INS CD-MENTAL HEALTH COVERAGE

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5557

Introduced 2/13/2026, by Rep. Maura Hirschauer

SYNOPSIS AS INTRODUCED:

215 ILCS 5/355.8 new

Amends the Illinois Insurance Code. Contains findings. Requires each
health carrier to annually submit completed templates with both plan-level
and carrier-level data to the Director of Insurance in the form, manner,
and time prescribed by the Director by no later than July 1 of each year
for data from the previous calendar year. Provides that data must be
sufficient to support independent technical evaluation and to enable
meaningful public understanding of access to and coverage for each
facility type and specified professional provider type. Requires each
health carrier to report, disaggregated by facility type, professional
provider type, youth, adult, in-person, and telehealth, the specified data
elements. Requires the Director to post, in an easily accessible,
consumer-friendly manner, on a public website, all underlying data and
data files reported no later than 3 months after receipt. Sets forth
provisions concerning certification of health carriers and administration
and enforcement of the provisions. Provides that the data submission
requirements apply to health benefit plans issued or renewed on or after
January 1, 2027. Effective immediately.
LRB104 20200 BAB 33651 b

A BILL FOR

HB5557
LRB104 20200 BAB 33651 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.
This Act may be referred to as the Truth in
5
Mental Health Coverage Act.

6

Section 2.
Findings.
The General Assembly finds that:
7

(1) Analyses by Milliman (2017, 2019) and RTI
8

International (2024) demonstrate that, over multiple
9

years, Illinois residents have experienced substantially
10

greater difficulty accessing in-network mental health and
11

substance use disorder services than accessing medical or
12

surgical services.
13

(2) In 2021, Illinois residents were 90% more likely
14

to receive outpatient behavioral health services out of
15

network than outpatient medical or surgical services; 190%
16

percent more likely to receive outpatient facility
17

behavioral health services out of network; and 350% more
18

likely to receive inpatient behavioral health services out
19

of network.
20

(3) In Illinois, average in-network reimbursement in
21

2021 for medical or surgical clinicians was 21%higher than
22

for behavioral health clinicians, indexed to Medicare
23

reimbursement. This gap discourages behavioral health

HB5557
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LRB104 20200 BAB 33651 b
1

clinicians from joining insurance networks and further
2

limits access to care for enrollees. More recent
3

Illinois-specific data are unavailable due to the absence
4

of standardized public reporting requirements.
5

(4) Federal regulators have cited the RTI
6

International data as evidence of the need for greater
7

accountability and transparency by health plans and
8

issuers.
9

(5) Youth face even greater barriers to access due to
10

health benefit plans' narrow networks that lack sufficient
11

child and adolescent behavioral health providers.
12

(6) Independent economic analyses by McKinsey &
13

Company show that individuals with behavioral health
14

diagnoses incur between 2 times and 4 times higher total
15

medical costs than those without such diagnoses, largely
16

because untreated behavioral health conditions worsen
17

physical health outcomes. Analyses by Milliman show that
18

individuals with behavioral health diagnoses incur between
19

3.2 times and 6.2 times higher medical costs. Earlier
20

access to effective treatment reduces these downstream
21

costs.
22

(7) Transparent, comparable information on coverage
23

and access, including information maintained on a public
24

dashboard, is an essential regulatory function necessary
25

to effectuate compliance with State insurance laws,
26

protect consumers and employers as informed purchasers,

HB5557
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LRB104 20200 BAB 33651 b
1

and reduce the higher downstream medical costs associated
2

with untreated mental health and substance use disorders.

3

Section 5.
The Illinois Insurance Code is amended by
4
adding Section 355.8 as follows:

5

(215 ILCS 5/355.8 new)
6

Sec. 355.8.
Truth in mental health coverage reporting
7
requirements.

