102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0061

 

Introduced 1/14/2021, by Rep. Terra Costa Howard

 

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.5
215 ILCS 130/4003  from Ch. 73, par. 1504-3
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. In provisions providing that a group or individual policy of accident and health insurance or managed care plan that provides coverage for prescription drugs shall not deny or limit coverage for prescription inhalants to enable persons to breathe when suffering from asthma or other life-threatening bronchial ailments based upon any restriction on the number of days before an inhaler refill may be obtained, requires coverage for prescription inhalants. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Illinois Public Aid Code to provide that health benefits under those Acts are subject to the provisions of the Illinois Insurance Code regarding prescription inhalants. Effective January 1, 2022.


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FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

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1    AN ACT concerning regulation.
 
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
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.5, 356z.8, 356z.9,
15356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
16356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
17356z.33, 356z.36, and 356z.41 of the Illinois Insurance Code.
18The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

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1by the Department of Central Management Services.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,

 

 

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1356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of the
3Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.5, 356z.6, 356z.8,
10356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
11356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
12356z.33, 356z.36, and 356z.41 of the Illinois Insurance Code.
13The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.5, 356z.6, 356z.8, 356z.9, 356z.11,
17356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
18356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of
19the Illinois Insurance Code. Insurance policies shall comply
20with Section 356z.19 of the Illinois Insurance Code. The
21coverage shall comply with Sections 155.22a, 355b, and 370c of
22the Illinois Insurance Code. The Department of Insurance shall
23enforce the requirements 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12changing Section 356z.5 as follows:
 
13    (215 ILCS 5/356z.5)
14    Sec. 356z.5. Prescription inhalants. A group or individual
15policy of accident and health insurance or managed care plan
16amended, delivered, issued, or renewed on or after the
17effective date of this amendatory Act of the 102nd General
18Assembly this amendatory Act of the 93rd General Assembly that
19provides coverage for prescription drugs must provide coverage
20for prescription inhalants and shall may not deny or limit
21coverage for prescription inhalants to enable persons to
22breathe when suffering from asthma or other life-threatening
23bronchial ailments based upon any restriction on the number of
24days before an inhaler refill may be obtained if, contrary to

 

 

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1those restrictions, the inhalants have been ordered or
2prescribed by the treating physician and are medically
3appropriate.
4(Source: P.A. 95-331, eff. 8-21-07.)
 
5    Section 30. The Limited Health Service Organization Act is
6amended by changing Section 4003 as follows:
 
7    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
8    Sec. 4003. Illinois Insurance Code provisions. Limited
9health service organizations shall be subject to the
10provisions 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, 155.37, 355.2, 355.3,
13355b, 356v, 356z.5, 356z.10, 356z.21, 356z.22, 356z.25,
14356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 368a,
15401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
16444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
17XXV, and XXVI of the Illinois Insurance Code. For purposes of
18the Illinois Insurance Code, except for Sections 444 and 444.1
19and Articles XIII and XIII 1/2, limited health service
20organizations in the following categories are deemed to be
21domestic companies:
22        (1) a corporation under the laws of this State; or
23        (2) a corporation organized under the laws of another
24    state, 30% or more of the enrollees of which are residents

 

 

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1    of this State, except a corporation subject to
2    substantially the same requirements in its state of
3    organization as is a domestic company under Article VIII
4    1/2 of the Illinois Insurance Code.
5(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
6100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
71-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
8eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
9    Section 35. 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, 356z.5, 356z.6,
17356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of
18the Illinois Insurance Code and (ii) be subject to the
19provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
20the Illinois Insurance Code.
21    The Department, by rule, shall adopt a model similar to
22the requirements of Section 356z.39 of the Illinois Insurance
23Code.
24    On and after July 1, 2012, the Department shall reduce any

 

 

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1rate of reimbursement for services or other payments or alter
2any methodologies authorized by this Code to reduce any rate
3of reimbursement for services or other payments in accordance
4with Section 5-5e.
5    To ensure full access to the benefits set forth in this
6Section, on and after January 1, 2016, the Department shall
7ensure that provider and hospital reimbursement for
8post-mastectomy care benefits required under this Section are
9no lower than the Medicare reimbursement rate.
10(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
11100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
127-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
13eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
 
14    Section 99. Effective date. This Act takes effect January
151, 2022.