Derek Robinson, M.D. ǀ DECEMBER 27, 2022
In August 2021, Governor JB Pritzker signed into law Illinois House Bill 2595 (Public Act 102-0579), Generally Accepted Standards of Behavioral Health Care Act of 2021. IL HB 2595 requires that insurers cover all medically necessary behavioral health care services as essential health care services, beginning Jan. 1, 2023, for all eligible members. As noted in the Illinois.gov press release , Illinois is the third state in the nation to require coverage for mental, emotional, nervous or substance use disorders, following California and Oregon.
Blue Cross and Blue Shield of Illinois (BCBSIL) fully supports and appreciates IL HB 2595, as the law seeks to address the state’s growing mental health crisis. Physical health does not truly exist without mental health, and mental health services should not be a challenge to access and should meet the needs of our communities. Now is the time to close this gap and ensure that quality care is available for the whole person, and for all people.
On the heels of the COVID-19 pandemic, BCBSIL recognized and increased educational outreach to help our members understand the importance of taking care of their mental health. We’ve championed increased access to behavioral health services for all of our members, especially those who may face barriers to care due to social determinants of health. As Governor Pritzker said, "Mental healthcare is healthcare. It's medically necessary, it's lifesaving, and it can help address the systemic trauma that has held many communities back for far too long."
What’s changing with IL HB 2595?
Per the legislation, American Society of Addiction Medicine (ASAM) clinical review criteria must be applied for a subset of behavioral health diagnoses for patients with state-regulated health insurance plans. In general, these diagnoses include cases where a patient’s physical health must be addressed prior to or concomitantly with behavioral health needs.
Effective Jan. 1, 2023, BCBSIL will ensure all plans in scope are compliant with ASAM criteria requirements.
Plans in scope for IL HB 2595 include:
- Commercial fully insured
- Illinois Medicaid – Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM
- Administrative Services Only (ASO) plans offered to state employees and by employers that are municipalities, counties or public schools
What’s not changing with IL HB 2595?
There are no changes to our members’ benefit plans related to HB 2595.
How does IL HB 2595 affect providers?
You can help by encouraging your patients to talk with you about their mental health, so they know when, why and how to ask for help. Otherwise, there’s nothing you need to do differently. Links to clinical review criteria are available in the Utilization Management section of our Provider website – go to the Commercial and Government Programs Prior Authorization Support Materials pages. Continue to check eligibility and benefits, request prior authorization if required, and submit claims as you normally do.
What’s BCBSIL doing to increase awareness?
As part of HB 2595, we’re ramping up educational efforts on clinical review criteria – what’s used to determine medical necessity and how the criteria are applied. In the coming weeks, we’ll introduce some new resources for members and providers on this topic. For example, we’re developing a quick reference guide that covers the basics and includes links to helpful resources. Other training resources may be added to our website for providers and office staff to complete as needed. Completion of training on an annual basis is recommended, but not required per HB 2595.
Please continue to watch our News and Updates for announcements on this initiative. We’ll keep you posted once educational materials become available. Also watch for related articles in the Blue Review as we all work together to destigmatize, improve access to, and increase awareness of the importance of behavioral health as an essential service for all Illinoisans, regardless of where they live or their socioeconomic status.
Let’s Keep the Conversation Going
If you’d like to share any challenges you’ve faced, or success stories about ways you and your staff have helped your patients feel more comfortable about talking about mental health concerns, please email our Blue Review editor.
As we look forward to 2023, on behalf of all of us here at BCBSIL, I’d like to wish you a healthy, happy and prosperous new year. We thank you for partnering with us to support the health and wellness journeys of all of our members, their families and the larger community.
The ASAM Criteria®, ©2021 American Society of Addiction Medicine. All rights reserved.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Further, the information presented is not intended to replace or supersede any requirements set forth in your contract with BCBSIL. Any samples or suggestions in this publication are for illustrative and/or educational purposes only and should not be relied on in determining how a specific provider will be reimbursed.