97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB2065

 

Introduced 2/22/2011, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
215 ILCS 5/356z.19 new
305 ILCS 5/5-16.8
410 ILCS 50/2.04  from Ch. 111 1/2, par. 5402.04
410 ILCS 50/5
410 ILCS 50/5.1 new
410 ILCS 50/5.2 new

    Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, Illinois Public Aid Code, and Illinois Insurance Code to provide that accident and health insurance policies and managed care plans shall cover all services ordered by a physician and provided in a hospital that are considered medically necessary. Amends the Medical Patient Rights Act. Includes limited health service organizations and voluntary health services plan in the definition of "insurance company". In the provision concerning statement of hospital patient's rights, provides that the statement shall include the right not to be discriminated against by the hospital due to the patient's race, color, or national origin. Sets forth provisions concerning discrimination grievance procedures and emergency room antidiscrimination notices. Effective immediately.


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A BILL FOR

 

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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, and 356z.17, and 356z.19 of the Illinois
16Insurance Code. The program of health benefits must comply with
17Section 155.37 of the Illinois Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.

 

 

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1(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
295-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
36-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
4eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
596-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
696-1000, eff. 7-2-10.)
 
7    Section 10. The Counties Code is amended by changing
8Section 5-1069.3 as follows:
 
9    (55 ILCS 5/5-1069.3)
10    Sec. 5-1069.3. Required health benefits. If a county,
11including a home rule county, is a self-insurer for purposes of
12providing health insurance coverage for its employees, the
13coverage shall include coverage for 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, 356g.5, 356g.5-1, 356u, 356w, 356x,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, and 356z.15, and 356z.19 of the Illinois Insurance
19Code. The requirement that health benefits be covered as
20provided in this Section is an exclusive power and function of
21the State and is a denial and limitation under Article VII,
22Section 6, subsection (h) of the Illinois Constitution. A home
23rule county to which this Section applies must comply with
24every provision of this Section.

 

 

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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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
895-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
96-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
10eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1196-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
12    Section 15. The Illinois Municipal Code is amended by
13changing Section 10-4-2.3 as follows:
 
14    (65 ILCS 5/10-4-2.3)
15    Sec. 10-4-2.3. Required health benefits. If a
16municipality, including a home rule municipality, is a
17self-insurer for purposes of providing health insurance
18coverage for its employees, the coverage shall include coverage
19for the post-mastectomy care benefits required to be covered by
20a policy of accident and health insurance under Section 356t
21and the coverage required under Sections 356g, 356g.5,
22356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
23356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.19 of
24the Illinois Insurance Code. The requirement that health

 

 

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1benefits be covered as provided in this is an exclusive power
2and function of the State and is a denial and limitation under
3Article VII, Section 6, subsection (h) of the Illinois
4Constitution. A home rule municipality to which this Section
5applies must comply with every provision of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1395-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
146-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
15eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1696-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
17    Section 20. The Illinois Insurance Code is amended by
18adding Section 356z.19 as follows:
 
19    (215 ILCS 5/356z.19 new)
20    Sec. 356z.19. Hospital patient assessments. A group or
21individual policy of accident and health insurance or managed
22care plan amended, delivered, issued, or renewed after the
23effective date of this amendatory Act of the 97th General
24Assembly that provides coverage for hospital care shall include

 

 

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1in that coverage all services ordered by a physician and
2provided in the hospital that are considered medically
3necessary for the evaluation, assessment, and diagnosis of the
4illness or condition that resulted in the hospital stay of the
5enrollee or recipient. The services are subject to reasonable
6review and utilization standards required by the policy or plan
7for all hospital services, as defined by the Department or its
8successor agency.
 
9    Section 25. 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, and 356z.6, and
17356z.19 of the Illinois Insurance Code and (ii) be subject to
18the provisions of Section 364.01 of the Illinois Insurance
19Code.
20(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
21    Section 30. The Medical Patient Rights Act is amended by
22changing Sections 2.04 and 5 and adding Sections 5.1 and 5.2 as
23follows:
 

 

 

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1    (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)
2    Sec. 2.04. "Insurance company" means (1) an insurance
3company, fraternal benefit society, and any other insurer
4subject to regulation under the Illinois Insurance Code; or (2)
5a health maintenance organization, a limited health service
6organization under the Limited Health Service Organization
7Act, or a voluntary health services plan under the Voluntary
8Health Services Plans Act.
9(Source: P.A. 85-677; 85-679.)
 
10    (410 ILCS 50/5)
11    Sec. 5. Statement of hospital patient's rights.
12    (a) Each patient admitted to a hospital, and the guardian
13or authorized representative or parent of a minor patient,
14shall be given a written statement of all the rights enumerated
15in this Act, or a similar statement of patients' rights
16required of the hospital by the Joint Commission on
17Accreditation of Healthcare Organizations or a similar
18accrediting organization. The statement shall be given at the
19time of admission or as soon thereafter as the condition of the
20patient permits.
21    (b) If a patient is unable to read the written statement, a
22hospital shall make a reasonable effort to provide it to the
23guardian or authorized representative of the patient.
24    (c) The statement shall also include the right not to be

 

 

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1discriminated against by the hospital due to the patient's
2race, color, or national origin where such characteristics are
3not relevant to the patient's medical diagnosis and treatment.
4The statement shall further provide each admitted patient or
5the patient's representative or guardian with notice of how to
6initiate a grievance regarding improper discrimination with
7the hospital and how the patient may lodge a grievance with the
8Department of Public Health regardless of whether the patient
9has first used the hospital's grievance process.
10(Source: P.A. 88-56; 88-670, eff. 12-2-94.)
 
11    (410 ILCS 50/5.1 new)
12    Sec. 5.1. Discrimination grievance procedures. Upon
13receipt of a grievance alleging unlawful discrimination on the
14basis of race, color, or national origin, the hospital must
15investigate the claim and work with the patient to address
16valid or proven concerns in accordance with the hospital's
17grievance process. At the conclusion of the hospital's
18grievance process, the hospital shall inform the patient that
19such grievances may be reported to the Department of Public
20Health if not resolved to the patient's satisfaction at the
21hospital level.
 
22    (410 ILCS 50/5.2 new)
23    Sec. 5.2. Emergency room antidiscrimination notice. Every
24hospital shall post a sign next to or in close proximity of its

 

 

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1sign required by Section 489.20 (q)(1) of Title 42 of the Code
2of Federal Regulations stating the following:
3        "You have the right not to be discriminated against by
4    the hospital due to your race, color, or national origin if
5    these characteristics are unrelated to your diagnosis or
6    treatment. If you believe this right has been violated,
7    please call (insert number for hospital grievance
8    officer).".
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.