Sen. Meg Loughran Cappel

Amends the Illinois Insurance Code. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in the State and Medicaid managed care organizations providing coverage for hospital or medical treatment shall provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions. Provides that an insurer shall not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public program. Provides that an insurer shall base any medical necessity determination or the utilization review criteria on current generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care. Provides that in conducting utilization review of covered health care services and benefits for the diagnosis, prevention, and treatment of mental, emotional, and nervous disorders or conditions in children, adolescents, and adults, an insurer shall exclusively apply the criteria and guidelines set forth in the most recent versions of the treatment criteria developed by the nonprofit professional association for the relevant clinical specialty. Provides that an insurer shall not apply different, additional, conflicting, or more restrictive utilization review criteria than the criteria and guidelines set forth in the treatment criteria. Provides that the Director may, after appropriate notice and opportunity for hearing, assess a civil penalty between $5,000 and $20,000 for each violation. Amends the Health Carrier External Review Act. Provides that the independent review organization shall comply with specified requirements for an adverse determination or final adverse determination involving mental, emotional, nervous, or substance use disorders or conditions. Makes other changes. Effective immediately. House Floor Amendment No. 1 In provisions concerning mental and emotional disorders, provides that an insurer shall not set a specific limit on the duration of benefits or coverage of medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions or limit coverage only to alleviation of the insured's current symptoms. Provides that nothing shall require the insurer to cover a treatment when the authorization was granted based on a material misrepresentation by the insured, the policyholder, or the provider. Provides that an insurer may apply specified utilization review criteria to health care services and benefits for mental, emotional, and nervous disorders or conditions that are outside the scope of specified criteria and guidelines or relate to advancements in technology or types of care that are not covered in the most recent versions of specified sources. Provides that if the Director of Insurance determines that an insurer has violated the provisions, the Director may assess a civil penalty between $1,000 and $5,000 for each violation (rather than between $5,000 and $20,000). Removes language that provides that changes in terminology, organization, or classification of mental, emotional, nervous, substance use disorder or condition in future versions of specified publications shall not affect the conditions covered by provisions concerning mental and emotional disorders as long as a condition is commonly understood to be a mental, emotional, nervous, or substance use disorder or condition by health care providers practicing in relevant clinical specialties. Removes language that provides that an insurer shall not limit benefits or coverage for mental, emotional, nervous, or substance use disorders or conditions to short-term or acute treatment at any level of placement. Makes other changes. Changes the effective date to January 1, 2022 (rather than an immediate effective date). Senate Committee Amendment No. 1 Adds reference to: 215 ILCS 5/370c.1 Replaces everything after the enacting clause with the provisions of the engrossed bill with the following changes. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in the State and Medicaid managed care organizations providing coverage for hospital or medical treatment shall provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions on or after January 1, 2023 (rather than January 1, 2022). Provides that an insurer or Medicaid managed care organization shall not be required to pay for services if the individual was not the insurer's enrollee or eligible for Medicaid at the time the service was rendered. Provides that an insurer shall not be required to cover benefits that have been authorized and provided for a covered person by a public entitlement program. Provides that for medical necessity determinations (rather than in conducting utilization review of covered health care services and benefits) relating to level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental, emotional, and nervous disorders or conditions, insurers and Medicaid managed care organizations shall apply specified patient placement criteria. Makes various changes to provisions concerning requirements for insurers regarding education of the insurer's staff and other stakeholders, publishing of utilization review criteria, and documentation of interrater reliability testing and remediation actions. Further amends the Illinois Insurance Code. In provisions concerning mental, emotional, nervous, or substance use disorder or condition parity, provides that not later than January 1 (rather than August 1) of each year, the Department of Insurance shall issue a joint report to the General Assembly and provide an educational presentation to the General Assembly. Removes language that provides that insurers shall base the duration of treatment on the insured's individual needs; that an insurer shall only engage applicable qualified providers in the treatment of mental, emotional, nervous, or substance use disorders or conditions or the appropriate subspecialty and who possess an active professional license or certificate to review, approve, or deny services; and that every insurer shall sponsor a formal education program by nonprofit clinical specialty associations. Makes other changes. Effective January 1, 2022, except that specified provisions take effect immediately.

