SB0661 EngrossedLRB099 05873 JLK 25921 b

1    AN ACT concerning public health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Hepatitis C Screening Act.
 
6    Section 5. Definitions. For purposes of this Act:
7    "Comprehensive physical examination" means a medical
8examination in which a health care practitioner takes a
9complete medical history to be used in the development of a
10comprehensive prevention and treatment plan, regardless of
11setting, including, but not limited to, a physician's office,
12clinic, in-patient or out-patient facility.
13    "Department" means the Department of Public Health.
14    "Health care practitioner" means a physician licensed to
15practice medicine in all its branches, a physician assistant,
16or an advanced practice nurse.
17    "Primary care" means the medical fields of family medicine,
18general internal medicine, obstetrics, or gynecology.
 
19    Section 10. Hepatitis C screening.
20    (a) Health care practitioners offering primary care shall
21offer a one-time hepatitis C screening to persons born between
22the years of 1945 and 1965 during comprehensive physical

 

 

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1examinations and for all new patients born between the years of
21945 and 1965. Nothing in this Act shall be construed to
3restrict a health care practitioner from recommending
4screening to any patient at any time.
5    (b) Health care practitioners engaged in a comprehensive
6physical examination, regardless of setting, shall offer a
7one-time hepatitis C screening to persons born between the
8years of 1945 and 1965 any time blood is drawn for testing.
9    (c) The requirements in subsections (a) and (b) do not
10apply when:
11        (1) the health care practitioner reasonably believes
12    that hepatitis C screening is contraindicated for the
13    patient;
14        (2) the health care practitioner believes an offer
15    would interfere with the appropriate care and treatment of
16    the patient under the circumstances;
17        (3) the patient is being seen for an acute ailment,
18    illness, or condition;
19        (4) the patient is being evaluated or treated for an
20    emergency as defined by the federal Emergency Medical
21    Treatment and Labor Act; or
22        (5) the patient has been previously screened for
23    hepatitis C.
 
24    Section 90. Repealer. This Act is repealed on January 1,
252020.
 

 

 

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1    Section 900. The State Employees Group Insurance Act of
21971 is amended by changing Section 6.11 as follows:
 
3    (5 ILCS 375/6.11)
4    Sec. 6.11. Required health benefits; Illinois Insurance
5Code requirements. The program of health benefits shall provide
6the post-mastectomy care benefits required to be covered by a
7policy of accident and health insurance under Section 356t of
8the Illinois Insurance Code. The program of health benefits
9shall provide the coverage required under Sections 356g,
10356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, 356z.17, and 356z.22, and 356z.23 of the
13Illinois Insurance Code. The program of health benefits must
14comply with Sections 155.22a, 155.37, 355b, and 356z.19 of the
15Illinois Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
23eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 

 

 

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1    Section 905. The Counties Code is amended by changing
2Section 5-1069.3 as follows:
 
3    (55 ILCS 5/5-1069.3)
4    Sec. 5-1069.3. Required health benefits. If a county,
5including a home rule county, is a self-insurer for purposes of
6providing health insurance coverage for its employees, the
7coverage shall include coverage for the post-mastectomy care
8benefits required to be covered by a policy of accident and
9health insurance under Section 356t and the coverage required
10under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, and 356z.22, and 356z.23 of the Illinois
13Insurance Code. The coverage shall comply with Sections
14155.22a, 355b, and 356z.19 of the Illinois Insurance Code. The
15requirement that health benefits be covered as provided in this
16Section is an exclusive power and function of the State and is
17a denial and limitation under Article VII, Section 6,
18subsection (h) of the Illinois Constitution. A home rule county
19to which this Section applies must comply with every provision
20of this Section.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
3eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
4    Section 910. The Illinois Municipal Code is amended by
5changing Section 10-4-2.3 as follows:
 
