98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB0021

 

Introduced 1/9/2013, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
215 ILCS 5/356z.22 new
305 ILCS 5/5-16.8
410 ILCS 50/2.04  from Ch. 111 1/2, par. 5402.04

    Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, Illinois Public Aid Code, and Illinois Insurance Code to provide that accident and health insurance policies and managed care plans shall cover all services ordered by a physician and provided in a hospital that are considered medically necessary. Amends the Medical Patient Rights Act. Includes limited health service organizations and voluntary health services plan in the definition of "insurance company". Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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, and 356z.17 and 356z.19, and 356z.22 of the
16Illinois Insurance Code. The program of health benefits must
17comply with Sections 155.22a, 155.37, and 356z.19 of the
18Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
396-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
497-343, eff. 1-1-12; 97-813, eff. 7-13-12.)
 
5    Section 10. The Counties Code is amended by changing
6Section 5-1069.3 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes of
10providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, and 356z.15, and 356z.22 of the Illinois Insurance
17Code. The coverage shall comply with Sections 155.22a and
18356z.19 of the Illinois Insurance Code. The requirement that
19health benefits be covered as provided in this Section is an
20exclusive power and function of the State and is a denial and
21limitation under Article VII, Section 6, subsection (h) of the
22Illinois Constitution. A home rule county to which this Section
23applies must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
796-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
897-813, eff. 7-13-12.)
 
9    Section 15. The Illinois Municipal Code is amended by
10changing Section 10-4-2.3 as follows:
 
11    (65 ILCS 5/10-4-2.3)
12    Sec. 10-4-2.3. Required health benefits. If a
13municipality, including a home rule municipality, is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, the coverage shall include coverage
16for the post-mastectomy care benefits required to be covered by
17a policy of accident and health insurance under Section 356t
18and the coverage required under Sections 356g, 356g.5,
19356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
20356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
21the Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a and 356z.19 of the Illinois Insurance Code.
23The requirement that health benefits be covered as provided in
24this is an exclusive power and function of the State and is a

 

 

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1denial and limitation under Article VII, Section 6, subsection
2(h) of the Illinois Constitution. A home rule municipality to
3which this Section applies must comply with every provision of
4this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1296-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1397-813, eff. 7-13-12.)
 
14    Section 20. The Illinois Insurance Code is amended by
15adding Section 356z.22 as follows:
 
16    (215 ILCS 5/356z.22 new)
17    Sec. 356z.22. Hospital patient assessments. A group or
18individual policy of accident and health insurance or managed
19care plan amended, delivered, issued, or renewed after the
20effective date of this amendatory Act of the 98th General
21Assembly that provides coverage for hospital care shall include
22in that coverage all services ordered by a physician and
23provided in the hospital that are considered medically
24necessary for the evaluation, assessment, and diagnosis of the

 

 

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1illness or condition that resulted in the hospital stay of the
2enrollee or recipient. The services are subject to reasonable
3review and utilization standards required by the policy or plan
4for all hospital services, as defined by the Department or its
5successor agency.
 
6    Section 25. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
14356z.22 of the Illinois Insurance Code and (ii) be subject to
15the provisions of Sections 356z.19 and 364.01 of the Illinois
16Insurance Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate of
20reimbursement for services or other payments in accordance with
21Section 5-5e.
22(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
 
23    Section 30. The Medical Patient Rights Act is amended by

 

 

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1changing Section 2.04 as follows:
 
2    (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)
3    Sec. 2.04. "Insurance company" means (1) an insurance
4company, fraternal benefit society, and any other insurer
5subject to regulation under the Illinois Insurance Code; or (2)
6a health maintenance organization, a limited health service
7organization under the Limited Health Service Organization
8Act, or a voluntary health services plan under the Voluntary
9Health Services Plans Act.
10(Source: P.A. 85-677; 85-679.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.