 The Senate signed off Thursday evening on a plan to remove prior authorization for outpatient and partial hospitalization for behavioral health services deemed medically necessary. The proposal from Sen. Laura Fine, D-Glenview, also requires private insurers to provide coverage for transportation, food and lodging if an individual has to travel for care because there is no local in-network provider. Insurers may deny reimbursement for food, lodging and travel if the provider is not in Illinois or within 100 miles of the beneficiary’s residence, unless no available provider is found within those parameters to provide services. Another provision requires insurers to provide an annual report to the Department of Insurance on the percentage of total premium revenue after accounting for collections or receipts for risk adjustments and payments of reinsurance focused on patient care and other essential non-claims costs. “This prohibits including executive compensation beyond base salary, accumulated profit or costs outside of the scope of relevant federal regulation,” Fine said. The bill covers mental health and substance use disorder treatments. Some Republicans said they worry the plan is another initiative that will raise insurance costs. “We’re getting to a point where insurance can be so expensive that people are dropping it so they won’t even have coverage available to even help with covering these children,” said Sen. Dave Syverson, R-Cherry Hill. Sen. Steve McClure, R-Litchfield, noted that no other conditions require coverage for expenses like food and travel. He said it was not fair that individuals undergoing cancer care did not receive the same support as those with behavioral health issues. “We’ve got to make sure that people with cancer are not paying higher premiums to pay for other people to travel,” he said. Fine responded that the plan makes sure that mental health gets the same support as physical health. “It’s about time that we put mental health front and center and make sure people get the care they need,” she said. The Senate approved the bill 45-11, and it heads to the House for concurrence. |
Senate approves removal of prior authorization for certain behavioral health services
