Healthcare (Mental Health)

Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs for FDA-approved prescription drugs that treat mental illness, requires the Department of Healthcare and Family Services and managed care organizations to report quarterly on compliance with the specified prohibitions beginning with dates of service on and after July 1, 2025. Requires the Department to post on its website a report on fee-for-service prescriptions and the reports from each managed care organization. Sets forth the information that must be contained in the quarterly reports, including, but not limited to: (i) the number of denied prescriptions and estimated net cost to the State for those covered prescriptions summarized by each of the allowed categories specified in the Code; (ii) the number of denied prescriptions and estimated net cost to the State for those prescriptions summarized by each of the non-allowed categories specified in the Code; and (iii) the number of denied prescriptions and estimated gross cost to the State for those prescriptions summarized by any other reason not specified in the Code. Requires the Department to sanction those managed care organizations that do not file the required reports. Effective immediately.

Amends the Illinois Insurance Code. Provides that an individual or group health benefit plan shall not impose any prior authorization requirements on outpatient services for the prevention, screening, diagnosis, or treatment of mental, emotional, nervous, or substance use disorders or conditions.

Creates the Psychiatric Residential Treatment Facilities (PRTF) Act. Requires the Department of Healthcare and Family Services to establish an Illinois Psychiatric Residential Treatment Facilities (PRTF) program that is family-driven, youth-guided, and trauma-informed, and includes youth and family involvement in all aspects of care planning. Requires the Department to submit a State Plan Amendment, by January 1, 2026, to the Centers for Medicare and Medicaid Services to establish coverage of federally authorized, medically necessary inpatient psychiatric services delivered by a certified PRTF to medical assistance beneficiaries under 21 years of age. Provides that the Department shall adopt rules to implement the PRTF program that at a minimum shall include: (i) certification and participation requirements for PRTF providers in compliance with all applicable federal laws, regulations, requirements, and policies; (ii) monitoring and oversight of PRTF services; (iii) a limit on allowable beds at any one PRTF, not to exceed 40 total beds; and other matters. Requires the Department to establish, and update as needed, a methodology for completing a statewide PRTF capacity analysis for the purposes of identifying capacity needs for PRTF services under the Illinois Medical Assistance Program. Requires the Department to establish a PRTF Advisory Committee responsible for reviewing and providing guidance on the Department's policies and implementations of the PRTF program. Requires the Department to publish on its website counts of reported emergency safety interventions and serious occurrences by State fiscal year and quarter. Makes conforming changes to the Specialized Mental Health Rehabilitation Act of 2013, the Child Care Act of 1969, and other various Acts. Effective immediately.

Creates the Youth Health Protection Act. Provides that a medical doctor shall not prescribe, provide, administer, or deliver puberty-suppressing drugs or cross-sex hormones and shall not perform surgical orchiectomy or castration, urethroplasty, vaginoplasty, mastectomy, phalloplasty, or metoidioplasty on biologically healthy and anatomically normal persons under the age of 18 for the purpose of treating the subjective, internal psychological condition of gender dysphoria or gender discordance. Provides that any efforts to modify the anatomy, physiology, or biochemistry of a biologically healthy person under the age of 18 who experiences gender dysphoria or gender discordance shall be considered unprofessional conduct and shall be subject to discipline by the licensing entity or disciplinary review board. Provides that no medical doctor or mental health provider shall refer any person under the age of 18 to any medical doctor for chemical or surgical interventions to treat gender dysphoria or gender discordance. Contains definitions, a statement of purpose, and legislative findings. Amends the Medical Practice Act of 1987 to make related changes.

Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision prohibiting prior authorization mandates and utilization management controls under the fee-for-service and managed care medical assistance programs for FDA-approved prescription drugs that treat mental illness, requires the Department of Healthcare and Family Services and managed care organizations to report quarterly on compliance with the specified prohibitions beginning with dates of service on and after July 1, 2025. Requires the Department to post on its website a report on fee-for-service prescriptions and the reports from each managed care organization. Sets forth the information that must be contained in the quarterly reports, including, but not limited to: (i) the number of denied prescriptions and estimated net cost to the State for those covered prescriptions summarized by each of the allowed categories specified in the Code; (ii) the number of denied prescriptions and estimated net cost to the State for those prescriptions summarized by each of the non-allowed categories specified in the Code; and (iii) the number of denied prescriptions and estimated gross cost to the State for those prescriptions summarized by any other reason not specified in the Code. Requires the Department to sanction those managed care organizations that do not file the required reports. Effective immediately.

Declares May 4 through May 10, 2025 as Tardive Dyskinesia Awareness Week (TDAW) in the State of Illinois. Expresses support for TDAW in recognition of the importance of early detection and intervention to improve outcomes for people living with mental health conditions and prescribed antipsychotics. Expresses support towards efforts to raise awareness about the causes and symptoms of tardive dyskinesia (TD) and the importance of routine TD screening.

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.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.

Creates the Wellness and Oversight for Psychological Resources Act. Defines terms. Provides that an individual, corporation, or entity may not provide, advertise, or otherwise offer therapy or psychotherapy services to the public in the State unless the therapy or psychotherapy services are conducted by an individual who is a licensed professional. Provides that a licensed professional may use an artificial intelligence system only to the extent the use of the artificial intelligence system meets the definition of permitted use of artificial intelligence systems. Provides that a licensed professional may not use an artificial intelligence system in therapy or psychotherapy services to make independent therapeutic decisions, directly interact with clients in any form of therapeutic communication, or generate therapeutic recommendations or treatment plans without the review and approval by a licensed professional. Provides that any individual, corporation, or entity found in violation of the Act shall pay a civil penalty to the Department of Financial and Professional Regulation in an amount not to exceed $10,000 per violation, as determined by the Department, with penalties assessed based on the degree of harm and the circumstances of the violation. Provides that the civil penalty shall be assessed by the Department after a hearing is held in accordance with the Department of Professional Regulation Law. Requires that an individual, corporation, or entity found in violation of the Act shall pay the civil penalty within 60 days after the date of an order by the Department imposing the civil penalty. Provides that the Department shall have authority to investigate any actual, alleged, or suspected violations of the Act. Effective immediately.

Amends the Illinois Insurance Code. Provides that an individual or group health benefit plan shall not impose any prior authorization requirements on outpatient services for the prevention, screening, diagnosis, or treatment of mental, emotional, nervous, or substance use disorders or conditions.