Chicago City Wire

Lindsey LaPointe introduced HB1085 in the Illinois House on Jan. 9, 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 revises the Counties Code, Illinois Municipal Code, School Code, and Illinois Insurance Code to mandate that self-insured counties, municipalities, and educational institutions include specific health benefits, such as post-mastectomy care and mental health services for employees. The bill also introduces a new section in the Illinois Insurance Code ensuring parity in reimbursement for mental health and substance use disorder treatments, specifying that reimbursement rates must be at least 141% of Medicare's rate for similar services starting January 1, 2027. It ensures that group or individual health policies include coverage for services provided by behavioral health trainees. The bill outlines timelines for insurers to complete contracting processes with mental health providers and mandates equal coverage for multiple services on the same day. It also requires the Illinois Department of Insurance to oversee compliance and impose penalties for violations, with rules necessary for implementation to be adopted by May 1, 2026. The bill stipulates a series of reports on impact and network adequacy due to the General Assembly by specific future dates. The act becomes effective upon being enacted into law.

LaPointe graduated from Grinnell College in 2004 with a BA.

Lindsey LaPointe is currently serving in the Illinois State House, representing the state's 19th House District. She replaced previous state representative Robert Martwick in 2019.

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
HB1085	01/09/2025	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.