Sen. Julie A. Morrison

Filed: 4/4/2024

 

 


 

 


 
10300SB2697sam002LRB103 35895 RPS 71782 a

1
AMENDMENT TO SENATE BILL 2697

2    AMENDMENT NO. ______. Amend Senate Bill 2697, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The State Employees Group Insurance Act of
61971 is amended by changing Section 6.11 as follows:
 
7    (5 ILCS 375/6.11)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
15356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,

 

 

10300SB2697sam002- 2 -LRB103 35895 RPS 71782 a

1356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
2356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
3356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
4356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
5and 356z.70 of the Illinois Insurance Code. The program of
6health benefits must comply with Sections 155.22a, 155.37,
7355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
8Illinois Insurance Code. The program of health benefits shall
9provide the coverage required under Section 356m of the
10Illinois Insurance Code and, for the employees of the State
11Employee Group Insurance Program only, the coverage as also
12provided in Section 6.11B of this Act. The Department of
13Insurance shall enforce the requirements of this Section with
14respect to Sections 370c and 370c.1 of the Illinois Insurance
15Code; all other requirements of this Section shall be enforced
16by the Department of Central Management Services.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
251-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
26eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

 

 

10300SB2697sam002- 3 -LRB103 35895 RPS 71782 a

1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
3eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
4103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
58-11-23; revised 8-29-23.)
 
6    Section 10. The Counties Code is amended by changing
7Section 5-1069.3 as follows:
 
8    (55 ILCS 5/5-1069.3)
9    Sec. 5-1069.3. Required health benefits. If a county,
10including a home rule county, is a self-insurer for purposes
11of providing health insurance coverage for its employees, the
12coverage shall include coverage for 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, 356g.5, 356g.5-1, 356q, 356u, 356u.10,
16356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
17356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
18356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
19356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
20356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
21356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
22of the Illinois Insurance Code. The coverage shall comply with
23Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
24Insurance Code. The Department of Insurance shall enforce the

 

 

10300SB2697sam002- 4 -LRB103 35895 RPS 71782 a

1requirements of this Section. The requirement that health
2benefits be covered as provided in this Section is an
3exclusive power and function of the State and is a denial and
4limitation under Article VII, Section 6, subsection (h) of the
5Illinois Constitution. A home rule county to which this
6Section applies must comply with every provision of this
7Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
161-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
17eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
18102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
191-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
20eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
228-29-23.)
 
23    Section 15. The Illinois Municipal Code is amended by
24changing Section 10-4-2.3 as follows:
 

 

 

10300SB2697sam002- 5 -LRB103 35895 RPS 71782 a

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, 356q, 356u, 356u.10, 356w, 356x, 356z.4,
10356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
12356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
13356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
14356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
15356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.
25    Rulemaking authority to implement Public Act 95-1045, if
26any, is conditioned on the rules being adopted in accordance

 

 

10300SB2697sam002- 6 -LRB103 35895 RPS 71782 a

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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
6102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
71-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
8eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
9102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
101-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
11eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
12103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
138-29-23.)
 
14    Section 20. The School Code is amended by changing Section
1510-22.3f as follows:
 
16    (105 ILCS 5/10-22.3f)
17    Sec. 10-22.3f. Required health benefits. Insurance
18protection and benefits for employees shall provide the
19post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t and
21the coverage required under Sections 356g, 356g.5, 356g.5-1,
22356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,
23356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
24356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,

 

 

10300SB2697sam002- 7 -LRB103 35895 RPS 71782 a

1356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
3and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
4356z.70 of the Illinois Insurance Code. Insurance policies
5shall comply with Section 356z.19 of the Illinois Insurance
6Code. The coverage shall comply with Sections 155.22a, 355b,
7and 370c of the Illinois Insurance Code. The Department of
8Insurance shall enforce the requirements of this Section.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
16102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
171-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
18eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
19102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
201-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
21eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
22103-551, eff. 8-11-23; revised 8-29-23.)
 
23    Section 25. The Illinois Insurance Code is amended by
24adding Section 356u.10 as follows:
 

 

 

10300SB2697sam002- 8 -LRB103 35895 RPS 71782 a

1    (215 ILCS 5/356u.10 new)
2    Sec. 356u.10. Genetic testing and evidence-based
3screenings for an inherited gene mutation.
4    (a) In this Section, "genetic testing for an inherited
5mutation" means germline multi-gene testing for an inherited
6mutation associated with an increased risk of cancer in
7accordance with evidence-based, clinical practice guidelines.
8    (b) A group policy of accident and health insurance or
9managed care plan that is amended, delivered, issued, or
10renewed after January 1, 2026 shall provide coverage for
11clinical genetic testing for an inherited gene mutation for
12individuals with a personal or family history of cancer, as
13recommended by a health care professional in accordance with
14current evidence-based clinical practice guidelines,
15including, but not limited to, the current version of the
16National Comprehensive Cancer Network clinical practice
17guidelines. The coverage shall limit the total amount that a
18covered person is required to pay for a clinical genetic test
19under this subsection to an amount not to exceed $50, except
20for services for which cost sharing is prohibited under 42
21U.S.C. 300gg-13. This subsection (b) shall not apply to
22coverage of genetic testing to the extent such coverage would
23disqualify a high-deductible health plan from eligibility for
24a health savings account pursuant to Section 223 of the
25Internal Revenue Code.
26    (c) For individuals with a genetic test that is positive

 

 

10300SB2697sam002- 9 -LRB103 35895 RPS 71782 a

1for an inherited mutation associated with an increased risk of
2cancer, coverage required under this Section shall include any
3evidence-based screenings, as recommended by a health care
4professional in accordance with current evidence-based
5clinical practice guidelines, to the extent that the
6management recommendation is not already covered by the
7policy, except that coverage for evidence-based screenings
8under this subsection (c) may be subject to a deductible,
9coinsurance, or other cost-sharing limitation so long as the
10limitation is not greater than that required for other related
11cancer risk management benefits covered under the policy. In
12this subsection, "evidence-based cancer screenings" means
13medically recommended evidence-based screening modalities in
14accordance with current clinical practice guidelines.
 
15    Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
 
17    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
18    Sec. 5-3. Insurance Code provisions.
19    (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140,
21141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
22154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
23355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10,
24356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,

 

 

10300SB2697sam002- 10 -LRB103 35895 RPS 71782 a

1356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
2356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
3356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
4356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
5356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
6356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
7356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
8356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
9356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
10368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
11408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
12subsection (2) of Section 367, and Articles IIA, VIII 1/2,
13XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
14Illinois Insurance Code.
15    (b) For purposes of the Illinois Insurance Code, except
16for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17Health Maintenance Organizations in the following categories
18are deemed to be "domestic companies":
19        (1) a corporation authorized under the Dental Service
20    Plan Act or the Voluntary Health Services Plans Act;
21        (2) a corporation organized under the laws of this
22    State; or
23        (3) a corporation organized under the laws of another
24    state, 30% or more of the enrollees of which are residents
25    of this State, except a corporation subject to
26    substantially the same requirements in its state of

 

 

10300SB2697sam002- 11 -LRB103 35895 RPS 71782 a

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

 

 

10300SB2697sam002- 12 -LRB103 35895 RPS 71782 a

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

 

 

10300SB2697sam002- 13 -LRB103 35895 RPS 71782 a

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

 

 

10300SB2697sam002- 14 -LRB103 35895 RPS 71782 a

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

 

 

10300SB2697sam002- 15 -LRB103 35895 RPS 71782 a

1eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
2102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
31-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
4eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
5103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
66-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
7eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
8    Section 35. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
 
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Insurance Code provisions. Health
12services plan corporations and all persons interested therein
13or dealing therewith shall be subject to the provisions of
14Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
15143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
16356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v,
17356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
18356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
19356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
20356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
21356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
22356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
23356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
24401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)

 

 

10300SB2697sam002- 16 -LRB103 35895 RPS 71782 a

1and (15) of Section 367 of the Illinois Insurance 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. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
9102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
1010-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
11eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
12102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
131-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
14eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
15103-551, eff. 8-11-23; revised 8-29-23.)
 
16    Section 40. The Illinois Public Aid Code is amended by
17adding Section 5-52 as follows:
 
18    (305 ILCS 5/5-52 new)
19    Sec. 5-52. Genetic testing and evidence-based screenings
20for an inherited gene mutation.
21    (a) In this Section, "genetic testing for an inherited
22mutation" means germline multi-gene testing for an inherited
23mutation associated with an increased risk of cancer in
24accordance with evidence-based, clinical practice guidelines.

 

 

10300SB2697sam002- 17 -LRB103 35895 RPS 71782 a

1    (b) Subject to federal approval, the medical assistance
2program, after January 1, 2026, shall provide coverage for
3clinical genetic testing for an inherited gene mutation for
4individuals with a personal or family history of cancer, as
5recommended by a health care professional in accordance with
6current evidence-based clinical practice guidelines,
7including, but not limited to, the current version of the
8National Comprehensive Cancer Network clinical practice
9guidelines.
10    (c) For individuals with a genetic test that is positive
11for an inherited mutation associated with an increased risk of
12cancer, coverage required under this Section shall include any
13evidence-based screenings, as recommended by a health care
14professional in accordance with current evidence-based
15clinical practice guidelines, to the extent that the
16management recommendation is not already covered by the
17medical assistance program. In this subsection,
18"evidence-based cancer screenings" means medically recommended
19evidence-based screening modalities in accordance with current
20clinical practice guidelines.
 
21    Section 99. Effective date. This Section and Section 40
22take effect January 1, 2025.".