093_HB1073sam001











                                     LRB093 05508 AMC 15642 a

 1                    AMENDMENT TO HOUSE BILL 1073

 2        AMENDMENT NO.     .  Amend House Bill 1073  by  replacing
 3    everything after the enacting clause with the following:

 4        "Section 3.  The Department of Insurance Law of the Civil
 5    Administrative  Code of Illinois is amended by adding Section
 6    1405-35 as follows:

 7        (20 ILCS 1405/1405-35 new)
 8        Sec. 1405-35.  Brain injury coverage study.
 9        (a)  The  Department  of  Insurance  shall   conduct   an
10    analysis  and  study  of  costs and benefits derived from the
11    implementation of the coverage requirements for treatment  of
12    brain  injuries  established  under  Section  356z.4  of  the
13    Illinois  Insurance  Code.  The  study  shall cover the years
14    2004, 2005, and 2006. The study shall include an analysis  of
15    the  effect  of  the  coverage  requirements  on  the cost of
16    insurance and health care, the results of the  treatments  to
17    patients,  any  improvements in the care of patients, and any
18    improvements in the quality of life of patients.
19        (b)  The Department shall report the results of its study
20    to the General Assembly and the Governor on or  before  March
21    1, 2007.
 
                            -2-      LRB093 05508 AMC 15642 a
 1        Section  5.  The  State  Employees Group Insurance Act of
 2    1971 is amended by changing Section 6.11 as follows:

 3        (5 ILCS 375/6.11)
 4        Sec. 6.11.  Required health benefits; Illinois  Insurance
 5    Code  requirements.   The  program  of  health benefits shall
 6    provide the post-mastectomy  care  benefits  required  to  be
 7    covered  by  a  policy of accident and health insurance under
 8    Section 356t of the Illinois Insurance Code.  The program  of
 9    health  benefits  shall  provide  the coverage required under
10    Sections 356u, 356w, 356x, and  356z.2,  and  356z.4  of  the
11    Illinois  Insurance Code. The program of health benefits must
12    comply with Section 155.37 of the Illinois Insurance Code.
13    (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03.)

14        Section 10.  The Counties Code  is  amended  by  changing
15    Section 5-1069.3 as follows:

16        (55 ILCS 5/5-1069.3)
17        Sec.  5-1069.3.  Required  health benefits.  If a county,
18    including a home rule county, is a self-insurer for  purposes
19    of providing health insurance coverage for its employees, the
20    coverage  shall include coverage for the post-mastectomy care
21    benefits required to be covered by a policy of  accident  and
22    health insurance under Section 356t and the coverage required
23    under  Sections  356u,  356w,  and  356x,  and  356z.4 of the
24    Illinois  Insurance  Code.   The  requirement   that   health
25    benefits  be  covered  as  provided  in  this  Section  is an
26    exclusive power and function of the State and is a denial and
27    limitation under Article VII, Section 6,  subsection  (h)  of
28    the  Illinois Constitution.  A home rule county to which this
29    Section applies must comply  with  every  provision  of  this
30    Section.
31    (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
 
                            -3-      LRB093 05508 AMC 15642 a
 1        Section  15.  The  Illinois  Municipal Code is amended by
 2    changing Section 10-4-2.3 as follows:

 3        (65 ILCS 5/10-4-2.3)
 4        Sec.  10-4-2.3.   Required   health   benefits.    If   a
 5    municipality,  including  a  home  rule  municipality,  is  a
 6    self-insurer  for  purposes  of  providing  health  insurance
 7    coverage  for  its  employees,  the  coverage  shall  include
 8    coverage for the post-mastectomy care benefits required to be
 9    covered  by  a  policy of accident and health insurance under
10    Section 356t and the coverage required under  Sections  356u,
11    356w,  and  356x,  and 356z.4 of the Illinois Insurance Code.
12    The requirement that health benefits be covered  as  provided
13    in  this  is an exclusive power and function of the State and
14    is a denial and limitation  under  Article  VII,  Section  6,
15    subsection  (h)  of  the  Illinois Constitution.  A home rule
16    municipality to which this Section applies must  comply  with
17    every provision of this Section.
18    (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)

19        Section  20.  The  Illinois  Insurance Code is amended by
20    changing Section 351B-5 and adding Section 356z.4 as follows:

21        (215 ILCS 5/351B-5) (from Ch. 73, par. 963B-5)
22        Sec. 351B-5.  Applicability of other Code provisions. All
23    policies of accident and health insurance issued  under  this
24    Article  shall be subject to the provisions of Sections 356c,
25    subsection (a) of Section 356g,  356h,  356n,  356z.4,  367c,
26    367d, 370, 370a, and 370e of this Code.
27    (Source: P.A. 86-1407; 87-792; 87-1066.)

