SPRINGFIELD — State lawmakers passed a bill late Thursday meant to make it easier for patients with mental health and addiction issues to get insurance coverage for treatment.
Advocacy and other groups pushed the bill in response to concerns that treatments for mental health and substance use disorders are not being covered at the same level as those for physical medical conditions despite a federal law prohibiting such disparities. Advocates considered the issue especially pressing given the epic of opioid addiction that has gripped the U.S. and Illinois.
Illinois already has a parity law on the books, but the bill sent to Gov. Bruce Rauner would add additional requirements. A spokeswoman for Rauner on Friday declined to say whether the governor would sign the bill.
Among other things, it would prohibit private insurers from requiring prior authorization for medications to treat addiction, and bar them from requiring patients try less expensive medications for addiction before stepping up to more expensive ones. Those requirements already apply to Medicaid managed care organizations.
The bill, which cleared the Senate Thursday after a Wednesday House vote, also would require insurers to put medications approved for addiction treatment on low tiers of prescription formularies, limiting patients' out-of-pocket costs. Insurers also would have to submit analyses of their compliance with parity laws to state regulators, and state regulators would have to conduct exams and audits of insurers' compliance with parity laws.
"Though parity has been the law for 10 years at the federal level now, there's still discrimination that occurs on a daily basis in mental health and addiction coverage," said David Lloyd, director of policy and programs for the Kennedy Forum Illinois, which was a driving force behind the measure.
The Illinois Association of Medicaid Health Plans did not take a position on the bill, but Executive Director Samantha Olds Frey said in a statement that the group has worked closely with advocates to ensure equitable coverage levels. The idea that Medicaid managed care organizations aren't doing enough to ensure parity is "unfounded," said group spokesman Glenn Harston II in an email.
Illinois Department of Insurance spokeswoman Whitney Barnes said in a statement that the department is "happy" to see some of its current practices potentially put into law.
The Kennedy Forum Illinois and several other groups released the results of a survey last year showing disparities in coverage in Illinois. According to that report, about 59 percent of hospitals, psychiatrists and other providers surveyed said Medicaid managed care organizations "always" or "often" denied coverage for inpatient treatment for addiction and mental health issues. Medicaid managed care organizations are insurers that administer benefits for Medicaid, a state- and federally funded insurance program for the poor.
About 10 percent of providers surveyed said private insurers "often" denied inpatient treatment for mental health and addiction services.
Aimee Boncosky, of Hawthorn Woods, said she's seen the disparity up close. Over the years, her family has had to press its insurer for coverage related to her now 18-year-old daughter's anorexia, including coverage for a specific therapist.
"It was a lot of red tape, supporting documents, hours spent on the telephone just fighting with the insurance company to eventually get it approved," Boncosky said. In the meantime, her family paid out-of-pocket for the therapist, unwilling to let the teen's treatment lapse.
"When you do have insurance, you just want it to do what it's there for and to have to go through the hurdles and hoops to get something covered can just be very challenging," Boncosky said.
If signed by Rauner, Illinois' measure could be the strongest state parity law in the nation, said former Rep. Patrick Kennedy, who founded the national Kennedy Forum, an advocacy group that seeks to end mental health and addiction stigma and discrimination. Kennedy founded the organization after his own experience with drug and alcohol addiction.
"When the legislature in Illinois sends such a powerful message, such an overwhelming message that this discrimination must stop, that is not only good for the people of Illinois ... but it's also good for the whole country," he said.