Illinois General Assembly - Full Text of HB2957
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Full Text of HB2957  100th General Assembly

HB2957enr 100TH GENERAL ASSEMBLY

  
  
  

 


 
HB2957 EnrolledLRB100 05656 SMS 15673 b

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, 356z.17, and 356z.22, and 356z.25 of the
16Illinois Insurance Code. The program of health benefits must
17comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
18370c.1 of the Illinois 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

 

 

HB2957 Enrolled- 2 -LRB100 05656 SMS 15673 b

1whatever reason, is unauthorized.
2(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
399-480, eff. 9-9-15.)
 
4    Section 10. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes of
9providing health insurance coverage for its employees, the
10coverage shall include coverage for 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, 356g.5, 356g.5-1, 356u, 356w, 356x,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.22, and 356z.25 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The requirement that health benefits be covered as
19provided in this Section is an exclusive power and function of
20the State and is a denial and limitation under Article VII,
21Section 6, subsection (h) of the Illinois Constitution. A home
22rule county to which this Section applies must comply with
23every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB2957 Enrolled- 3 -LRB100 05656 SMS 15673 b

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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
799-480, eff. 9-9-15.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include coverage
15for the post-mastectomy care benefits required to be covered by
16a policy of accident and health insurance under Section 356t
17and the coverage required under Sections 356g, 356g.5,
18356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22, and
20356z.25 of the Illinois Insurance Code. The coverage shall
21comply with Sections 155.22a, 355b, 356z.19, and 370c of the
22Illinois Insurance Code. The requirement that health benefits
23be covered as provided in this is an exclusive power and
24function of the State and is a denial and limitation under

 

 

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1Article VII, Section 6, subsection (h) of the Illinois
2Constitution. A home rule municipality to which this Section
3applies must comply with every provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1199-480, eff. 9-9-15.)
 
12    Section 20. The School Code is amended by changing Section
1310-22.3f as follows:
 
14    (105 ILCS 5/10-22.3f)
15    Sec. 10-22.3f. Required health benefits. Insurance
16protection and benefits for employees shall provide the
17post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t and
19the coverage required under Sections 356g, 356g.5, 356g.5-1,
20356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
21356z.13, 356z.14, 356z.15, and 356z.22, and 356z.25 of the
22Illinois Insurance Code. Insurance policies shall comply with
23Section 356z.19 of the Illinois Insurance Code. The coverage
24shall comply with Sections 155.22a and 355b of the Illinois

 

 

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1Insurance Code.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
9eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
10    Section 25. The Illinois Insurance Code is amended by
11adding Section 356z.25 as follows:
 
12    (215 ILCS 5/356z.25 new)
13    Sec. 356z.25. Synchronization.
14    (a) As used in this Section, "synchronization" means the
15coordination of medication refills for a patient taking 2 or
16more medications for one or more chronic conditions such that
17the patient's medications are refilled on the same schedule for
18a given time period.
19    (b) Every policy of health and accident insurance amended,
20delivered, issued, or renewed after the effective date of this
21amendatory Act of the 100th General Assembly that provides
22coverage for prescription drugs shall provide for
23synchronization of prescription drug refills on at least one
24occasion per insured per year, provided all of the following

 

 

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1conditions are met:
2        (1) the prescription drugs are covered by the policy's
3    clinical coverage policy or have been approved by a
4    formulary exceptions process;
5        (2) the prescription drugs are maintenance medications
6    as defined by the policy and have available refill
7    quantities at the time of synchronization;
8        (3) the medications are not Schedule II, III, or IV
9    controlled substances;
10        (4) the insured meets all utilization management
11    criteria specific to the prescription drugs at the time of
12    synchronization;
13        (5) the prescription drugs are of a formulation that
14    can be safely split into short-fill periods to achieve
15    synchronization; and
16        (6) the prescription drugs do not have special handling
17    or sourcing needs as determined by the policy, contract, or
18    agreement that require a single, designated pharmacy to
19    fill or refill the prescription.
20    (c) When necessary to permit synchronization, the policy
21shall apply a prorated daily cost-sharing rate to any
22medication dispensed by a network pharmacy pursuant to this
23Section. No dispensing fees shall be prorated, and all
24dispensing fees shall be based on the number of prescriptions
25filled or refilled.
26    
 

 

 

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1    Section 30. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    (Text of Section before amendment by P.A. 99-761)
5    Sec. 5-3. Insurance Code provisions.
6    (a) Health Maintenance Organizations shall be subject to
7the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
8141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
9154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
10355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
13356z.22, 356z.25, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
14368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
15408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
16subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
17XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
18Insurance Code.
19    (b) For purposes of the Illinois Insurance Code, except for
20Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
21Maintenance Organizations in the following categories are
22deemed to be "domestic companies":
23        (1) a corporation authorized under the Dental Service
24    Plan Act or the Voluntary Health Services Plans Act;

