Substitute Senate Bill No. 10, also known as Public Act No. 25-94, establishes new compliance requirements for health carriers concerning mental health and substance use disorder benefits, effective October 1, 2025. Health carriers are mandated to file an annual certification with the Insurance Commissioner to confirm adherence to state and federal reporting requirements. If non-compliance is identified, carriers must specify the issues and outline corrective actions. The bill also repeals existing provisions that required the Insurance Commissioner to submit reports without disclosing health carrier identities, making such information confidential. Additionally, penalties for non-compliance are introduced, allowing civil penalties of up to $100 per participant and late fees for missed filings, both capped at $625,000. The bill modifies step therapy protocols, reducing the maximum duration from sixty to thirty days and expanding protections for patients with specific conditions, ensuring they are not subjected to prolonged step therapy.

Furthermore, the bill enhances transparency in hospital billing practices by requiring hospitals to provide 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 translated into the top fifteen languages spoken in the state. Starting July 1, 2024, facility fees will be prohibited for certain outpatient services provided off-site from a hospital campus, with exceptions for emergency departments. The bill also introduces civil penalties for hospitals that violate facility fee regulations and mandates annual reporting on facility fees to the Commissioner of Health Strategy. Overall, the bill aims to improve patient access to necessary medications, ensure fair insurance practices, and enhance transparency in healthcare billing.

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