Amends the Dual Credit Quality Act. Provides that a community college district shall, upon the request of a school district within the jurisdiction of the community college district, enter into a partnership agreement with the school district to offer dual credit courses for students with intellectual disabilities. Provides that courses shall include, if appropriate, support outlined in the student's individualized education program and support provided under a significantly modified curriculum. Provides that within one year after the effective date of the amendatory Act, every community college district in this State shall create a plan outlining a partnership agreement with a school district to offer dual credit courses for students with intellectual disabilities; requires the plan to be updated every 3 years thereafter. Effective immediately. House Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Dual Credit Quality Act. Within one year after the effective date of the amendatory Act, requires each community college district to develop a plan to offer dual credit courses to high school students with disabilities enrolled in school districts located within the jurisdiction of the community college district who have an individualized education program under the Children with Disabilities Article of the School Code and who do not otherwise meet the academic criteria for dual credit course eligibility pursuant to the Act. Sets forth requirements concerning the plan. Effective immediately. House Floor Amendment No. 2 Adds reference to: 105 ILCS 5/14-8.03 from Ch. 122, par. 14-8.03 110 ILCS 27/16 110 ILCS 805/3-29.14 new Replaces everything after the enacting clause. Amends the Children with Disabilities Article of the School Code in provisions concerning transition services. Makes changes relating to the definition of terms. Provides that, as a component of transition planning, a school district shall provide a student with information about the school district's career and technical education (CTE) opportunities and postsecondary CTE opportunities; sets forth what the CTE information must include. Provides that a student in high school with an individualized education program may enroll in the school district's CTE program at any time if participation in a CTE program is consistent with the student's transition goals. Makes changes concerning the participants in the transition planning process. Amends the Dual Credit Quality Act. Requires a high school and community college partnership agreement to include the collaborative process and criteria by which a school district and a community college district shall work to ensure that individual students with disabilities have access to dual credit courses, provided that those students are able to meet the criteria for entry into a dual credit course; sets forth other requirements. Amends the Public Community College Act. Requires each community college district to provide access to higher education for students with disabilities. Encourages each community college to offer for-credit and non-credit courses as deemed appropriate for the individual student based on the student's abilities, interests, and postsecondary transition goals, with the appropriate individualized supplementary aids and accommodations. Strongly encourages each community college to have its disability services coordinator or the coordinator's representative participate either in person or remotely in meetings held by high schools within the community college district to provide information to the student's individualized education program team about the community college and the availability of courses and programs at the community college. Effective immediately.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan shall provide coverage for A1C testing recommended by a health care provider for prediabetes, type 1 diabetes, and type 2 diabetes in accordance with prediabetes and diabetes risk factors identified by the United States Centers for Disease Control and Prevention. Provides that a group or individual policy of accident and health insurance or managed care plan shall provide coverage for vitamin D testing recommended by a health care provider in accordance with vitamin D deficiency risk factors identified by the United States Centers for Disease Control and Prevention. Defines "A1C testing" and "vitamin D testing". Makes conforming changes in the Medical Assistance Article of the Illinois Public Aid Code.

Amends the Downstate Teacher Article of the Illinois Pension Code. Allows a member to establish optional credit for up to 2 years of service as a teacher or administrator employed by a private school recognized by the Illinois State Board of Education, provided that the teacher (i) was certified under the law governing the certification of teachers at the time the service was rendered, (ii) applies in writing on or before June 30, 2023, (iii) supplies satisfactory evidence of the employment, (iv) completes at least 10 years of contributing service as a teacher, and (v) pays the required contribution. Effective immediately. House Floor Amendment No. 2 Adds reference to: 40 ILCS 5/16-158 from Ch. 108 1/2, par. 16-158 Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill with the following changes. Further amends the Downstate Teacher Article of the Illinois Pension Code. In a provision that requires an employer to make an additional contribution to the System for certain salary increases greater than 6%, excludes salary increases resulting from teaching summer school on or after May 1, 2021 and before September 15, 2022. Effective immediately. Pension Note, House Floor Amendment No. 2 (Government Forecasting & Accountability) SB 1646, as amended by HA 2, would reopen a window for teachers to apply for optional service credit for work done in approved private schools as teachers and administrators. The Teachers' Retirement System reports having 3,463 members who have applied for this private school credit in previous window openings, as described below. TRS estimates that the fiscal impact of this bill would be low, as the member must pay both the member and employer contributions, plus the actuarially assumed rate of interest to take advantage of this credit. The fiscal impact to TRS as a result of exempting summer school teaching from the 6% Final Average Salary Cap is unknown, as it is not known how many teachers would accrue pensionable salary in excess of 6% from the previous school year with the same employer via summer school teaching rendered between May 1, 2021 and September 15, 2022. Fiscal Note, House Floor Amendment No. 2 (Teachers Retirement System) Actuarial cost impact. SB 1646 as amended would have an unknown impact to TRS. Changes allowing optional service purchase under the bill are designed to be fully paid for by the related member contributions. Changes in required school district contributions would likely create some additional cost to the State of Illinois, but the total cost cannot be calculated without knowing the actual behavior of individual school districts and employees. Administrative cost impact. Administering the provisions of this bill would not increase the administrative costs ofTRS.

Amends the Downstate Teacher Article of the Illinois Pension Code. Provides that through June 30, 2023 (instead of June 30, 2021), an annuitant may accept employment as a teacher without impairing his or her retirement status if that employment is not within the school year during which service was terminated and does not exceed 120 paid days or 600 paid hours in each school year. Makes a conforming change. Effective immediately.

