Rep. Natalie A. Manley

Filed: 3/24/2017

 

 


 

 


 
10000HB1333ham001LRB100 03041 SMS 23974 a

1
AMENDMENT TO HOUSE BILL 1333

2    AMENDMENT NO. ______. Amend House Bill 1333 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.17, and 356z.22, and 356z.25 of the
16Illinois Insurance Code. The program of health benefits must

 

 

10000HB1333ham001- 2 -LRB100 03041 SMS 23974 a

1comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
2370c.1 of the Illinois Insurance Code.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1099-480, eff. 9-9-15.)
 
11    Section 10. The Counties Code is amended by changing
12Section 5-1069.3 as follows:
 
13    (55 ILCS 5/5-1069.3)
14    Sec. 5-1069.3. Required health benefits. If a county,
15including a home rule county, is a self-insurer for purposes of
16providing health insurance coverage for its employees, the
17coverage shall include coverage for the post-mastectomy care
18benefits required to be covered by a policy of accident and
19health insurance under Section 356t and the coverage required
20under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
21356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
22356z.14, 356z.15, and 356z.22, and 356z.25 of the Illinois
23Insurance Code. The coverage shall comply with Sections
24155.22a, 355b, 356z.19, and 370c of the Illinois Insurance

 

 

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1Code. The requirement that health benefits be covered as
2provided in this Section is an exclusive power and function of
3the State and is a denial and limitation under Article VII,
4Section 6, subsection (h) of the Illinois Constitution. A home
5rule county to which this Section applies must comply with
6every provision of this Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1499-480, eff. 9-9-15.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include coverage
22for the post-mastectomy care benefits required to be covered by
23a policy of accident and health insurance under Section 356t
24and the coverage required under Sections 356g, 356g.5,

 

 

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1356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
2356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22, and
3356z.25 of the Illinois Insurance Code. The coverage shall
4comply with Sections 155.22a, 355b, 356z.19, and 370c of the
5Illinois Insurance Code. The requirement that health benefits
6be covered as provided in this is an exclusive power and
7function of the State and is a denial and limitation under
8Article VII, Section 6, subsection (h) of the Illinois
9Constitution. A home rule municipality to which this Section
10applies must comply with every provision of this Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1899-480, eff. 9-9-15.)
 
19    Section 20. The School Code is amended by changing Section
2010-22.3f as follows:
 
21    (105 ILCS 5/10-22.3f)
22    Sec. 10-22.3f. Required health benefits. Insurance
23protection and benefits for employees shall provide the
24post-mastectomy care benefits required to be covered by a

 

 

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1policy of accident and health insurance under Section 356t and
2the coverage required under Sections 356g, 356g.5, 356g.5-1,
3356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
4356z.13, 356z.14, 356z.15, and 356z.22, and 356z.25 of the
5Illinois Insurance Code. Insurance policies shall comply with
6Section 356z.19 of the Illinois Insurance Code. The coverage
7shall comply with Sections 155.22a and 355b of the Illinois
8Insurance Code.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
16eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.25 as follows:
 
19    (215 ILCS 5/356z.25 new)
20    Sec. 356z.25. Coverage for hearing instruments.
21    (a) As used in this Section:
22    "Hearing care professional" means a person who is a
23licensed audiologist or a licensed physician.
24    "Hearing instrument" means any wearable non-disposable

 

 

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1instrument or device designed to aid or compensate for impaired
2human hearing and any parts, attachments, or accessories for
3the instrument or device, including an ear mold but excluding
4batteries and cords.
5    "Related services" means those services necessary to
6assess, select, and adjust or fit the hearing instrument to
7ensure optimal performance, including, but not limited to:
8audiological exams, replacement ear molds, and repairs to the
9hearing instrument.
10    (b) An individual or group policy of accident and health
11insurance or managed care plan that is amended, delivered,
12issued, or renewed after the effective date of this amendatory
13Act of the 100th General Assembly must provide coverage for
14hearing instruments and related services for all individuals 63
15years of age and older when a hearing care professional
16prescribes a hearing instrument to augment communication.
17    (c) An insurer shall provide coverage, subject to all
18applicable co-payments, co-insurance, deductibles, and
19out-of-pocket limits for the cost of a hearing instrument for
20each ear, as needed, as well as related services, with a
21maximum for the hearing instrument and related services of no
22less than $1,500 per hearing instrument every 24 months.
23    (d) An insurer shall not be required to pay a claim filed
24by its insured for the payment of the cost of a hearing
25instrument covered by this Section if less than 24 months prior
26to the date of the claim its insured filed a claim for payment

 

 

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1of the cost of the hearing instrument and the claim was paid by
2the insurer.
 
