100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB2957

 

Introduced , by Rep. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.25 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Provides that every policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of the amendatory Act that provides coverage for prescription drugs shall provide for synchronization of prescription drug refills on at least one occasion per insured per year provided that certain conditions are met. Requires insurers to provide prorated daily cost-sharing rates when necessary. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Services Organization Act, the Voluntary Health Services Plan Act, and the Illinois Public Aid Code. Effective immediately.


LRB100 05656 SMS 15673 b

 

 

A BILL FOR

 

HB2957LRB100 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

 

 

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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

 

 

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

 

 

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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;
25        (2) a corporation organized under the laws of this

 

 

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

 

 

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

 

 

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

 

 

HB2957- 11 -LRB100 05656 SMS 15673 b

1    made or additional premium to be paid pursuant to this
2    subsection (f)). The Health Maintenance Organization and
3    the group or enrollment unit may agree that the profitable
4    or unprofitable experience may be calculated taking into
5    account the refund period and the immediately preceding 2
6    plan years.
7    The Health Maintenance Organization shall include a
8statement in the evidence of coverage issued to each enrollee
9describing the possibility of a refund or additional premium,
10and upon request of any group or enrollment unit, provide to
11the group or enrollment unit a description of the method used
12to calculate (1) the Health Maintenance Organization's
13profitable experience with respect to the group or enrollment
14unit and the resulting refund to the group or enrollment unit
15or (2) the Health Maintenance Organization's unprofitable
16experience with respect to the group or enrollment unit and the
17resulting additional premium to be paid by the group or
18enrollment unit.
19    In no event shall the Illinois Health Maintenance
20Organization Guaranty Association be liable to pay any
21contractual obligation of an insolvent organization to pay any
22refund authorized under this Section.
23    (g) Rulemaking authority to implement Public Act 95-1045,
24if any, is conditioned on the rules being adopted in accordance
25with all provisions of the Illinois Administrative Procedure
26Act and all rules and procedures of the Joint Committee on

 

 

HB2957- 12 -LRB100 05656 SMS 15673 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
4eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
5eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
698-1091, eff. 1-1-15.)
 
7    (Text of Section after amendment by P.A. 99-761)
8    Sec. 5-3. Insurance Code provisions.
9    (a) Health Maintenance Organizations shall be subject to
10the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
11141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
12154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
13355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
14356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
15356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
16356z.22, 356z.25, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
17368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
18403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
19subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
20XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
21Insurance Code.
22    (b) For purposes of the Illinois Insurance Code, except for
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
24Maintenance Organizations in the following categories are
25deemed to be "domestic companies":

 

 

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

 

 

HB2957- 14 -LRB100 05656 SMS 15673 b

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

 

 

HB2957- 15 -LRB100 05656 SMS 15673 b

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

 

 

HB2957- 16 -LRB100 05656 SMS 15673 b

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

 

 

HB2957- 17 -LRB100 05656 SMS 15673 b

1if any, 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;
799-761, eff. 1-1-18.)
 
8    Section 35. The Limited Health Service Organization Act is
9amended by changing Section 4003 as follows:
 
10    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
11    Sec. 4003. Illinois Insurance Code provisions. Limited
12health service organizations shall be subject to the provisions
13of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
14143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
15154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
16356z.10, 356z.21, 356z.22, 356z.25, 368a, 401, 401.1, 402, 403,
17403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
18VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
19Illinois Insurance Code. For purposes of the Illinois Insurance
20Code, except for Sections 444 and 444.1 and Articles XIII and
21XIII 1/2, limited health service organizations in the following
22categories are deemed to be domestic companies:
23        (1) a corporation under the laws of this State; or
24        (2) a corporation organized under the laws of another

 

 

HB2957- 18 -LRB100 05656 SMS 15673 b

1    state, 30% or of more of the enrollees of which are
2    residents of this State, except a corporation subject to
3    substantially the same requirements in its state of
4    organization as is a domestic company under Article VIII
5    1/2 of the Illinois Insurance Code.
6(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
71-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
8eff. 1-1-15; revised 10-5-16.)
 
9    Section 40. The Voluntary Health Services Plans Act is
10amended by changing Section 10 as follows:
 
11    (215 ILCS 165/10)  (from Ch. 32, par. 604)
12    Sec. 10. Application of Insurance Code provisions. Health
13services plan corporations and all persons interested therein
14or dealing therewith shall be subject to the provisions of
15Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
16143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
17356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
18356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
19356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
20356z.19, 356z.21, 356z.22, 356z.25, 364.01, 367.2, 368a, 401,
21401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
22and (15) of Section 367 of the Illinois Insurance Code.
23    Rulemaking authority to implement Public Act 95-1045, if
24any, is conditioned on the rules being adopted in accordance

 

 

HB2957- 19 -LRB100 05656 SMS 15673 b

1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
6eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
7eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
8    Section 45. The Illinois Public Aid Code is amended by
9changing Section 5-16.8 as follows:
 
10    (305 ILCS 5/5-16.8)
11    Sec. 5-16.8. Required health benefits. The medical
12assistance program shall (i) provide the post-mastectomy care
13benefits required to be covered by a policy of accident and
14health insurance under Section 356t and the coverage required
15under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
16356z.25 of the Illinois Insurance Code and (ii) be subject to
17the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
18the Illinois Insurance Code.
19    On and after July 1, 2012, the Department shall reduce any
20rate of reimbursement for services or other payments or alter
21any methodologies authorized by this Code to reduce any rate of
22reimbursement for services or other payments in accordance with
23Section 5-5e.
24    To ensure full access to the benefits set forth in this

 

 

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1Section, on and after January 1, 2016, the Department shall
2ensure that provider and hospital reimbursement for
3post-mastectomy care benefits required under this Section are
4no lower than the Medicare reimbursement rate.
5(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
699-642, eff. 7-28-16.)
 
7    Section 95. No acceleration or delay. Where this Act makes
8changes in a statute that is represented in this Act by text
9that is not yet or no longer in effect (for example, a Section
10represented by multiple versions), the use of that text does
11not accelerate or delay the taking effect of (i) the changes
12made by this Act or (ii) provisions derived from any other
13Public Act.
 
14    Section 99. Effective date. This Act takes effect upon
15becoming law.