INS-BEHAV HEALTH EMERG SERVICE

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5497

Introduced 2/13/2026, by Rep. Laura Faver Dias

SYNOPSIS AS INTRODUCED:

215 ILCS 5/370c.5 new
215 ILCS 124/25.5 new

Amends the Illinois Insurance Code. Provides that any policy of
insurance amended, delivered, issued, or renewed on or after January 1,
2027 that provides coverage for emergency services for medical or surgical
conditions shall also provide coverage for behavioral health emergency
services on coverage terms no more restrictive than those applied to
emergency services for medical or surgical conditions. Requires coverage
for post-stabilization services. Sets forth provisions concerning
behavioral health emergency services parity; coverage of services provided
by nonlicensed staff performing under direct supervision; restrictions on
prior authorization, utilization review, and cost sharing; reimbursement
rates; and rulemaking. Amends the Network Adequacy and Transparency Act.
Includes behavioral health emergency services providers in network
adequacy determinations under the Act. Establishes provisions concerning
rulemaking for the Department of Insurance; behavioral health emergency
services requirements for health insurance issuers; and enforcement
coordination with specified federal law. Effective January 1, 2027.
LRB104 20224 BAB 33675 b

A BILL FOR

HB5497
LRB104 20224 BAB 33675 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 1.
Findings.
The General Assembly finds that:
5

(1) Individuals experiencing behavioral health
6

emergencies, including mental health and substance use
7

challenges, may face urgent situations that require
8

immediate support to promote safety, stability, and
9

overall well-being for themselves, their families, and
10

their communities.
11

(2) Timely access to a full continuum of behavioral
12

health emergency services, including crisis intervention,
13

stabilization, mobile crisis response, and
14

post-stabilization care, is essential to support recovery,
15

reduce harm, and prevent unnecessary hospitalizations or
16

interactions with law enforcement.
17

(3) Commercial health insurance policies in Illinois
18

generally do not provide coverage for behavioral health
19

emergency services, resulting in the costs of these
20

services being covered primarily by State and federal
21

funds.
22

(4) Evidence demonstrates that mobile crisis response
23

services are more cost-effective than hospitalization and
24

provide more timely, person-centered care by stabilizing

HB5497
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LRB104 20224 BAB 33675 b
1

individuals in their communities, reducing unnecessary
2

emergency department visits and inpatient admissions, and
3

improving connections to ongoing behavioral health
4

supports.
5

(5) Disparities in coverage, prior authorization
6

requirements, and cost-sharing obligations create barriers
7

that prevent individuals from accessing necessary,
8

life-saving behavioral health services.
9

(6) Commercial insurance policies that provide
10

coverage for emergency medical or surgical services should
11

provide equivalent coverage for behavioral health
12

emergency services to ensure parity and compliance with
13

the Mental Health Parity and Addiction Equity Act.
14

(7) Under widely recognized mobile crisis response
15

models, behavioral health crisis teams often include
16

nonlicensed staff, including peer specialists and
17

individuals with lived experience, working under the
18

direct supervision of licensed clinicians, enabling the
19

team to deliver timely, effective, and community-based
20

crisis services without unnecessary administrative or
21

financial barriers.
22

(8) Ensuring network adequacy, including travel time,
23

distance, and mobile crisis response times consistent with
24

standards established by the Illinois Division of
25

Behavioral Health and Recovery and the Department of
26

Healthcare and Family Services under the Mobile Response

HB5497
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LRB104 20224 BAB 33675 b
1

and Stabilization Services program, is critical to
2

providing rapid access to behavioral health emergency
3

services.

4

Section 5.
The Illinois Insurance Code is amended by
5
adding Section 370c.5 as follows:

6

(215 ILCS 5/370c.5 new)
7

Sec. 370c.5.
Behavioral health emergency services.
8

(a) This Section applies to all policies of insurance
9
amended, delivered, issued, or renewed on and after January 1,
10
2027.
11

(b) In this Section, "behavioral health emergency
12
services" means the continuum of services to address crisis
13
intervention, crisis stabilization, and crisis residential
14
treatment needs of those experiencing a mental health or
15
substance use disorder crisis that are wellness, resilience,
16
and recovery oriented.
17

"Behavioral health emergency services" includes, but is
18
not limited to, crisis intervention, including counseling
19
provided by 9-8-8 Suicide and Crisis Lifeline centers, mobile
20
crisis response, crisis de-escalation, crisis receiving and
21
stabilization services, and coordination with health, social,
22
and other services and supports year-round 24-hour
23
availability for up to a 72-hour crisis period.
24

