Substitute Senate Bill No. 10, also known as Public Act No. 25-94, introduces significant changes to health insurance regulations, particularly focusing on mental health and substance use disorder benefits, premium rate approvals, and facility fees charged by hospitals. 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 failure to file required information. Additionally, it modifies existing regulations on prescription drug coverage and step therapy protocols, reducing the maximum duration for mandated step therapy from sixty days to thirty days and expanding protections for patients with specific conditions such as stage IV metastatic cancer.

The bill further enhances transparency regarding facility fees by mandating hospitals to provide written notices to patients about potential financial liabilities and the distinction between facility and professional fees. Starting July 1, 2024, the Commissioner of Health Strategy can impose civil penalties for violations related to facility fees, and hospitals must report annually on the facility fees charged. The bill also includes provisions to ensure that notices are accessible in multiple languages and that patients are informed of their rights regarding facility fees. Overall, Substitute Senate Bill No. 10 aims to improve patient care, streamline access to necessary medications, and promote fair billing practices in the healthcare system.

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