Sen. Laura M. Murphy

Filed: 2/22/2024

 

 


 

 


 
10300SB2672sam001LRB103 35845 RPS 69884 a

1
AMENDMENT TO SENATE BILL 2672

2    AMENDMENT NO. ______. Amend Senate Bill 2672 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 356z.71 as follows:
 
6    (215 ILCS 5/356z.71 new)
7    Sec. 356z.71. Coverage during a generic drug shortage.
8    (a) As used in this Section:
9    "Eligible prescription drug" means a prescription drug
10approved under 21 U.S.C. 355(c) that is not under patent.
11    "Generic drug" means a drug that is approved pursuant to
12an application referencing an eligible prescription drug that
13is submitted under subsection (j) of Section 505 of the
14Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(j).
15    "Unavailable" means being listed as Currently in Shortage
16or as a Discontinuation in the United States Food and Drug

 

 

10300SB2672sam001- 2 -LRB103 35845 RPS 69884 a

1Administration's Drug Shortages Database. "Unavailable" does
2not include being listed as a Resolved Shortage in the United
3States Food and Drug Administration's Drug Shortages Database.
4    (b) If a generic drug or a therapeutic equivalent is
5unavailable due to a supply issue and dosage cannot be
6adjusted, a group or individual policy of accident and health
7insurance or a managed care plan that is amended, delivered,
8issued, or renewed after January 1, 2026 shall provide
9coverage for a brand name eligible prescription drug until
10supply of the generic drug or a therapeutic equivalent is
11available.
 
12    Section 10. The Health Maintenance Organization Act is
13amended by changing Section 5-3 as follows:
 
14    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
15    Sec. 5-3. Insurance Code provisions.
16    (a) Health Maintenance Organizations shall be subject to
17the provisions of Sections 133, 134, 136, 137, 139, 140,
18141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
19154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
20355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
21356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
22356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
23356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
24356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,

 

 

10300SB2672sam001- 3 -LRB103 35845 RPS 69884 a

1356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
2356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
3356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
4356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
5356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
6356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
7368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
8408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
9subsection (2) of Section 367, and Articles IIA, VIII 1/2,
10XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
11Illinois Insurance Code.
12    (b) For purposes of the Illinois Insurance Code, except
13for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
14Health Maintenance Organizations in the following categories
15are deemed to be "domestic companies":
16        (1) a corporation authorized under the Dental Service
17    Plan Act or the Voluntary Health Services Plans Act;
18        (2) a corporation organized under the laws of this
19    State; or
20        (3) a corporation organized under the laws of another
21    state, 30% or more of the enrollees of which are residents
22    of this State, except a corporation subject to
23    substantially the same requirements in its state of
24    organization as is a "domestic company" under Article VIII
25    1/2 of the Illinois Insurance Code.
26    (c) In considering the merger, consolidation, or other

 

 

10300SB2672sam001- 4 -LRB103 35845 RPS 69884 a

1acquisition of control of a Health Maintenance Organization
2pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3        (1) the Director shall give primary consideration to
4    the continuation of benefits to enrollees and the
5    financial conditions of the acquired Health Maintenance
6    Organization after the merger, consolidation, or other
7    acquisition of control takes effect;
8        (2)(i) the criteria specified in subsection (1)(b) of
9    Section 131.8 of the Illinois Insurance Code shall not
10    apply and (ii) the Director, in making his determination
11    with respect to the merger, consolidation, or other
12    acquisition of control, need not take into account the
13    effect on competition of the merger, consolidation, or
14    other acquisition of control;
15        (3) the Director shall have the power to require the
16    following information:
17            (A) certification by an independent actuary of the
18        adequacy of the reserves of the Health Maintenance
19        Organization sought to be acquired;
20            (B) pro forma financial statements reflecting the
21        combined balance sheets of the acquiring company and
22        the Health Maintenance Organization sought to be
23        acquired as of the end of the preceding year and as of
24        a date 90 days prior to the acquisition, as well as pro
25        forma financial statements reflecting projected
26        combined operation for a period of 2 years;

 

 

10300SB2672sam001- 5 -LRB103 35845 RPS 69884 a

1            (C) a pro forma business plan detailing an
2        acquiring party's plans with respect to the operation
3        of the Health Maintenance Organization sought to be
4        acquired for a period of not less than 3 years; and
5            (D) such other information as the Director shall
6        require.
7    (d) The provisions of Article VIII 1/2 of the Illinois
8Insurance Code and this Section 5-3 shall apply to the sale by
9any health maintenance organization of greater than 10% of its
10enrollee population (including, without limitation, the health
11maintenance organization's right, title, and interest in and
12to its health care certificates).
13    (e) In considering any management contract or service
14agreement subject to Section 141.1 of the Illinois Insurance
15Code, the Director (i) shall, in addition to the criteria
16specified in Section 141.2 of the Illinois Insurance Code,
17take into account the effect of the management contract or
18service agreement on the continuation of benefits to enrollees
19and the financial condition of the health maintenance
20organization to be managed or serviced, and (ii) need not take
21into account the effect of the management contract or service
22agreement on competition.
23    (f) Except for small employer groups as defined in the
24Small Employer Rating, Renewability and Portability Health
25Insurance Act and except for medicare supplement policies as
26defined in Section 363 of the Illinois Insurance Code, a

