinois General Assembly site, the legislature summarized the bill's official text as follows: "Amends the Illinois Insurance Code. Establishes reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2027 or for any contracted third party administering the behavioral health benefits for the insurer. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 or any contracted third party administering the behavioral health benefits for the insurer to cover certain medically necessary mental health and substance use disorder treatment services. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 for each violation. Excludes certain health care plans serving Medicaid populations who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Requires the Department to review the impact of the proposed mental health and substance abuse mandate on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Permits the Department to examine out-of-network utilization and out-of-pocket costs for insureds for mental health and substance use treatment and services for all plans to compare with in-network utilization. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under those provisions. Effective immediately."

The following is our breakdown, based on the actual bill text, and may include interpretation to clarify its provisions.

In essence, this bill amends the Illinois Insurance Code to establish reimbursement rates for mental health and substance use disorder treatment services for insurance policies and managed care plans effective from Jan. 1, 2027. It mandates coverage for medically necessary mental health and substance use disorder services effective Jan. 1, 2026. The bill sets civil penalties for insurers that violate parity provisions at $1,000 per violation and excludes certain Medicaid plans from these parity provisions. The Department of Insurance is tasked with reviewing the impact on network adequacy and can examine out-of-network and in-network utilization and costs. It requires insurers to process participating provider applications within 60 days and mandates coverage for services provided by behavioral health trainees. This bill takes effect immediately upon becoming law.

Karina Villa is currently serving in the Illinois State Senate, representing the state's 25th Senate District. She replaced previous state senator Jim Oberweis in 2021.

Bills in Illinois follow a multi-step legislative process, beginning with introduction in either the House or Senate, followed by committee review, floor debates, and votes in both chambers before reaching the governor for approval or veto. The General Assembly operates on a biennial schedule, and while typically thousands of bills are introduced each session, only a fraction successfully pass through the process to become law.

You can read more about bills and other measures here.

Bill Number	Date Introduced	Short Description
SB0055	01/13/2025	Amends the Illinois Insurance Code. Establishes reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2027 or for any contracted third party administering the behavioral health benefits for the insurer. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 or any contracted third party administering the behavioral health benefits for the insurer to cover certain medically necessary mental health and substance use disorder treatment services. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 for each violation. Excludes certain health care plans serving Medicaid populations who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Requires the Department to review the impact of the proposed mental health and substance abuse mandate on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Permits the Department to examine out-of-network utilization and out-of-pocket costs for insureds for mental health and substance use treatment and services for all plans to compare with in-network utilization. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under those provisions. Effective immediately.