Sen. John G. Mulroe

Filed: 4/17/2015

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 661

2    AMENDMENT NO. ______. Amend Senate Bill 661, AS AMENDED, by
3replacing everything after the enacting clause with the
4following:
 
5    "Section 1. Short title. This Act may be cited as the
6Hepatitis C Screening Act.
 
7    Section 5. Definitions. For purposes of this Act:
8    "Comprehensive physical examination" means a medical
9examination in which a health care practitioner takes a
10complete medical history to be used in the development of a
11comprehensive prevention and treatment plan, regardless of
12setting, including, but not limited to, a physician's office,
13clinic, in-patient or out-patient facility.
14    "Department" means the Department of Public Health.
15    "Health care practitioner" means a physician licensed to
16practice medicine in all its branches, a physician assistant,

 

 

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1or an advanced practice nurse.
2    "Primary care" means the medical fields of family medicine,
3general internal medicine, obstetrics, or gynecology.
 
4    Section 10. Hepatitis C screening.
5    (a) Health care practitioners offering primary care shall
6offer a one-time hepatitis C screening to persons born between
7the years of 1945 and 1965 during comprehensive physical
8examinations and for all new patients born between the years of
91945 and 1965. Nothing in this Act shall be construed to
10restrict a health care practitioner from recommending
11screening to any patient at any time.
12    (b) Health care practitioners engaged in a comprehensive
13physical examination, regardless of setting, shall offer a
14one-time hepatitis C screening to persons born between the
15years of 1945 and 1965 any time blood is drawn for testing.
16    (c) The requirements in subsections (a) and (b) do not
17apply when:
18        (1) the health care practitioner reasonably believes
19    that hepatitis C screening is contraindicated for the
20    patient;
21        (2) the health care practitioner believes an offer
22    would interfere with the appropriate care and treatment of
23    the patient under the circumstances;
24        (3) the patient is being seen for an acute ailment,
25    illness, or condition;

 

 

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1        (4) the patient is being evaluated or treated for an
2    emergency as defined by the federal Emergency Medical
3    Treatment and Labor Act; or
4        (5) the patient has been previously screened for
5    hepatitis C.
 
6    Section 90. Repealer. This Act is repealed on January 1,
72020.
 
8    Section 900. The State Employees Group Insurance Act of
91971 is amended by changing Section 6.11 as follows:
 
10    (5 ILCS 375/6.11)
11    Sec. 6.11. Required health benefits; Illinois Insurance
12Code requirements. The program of health benefits shall provide
13the post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t of
15the Illinois Insurance Code. The program of health benefits
16shall provide the coverage required under Sections 356g,
17356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, 356z.17, and 356z.22, and 356z.23 of the
20Illinois Insurance Code. The program of health benefits must
21comply with Sections 155.22a, 155.37, 355b, and 356z.19 of the
22Illinois Insurance Code.
23    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 905. The Counties Code is amended by changing
9Section 5-1069.3 as follows:
 
10    (55 ILCS 5/5-1069.3)
11    Sec. 5-1069.3. Required health benefits. If a county,
12including a home rule county, is a self-insurer for purposes of
13providing health insurance coverage for its employees, the
14coverage shall include coverage for the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, and 356z.22, and 356z.23 of the Illinois
20Insurance Code. The coverage shall comply with Sections
21155.22a, 355b, and 356z.19 of the Illinois Insurance Code. The
22requirement that health benefits be covered as provided in this
23Section is an exclusive power and function of the State and is
24a denial and limitation under Article VII, Section 6,

 

 

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1subsection (h) of the Illinois Constitution. A home rule county
2to which this Section applies must comply with every provision
3of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
11eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
12    Section 910. 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, 356z.15, and 356z.22, and
24356z.23 of the Illinois Insurance Code. The coverage shall

 

 

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1comply with Sections 155.22a, 355b, and 356z.19 of the Illinois
2Insurance Code. The requirement that health benefits be covered
3as provided in this is an exclusive power and function of the
4State and is a denial and limitation under Article VII, Section
56, subsection (h) of the Illinois Constitution. A home rule
6municipality to which this Section applies must comply with
7every provision of this Section.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
15eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
16    Section 915. The School Code is amended by changing Section
1710-22.3f as follows:
 