8

(a) In this Section:

9

"Adult" means an individual 18 years of age or older.
10

"Facility type" means categories of facilities and levels
11
of care in which mental health disorder services, substance
12
use disorder services, behavioral health services, or medical
13
or surgical services are delivered, including outpatient
14
facilities such as intensive outpatient programs, partial
15
hospitalization programs, and outpatient surgery facilities,
16
acute inpatient facilities, and subacute inpatient facilities
17
such as residential and skilled nursing facilities.
18

"Health benefit plan" has the meaning given to that term
19
in Section 370c of this Code.
20

"Health carrier" has the meaning given to that term in
21
Section 370c of this Code.
22

"Mental health and substance use disorders" means mental,
23
emotional, nervous, or substance use disorders, as that term
24
is used in Section 370c of this Code.

HB5557
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LRB104 20200 BAB 33651 b
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"Mental health disorders" means mental, emotional, or
2
nervous disorders other than substance use disorders, as
3
classified in the mental and behavioral disorders chapters of
4
the most current version of the International Classification
5
of Diseases and the mental disorder diagnostic categories of
6
the most current version of the Diagnostic and Statistical
7
Manual of Mental Disorders.
8

"Medical or surgical disorders" means all physical health
9
conditions or diseases that are not mental health disorders or
10
substance use disorders.
11

"Medical or surgical services" means health care services
12
or benefits for the diagnosis or treatment of medical or
13
surgical disorders.
14

"Out-of-network allowed claims" means claims allowed at
15
the out-of-network benefit level, with corresponding enrollee
16
cost-sharing, rather than the in-network benefit level.
17

"Plan level" means a carrier's product or health benefit
18
plan, as defined by the Director for purposes of public
19
comparison.
20

"Professional provider type" means categories of health
21
care professionals that furnish mental health disorder
22
services, substance use disorder services, behavioral health
23
services, or medical or surgical services in an office
24
setting, including, but not limited to, psychiatrists,
25
psychologists, psychiatric nurse practitioners, other
26
independently licensed behavioral health clinicians, primary

HB5557
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LRB104 20200 BAB 33651 b
1
care physicians, medical or surgical specialist physicians,
2
physician assistants, and medical or surgical nurse
3
practitioners, and includes youth-serving providers.
4

"Substance use disorders" means disorders classified in
5
the substance-related and addictive disorders chapters of the
6
most current version of the International Classification of
7
Diseases and the substance-related and addictive disorders
8
diagnostic categories of the most current version of the
9
Diagnostic and Statistical Manual of Mental Disorders.
10

"Templates" means Microsoft Excel or similar documents
11
containing embedded formulas for quantitative data using
12
definitions and instructions specified by the Director.
13

"Utilization review" has the meaning given to that term in
14
Section 370c of this Code.
15

"Youth" means an individual under 18 years of age.
16

(b)(1) Each health carrier shall annually submit completed
17
templates with both plan-level and carrier-level data to the
18
Director in the form, manner, and time prescribed by the
19
Director by no later than July 1 of each year for data from the
20
previous calendar year.
21

(2) Data must be sufficient to support independent
22
technical evaluation and to enable meaningful public
23
understanding of access to and coverage for each facility type
24
and professional provider type of:
25

(A) mental health disorder services;
26

(B) substance use disorder services;

HB5557
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LRB104 20200 BAB 33651 b
1

(C) behavioral health services;
2

(D) medical or surgical services;
3

(E) youth and adult services, separately and combined;
4

(F) in-person and telehealth services, separately and
5

combined;
6

(G) geographic area, as specified by the Director; and
7

(H) whether the facility or professional provider is
8

affiliated with, owned by, or under common control with
9

the health carrier.
10

(3) Any data cell containing fewer than 11 enrollees must
11
be suppressed consistent with Centers for Medicare and
12
Medicaid Services cell-suppression standards.
13

(c) Each health carrier shall report, disaggregated by
14
facility type, professional provider type, youth, adult,
15
in-person, and telehealth:
16

(1) utilization review, including the number and
17

percentage of approvals, modified approvals, denials, and
18

partial denials, average decision timeframes, top denial
19

reasons, and other measures specified by the Director to
20

assess the effects of utilization review on access to
21

timely, clinically appropriate care;
22

(2) out-of-network utilization rates using allowed
23

claims data;
24

(3) in-network reimbursement, including average
25

allowed amounts and allowed amounts at the 50th, 75th, and
26

95th percentiles, each indexed to Medicare;

