Substitute Senate Bill No. 10, also known as Public Act No. 25-94, introduces comprehensive changes to health insurance regulations, particularly focusing on mental health and substance use disorder benefits. Effective October 1, 2025, health carriers are required to file an annual certification 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. Additionally, it modifies existing regulations on prescription drug coverage, limiting step therapy duration from sixty to thirty days and expanding conditions for override requests by healthcare providers. The bill repeals certain provisions related to step therapy for specific medical conditions, ensuring timely access to necessary medications for patients with serious health issues.

Furthermore, the bill enhances transparency in hospital billing practices by mandating that hospitals provide written notices to patients regarding facility fees, including potential financial liabilities and comparisons to Medicare reimbursement rates. Starting July 1, 2024, facility fees for certain outpatient services will be prohibited if provided off-site from a hospital campus, with exceptions for emergency departments. The bill also imposes civil penalties for violations of facility fee regulations and requires hospitals to report annually on facility fees charged. Overall, Substitute Senate Bill No. 10 aims to protect patients from unexpected financial burdens and improve their understanding of healthcare costs while ensuring compliance and accountability among health carriers and hospitals.

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