 

 

10300SB2672sam001- 6 -LRB103 35845 RPS 69884 a

1Health Maintenance Organization may by contract agree with a
2group or other enrollment unit to effect refunds or charge
3additional premiums under the following terms and conditions:
4        (i) the amount of, and other terms and conditions with
5    respect to, the refund or additional premium are set forth
6    in the group or enrollment unit contract agreed in advance
7    of the period for which a refund is to be paid or
8    additional premium is to be charged (which period shall
9    not be less than one year); and
10        (ii) the amount of the refund or additional premium
11    shall not exceed 20% of the Health Maintenance
12    Organization's profitable or unprofitable experience with
13    respect to the group or other enrollment unit for the
14    period (and, for purposes of a refund or additional
15    premium, the profitable or unprofitable experience shall
16    be calculated taking into account a pro rata share of the
17    Health Maintenance Organization's administrative and
18    marketing expenses, but shall not include any refund to be
19    made or additional premium to be paid pursuant to this
20    subsection (f)). The Health Maintenance Organization and
21    the group or enrollment unit may agree that the profitable
22    or unprofitable experience may be calculated taking into
23    account the refund period and the immediately preceding 2
24    plan years.
25    The Health Maintenance Organization shall include a
26statement in the evidence of coverage issued to each enrollee

 

 

10300SB2672sam001- 7 -LRB103 35845 RPS 69884 a

1describing the possibility of a refund or additional premium,
2and upon request of any group or enrollment unit, provide to
3the group or enrollment unit a description of the method used
4to calculate (1) the Health Maintenance Organization's
5profitable experience with respect to the group or enrollment
6unit and the resulting refund to the group or enrollment unit
7or (2) the Health Maintenance Organization's unprofitable
8experience with respect to the group or enrollment unit and
9the resulting additional premium to be paid by the group or
10enrollment unit.
11    In no event shall the Illinois Health Maintenance
12Organization Guaranty Association be liable to pay any
13contractual obligation of an insolvent organization to pay any
14refund authorized under this Section.
15    (g) Rulemaking authority to implement Public Act 95-1045,
16if any, is conditioned on the rules being adopted in
17accordance with all provisions of the Illinois Administrative
18Procedure Act and all rules and procedures of the Joint
19Committee on Administrative Rules; any purported rule not so
20adopted, for whatever reason, is unauthorized.
21(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
22102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
231-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
24eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
25102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
261-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,

 

 

10300SB2672sam001- 8 -LRB103 35845 RPS 69884 a

1eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
2103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
36-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
4eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
5    Section 15. 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, 155.49, 355.2,
13355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
14356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
15356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
16356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
17364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
18444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
19XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
20Nothing in this Section shall require a limited health care
21plan to cover any service that is not a limited health service.
22For purposes of the Illinois Insurance Code, except for
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
24health service organizations in the following categories are

 

 

10300SB2672sam001- 9 -LRB103 35845 RPS 69884 a

1deemed to be domestic companies:
2        (1) a corporation under the laws of this State; or
3        (2) 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(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
10102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
111-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
12eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
13102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
141-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
15eff. 1-1-24; revised 8-29-23.)
 
16    Section 20. The Voluntary Health Services Plans Act is
17amended by changing Section 10 as follows:
 
18    (215 ILCS 165/10)  (from Ch. 32, par. 604)
19    Sec. 10. Application of Insurance Code provisions. Health
20services plan corporations and all persons interested therein
21or dealing therewith shall be subject to the provisions of
22Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
23143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
24356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,

 

 

10300SB2672sam001- 10 -LRB103 35845 RPS 69884 a

1356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
2356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
3356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
4356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
5356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
6356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
7356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401,
8401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
9and (15) of Section 367 of the Illinois Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
17102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
1810-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
19eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
20102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
211-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
22eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
23103-551, eff. 8-11-23; revised 8-29-23.)
 
24    Section 25. The Illinois Public Aid Code is amended by
25changing Section 5-16.8 as follows:
 

 

 

10300SB2672sam001- 11 -LRB103 35845 RPS 69884 a

1    (305 ILCS 5/5-16.8)
2    Sec. 5-16.8. Required health benefits. The medical
3assistance program shall (i) provide the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
7356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
8356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
9356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois
10Insurance Code, (ii) be subject to the provisions of Sections
11356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
12Illinois Insurance Code, and (iii) be subject to the
13provisions of subsection (d-5) of Section 10 of the Network
14Adequacy and Transparency Act.
15    The Department, by rule, shall adopt a model similar to
16the requirements of Section 356z.39 of the Illinois Insurance
17Code.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate
21of reimbursement for services or other payments in accordance
22with Section 5-5e.
23    To ensure full access to the benefits set forth in this
24Section, on and after January 1, 2016, the Department shall
25ensure that provider and hospital reimbursement for

 

 

10300SB2672sam001- 12 -LRB103 35845 RPS 69884 a

1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
4102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
51-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
6eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
7102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
81-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)".