18    (105 ILCS 5/10-22.3f)
19    Sec. 10-22.3f. Required health benefits. Insurance
20protection and benefits for employees shall provide the
21post-mastectomy care benefits required to be covered by a
22policy of accident and health insurance under Section 356t and
23the coverage required under Sections 356g, 356g.5, 356g.5-1,
24356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,

 

 

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1356z.13, 356z.14, 356z.15, and 356z.22, and 356z.23 of the
2Illinois Insurance Code. Insurance policies shall comply with
3Section 356z.19 of the Illinois Insurance Code. The coverage
4shall comply with Sections 155.22a and 355b of the Illinois
5Insurance Code.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
13eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
14    Section 920. The Illinois Insurance Code is amended by
15adding Section 356z.23 as follows:
 
16    (215 ILCS 5/356z.23 new)
17    Sec. 356z.23. Hepatitis C testing. On and after the
18effective date of this amendatory Act of the 99th General
19Assembly, every insurer that amends, delivers, issues, or
20renews a group or individual major medical policy of accident
21and health insurance in this State providing coverage for
22hospital or medical treatment shall provide coverage for
23hepatitis C screening and confirmatory testing consistent with
24reasonable medical standards.
 

 

 

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1    Section 925. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    Sec. 5-3. Insurance Code provisions.
5    (a) Health Maintenance Organizations shall be subject to
6the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
7141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
8154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
9355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
10356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
12356z.22, 356z.23, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
13368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
14408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
15subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
16XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
17Insurance Code.
18    (b) For purposes of the Illinois Insurance Code, except for
19Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
20Maintenance Organizations in the following categories are
21deemed to be "domestic companies":
22        (1) a corporation authorized under the Dental Service
23    Plan Act or the Voluntary Health Services Plans Act;
24        (2) a corporation organized under the laws of this

 

 

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

 

 

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

 

 

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

 

 

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1    made or additional premium to be paid pursuant to this
2    subsection (f)). The Health Maintenance Organization and
3    the group or enrollment unit may agree that the profitable
4    or unprofitable experience may be calculated taking into
5    account the refund period and the immediately preceding 2
6    plan years.
7    The Health Maintenance Organization shall include a
8statement in the evidence of coverage issued to each enrollee
9describing the possibility of a refund or additional premium,
10and upon request of any group or enrollment unit, provide to
11the group or enrollment unit a description of the method used
12to calculate (1) the Health Maintenance Organization's
13profitable experience with respect to the group or enrollment
14unit and the resulting refund to the group or enrollment unit
15or (2) the Health Maintenance Organization's unprofitable
16experience with respect to the group or enrollment unit and the
17resulting additional premium to be paid by the group or
18enrollment unit.
19    In no event shall the Illinois Health Maintenance
20Organization Guaranty Association be liable to pay any
21contractual obligation of an insolvent organization to pay any
22refund authorized under this Section.
23    (g) Rulemaking authority to implement Public Act 95-1045,
24if any, is conditioned on the rules being adopted in accordance
25with all provisions of the Illinois Administrative Procedure
26Act and all rules and procedures of the Joint Committee on

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
4eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
5eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
698-1091, eff. 1-1-15.)
 
7    Section 930. The Voluntary Health Services Plans Act is
8amended by changing Section 10 as follows:
 
9    (215 ILCS 165/10)  (from Ch. 32, par. 604)
10    Sec. 10. Application of Insurance Code provisions. Health
11services plan corporations and all persons interested therein
12or dealing therewith shall be subject to the provisions of
13Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
14143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
15356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
16356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
17356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
18356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401,
19401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
20and (15) of Section 367 of the Illinois Insurance Code.
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

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
4eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
5eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
6    Section 935. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
14356z.23 of the Illinois Insurance Code and (ii) be subject to
15the provisions of Sections 356z.19 and 364.01 of the Illinois
16Insurance Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate of
20reimbursement for services or other payments in accordance with
21Section 5-5e.
22(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)".