6    (65 ILCS 5/10-4-2.3)
7    Sec. 10-4-2.3. Required health benefits. If a
8municipality, including a home rule municipality, is a
9self-insurer for purposes of providing health insurance
10coverage for its employees, the coverage shall include coverage
11for the post-mastectomy care benefits required to be covered by
12a policy of accident and health insurance under Section 356t
13and the coverage required under Sections 356g, 356g.5,
14356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22, and
16356z.23 of the Illinois Insurance Code. The coverage shall
17comply with Sections 155.22a, 355b, and 356z.19 of the Illinois
18Insurance Code. The requirement that health benefits be covered
19as provided in this is an exclusive power and function of the
20State and is a denial and limitation under Article VII, Section
216, subsection (h) of the Illinois Constitution. A home rule
22municipality to which this Section applies must comply with
23every provision 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
7eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
8    Section 915. 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.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, and 356z.22, and 356z.23 of the
18Illinois Insurance Code. Insurance policies shall comply with
19Section 356z.19 of the Illinois Insurance Code. The coverage
20shall comply with Sections 155.22a and 355b of the Illinois
21Insurance Code.
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

 

 

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1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
5eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
6    Section 920. The Illinois Insurance Code is amended by
7adding Section 356z.23 as follows:
 
8    (215 ILCS 5/356z.23 new)
9    Sec. 356z.23. Hepatitis C testing. On and after the
10effective date of this amendatory Act of the 99th General
11Assembly, every insurer that amends, delivers, issues, or
12renews a group or individual major medical policy of accident
13and health insurance in this State providing coverage for
14hospital or medical treatment shall provide coverage for
15hepatitis C screening and confirmatory testing consistent with
16reasonable medical standards.
 
17    Section 925. The Health Maintenance Organization Act is
18amended by changing Section 5-3 as follows:
 
19    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
20    Sec. 5-3. Insurance Code provisions.
21    (a) Health Maintenance Organizations shall be subject to
22the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,

 

 

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1141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
2154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
3355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
4356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
5356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
6356z.22, 356z.23, 364.01, 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, XII,
10XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
11Insurance Code.
12    (b) For purposes of the Illinois Insurance Code, except for
13Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
14Maintenance Organizations in the following categories are
15deemed 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

 

 

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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 financial
5    conditions of the acquired Health Maintenance Organization
6    after the merger, consolidation, or other acquisition of
7    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;

 

 

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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 to
12its 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, take
17into account the effect of the management contract or service
18agreement on the continuation of benefits to enrollees and the
19financial condition of the health maintenance organization to
20be managed or serviced, and (ii) need not take into account the
21effect of the management contract or service agreement on
22competition.
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 Health

 

 

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1Maintenance Organization may by contract agree with a group or
2other enrollment unit to effect refunds or charge additional
3premiums 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 not
9    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

 

 

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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 the
9resulting 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 accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
22eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
23eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
2498-1091, eff. 1-1-15.)
 
25    Section 930. The Voluntary Health Services Plans Act is

 

 

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1amended by changing Section 10 as follows:
 
2    (215 ILCS 165/10)  (from Ch. 32, par. 604)
3    Sec. 10. Application of Insurance Code provisions. Health
4services plan corporations and all persons interested therein
5or dealing therewith shall be subject to the provisions of
6Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
7143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
8356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
9356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
11356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401,
12401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
13and (15) of Section 367 of the Illinois Insurance Code.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
21eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
22eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
23    Section 935. The Illinois Public Aid Code is amended by
24changing Section 5-16.8 as follows:
 

 

 

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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, 356u, 356w, 356x, and 356z.6, and
7356z.23 of the Illinois Insurance Code and (ii) be subject to
8the provisions of Sections 356z.19 and 364.01 of the Illinois
9Insurance Code.
10    On and after July 1, 2012, the Department shall reduce any
11rate of reimbursement for services or other payments or alter
12any methodologies authorized by this Code to reduce any rate of
13reimbursement for services or other payments in accordance with
14Section 5-5e.
15(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)