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Public Act 095-0189


 

Public Act 0189 95TH GENERAL ASSEMBLY



 


 
Public Act 095-0189
 
HB0147 Enrolled LRB095 03747 DRJ 23776 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 1. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
 
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, and 356z.6 of the Illinois
Insurance Code. The program of health benefits must comply with
Section 155.37 of the Illinois Insurance Code.
(Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03;
93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)
 
    Section 2. The Department of Public Health Powers and
Duties Law of the Civil Administrative Code of Illinois is
amended by changing Section 2310-345 as follows:
 
    (20 ILCS 2310/2310-345)  (was 20 ILCS 2310/55.49)
    Sec. 2310-345. Breast cancer; written summary regarding
early detection and treatment.
    (a) From funds made available for this purpose, the
Department shall publish, in layman's language, a standardized
written summary outlining methods for the early detection and
diagnosis of breast cancer. The summary shall include
recommended guidelines for screening and detection of breast
cancer through the use of techniques that shall include but not
be limited to self-examination, clinical breast exams, and
diagnostic radiology.
    (b) The summary shall also suggest that women seek
mammography services from facilities that are certified to
perform mammography as required by the federal Mammography
Quality Standards Act of 1992.
    (c) The summary shall also include the medically viable
alternative methods for the treatment of breast cancer,
including, but not limited to, hormonal, radiological,
chemotherapeutic, or surgical treatments or combinations
thereof. The summary shall contain information on breast
reconstructive surgery, including, but not limited to, the use
of breast implants and their side effects. The summary shall
inform the patient of the advantages, disadvantages, risks, and
dangers of the various procedures. The summary shall include
(i) a statement that mammography is the most accurate method
for making an early detection of breast cancer, however, no
diagnostic tool is 100% effective, (ii) the benefits of
clinical breast exams, and (iii) and (ii) instructions for
instructions for performing breast self-examination and a
statement that it is important to perform a breast
self-examination monthly.
    (c-5) The summary shall specifically address the benefits
of early detection and review the clinical standard
recommendations by the Centers for Disease Control and
Prevention and the American Cancer Society for mammography,
clinical breast exams, and breast self-exams.
    (c-10) The summary shall also inform individuals that
public and private insurance providers shall pay for clinical
breast exams as part of an exam, as indicated by guidelines of
practice.
    (d) In developing the summary, the Department shall consult
with the Advisory Board of Cancer Control, the Illinois State
Medical Society and consumer groups. The summary shall be
updated by the Department every 2 years.
    (e) The summaries shall additionally be translated into
Spanish, and the Department shall conduct a public information
campaign to distribute the summaries to the Hispanic women of
this State in order to inform them of the importance of early
detection and mammograms.
    (f) The Department shall distribute the summary to
hospitals, public health centers, and physicians who are likely
to perform or order diagnostic tests for breast disease or
treat breast cancer by surgical or other medical methods. Those
hospitals, public health centers, and physicians shall make the
summaries available to the public. The Department shall also
distribute the summaries to any person, organization, or other
interested parties upon request. The summaries may be
duplicated by any person, provided the copies are identical to
the current summary prepared by the Department.
    (g) The summary shall display, on the inside of its cover,
printed in capital letters, in bold face type, the following
paragraph:
    "The information contained in this brochure regarding
recommendations for early detection and diagnosis of breast
disease and alternative breast disease treatments is only for
the purpose of assisting you, the patient, in understanding the
medical information and advice offered by your physician. This
brochure cannot serve as a substitute for the sound
professional advice of your physician. The availability of this
brochure or the information contained within is not intended to
alter, in any way, the existing physician-patient
relationship, nor the existing professional obligations of
your physician in the delivery of medical services to you, the
patient."
    (h) The summary shall be updated when necessary.
(Source: P.A. 91-239, eff. 1-1-00; revised 10-19-05.)
 
    Section 3. The Counties Code is amended by changing Section
5-1069.3 as follows:
 
    (55 ILCS 5/5-1069.3)
    Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes of
providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x and 356z.6 of the
Illinois Insurance Code. The requirement that health benefits
be covered as provided in this Section is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule county to which this Section applies
must comply with every provision of this Section.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    Section 3.5. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
 
    (65 ILCS 5/10-4-2.3)
    Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include coverage
for the post-mastectomy care benefits required to be covered by
a policy of accident and health insurance under Section 356t
and the coverage required under Sections 356g.5, 356u, 356w,
356x and 356z.6 of the Illinois Insurance Code. The requirement
that health benefits be covered as provided in this is an
exclusive power and function of the State and is a denial and
limitation under Article VII, Section 6, subsection (h) of the
Illinois Constitution. A home rule municipality to which this
Section applies must comply with every provision of this
Section.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    Section 4. The School Code is amended by changing Section
10-22.3f as follows:
 
    (105 ILCS 5/10-22.3f)
    Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g.5, 356u, 356w, 356x
and 356z.6 of the Illinois Insurance Code.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    Section 5. The Illinois Insurance Code is amended by adding
Section 356g.5 as follows:
 
    (215 ILCS 5/356g.5 new)
    Sec. 356g.5. Clinical breast exam.
    (a) The General Assembly finds that clinical breast
examinations are a critical tool in the early detection of
breast cancer, while the disease is in its earlier and
potentially more treatable stages. Insurer reimbursement of
clinical breast examinations is essential to the effort to
reduce breast cancer deaths in Illinois.
    (b) Every insurer shall provide, in each group or
individual policy, contract, or certificate of accident or
health insurance issued or renewed for persons who are
residents of Illinois, coverage for complete and thorough
clinical breast examinations as indicated by guidelines of
practice, performed by a physician licensed to practice
medicine in all its branches, an advanced practice nurse who
has a collaborative agreement with a collaborating physician
that authorizes breast examinations, or a physician assistant
who has been delegated authority to provide breast
examinations, to check for lumps and other changes for the
purpose of early detection and prevention of breast cancer as
follows:
        (1) at least every 3 years for women at least 20 years
    of age but less than 40 years of age; and
        (2) annually for women 40 years of age or older.
    (c) Upon approval of a nationally recognized separate and
distinct clinical breast exam code that is compliant with all
State and federal laws, rules, and regulations, public and
private insurance plans shall take action to cover clinical
breast exams on a separate and distinct basis.
 
    Section 10. The Health Maintenance Organization Act is
amended by changing Section 4-6.5 as follows:
 
    (215 ILCS 125/4-6.5)
    Sec. 4-6.5. Required health benefits; Illinois Insurance
Code requirements. A health maintenance organization is
subject to the provisions of Sections 155.37, 356g.5, 356t,
356u, and 356z.1 of the Illinois Insurance Code.
(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01;
92-651, eff. 7-11-02.)
 
    Section 15. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
 
    (215 ILCS 165/10)  (from Ch. 32, par. 604)
    Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v, 356w,
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 364.01,
367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
and paragraphs (7) and (15) of Section 367 of the Illinois
Insurance Code.
(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01;
92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04;
93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff.
1-1-05; revised 10-14-04.)
 
    Section 20. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
 
    (305 ILCS 5/5-16.8)
    Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
Illinois Insurance Code and (ii) be subject to the provisions
of Section 364.01 of the Illinois Insurance Code.
(Source: P.A. 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05;
revised 10-14-04.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 8/16/2007