3    Section 30. The Health Maintenance Organization Act is
4amended by changing Section 5-3 as follows:
 
5    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
6    (Text of Section before amendment by P.A. 99-761)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
10141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
11154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
12355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
13356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
14356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
15356z.22, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
16368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
17409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
18Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
19XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
20    (b) For purposes of the Illinois Insurance Code, except for
21Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
22Maintenance Organizations in the following categories are
23deemed to be "domestic companies":
24        (1) a corporation authorized under the Dental Service

 

 

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1    Plan Act or the Voluntary Health Services Plans Act;
2        (2) a corporation organized under the laws of this
3    State; or
4        (3) a corporation organized under the laws of another
5    state, 30% or more of the enrollees of which are residents
6    of this State, except a corporation subject to
7    substantially the same requirements in its state of
8    organization as is a "domestic company" under Article VIII
9    1/2 of the Illinois Insurance Code.
10    (c) In considering the merger, consolidation, or other
11acquisition of control of a Health Maintenance Organization
12pursuant to Article VIII 1/2 of the Illinois Insurance Code,
13        (1) the Director shall give primary consideration to
14    the continuation of benefits to enrollees and the financial
15    conditions of the acquired Health Maintenance Organization
16    after the merger, consolidation, or other acquisition of
17    control takes effect;
18        (2)(i) the criteria specified in subsection (1)(b) of
19    Section 131.8 of the Illinois Insurance Code shall not
20    apply and (ii) the Director, in making his determination
21    with respect to the merger, consolidation, or other
22    acquisition of control, need not take into account the
23    effect on competition of the merger, consolidation, or
24    other acquisition of control;
25        (3) the Director shall have the power to require the
26    following information:

 

 

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1            (A) certification by an independent actuary of the
2        adequacy of the reserves of the Health Maintenance
3        Organization sought to be acquired;
4            (B) pro forma financial statements reflecting the
5        combined balance sheets of the acquiring company and
6        the Health Maintenance Organization sought to be
7        acquired as of the end of the preceding year and as of
8        a date 90 days prior to the acquisition, as well as pro
9        forma financial statements reflecting projected
10        combined operation for a period of 2 years;
11            (C) a pro forma business plan detailing an
12        acquiring party's plans with respect to the operation
13        of the Health Maintenance Organization sought to be
14        acquired for a period of not less than 3 years; and
15            (D) such other information as the Director shall
16        require.
17    (d) The provisions of Article VIII 1/2 of the Illinois
18Insurance Code and this Section 5-3 shall apply to the sale by
19any health maintenance organization of greater than 10% of its
20enrollee population (including without limitation the health
21maintenance organization's right, title, and interest in and to
22its health care certificates).
23    (e) In considering any management contract or service
24agreement subject to Section 141.1 of the Illinois Insurance
25Code, the Director (i) shall, in addition to the criteria
26specified in Section 141.2 of the Illinois Insurance Code, take

 

 

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1into account the effect of the management contract or service
2agreement on the continuation of benefits to enrollees and the
3financial condition of the health maintenance organization to
4be managed or serviced, and (ii) need not take into account the
5effect of the management contract or service agreement on
6competition.
7    (f) Except for small employer groups as defined in the
8Small Employer Rating, Renewability and Portability Health
9Insurance Act and except for medicare supplement policies as
10defined in Section 363 of the Illinois Insurance Code, a Health
11Maintenance Organization may by contract agree with a group or
12other enrollment unit to effect refunds or charge additional
13premiums under the following terms and conditions:
14        (i) the amount of, and other terms and conditions with
15    respect to, the refund or additional premium are set forth
16    in the group or enrollment unit contract agreed in advance
17    of the period for which a refund is to be paid or
18    additional premium is to be charged (which period shall not
19    be less than one year); and
20        (ii) the amount of the refund or additional premium
21    shall not exceed 20% of the Health Maintenance
22    Organization's profitable or unprofitable experience with
23    respect to the group or other enrollment unit for the
24    period (and, for purposes of a refund or additional
25    premium, the profitable or unprofitable experience shall
26    be calculated taking into account a pro rata share of the

 

 

