Rep. Angelica Guerrero-Cuellar

Filed: 5/3/2024

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3538

2    AMENDMENT NO. ______. Amend Senate Bill 3538 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Counties Code is amended by changing
5Section 5-1069 as follows:
 
6    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)
7    Sec. 5-1069. Group life, health, accident, hospital, and
8medical insurance.
9    (a) The county board of any county may arrange to provide,
10for the benefit of employees of the county, group life,
11health, accident, hospital, and medical insurance, or any one
12or any combination of those types of insurance, or the county
13board may self-insure, for the benefit of its employees, all
14or a portion of the employees' group life, health, accident,
15hospital, and medical insurance, or any one or any combination
16of those types of insurance, including a combination of

 

 

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1self-insurance and other types of insurance authorized by this
2Section, provided that the county board complies with all
3other requirements of this Section. The insurance may include
4provision for employees who rely on treatment by prayer or
5spiritual means alone for healing in accordance with the
6tenets and practice of a well recognized religious
7denomination. The county board may provide for payment by the
8county of a portion or all of the premium or charge for the
9insurance with the employee paying the balance of the premium
10or charge, if any. If the county board undertakes a plan under
11which the county pays only a portion of the premium or charge,
12the county board shall provide for withholding and deducting
13from the compensation of those employees who consent to join
14the plan the balance of the premium or charge for the
15insurance.
16    (b) If the county board does not provide for
17self-insurance or for a plan under which the county pays a
18portion or all of the premium or charge for a group insurance
19plan, the county board may provide for withholding and
20deducting from the compensation of those employees who consent
21thereto the total premium or charge for any group life,
22health, accident, hospital, and medical insurance.
23    (c) The county board may exercise the powers granted in
24this Section only if it provides for self-insurance or, where
25it makes arrangements to provide group insurance through an
26insurance carrier, if the kinds of group insurance are

 

 

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1obtained from an insurance company authorized to do business
2in the State of Illinois. The county board may enact an
3ordinance prescribing the method of operation of the insurance
4program.
5    (d) If a county, including a home rule county, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the insurance coverage shall
8include screening by low-dose mammography for all women 35
9years of age or older for the presence of occult breast cancer
10unless the county elects to provide mammograms itself under
11Section 5-1069.1. The coverage shall be as follows:
12        (1) A baseline mammogram for women 35 to 39 years of
13    age.
14        (2) An annual mammogram for women 40 years of age or
15    older.
16        (3) A mammogram at the age and intervals considered
17    medically necessary by the woman's health care provider
18    for women under 40 years of age and having a family history
19    of breast cancer, prior personal history of breast cancer,
20    positive genetic testing, or other risk factors.
21        (4) For a group policy of accident and health
22    insurance that is amended, delivered, issued, or renewed
23    on or after the effective date of this amendatory Act of
24    the 101st General Assembly, a comprehensive ultrasound
25    screening of an entire breast or breasts if a mammogram
26    demonstrates heterogeneous or dense breast tissue or when

 

 

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1    medically necessary as determined by a physician licensed
2    to practice medicine in all of its branches, advanced
3    practice registered nurse, or physician assistant.
4        (5) For a group policy of accident and health
5    insurance that is amended, delivered, issued, or renewed
6    on or after the effective date of this amendatory Act of
7    the 101st General Assembly, a diagnostic mammogram when
8    medically necessary, as determined by a physician licensed
9    to practice medicine in all its branches, advanced
10    practice registered nurse, or physician assistant.
11    A policy subject to this subsection shall not impose a
12deductible, coinsurance, copayment, or any other cost-sharing
13requirement on the coverage provided; except that this
14sentence does not apply to coverage of diagnostic mammograms
15to the extent such coverage would disqualify a high-deductible
16health plan from eligibility for a health savings account
17pursuant to Section 223 of the Internal Revenue Code (26
18U.S.C. 223).
19    For purposes of this subsection:
20    "Diagnostic mammogram" means a mammogram obtained using
21diagnostic mammography.
22    "Diagnostic mammography" means a method of screening that
23is designed to evaluate an abnormality in a breast, including
24an abnormality seen or suspected on a screening mammogram or a
25subjective or objective abnormality otherwise detected in the
26breast.

 

 

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1    "Low-dose mammography" means the x-ray examination of the
2breast using equipment dedicated specifically for mammography,
3including the x-ray tube, filter, compression device, and
4image receptor, with an average radiation exposure delivery of
5less than one rad per breast for 2 views of an average size
6breast. The term also includes digital mammography.
7    (d-5) Coverage as described by subsection (d) shall be
8provided at no cost to the insured and shall not be applied to
9an annual or lifetime maximum benefit.
10    (d-10) When health care services are available through
11contracted providers and a person does not comply with plan
12provisions specific to the use of contracted providers, the
13requirements of subsection (d-5) are not applicable. When a
14person does not comply with plan provisions specific to the
15use of contracted providers, plan provisions specific to the
16use of non-contracted providers must be applied without
17distinction for coverage required by this Section and shall be
18at least as favorable as for other radiological examinations
19covered by the policy or contract.
20    (d-15) If a county, including a home rule county, is a
21self-insurer for purposes of providing health insurance
22coverage for its employees, the insurance coverage shall
23include mastectomy coverage, which includes coverage for
24prosthetic devices or reconstructive surgery incident to the
25mastectomy. Coverage for breast reconstruction in connection
26with a mastectomy shall include:

 

 