 

 

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

 

 

HB2957 Enrolled- 9 -LRB100 05656 SMS 15673 b

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

 

 

HB2957 Enrolled- 10 -LRB100 05656 SMS 15673 b

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

 

 

HB2957 Enrolled- 11 -LRB100 05656 SMS 15673 b

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

 

 

HB2957 Enrolled- 12 -LRB100 05656 SMS 15673 b

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
5eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
6eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
798-1091, eff. 1-1-15.)
 
8    (Text of Section after amendment by P.A. 99-761)
9    Sec. 5-3. Insurance Code provisions.
10    (a) Health Maintenance Organizations shall be subject to
11the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
12141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
13154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
14355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
15356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
16356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
17356z.22, 356z.25, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
18368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
19403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
20subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
21XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
22Insurance Code.
23    (b) For purposes of the Illinois Insurance Code, except for
24Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
25Maintenance Organizations in the following categories are

 

 

HB2957 Enrolled- 13 -LRB100 05656 SMS 15673 b

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

 

 

HB2957 Enrolled- 14 -LRB100 05656 SMS 15673 b

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

 

 

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

 

 

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

 

 

HB2957 Enrolled- 17 -LRB100 05656 SMS 15673 b

1    (g) Rulemaking authority to implement Public Act 95-1045,
2if any, 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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
899-761, eff. 1-1-18.)
 
9    Section 35. The Limited Health Service Organization Act is
10amended by changing Section 4003 as follows:
 
11    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
12    Sec. 4003. Illinois Insurance Code provisions. Limited
13health service organizations shall be subject to the provisions
14of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
15143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
16154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
17356z.10, 356z.21, 356z.22, 356z.25, 368a, 401, 401.1, 402, 403,
18403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
19VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
20Illinois Insurance Code. For purposes of the Illinois Insurance
21Code, except for Sections 444 and 444.1 and Articles XIII and
22XIII 1/2, limited health service organizations in the following
23categories are deemed to be domestic companies:
24        (1) a corporation under the laws of this State; or

 

 

HB2957 Enrolled- 18 -LRB100 05656 SMS 15673 b

1        (2) a corporation organized under the laws of another
2    state, 30% or of more of the enrollees of which are
3    residents of this State, except a corporation subject to
4    substantially the same requirements in its state of
5    organization as is a domestic company under Article VIII
6    1/2 of the Illinois Insurance Code.
7(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
81-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
9eff. 1-1-15; revised 10-5-16.)
 
10    Section 40. The Voluntary Health Services Plans Act is
11amended by changing Section 10 as follows:
 
12    (215 ILCS 165/10)  (from Ch. 32, par. 604)
13    Sec. 10. Application of Insurance Code provisions. Health
14services plan corporations and all persons interested therein
15or dealing therewith shall be subject to the provisions of
16Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
17143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
18356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
19356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
20356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
21356z.19, 356z.21, 356z.22, 356z.25, 364.01, 367.2, 368a, 401,
22401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
23and (15) of Section 367 of the Illinois Insurance Code.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB2957 Enrolled- 19 -LRB100 05656 SMS 15673 b

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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
7eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
8eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
9    Section 45. The Illinois Public Aid Code is amended by
10changing Section 5-16.8 as follows:
 
11    (305 ILCS 5/5-16.8)
12    Sec. 5-16.8. Required health benefits. The medical
13assistance program shall (i) provide the post-mastectomy care
14benefits required to be covered by a policy of accident and
15health insurance under Section 356t and the coverage required
16under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
17356z.25 of the Illinois Insurance Code and (ii) be subject to
18the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
19the Illinois Insurance Code.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate of
23reimbursement for services or other payments in accordance with
24Section 5-5e.

 

 

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1    To ensure full access to the benefits set forth in this
2Section, on and after January 1, 2016, the Department shall
3ensure that provider and hospital reimbursement for
4post-mastectomy care benefits required under this Section are
5no lower than the Medicare reimbursement rate.
6(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
799-642, eff. 7-28-16.)
 
8    Section 95. No acceleration or delay. Where this Act makes
9changes in a statute that is represented in this Act by text
10that is not yet or no longer in effect (for example, a Section
11represented by multiple versions), the use of that text does
12not accelerate or delay the taking effect of (i) the changes
13made by this Act or (ii) provisions derived from any other
14Public Act.
 
15    Section 99. Effective date. This Act takes effect upon
16becoming law.