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1    Health Maintenance Organization's administrative and
2    marketing expenses, but shall not include any refund to be
3    made or additional premium to be paid pursuant to this
4    subsection (f)). The Health Maintenance Organization and
5    the group or enrollment unit may agree that the profitable
6    or unprofitable experience may be calculated taking into
7    account the refund period and the immediately preceding 2
8    plan years.
9    The Health Maintenance Organization shall include a
10statement in the evidence of coverage issued to each enrollee
11describing the possibility of a refund or additional premium,
12and upon request of any group or enrollment unit, provide to
13the group or enrollment unit a description of the method used
14to calculate (1) the Health Maintenance Organization's
15profitable experience with respect to the group or enrollment
16unit and the resulting refund to the group or enrollment unit
17or (2) the Health Maintenance Organization's unprofitable
18experience with respect to the group or enrollment unit and the
19resulting additional premium to be paid by the group or
20enrollment unit.
21    In no event shall the Illinois Health Maintenance
22Organization Guaranty Association be liable to pay any
23contractual obligation of an insolvent organization to pay any
24refund authorized under this Section.
25    (g) Rulemaking authority to implement Public Act 95-1045,
26if any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
6eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
7eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
898-1091, eff. 1-1-15.)
 
9    (Text of Section after amendment by P.A. 99-761)
10    Sec. 5-3. Insurance Code provisions.
11    (a) Health Maintenance Organizations shall be subject to
12the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
13141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
14154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
15355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
16356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
18356z.22, 356z.25, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
19368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
20403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
21subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
22XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
23Insurance Code.
24    (b) For purposes of the Illinois Insurance Code, except for
25Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health

 

 

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1Maintenance Organizations in the following categories are
2deemed to be "domestic companies":
3        (1) a corporation authorized under the Dental Service
4    Plan Act or the Voluntary Health Services Plans Act;
5        (2) a corporation organized under the laws of this
6    State; or
7        (3) a corporation organized under the laws of another
8    state, 30% or more of the enrollees of which are residents
9    of this State, except a corporation subject to
10    substantially the same requirements in its state of
11    organization as is a "domestic company" under Article VIII
12    1/2 of the Illinois Insurance Code.
13    (c) In considering the merger, consolidation, or other
14acquisition of control of a Health Maintenance Organization
15pursuant to Article VIII 1/2 of the Illinois Insurance Code,
16        (1) the Director shall give primary consideration to
17    the continuation of benefits to enrollees and the financial
18    conditions of the acquired Health Maintenance Organization
19    after the merger, consolidation, or other acquisition of
20    control takes effect;
21        (2)(i) the criteria specified in subsection (1)(b) of
22    Section 131.8 of the Illinois Insurance Code shall not
23    apply and (ii) the Director, in making his determination
24    with respect to the merger, consolidation, or other
25    acquisition of control, need not take into account the
26    effect on competition of the merger, consolidation, or

 

 

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1    other acquisition of control;
2        (3) the Director shall have the power to require the
3    following information:
4            (A) certification by an independent actuary of the
5        adequacy of the reserves of the Health Maintenance
6        Organization sought to be acquired;
7            (B) pro forma financial statements reflecting the
8        combined balance sheets of the acquiring company and
9        the Health Maintenance Organization sought to be
10        acquired as of the end of the preceding year and as of
11        a date 90 days prior to the acquisition, as well as pro
12        forma financial statements reflecting projected
13        combined operation for a period of 2 years;
14            (C) a pro forma business plan detailing an
15        acquiring party's plans with respect to the operation
16        of the Health Maintenance Organization sought to be
17        acquired for a period of not less than 3 years; and
18            (D) such other information as the Director shall
19        require.
20    (d) The provisions of Article VIII 1/2 of the Illinois
21Insurance Code and this Section 5-3 shall apply to the sale by
22any health maintenance organization of greater than 10% of its
23enrollee population (including without limitation the health
24maintenance organization's right, title, and interest in and to
25its health care certificates).
26    (e) In considering any management contract or service

 

 

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1agreement subject to Section 141.1 of the Illinois Insurance
2Code, the Director (i) shall, in addition to the criteria
3specified in Section 141.2 of the Illinois Insurance Code, take
4into account the effect of the management contract or service
5agreement on the continuation of benefits to enrollees and the
6financial condition of the health maintenance organization to
7be managed or serviced, and (ii) need not take into account the
8effect of the management contract or service agreement on
9competition.
10    (f) Except for small employer groups as defined in the
11Small Employer Rating, Renewability and Portability Health
12Insurance Act and except for medicare supplement policies as
13defined in Section 363 of the Illinois Insurance Code, a Health
14Maintenance Organization may by contract agree with a group or
15other enrollment unit to effect refunds or charge additional
16premiums under the following terms and conditions:
17        (i) the amount of, and other terms and conditions with
18    respect to, the refund or additional premium are set forth
19    in the group or enrollment unit contract agreed in advance
20    of the period for which a refund is to be paid or
21    additional premium is to be charged (which period shall not
22    be less than one year); and
23        (ii) the amount of the refund or additional premium
24    shall not exceed 20% of the Health Maintenance
25    Organization's profitable or unprofitable experience with
26    respect to the group or other enrollment unit for the

