Providing Tools to Enforce Existing Law on Mental Health & Substance Use Disorder Parity
April 3, 2017

The Kennedy forum supports a proposal recently introduced in the Illinois General Assembly, HB68, HAM1 – Amendments to the Heroin Crisis Act (Lang). We believe this bill improves enforcement of existing mental health and addiction parity laws.

Provides clarity and specificity

  • Updates unclear definitions in current law
  • Clarifies state agencies’ jurisdictions and application of existing parity law to individual and marketplace plans (already required under federal law)
  • Clarifies that all MAT (Medication Assisted Treatment) medical necessity determinations, just as other substance use disorder treatments, must comply with the American Society of Addiction Medicine Practice Guidelines

Requires transparency

  • Specifies information that plans must report to ensure compliance
  • Specifies information to be included in annual report to the General Assembly

Ensures accountability

  • Specifies how the respective agencies are expected to enforce the law
  • Provides a mechanism by which IDOI and DHFS may request formal opinion of the Attorney General on the interpretation, implementation, or enforcement of the law
  • Allows consumers and providers to pursue causes of action against the plans for mental health and substance use disorder (MH/SUD) parity violations

Why HB68 is Needed

Inadequate Networks, High Out-of-Pocket Costs

  • In-network providers are harder to find and patient out-of-pocket costs are often higher for mental health services, according to NAMI data

More Frequent Denials

  • Claims for MH/SUD are more frequently denied than medical/surgical claims, according the federal Mental Health and Substance Use Disorder Parity Task Force
  • 29{c48ccdf3c73afb47c94c61fa7aae86e62bfbb2e57db984400d0c5994c9d92c5c} of respondents in a recent NAMI survey reported having mental health services denied, compared to only 14{c48ccdf3c73afb47c94c61fa7aae86e62bfbb2e57db984400d0c5994c9d92c5c} of respondents who had been denied for general medical care

Consumers Kept in the Dark

  • Without transparency, consumers often cannot know if they are being discriminated against
  • “Non-Quantitative Treatment Limitations” are particularly problematic because they are currently difficult to track and often applied inequitably

Enforcement Makes a Difference

    • Nearly half of previously rejected MH/SUD claims were overturned on appeal after New York increased enforcement of parity laws Based on Expert Recommendations
    • Provisions are consistent with SAMHSA findings on State best practices in parity implementation and with recommendations from a MH/SUD working group of the Department of Insurance

Who Supports HB68
American Foundation for Suicide Prevention
Community Behavioral Healthcare Association
Depression & Bipolar Support Alliance
Family Guidance Centers
Gateway Foundation
Health & Medicine Policy Research Group
Illinois Association for Behavioral Health
Illinois Collaboration on Youth
Illinois Health and Hospital Association
Illinois Psychiatric Society
Illinois Psychological Association
Illinois State Medical Society
MADO Healthcare<
NAMI Barrington Are
NAMI Chicago
NAMI Illinois
Sargent Shriver National Center on Poverty Law
TheKennedy Forum
Additional resources



To sign on as a supporter, or for more informaion, contacft Kelly O’Brien or David Lloyd with The Kennedy Forum;

Download the Testimony and Fact Sheets Here:

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