28        (215 ILCS 5/356z.4 new)
29        Sec.  356z.4.  Coverage  for  certain benefits related to
30    brain injury.
 
                            -4-      LRB093 05508 AMC 15642 a
 1        (a)  A group or individual policy of accident and  health
 2    insurance,  a managed care plan, or multiple employer welfare
 3    arrangement, that is amended, delivered, issued,  or  renewed
 4    after  the  effective date of this amendatory Act of the 93rd
 5    General Assembly  may  not  exclude  coverage  for  cognitive
 6    rehabilitation   therapy,  cognitive  communication  therapy,
 7    neurocognitive therapy and  rehabilitation,  neurobehavioral,
 8    neurophysiological,          neuropsychological,          and
 9    psychophysiological   testing   or  treatment,  neurofeedback
10    therapy,  remediation,  post-acute  transition  services,  or
11    community reintegration services necessary as a result of and
12    related to an acquired brain injury.
13        (b)  Coverage required under this Section may be  subject
14    to deductibles, copayments, coinsurance, or annual or maximum
15    payment   limits   that   are  consistent  with  deductibles,
16    copayments, coinsurance, and annual or maximum payment limits
17    applicable to other similar coverage under the policy.
18        (c)  The Department shall adopt  rules  as  necessary  to
19    implement this Section.
20        (d)  This Section is inoperative after December 31, 2007.

21        Section  25.  The  Health Maintenance Organization Act is
22    amended by changing Section 4-6.5 as follows:

23        (215 ILCS 125/4-6.5)
24        Sec. 4-6.5.  Required health benefits; Illinois Insurance
25    Code requirements.   A  health  maintenance  organization  is
26    subject to the provisions of Sections 155.37, 356t, 356u, and
27    356z.1, and 356z.4 of the Illinois Insurance Code.
28    (Source:  P.A.  92-130,  eff.  7-20-01; 92-440, eff. 8-17-01;
29    92-651, eff. 7-11-02.)

30        Section 30.  The Voluntary Health Services Plans  Act  is
31    amended by changing Section 10 as follows:
 
                            -5-      LRB093 05508 AMC 15642 a
 1        (215 ILCS 165/10) (from Ch. 32, par. 604)
 2        Sec.   10.  Application  of  Insurance  Code  provisions.
 3    Health services plan corporations and all persons  interested
 4    therein   or  dealing  therewith  shall  be  subject  to  the
 5    provisions of Articles IIA and XII 1/2 and Sections 3.1, 133,
 6    140, 143, 143c, 149, 155.37, 354, 355.2,  356r,  356t,  356u,
 7    356v,  356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 367.2, 368a,
 8    401,  401.1,  402,  403,  403A,  408,  408.2,  and  412,  and
 9    paragraphs (7) and  (15)  of  Section  367  of  the  Illinois
10    Insurance Code.
11    (Source: P.A.  91-406,  eff.  1-1-00;  91-549,  eff. 8-14-99;
12    91-605, eff. 12-14-99;  91-788,  eff.  6-9-00;  92-130,  eff.
13    7-20-01;  92-440, eff. 8-17-01; 92-651, eff. 7-11-02; 92-764,
14    eff. 1-1-03.)

15        Section 90.  The State Mandates Act is amended by  adding
16    Section 8.27 as follows:

17        (30 ILCS 805/8.27 new)
18        Sec.  8.27.  Exempt  mandate.  Notwithstanding Sections 6
19    and 8 of this Act, no reimbursement by the State is  required
20    for  the  implementation  of  any  mandate  created  by  this
21    amendatory Act of the 93rd General Assembly.".