Creates the Fire and Smoke Damper Inspection Act. Requires inspections and testing of HVAC fire dampers and smoke dampers to be conducted by individuals certified by the International Certification Board and Accredited to comply with specified requirements. Provides that (1) fire damper and smoke damper inspections and testing shall be conducted by inspectors certified by the International Certification Board and accredited by specified entities and (2) inspectors shall certify that all fire and smoke dampers inspected meet the standards established in the current International Fire Code adopted by the State of Illinois and the authority having jurisdiction. House Floor Amendment No. 1 Provides that inspectors shall certify that all fire and smoke dampers inspected meet the standards established in the applicable code or codes adopted by any authority having jurisdiction (rather than established in the current International Fire Code adopted by the State of Illinois and the authority having jurisdiction). House Floor Amendment No. 2 Provides an exemption for facilities licensed by the federal Nuclear Regulatory Commission under specified federal provisions and for employees of those facilities while engaged in the performance of their official duties.

Amends various Acts relating to the governance of public universities in Illinois. With respect to the high school coursework that a person must satisfactorily complete for university admission, adds agricultural sciences as a course option for the science category and agricultural education as a course option for the electives category. Senate Floor Amendment No. 1 Replaces everything after the enacting clause. Reinserts the contents of the bill, but changes references from vocational education to career and technical education.

Amends the School Safety Drill Act. Provides that parents or guardians must receive prior notice of a law enforcement drill not less than 5 days prior to the drill. Provides that a law enforcement drill (i) must not include simulations that mimic an actual school shooting incident or active shooter event, (ii) must be announced in advance to all school personnel and students prior to the commencement of the drill, (iii) must include content that is age appropriate and developmentally appropriate, (iv) must include and involve school personnel, including school-based mental health professionals, and (v) must include trauma-informed approaches to address the concerns and well-being of students and school personnel. Requires a school district to include in its annual review of each school building's emergency and crisis response plans, protocols, and procedures an examination of the efficacy and effects of law enforcement drills. Effective immediately. House Floor Amendment No. 2 Changes certain references relating to law enforcement drills to law enforcement lockdown drills. Removes the requirement that parents or guardians must receive prior notice of a law enforcement drill not less than 5 days prior to the drill. Provides that (i) school administrators and school support personnel may, in their discretion, exempt a student or students from participating in a walk-through lockdown drill; (ii) schools must provide sufficient information and notification to parents and guardians in advance of any walk-through lockdown drill that involves the participation of students and must also provide to parents and guardians an opportunity to exempt their child for any reason from participating in the walk-through lockdown drill; (iii) schools must provide alternative safety education and instruction related to an active threat or active shooter event to students who do not participate in a walk-through lockdown drill to provide them with essential information, training, and instruction through less sensorial safety training methods; (iv) during a drill, students must be allowed to ask questions related to the drill; and (v) law enforcement may choose to run an active shooter simulation, but only on school days when students are not present, and parental notification is not required if students are not required to be present. Corrects a typographical error.

Amends the Managed Care Reform and Patient Rights Act. Requires health insurance carriers that provide coverage for prescription drugs to ensure that, within service areas and levels of coverage specified by federal law, at least half of individual and group plans meet one or more of the following criteria: apply a pre-deductible and flat-dollar copayment structure to the entire drug benefit, limit a beneficiary's monthly out-of-pocket financial responsibility for prescription drugs to a specified amount, or limit a beneficiary's annual out-of-pocket financial responsibility for prescription drugs to a specified amount. Provides that all plans for prescription drugs offered under the amendatory Act must be clearly and appropriately named, marketed in the same manner as other plans offered by the health insurance carrier, and offered for purchase to any individual and group plan sponsor. Effective January 1, 2022. House Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Managed Care Reform and Patient Rights Act. In provisions concerning individual health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall ensure that at least 10% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall ensure that at least 25% of individual health care plans offered in each applicable service area apply a flat-dollar copayment structure to the entire drug benefit. In provisions concerning group health plans that provide coverage for prescription drugs, provides that beginning January 1, 2023, health insurance carriers shall offer at least one group health plan in each applicable service area that applies a flat-dollar copayment structure to the entire drug benefit; and beginning January 1, 2024, health insurance carriers shall offer at least 2 group health plans in each applicable service area that apply a flat-dollar copayment structure to the entire drug benefit. Provides that the flat-dollar copayment structure for prescription drugs must be applied pre-deductible and be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs. Requires the health insurance carriers to clearly and appropriately name the plans to aid in individual or group plan selection. Requires the health insurance carriers to market the plans in the same manner as their other plans. Requires the Department of Insurance to adopt rules necessary to implement and enforce the provisions. Effective January 1, 2023.

Amends the Military Code of Illinois. Provides that members of the Illinois National Guard serving on State Active Duty, in addition to those serving in a federal duty or training status, shall have a State flag presented to their next of kin upon their death.