11/13/2024
Friends! If you LOVE YOUR THERAPIST and live in IL, please contact your state senator and rep and let them know that mental health is as important as physical health and that they should support this bill!
Re: INS CD-BEHAVIORIAL HEALTH – Pending Legislation that amends the Illinois Insurance Code (“Strengthening Mental Health and Substance Use Parity Act” - HB4475) which also addresses reimbursement rates.
Dear All,
This Bill is very important concerning the providing of care and reimbursement rates. I have been in contact with my State Senator’s Office. I am sharing with you the following information given to me by his office. Please read and see the highlighted text.
Support Bill HB4475 by calling and emailing your State Senator and House Representative (links are to online directories).
You may find that some of your Legislators are listed on Bill HB4475 already as supporters. Call and write them anyway. For those Senators and Reps who are not on the bill, educate them about it, let them know why it matters so much to you and ask them for support. The volume of calls and emails matter. The offices tally each phone and email encounter and bring the total to each meeting that they have about this very important bill.
Below you will see what I received from my State Senator’s office about Bill HB4475.
My Senator’s office told me that the next meeting on this bill is November 12-14, November 19-21 and other dates in January. If you are interested, please contact your State Senator and House Representative ASAP. Use the directories provided above.
Here is Executive Summary and Bill Analysis for HB4475 sent by my State Senator’s office:
HB 4475 creates the Strengthening Mental Health and Substance Use Parity Act. The bill provides that accident and health insurance policies and managed care plans must cover all medically necessary out-of-network mental health and substance use benefits as if they were in-network, for cost-sharing purposes.
HB 4475 also creates standards for reimbursement, credentialing of providers, and responsibility for compliance.
Specifically, HB 4475 sets a minimum reimbursement rate for mental health and substance use services at 141% of the Medicare rate, and 144% for non-Medicare covered services. The bill requires certain standards to ensure that any plan or managed care plan, including those run by third-party administrators, provides timeline and transparent credentialing for health care providers.
Finally, the bill imposes a civil penalty of $1,000 for every violation of the Act, and authorizes the Department of Insurance to enforce the Act.
And here is a more in-depth summary also sent to me by my State Senator’s office:
(1) Purpose: HB 4475 is an initiative of Thresholds in conjunction with Healthy Minds Healthy Lives Coalition. Illinois parity laws require insurers to cover mental health and substance use treatments the same as medical and surgical treatments. Advocates feel that commercial insurers are not abiding by Illinois' parity laws and believe that HB 4475 will help address this issue and improve access to mental health and substance use care. However, rather than amending the current parity law, Thresholds seeks to create a new Act to strengthen the Illinois parity laws already on the books.
(2) Current Law: The Mental Health Parity and Addiction Equity Act (MHPAEA) is federal law that encompasses provider payment rates and network adequacy. MHPAEA rules explicitly state that disparate results, like the ones found in the Milliman study (see below), are not in and of themselves definitive evidence of noncompliance of parity laws.
Proponents: Thresholds; Illinois Psychological Association; Illinois Association for Behavioral Health; Community Mental Health & Substance Use Providers
Opponents: ILHIC; AHIP; BCBS
Neutrals: None at this time
(3) Milliman Study: The Milliman Study report was conducted in 2019 and commissioned by the Mental Health Treatment and Research Institute, a subsidiary of the Bowman Family Foundation, a private foundation that qualifies as a 501(c)(3). The study focused on using third party administrative claims data to assess non-quantitative treatment limitations associated with behavioral health services. The study found that disparities exist in both network use and at the provider reimbursement level when comparing behavioral healthcare to medical or surgical services. Further, the report found that 26% of psychiatrists, and 21% of therapists are not in-network due to insurer practices. The report also states that, in Illinois, 18% of patients are forced to go out-of-network for behavioral health care compared to 2.8% for other health care needs. It goes on to say that behavioral health providers are reimbursed "nearly 20% less than other healthcare providers when comparing rates to Medicare: behavioral health providers are reimbursed 97% of Medicare, other medical providers at 116% of Medicare."
Again, please support Bill HB4475 by calling and emailing your State Senator and House Representative.
