A Senate committee signed off Tuesday evening on a plan that would remove prior authorization for outpatient and partial hospitalization for behavioral health services.
The proposal from Sen. Laura Fine, D-Glenview, also tasks insurers with providing coverage for transportation, food and lodging if there is no in-network provider and an individual has to travel for care.
An insurer 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.
The bill covers mental health and substance use disorder treatments.
Department of Insurance acting Director Ann Gillespie told the Senate’s Insurance Committee that several changes were made to the language to bring the insurance industry to neutral on the bill, including an expansion of eligible providers.
She said there are several conditions for which insurers can deny coverage, such as if benefits are not provided, if the patient received treatment was not enrolled at the end of the policy or if there was a “material misrepresentation” by the patient or provider.
Sen. Dave Syverson, R-Cherry Valley, said he did not understand why the proposal would cover services like transportation and lodging, adding that it is not typically within the scope of insurance.
Gillespie said that provision was included in the bill due to the lack of mental health providers in many areas of the state.
“People do have to travel fairly extensively for that, it’s a bigger issue for these services than it is for others,” she said.
Fine told colleagues her proposal builds on insurance reform passed by lawmakers last year.
“What we’ve found is that intensive outpatient treatment is less costly than inpatient treatment and far more effective for some people,” she said. “So this is the direction that we’re moving in this year again.”
The bill passed along party lines and heads to the full Senate for further consideration.