Rep. Mary E. Flowers

Filed: 3/19/2014

 

 


 

 


 
09800HB4335ham001LRB098 17245 RPM 57117 a

1
AMENDMENT TO HOUSE BILL 4335

2    AMENDMENT NO. ______. Amend House Bill 4335 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, and 356z.17, and 356z.22 of the Illinois
16Insurance Code. The program of health benefits must comply with

 

 

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1Sections 155.22a, 155.37, 355b, and 356z.19 of the Illinois
2Insurance 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
10eff. 7-13-12; 98-189, eff. 1-1-14.)
 
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, and 356z.15, and 356z.22 of the Illinois Insurance
23Code. The coverage shall comply with Sections 155.22a, 355b,
24and 356z.19 of the Illinois Insurance Code. The requirement

 

 

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1that health benefits be covered as provided in this Section is
2an exclusive power and function of the State and is a denial
3and limitation under Article VII, Section 6, subsection (h) of
4the Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
14eff. 7-13-12; 98-189, eff. 1-1-14.)
 
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, and 356z.15, and 356z.22 of
3the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, and 356z.19 of the Illinois Insurance
5Code. The requirement that health benefits be covered as
6provided in this is an exclusive power and function of the
7State and is a denial and limitation under Article VII, Section
86, subsection (h) of the Illinois Constitution. A home rule
9municipality to which this Section applies must comply with
10every 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
18eff. 7-13-12; 98-189, eff. 1-1-14.)
 
19    Section 20. The Illinois Insurance Code is amended by
20adding Section 356z.22 as follows:
 
21    (215 ILCS 5/356z.22 new)
22    Sec. 356z.22. Hospital patient assessments. A group or
23individual policy of accident and health insurance or managed
24care plan amended, delivered, issued, or renewed after the

 

 

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1effective date of this amendatory Act of the 98th General
2Assembly that provides coverage for hospital care shall include
3in that coverage all services ordered by a physician and
4provided in the hospital that are considered medically
5necessary for the evaluation, assessment, and diagnosis of the
6illness or condition that resulted in the hospital stay of the
7enrollee or recipient. The services are subject to reasonable
8review and utilization standards required by the policy or plan
9for all hospital services, as defined by the Department or its
10successor agency.
 
11    Section 25. The Illinois Public Aid Code is amended by
12changing Section 5-16.8 as follows:
 
13    (305 ILCS 5/5-16.8)
14    Sec. 5-16.8. Required health benefits. The medical
15assistance program shall (i) provide the post-mastectomy care
16benefits required to be covered by a policy of accident and
17health insurance under Section 356t and the coverage required
18under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
19356z.22 of the Illinois Insurance Code and (ii) be subject to
20the provisions of Sections 356z.19 and 364.01 of the Illinois
21Insurance Code.
22    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate of

 

 

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1reimbursement for services or other payments in accordance with
2Section 5-5e.
3(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
 
4    Section 30. The Medical Patient Rights Act is amended by
5changing Section 2.04 and adding Section 5.3 as follows:
 
6    (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)
7    Sec. 2.04. "Insurance company" means (1) an insurance
8company, fraternal benefit society, and any other insurer
9subject to regulation under the Illinois Insurance Code; or (2)
10a health maintenance organization, a limited health service
11organization under the Limited Health Service Organization
12Act, or a voluntary health services plan under the Voluntary
13Health Services Plans Act.
14(Source: P.A. 85-677; 85-679.)
 
15    (410 ILCS 50/5.3 new)
16    Sec. 5.3. Patient notice of observation services.
17    (a) Every general hospital shall provide patients who are
18placed into observation services by the general hospital with
19an oral and written notice within 24 hours after placement that
20the patient is not admitted to the hospital and is under
21observation status. The written notice shall be signed by the
22patient or the patient's legal representative to acknowledge
23receipt and shall include, but not be limited to, the following

 

 

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1information:
2        (1) a statement that observation status may affect the
3    patient's Medicare, Medicaid, and private insurance
4    coverage for the current hospital services, including
5    medications and other pharmaceutical supplies, as well as
6    coverage for any subsequent discharge to a skilled nursing
7    facility or home and community based care; and
8        (2) that the patient should contact his or her
9    insurance plan to better understand the implications of
10    being placed in observation status.
11    (b) The Director of Public Health shall develop and make
12available guidance on the notice as described in this Section.
13    (c) The Director of Public Health shall direct the Long
14Term Care Advisory Committee and appropriate Department staff
15involved in regulating hospitals and nursing homes to
16investigate strategies for reducing the number of observation
17stays that extend past 48 hours, including exploring
18provisional and retroactive admissions. The Long Term Care
19Advisory Committee shall report to the Director, the Governor,
20the President of the Senate, and the Speaker of the House no
21later than 180 days after the effective date of this amendatory
22Act of the 98th General Assembly.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".