Bill Text: IL SB1603 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2025-02-11 - Assigned to Insurance [SB1603 Detail]

Download: Illinois-2025-SB1603-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1603 Introduced 2/4/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
5 ILCS 375/6.17 new
65 ILCS 5/10-4-2.9 new
105 ILCS 5/10-22.3g new
215 ILCS 5/370c.3 new
215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
215 ILCS 200/85
305 ILCS 5/5-5.12g new
Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.
LRB104 11460 BAB 21548 b
A BILL FOR
SB1603 LRB104 11460 BAB 21548 b
AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by adding Section 6.17 as follows:
(5 ILCS 375/6.17 new)
Sec. 6.17. Behavioral health services; no utilization or
prior approval mandates. The program of health benefits is
subject to the provisions of Section 370c.3 of the Illinois
Insurance Code prohibiting the implementation of prior
authorization mandates or utilization management controls for
the delivery of behavioral health services.
Section 10. The Illinois Municipal Code is amended by
adding Section 10-4-2.9 as follows:
(65 ILCS 5/10-4-2.9 new)
Sec. 10-4-2.9. Behavioral health services; no utilization
or prior approval mandates. The corporate authorities of all
municipalities are subject to the provisions of Section 370c.3
of the Illinois Insurance Code prohibiting the implementation
of prior authorization mandates or utilization management
controls for the delivery of behavioral health services.

SB1603 - 2 - LRB104 11460 BAB 21548 b
Section 15. The School Code is amended by adding Section
10-22.3g as follows:
(105 ILCS 5/10-22.3g new)
Sec. 10-22.3g. Behavioral health services; no utilization
or prior approval mandates. Insurance protection and benefits
for employees are subject to the provisions of Section 370c.3
of the Illinois Insurance Code prohibiting the implementation
of prior authorization mandates or utilization management
controls for the delivery of behavioral health services.
Section 20. The Illinois Insurance Code is amended by
adding Section 370c.3 as follows:
(215 ILCS 5/370c.3 new)
Sec. 370c.3. Behavioral health services; no utilization or
prior approval mandates.
(a) As used in this Section:
"Behavioral health service" means any service, including a
preventive service, intended to treat a mental, emotional,
nervous, or substance use disorder or condition across an
individual's entire life span.
"Mental, emotional, nervous, or substance use disorder or
condition" has the meaning given to that term in Section
370c.1 of this Code.

SB1603 - 3 - LRB104 11460 BAB 21548 b
(b) For all group or individual policies of accident and
health insurance or managed care plans that are amended,
delivered, issued, or renewed on or after January 1, 2026, a
health insurance issuer offering a health benefit plan in the
State of Illinois shall not impose any prior authorization or
utilization management controls on covered behavioral health
services.
(c) This Section shall not be construed to conflict with
any federal law, including, but not limited to, the federal
Social Security Act or any implementing regulations,
agreements, or decrees.
(d) The Department shall establish a process for receiving
complaints from providers and covered individuals for
violations of this Section. The Department shall timely review
and investigate all complaints received in accordance with
this Section. The Department shall adopt rules related to
enforcement of this Section and post information about how
providers can make complaints for violations of this Section
on the Department's publicly available website.
(e) The Department shall enforce the provisions of this
Section in accordance with the enforcement powers granted to
it by law. The Department is granted the specific authority to
issue a cease and desist order for violations of this Section.
Subject to the provisions of the Illinois Administrative
Procedure Act, the Department may impose upon a managed care
organization an administrative fine not to exceed $250,000 for

SB1603 - 4 - LRB104 11460 BAB 21548 b
failure to comply with the requirements of this Section or
repeated violations of this Section.
Section 25. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
(Text of Section before amendment by P.A. 103-808)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c,

SB1603 - 5 - LRB104 11460 BAB 21548 b
368d, 368e, 370c, 370c.1, 370c.3, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other

SB1603 - 6 - LRB104 11460 BAB 21548 b
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.

SB1603 - 7 - LRB104 11460 BAB 21548 b
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance

SB1603 - 8 - LRB104 11460 BAB 21548 b
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall
not be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit

SB1603 - 9 - LRB104 11460 BAB 21548 b
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,

SB1603 - 10 - LRB104 11460 BAB 21548 b
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
(Text of Section after amendment by P.A. 103-808)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
356z.77, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
368c, 368d, 368e, 370c, 370c.1, 370c.3, 401, 401.1, 402, 403,
403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
subsection (2) of Section 367, and Articles IIA, VIII 1/2,

SB1603 - 11 - LRB104 11460 BAB 21548 b
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not

SB1603 - 12 - LRB104 11460 BAB 21548 b
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its

SB1603 - 13 - LRB104 11460 BAB 21548 b
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall
not be less than one year); and

SB1603 - 14 - LRB104 11460 BAB 21548 b
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or

SB1603 - 15 - LRB104 11460 BAB 21548 b
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised

SB1603 - 16 - LRB104 11460 BAB 21548 b
11-26-24.)
Section 30. The Prior Authorization Reform Act is amended
by changing Section 85 as follows:
(215 ILCS 200/85)
Sec. 85. Administration and enforcement.
(a) The Department shall enforce the provisions of this
Act pursuant to the enforcement powers granted to it by law. To
enforce the provisions of this Act, the Director is hereby
granted specific authority to issue a cease and desist order
or require a utilization review organization or health
insurance issuer to submit a plan of correction for violations
of this Act, or both, in accordance with the requirements and
authority set forth in Section 85 of the Managed Care Reform
and Patient Rights Act. Subject to the provisions of the
Illinois Administrative Procedure Act, the Director may,
pursuant to Section 403A of the Illinois Insurance Code,
impose upon a utilization review organization or health
insurance issuer an administrative fine not to exceed $250,000
for failure to submit a requested plan of correction, failure
to comply with its plan of correction, or repeated violations
of this Act.
(b) Any person who believes that his or her utilization
review organization or health insurance issuer is in violation
of the provisions of this Act may file a complaint with the

SB1603 - 17 - LRB104 11460 BAB 21548 b
Department. The Department shall review all complaints
received and investigate all complaints that it deems to state
a potential violation. The Department shall fairly,
efficiently, and timely review and investigate complaints.
Health insurance issuers and utilization review organizations
found to be in violation of this Act shall be penalized in
accordance with this Section.
(c) The Department of Healthcare and Family Services shall
enforce the provisions of this Act as it applies to persons
enrolled under Article V of the Illinois Public Aid Code or
under the Children's Health Insurance Program Act and shall
adopt rules consistent with this Act.
(Source: P.A. 102-409, eff. 1-1-22.)
Section 35. The Illinois Public Aid Code is amended by
adding Section 5-5.12g as follows:
(305 ILCS 5/5-5.12g new)
Sec. 5-5.12g. Behavioral health services; no utilization
or prior approval mandates.
(a) As used in this Section:
"Behavioral health service" means any service, including a
preventive service, intended to treat a mental, emotional,
nervous, or substance use disorder or condition across an
individual's entire life span.
"Mental, emotional, nervous, or substance use disorder or

SB1603 - 18 - LRB104 11460 BAB 21548 b
condition" has the meaning given to that term in Section
370c.1 of the Illinois Insurance Code.
(b) Notwithstanding any other provision of this Code to
the contrary, for the purpose of removing barriers to the
timely treatment of behavioral health conditions, including
both mental health and substance use disorders, beginning on
January 1, 2026, prior authorization, or any other utilization
management controls, shall be prohibited under the
fee-for-service and managed care medical assistance programs
on any behavioral health service.
(c) This Section shall not be construed to conflict with
any federal law, including, but not limited to, the federal
Social Security Act or any implementing regulations,
agreements, or decrees.
(d) The Department shall establish a process to accept
complaints from providers or individuals eligible for medical
assistance for any violations of this Section. The Department
shall review and investigate all complaints received. The
Department shall fairly, efficiently, and timely review and
investigate complaints. The Department shall adopt rules
related to enforcement of this Section and post information
about how providers can make complaints for violations of this
Section on the Department's publicly available website.
(e) The Department shall enforce the provisions of this
Section in accordance with the enforcement powers granted to
it by law. The Department is granted the specific authority to

SB1603 - 19 - LRB104 11460 BAB 21548 b
issue a cease and desist order for violations of this Section.
Subject to the provisions of the Illinois Administrative
Procedure Act, the Department may impose upon a managed care
organization an administrative fine not to exceed $250,000 for
failure to comply with the requirements of this Section or
repeated violations of this Section.
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.
Section 99. Effective date. This Section and Section 30
take effect upon becoming law.