HB5557
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LRB104 20200 BAB 33651 b
1

(4) the number of unique enrollees served by listed
2

in-network professional providers, including
3

youth-serving providers;
4

(5) the percentage of listed in-network providers
5

relative to State-licensed providers of the same type,
6

including youth-serving providers;
7

(6) network admission evaluation, including the
8

average time from completed application to network
9

admission for each facility and professional provider
10

type, including youth-serving facilities and professional
11

providers;
12

(7) psychiatric Collaborative Care Model data,
13

including the number of enrollees, pediatric and adult
14

collaborative care separately, penetration rate per
15

100,000 covered lives with a behavioral health diagnosis,
16

and reimbursement indexed to Medicare;
17

(8) appeals and external review, including counts and
18

outcomes of adverse benefit determinations and independent
19

review decisions; and
20

(9) additional metrics the Director determines
21

necessary for public comparison or oversight.
22

(d) In specifying the templates, the Director shall review
23
formats that are:
24

(1) used by state insurance regulators;
25

(2) endorsed and used by one or more employer
26

coalitions, human resources associations, or mental health

HB5557
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LRB104 20200 BAB 33651 b
1

nonprofit organizations; and
2

(3) cited by the United States Department of Labor or
3

the United States Department of Health and Human Services.
4

(e)(1) The Director shall post, in an easily accessible,
5
consumer-friendly manner, on a public website, all underlying
6
data and data files reported under this Section no later than 3
7
months after receipt.
8

(2) The posting must include raw data and downloadable
9
files in a machine-readable format to permit public analysis,
10
research, and independent comparison.
11

(3) Data must be posted separately for the plan level and
12
aggregated at the carrier level.
13

(4) Information collected under this Section is not
14
proprietary or confidential and must be publicly disclosed,
15
subject only to cell-suppression standards.
16

(f)(1) The Director shall maintain an interactive public
17
dashboard that visually presents the posted data, including
18
separate display of youth and adult outcomes, and allows
19
comparison across plans and carriers.
20

(2) The dashboard must allow users to view metrics for
21
mental health disorder services, substance use disorder
22
services, behavioral health services, and medical or surgical
23
services, separately and combined.
24

(3) The dashboard must be updated no later than 3 months
25
after receipt of the data.
26

(g) Each health carrier shall submit a certification, in a

HB5557
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LRB104 20200 BAB 33651 b
1
form and manner specified by the Director, signed under
2
penalty of perjury by the chief financial officer of the
3
carrier, stating that the reported data are complete and
4
accurate and follow template definitions and instructions.
5

(h)(1) The Director shall adopt uniform templates,
6
definitions, audit procedures, and correction protocols to
7
ensure comparability across carriers and over time. The
8
Director may satisfy reporting requirements under this Section
9
by using data already collected or maintained by the
10
Department for any regulatory, oversight, or enforcement
11
purpose. Data used or incorporated for purposes of this
12
Section is deemed collected for public reporting and must be
13
made available in accordance with this Section.
14

(2) The Director may adopt rules to carry out this
15
Section.
16

(3) Each health carrier must retain all data underlying
17
the reported information for at least 3 years and make such
18
records available to the Director upon request.
19

(i) A health carrier's failure to comply with this Section
20
constitutes an unfair or deceptive act or practice under this
21
Code and is subject to enforcement by the Director, including
22
referral to the Attorney General.
23

(j) The costs of implementing and administering this Act
24
shall be paid from the Insurance Producer Administration Fund
25
or another appropriate regulatory fund administered by the
26
Department, and such costs shall reflect the actual and

HB5557
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LRB104 20200 BAB 33651 b
1
reasonable costs incurred by the Department in administering,
2
overseeing, and enforcing this Section with respect to health
3
carriers subject to this Section.
4

(k) This Section applies to health benefit plans issued or
5
renewed on or after January 1, 2027.
6

(l) The provisions of this Section are severable under
7
Section 1.31 of the Statute on Statutes.

8

Section 99.
Effective date.
This Act takes effect upon
9
becoming law.

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