(c) Any policy that provides coverage for emergency

HB5497
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LRB104 20224 BAB 33675 b
1
services for medical or surgical conditions shall also provide
2
coverage for behavioral health emergency services, on coverage
3
terms no more restrictive than those applied to emergency
4
services for medical or surgical conditions, if any of the
5
following conditions are met:
6

(1) the insured has acute symptoms or distress that
7

would cause a prudent layperson experiencing them to
8

reasonably seek immediate care;
9

(2) a clinical assessment of the insured indicates a
10

behavioral health crisis requiring immediate evaluation or
11

intervention; or
12

(3) the insured is referred, transported, or directed
13

to behavioral health emergency services by a 9-8-8 Suicide
14

and Crisis Lifeline center, emergency medical services,
15

law enforcement, or other crisis responder.
16

Coverage shall not be denied solely because the enrollee
17
is unable to recognize or communicate the need for emergency
18
care.
19

(d) A policy subject to this Section shall provide
20
coverage and reimbursement for post-stabilization services, as
21
required by 42 U.S.C. 300gg-111(a)(3)(C)(ii), and those
22
services shall be covered as behavioral health emergency
23
services under this Section.
24

(e) A health insurance issuer shall cover behavioral
25
health emergency services provided by nonlicensed staff who
26
are performing services under the direct supervision of a

HB5497
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LRB104 20224 BAB 33675 b
1
fully licensed mental health clinician. Services delivered by
2
such supervised nonlicensed staff shall be billed under the
3
supervising clinician's rendering National Provider
4
Identifier, in accordance with the issuer's credentialing and
5
billing policies and applicable law.
6

(f) Coverage under this Section shall not be conditioned
7
on prior authorization, utilization review, or plan
8
notification and shall not vary based on whether services are
9
provided by a participating or nonparticipating provider or
10
facility, on the licensure category of the provider or
11
facility, or on the location where services are delivered, so
12
long as the services are within the scope of practice under
13
Illinois law.
14

(g) Reimbursement for behavioral health emergency services
15
under this Section shall not be made in an amount less than the
16
applicable reimbursement rate floor established under Section
17
370c.4 of this Code, regardless of network status, and shall
18
adopt applicable Medicaid procedure codes, modifiers, and fee
19
schedules where available to streamline billing and ensure
20
consistency.
21

(h) Notwithstanding any other provision of this Code, a
22
policy subject to this Section shall not impose any
23
deductible, copayment, coinsurance, or other cost-sharing
24
requirement on behavioral health emergency services, including
25
post-stabilization services covered under subsection (d).
26

(i) The Department may adopt rules to implement this

HB5497
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LRB104 20224 BAB 33675 b
1
Section, including rules regarding enforcement and
2
coordination with federal requirements.

3

Section 10.
The Network Adequacy and Transparency Act is
4
amended by adding Section 25.5 as follows:

5

(215 ILCS 124/25.5 new)
6

Sec. 25.5.
Behavioral health emergency services network
7
adequacy.
8

(a) This Section applies to an individual or group policy
9
of health insurance coverage with a network plan amended,
10
delivered, issued, or renewed in this State on and after
11
January 1, 2027.
12

(b) For purposes of this Section, "behavioral health
13
emergency services" has the meaning given to that term in
14
Section 370c.4 of the Illinois Insurance Code.
15

(c) Behavioral health emergency services providers,
16
including, but not limited to, mobile crisis response teams
17
and crisis receiving and stabilization providers, shall be
18
included in network adequacy determinations under this Act.
19

(d) The Department shall adopt maximum travel time and
20
distance standards for enrollees to access in-network,
21
facility-based behavioral health emergency services and shall
22
establish maximum response time standards for mobile crisis
23
response teams to reach enrollees in the community. All
24
travel, distance, and response time standards shall be no less

HB5497
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LRB104 20224 BAB 33675 b
1
stringent than the requirements established by the Illinois
2
Division of Behavioral Health and Recovery and the Department
3
of Healthcare and Family Services under the Mobile Response
4
and Stabilization Services program.
5

(e) A health insurance issuer offering a network plan
6
shall ensure 24-hour-a-day, 7-day-a-week timely access to
7
behavioral health emergency services in each geographic region
8
served by the plan.
9

(f) Enforcement of this Section shall be coordinated with
10
federal requirements under the Paul Wellstone and Pete
11
Domenici Mental Health Parity and Addiction Equity Act of 2008
12
and the No Surprises Act.

13

Section 99.
Effective date.
This Act takes effect January
14
1, 2027.

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