Substitute Senate Bill No. 10, also known as Public Act No. 25-94, introduces comprehensive reforms aimed at improving mental health and substance use disorder benefits, as well as enhancing transparency in hospital billing practices. Effective October 1, 2025, health carriers are required to file annual certifications with the Insurance Commissioner to confirm compliance with state and federal reporting requirements. The bill also establishes penalties for non-compliance, including civil penalties of up to $100 per participant and late fees for missed filings. Significant changes to step therapy protocols are included, reducing the maximum duration from sixty days to thirty days and expanding the conditions under which override requests can be granted. Additionally, the bill prohibits mandatory mail-order pharmacy use and ensures that patients with serious conditions, such as stage IV metastatic cancer, are not subjected to prolonged step therapy.

The bill further mandates that hospitals provide clear written notices to patients regarding facility fees, including potential financial liabilities and the distinction between facility and professional fees. These notices must be accessible and available in the top fifteen languages spoken in the state. Starting July 1, 2024, hospitals will be prohibited from collecting facility fees for certain outpatient services provided off-site, and civil penalties may be imposed for violations. Hospitals are also required to report annually on facility fees charged, with the Commissioner of Health Strategy tasked with publishing this information to promote transparency. Overall, the bill aims to enhance patient care, streamline healthcare processes, and ensure that patients are well-informed about their financial responsibilities related to healthcare services.

Statutes affected:
Committee Bill:
INS Joint Favorable Substitute:
File No. 419:
JUD Joint Favorable:
APP Joint Favorable:
Public Act No. 25-94: