SB3599 EngrossedLRB103 37134 RPS 67253 b

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, 356q, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
19and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
20and 356z.71 of the Illinois Insurance Code. The program of
21health benefits must comply with Sections 155.22a, 155.37,
22355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
23Illinois Insurance Code. The program of health benefits shall

 

 

SB3599 Engrossed- 2 -LRB103 37134 RPS 67253 b

1provide the coverage required under Section 356m of the
2Illinois Insurance Code and, for the employees of the State
3Employee Group Insurance Program only, the coverage as also
4provided in Section 6.11B of this Act. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
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; 102-768,
18eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
19102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
201-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
21eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
22103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
238-11-23; revised 8-29-23.)
 
24    Section 10. The Counties Code is amended by changing
25Section 5-1069.3 as follows:
 

 

 

SB3599 Engrossed- 3 -LRB103 37134 RPS 67253 b

1    (55 ILCS 5/5-1069.3)
2    Sec. 5-1069.3. Required health benefits. If a county,
3including a home rule county, is a self-insurer for purposes
4of providing health insurance coverage for its employees, the
5coverage shall include coverage for the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
9356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
10356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
11356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
12356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
13356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and
14356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of
15the Illinois Insurance Code. The coverage shall comply with
16Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
17Insurance Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this Section is an
20exclusive power and function of the State and is a denial and
21limitation under Article VII, Section 6, subsection (h) of the
22Illinois Constitution. A home rule county to which this
23Section applies must comply with every provision of this
24Section.
25    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB3599 Engrossed- 4 -LRB103 37134 RPS 67253 b

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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
81-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
9eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
10102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
111-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
12eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
13103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
148-29-23.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include
22coverage for the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t and the coverage required under Sections 356g,

 

 

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1356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
2356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
3356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
4356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
5356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
6356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
7356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
8Illinois Insurance Code. The coverage shall comply with
9Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
10Insurance Code. The Department of Insurance shall enforce the
11requirements of this Section. The requirement that health
12benefits be covered as provided in this is an exclusive power
13and function of the State and is a denial and limitation under
14Article VII, Section 6, subsection (h) of the Illinois
15Constitution. A home rule municipality to which this Section
16applies must comply with every provision of this Section.
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; 102-443, eff.
251-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
26eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

 

 

SB3599 Engrossed- 6 -LRB103 37134 RPS 67253 b

1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
3eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
58-29-23.)
 
6    Section 20. The School Code is amended by changing Section
710-22.3f as follows:
 
8    (105 ILCS 5/10-22.3f)
9    Sec. 10-22.3f. Required health benefits. Insurance
10protection and benefits for employees shall provide the
11post-mastectomy care benefits required to be covered by a
12policy of accident and health insurance under Section 356t and
13the coverage required under Sections 356g, 356g.5, 356g.5-1,
14356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
15356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
19356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
20356z.71 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

 

 

SB3599 Engrossed- 7 -LRB103 37134 RPS 67253 b

1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
91-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
10eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
11102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
121-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
13eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
14103-551, eff. 8-11-23; revised 8-29-23.)
 
15    Section 25. The Illinois Insurance Code is amended by
16adding Section 356z.71 as follows:
 
17    (215 ILCS 5/356z.71 new)
18    Sec. 356z.71. Coverage for mobile integrated health care
19services.
20    (a) In this Section:
21    "Eligible recipient" means an individual who has received
22hospital emergency department services 3 or more times in a
23period of 4 consecutive months in the past 12 months or an
24individual who has been identified by a health care provider

 

 

SB3599 Engrossed- 8 -LRB103 37134 RPS 67253 b

1as an individual for whom mobile integrated health care
2services would likely prevent admission or readmission to or
3would allow discharge from a hospital, behavioral health
4facility, acute care facility, or nursing facility.
5    "Mobile integrated health care services" means medically
6necessary health services provided on-site by emergency
7medical services personnel, as defined in Section 5 of the
8Emergency Medical Services (EMS) Systems Act.
9    "Mobile integrated health care services" includes health
10assessment, chronic disease monitoring and education,
11medication compliance, immunizations and vaccinations,
12laboratory specimen collection, hospital discharge follow-up
13care, and minor medical procedures as approved by the
14applicable EMS Medical Director.
15    "Mobile integrated health care services" does not include
16nonemergency ambulance transport.
17    (b) A group or individual policy of accident and health
18insurance or a managed care plan that is amended, delivered,
19issued, or renewed on or after January 1, 2026, shall provide
20coverage to an eligible recipient for medically necessary
21mobile integrated health care services.
 
22    Section 30. The Health Maintenance Organization Act is
23amended by changing Section 5-3 as follows:
 
24    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)

 

 

SB3599 Engrossed- 9 -LRB103 37134 RPS 67253 b

1    Sec. 5-3. Insurance Code provisions.
2    (a) Health Maintenance Organizations shall be subject to
3the provisions of Sections 133, 134, 136, 137, 139, 140,
4141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
5154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
6355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
7356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
8356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
9356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
10356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
11356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
12356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
13356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
14356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
15356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
16356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
17368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
18408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
19subsection (2) of Section 367, and Articles IIA, VIII 1/2,
20XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
21Illinois Insurance Code.
22    (b) For purposes of the Illinois Insurance Code, except
23for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
24Health Maintenance Organizations in the following categories
25are deemed to be "domestic companies":
26        (1) a corporation authorized under the Dental Service

 

 

SB3599 Engrossed- 10 -LRB103 37134 RPS 67253 b

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

 

 

SB3599 Engrossed- 11 -LRB103 37134 RPS 67253 b

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

 

 

SB3599 Engrossed- 12 -LRB103 37134 RPS 67253 b

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

 

 

SB3599 Engrossed- 13 -LRB103 37134 RPS 67253 b

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

 

 

SB3599 Engrossed- 14 -LRB103 37134 RPS 67253 b

1accordance with all provisions of the Illinois Administrative
2Procedure Act and all rules and procedures of the Joint
3Committee on Administrative Rules; any purported rule not so
4adopted, for whatever reason, is unauthorized.
5(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
6102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
71-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
8eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
9102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
101-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
11eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
12103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
136-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
14eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
15    Section 35. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
23355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
24356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,

 

 

SB3599 Engrossed- 15 -LRB103 37134 RPS 67253 b

1356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
2356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
3364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
4444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
5XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
6Nothing in this Section shall require a limited health care
7plan to cover any service that is not a limited health service.
8For purposes of the Illinois Insurance Code, except for
9Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
10health service organizations in the following categories are
11deemed to be domestic companies:
12        (1) a corporation under the laws of this State; or
13        (2) a corporation organized under the laws of another
14    state, 30% or more of the enrollees of which are residents
15    of this State, except a corporation subject to
16    substantially the same requirements in its state of
17    organization as is a domestic company under Article VIII
18    1/2 of the Illinois Insurance Code.
19(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
211-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
22eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
23102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
241-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25eff. 1-1-24; revised 8-29-23.)
 

 

 

SB3599 Engrossed- 16 -LRB103 37134 RPS 67253 b

1    Section 40. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
10356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
13356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
14356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
15356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
16356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401,
17401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18and (15) of Section 367 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
24whatever reason, is unauthorized.
25(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

 

 

SB3599 Engrossed- 17 -LRB103 37134 RPS 67253 b

1102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
3eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
4102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
51-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
6eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7103-551, eff. 8-11-23; revised 8-29-23.)
 
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, 356q, 356u, 356w, 356x, 356z.6,
16356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
17356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
18356z.61, 356z.64, 356z.67, and 356z.71, of the Illinois
19Insurance Code, (ii) be subject to the provisions of Sections
20356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
21Illinois Insurance Code, and (iii) be subject to the
22provisions of subsection (d-5) of Section 10 of the Network
23Adequacy and Transparency Act.
24    The Department, by rule, shall adopt a model similar to

 

 

SB3599 Engrossed- 18 -LRB103 37134 RPS 67253 b

1the requirements of Section 356z.39 of the Illinois Insurance
2Code.
3    On and after July 1, 2012, the Department shall reduce any
4rate of reimbursement for services or other payments or alter
5any methodologies authorized by this Code to reduce any rate
6of reimbursement for services or other payments in accordance
7with Section 5-5e.
8    To ensure full access to the benefits set forth in this
9Section, on and after January 1, 2016, the Department shall
10ensure that provider and hospital reimbursement for
11post-mastectomy care benefits required under this Section are
12no lower than the Medicare reimbursement rate.
13(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
151-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
16eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
181-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)