SB0471 Summary

• Requires insurers to file network adequacy policies with the Director including provider addition procedures, referral processes, and 24/7 access to primary care and emergency services.

• Establishes minimum provider-to-beneficiary ratios and maximum travel distance standards (30 minutes/miles in Cook County metro area, 60 minutes/miles elsewhere) for mental health and substance use disorder treatment, with required appointment wait times of 10 business days for initial visits and 20 business days for follow-ups.

• Mandates insurers provide covered services at in-network cost-sharing levels when beneficiaries make good faith efforts to use preferred providers but cannot access appropriate providers due to insufficient availability or unreasonable distance.

• Applies network adequacy standards for mental, emotional, nervous, and substance use disorder treatment using comparable processes and standards as medical/surgical services, with insurance company exceptions to networks when in-network providers are unavailable.

• Extends mental health parity requirements to Illinois Medicaid managed care organizations and requires MCOs to meet the same behavioral health network adequacy standards as commercial insurers.