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1        (1) reconstruction of the breast upon which the
2    mastectomy has been performed;
3        (2) surgery and reconstruction of the other breast to
4    produce a symmetrical appearance; and
5        (3) prostheses and treatment for physical
6    complications at all stages of mastectomy, including
7    lymphedemas.
8Care shall be determined in consultation with the attending
9physician and the patient. The offered coverage for prosthetic
10devices and reconstructive surgery shall be subject to the
11deductible and coinsurance conditions applied to the
12mastectomy, and all other terms and conditions applicable to
13other benefits. When a mastectomy is performed and there is no
14evidence of malignancy then the offered coverage may be
15limited to the provision of prosthetic devices and
16reconstructive surgery to within 2 years after the date of the
17mastectomy. As used in this Section, "mastectomy" means the
18removal of all or part of the breast for medically necessary
19reasons, as determined by a licensed physician.
20    A county, including a home rule county, that is a
21self-insurer for purposes of providing health insurance
22coverage for its employees, may not penalize or reduce or
23limit the reimbursement of an attending provider or provide
24incentives (monetary or otherwise) to an attending provider to
25induce the provider to provide care to an insured in a manner
26inconsistent with this Section.

 

 

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1    (d-20) The requirement that mammograms be included in
2health insurance coverage as provided in subsections (d)
3through (d-15) is an exclusive power and function of the State
4and is a denial and limitation under Article VII, Section 6,
5subsection (h) of the Illinois Constitution of home rule
6county powers. A home rule county to which subsections (d)
7through (d-15) apply must comply with every provision of those
8subsections.
9    (e) The term "employees" as used in this Section includes
10elected or appointed officials but does not include temporary
11employees.
12    (f) The county board may, by ordinance, arrange to provide
13group life, health, accident, hospital, and medical insurance,
14or any one or a combination of those types of insurance, under
15this Section to retired former employees and retired former
16elected or appointed officials of the county.
17    (g) Rulemaking authority to implement this amendatory Act
18of the 95th General Assembly, if any, is conditioned on the
19rules being adopted in accordance with all provisions of the
20Illinois Administrative Procedure Act and all rules and
21procedures of the Joint Committee on Administrative Rules; any
22purported rule not so adopted, for whatever reason, is
23unauthorized.
24    (h) If a county, including a home rule county, is a
25self-insurer for purposes of providing health insurance
26coverage for its employees, the insurance coverage shall

 

 

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1include, on and after June 1, 2025, mental health counseling
2for any county employee who is a first responder without
3imposing a deductible, coinsurance, copayment, or any other
4cost-sharing requirement on the coverage provided, except that
5this subsection does not apply to the extent such coverage
6would disqualify a high-deductible health plan from
7eligibility for a health savings account pursuant to Section
8223 of the Internal Revenue Code.
9    The requirement that mental health counseling be included
10in health insurance coverage as provided in this subsection is
11an exclusive power and function of the State and is a denial
12and limitation under Article VII, Section 6, subsection (h) of
13the Illinois Constitution of home rule county powers.
14    As used in this subsection:
15    "First responders" means police and corrections officers,
16deputy sheriffs, firefighters, emergency medical services
17personnel, as that term is defined in Section 3.5 of the
18Emergency Medical Services (EMS) Systems Act, dispatched
19pursuant to a 9-1-1 call, emergency medical dispatchers, as
20that term is defined in Section 3.70 of the Emergency Medical
21Services (EMS) Systems Act, public safety telecommunicators,
22as that term is defined in Section 2 of the Emergency Telephone
23System Act, and mental health professionals employed and
24dispatched by any unit of local government in response to
25emergency crisis calls received on public emergency service
26lines instead of or in conjunction with law enforcement.

 

 

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1    "Mental health counseling" means counseling therapy
2sessions provided by a clinical social worker, professional
3counselor, or licensed psychologist.
4(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 
5    Section 10. The Illinois Municipal Code is amended by
6adding Section 10-4-2.4 as follows:
 
7    (65 ILCS 5/10-4-2.4 new)
8    Sec. 10-4-2.4. Mental health counseling.
9    (a) As used in this Section:
10    "First responders" means police and corrections officers,
11deputy sheriffs, firefighters, emergency medical services
12personnel, as that term is defined in Section 3.5 of the
13Emergency Medical Services (EMS) Systems Act, dispatched
14pursuant to a 9-1-1 call, emergency medical dispatchers, as
15that term is defined in Section 3.70 of the Emergency Medical
16Services (EMS) Systems Act, public safety telecommunicators,
17as that term is defined in Section 2 of the Emergency Telephone
18System Act, and mental health professionals employed and
19dispatched by any unit of local government in response to
20emergency crisis calls received on public emergency service
21lines instead of or in conjunction with law enforcement.
22    "Mental health counseling" means counseling therapy
23sessions provided by a clinical social worker, professional
24counselor, or licensed psychologist.

 

 

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1    (b) If a municipality, including a home rule municipality,
2is a self-insurer for purposes of providing health insurance
3coverage for its employees, the insurance coverage shall
4include, on and after June 1, 2025, mental health counseling
5for any employee who is a first responder without imposing a
6deductible, coinsurance, copayment, or any other cost-sharing
7requirement on the coverage provided, except that this Section
8does not apply to the extent such coverage would disqualify a
9high-deductible health plan from eligibility for a health
10savings account pursuant to Section 223 of the Internal
11Revenue Code.
12    (c) The requirement that mental health counseling be
13included in health insurance coverage as provided in this
14Section is an exclusive power and function of the State and is
15a denial and limitation under Article VII, Section 6,
16subsection (h) of the Illinois Constitution of home rule
17powers.".