 

 

10000HB1333ham001- 16 -LRB100 03041 SMS 23974 a

1    period (and, for purposes of a refund or additional
2    premium, the profitable or unprofitable experience shall
3    be calculated taking into account a pro rata share of the
4    Health Maintenance Organization's administrative and
5    marketing expenses, but shall not include any refund to be
6    made or additional premium to be paid pursuant to this
7    subsection (f)). The Health Maintenance Organization and
8    the group or enrollment unit may agree that the profitable
9    or unprofitable experience may be calculated taking into
10    account the refund period and the immediately preceding 2
11    plan years.
12    The Health Maintenance Organization shall include a
13statement in the evidence of coverage issued to each enrollee
14describing the possibility of a refund or additional premium,
15and upon request of any group or enrollment unit, provide to
16the group or enrollment unit a description of the method used
17to calculate (1) the Health Maintenance Organization's
18profitable experience with respect to the group or enrollment
19unit and the resulting refund to the group or enrollment unit
20or (2) the Health Maintenance Organization's unprofitable
21experience with respect to the group or enrollment unit and the
22resulting additional premium to be paid by the group or
23enrollment unit.
24    In no event shall the Illinois Health Maintenance
25Organization Guaranty Association be liable to pay any
26contractual obligation of an insolvent organization to pay any

 

 

10000HB1333ham001- 17 -LRB100 03041 SMS 23974 a

1refund authorized under this Section.
2    (g) Rulemaking authority to implement Public Act 95-1045,
3if any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
999-761, eff. 1-1-18.)
 
10    Section 35. The Limited Health Service Organization Act is
11amended by changing Section 4003 as follows:
 
12    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
13    Sec. 4003. Illinois Insurance Code provisions. Limited
14health service organizations shall be subject to the provisions
15of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
16143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
17154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
18356z.10, 356z.21, 356z.22, 356z.25, 368a, 401, 401.1, 402, 403,
19403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
20VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
21Illinois Insurance Code. For purposes of the Illinois Insurance
22Code, except for Sections 444 and 444.1 and Articles XIII and
23XIII 1/2, limited health service organizations in the following
24categories are deemed to be domestic companies:

 

 

10000HB1333ham001- 18 -LRB100 03041 SMS 23974 a

1        (1) a corporation under the laws of this State; or
2        (2) a corporation organized under the laws of another
3    state, 30% or of more of the enrollees of which are
4    residents of this State, except a corporation subject to
5    substantially the same requirements in its state of
6    organization as is a domestic company under Article VIII
7    1/2 of the Illinois Insurance Code.
8(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
91-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
10eff. 1-1-15; revised 10-5-16.)
 
11    Section 40. The Voluntary Health Services Plans Act is
12amended by changing Section 10 as follows:
 
13    (215 ILCS 165/10)  (from Ch. 32, par. 604)
14    Sec. 10. Application of Insurance Code provisions. Health
15services plan corporations and all persons interested therein
16or dealing therewith shall be subject to the provisions of
17Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
18143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
19356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
20356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
21356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
22356z.19, 356z.21, 356z.22, 356z.25, 364.01, 367.2, 368a, 401,
23401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
24and (15) of Section 367 of the Illinois Insurance Code.

 

 

10000HB1333ham001- 19 -LRB100 03041 SMS 23974 a

1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
8eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
9eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
10    Section 45. The Illinois Public Aid Code is amended by
11changing Section 5-16.8 as follows:
 
12    (305 ILCS 5/5-16.8)
13    Sec. 5-16.8. Required health benefits. The medical
14assistance program shall (i) provide the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
18356z.25 of the Illinois Insurance Code and (ii) be subject to
19the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
20the Illinois Insurance Code.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate of
24reimbursement for services or other payments in accordance with

 

 

10000HB1333ham001- 20 -LRB100 03041 SMS 23974 a

1Section 5-5e.
2    To ensure full access to the benefits set forth in this
3Section, on and after January 1, 2016, the Department shall
4ensure that provider and hospital reimbursement for
5post-mastectomy care benefits required under this Section are
6no lower than the Medicare reimbursement rate.
7(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
899-642, eff. 7-28-16.)
 
9    Section 95. No acceleration or delay. Where this Act makes
10changes in a statute that is represented in this Act by text
11that is not yet or no longer in effect (for example, a Section
12represented by multiple versions), the use of that text does
13not accelerate or delay the taking effect of (i) the changes
14made by this Act or (ii) provisions derived from any other
15Public Act.".