Full Text of HB1191 97th General Assembly
HB1191ham002 97TH GENERAL ASSEMBLY | Rep. Greg Harris Filed: 3/9/2011
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| 1 | | AMENDMENT TO HOUSE BILL 1191
| 2 | | AMENDMENT NO. ______. Amend House Bill 1191 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | Sec. 6.11. Required health benefits; Illinois Insurance | 8 | | Code
requirements. The program of health
benefits shall provide | 9 | | the post-mastectomy care benefits required to be covered
by a | 10 | | policy of accident and health insurance under Section 356t of | 11 | | the Illinois
Insurance Code. The program of health benefits | 12 | | shall provide the coverage
required under Sections 356g, | 13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.17 , and 364.01 of the
Illinois | 16 | | Insurance Code.
The program of health benefits must comply with |
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| 1 | | Section 155.37 of the
Illinois Insurance Code.
| 2 | | Rulemaking authority to implement Public Act 95-1045, if | 3 | | any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 9 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 10 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, | 11 | | eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 12 | | 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | 13 | | 96-1000, eff. 7-2-10.) | 14 | | Section 10. The Counties Code is amended by changing | 15 | | Section 5-1069.3 as follows: | 16 | | (55 ILCS 5/5-1069.3)
| 17 | | Sec. 5-1069.3. Required health benefits. If a county, | 18 | | including a home
rule
county, is a self-insurer for purposes of | 19 | | providing health insurance coverage
for its employees, the | 20 | | coverage shall include coverage for the post-mastectomy
care | 21 | | benefits required to be covered by a policy of accident and | 22 | | health
insurance under Section 356t and the coverage required | 23 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 24 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
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| 1 | | 356z.14, and 356z.15 , and 364.01 of
the Illinois Insurance | 2 | | Code. The requirement that health benefits be covered
as | 3 | | provided in this Section is an
exclusive power and function of | 4 | | the State and is a denial and limitation under
Article VII, | 5 | | Section 6, subsection (h) of the Illinois Constitution. A home
| 6 | | rule county to which this Section applies must comply with | 7 | | every provision of
this Section.
| 8 | | Rulemaking authority to implement Public Act 95-1045, if | 9 | | any, is conditioned on the rules being adopted in accordance | 10 | | with all provisions of the Illinois Administrative Procedure | 11 | | Act and all rules and procedures of the Joint Committee on | 12 | | Administrative Rules; any purported rule not so adopted, for | 13 | | whatever reason, is unauthorized. | 14 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 15 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 16 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 17 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 18 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.) | 19 | | Section 15. The Illinois Municipal Code is amended by | 20 | | changing Section 10-4-2.3 as follows: | 21 | | (65 ILCS 5/10-4-2.3)
| 22 | | Sec. 10-4-2.3. Required health benefits. If a | 23 | | municipality, including a
home rule municipality, is a | 24 | | self-insurer for purposes of providing health
insurance |
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| 1 | | coverage for its employees, the coverage shall include coverage | 2 | | for
the post-mastectomy care benefits required to be covered by | 3 | | a policy of
accident and health insurance under Section 356t | 4 | | and the coverage required
under Sections 356g, 356g.5, | 5 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 6 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 364.01 of | 7 | | the Illinois
Insurance
Code. The requirement that health
| 8 | | benefits be covered as provided in this is an exclusive power | 9 | | and function of
the State and is a denial and limitation under | 10 | | Article VII, Section 6,
subsection (h) of the Illinois | 11 | | Constitution. A home rule municipality to which
this Section | 12 | | applies must comply with every provision of this Section.
| 13 | | Rulemaking authority to implement Public Act 95-1045, if | 14 | | any, is conditioned on the rules being adopted in accordance | 15 | | with all provisions of the Illinois Administrative Procedure | 16 | | Act and all rules and procedures of the Joint Committee on | 17 | | Administrative Rules; any purported rule not so adopted, for | 18 | | whatever reason, is unauthorized. | 19 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 20 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 21 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 22 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 23 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.) | 24 | | Section 20. The School Code is amended by changing Section | 25 | | 10-22.3f as follows: |
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| 1 | | (105 ILCS 5/10-22.3f)
| 2 | | Sec. 10-22.3f. Required health benefits. Insurance | 3 | | protection and
benefits
for employees shall provide the | 4 | | post-mastectomy care benefits required to be
covered by a | 5 | | policy of accident and health insurance under Section 356t and | 6 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 7 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 8 | | 356z.13, 356z.14, and 356z.15 , and 364.01 of
the
Illinois | 9 | | Insurance Code.
| 10 | | Rulemaking authority to implement Public Act 95-1045, if | 11 | | any, is conditioned on the rules being adopted in accordance | 12 | | with all provisions of the Illinois Administrative Procedure | 13 | | Act and all rules and procedures of the Joint Committee on | 14 | | Administrative Rules; any purported rule not so adopted, for | 15 | | whatever reason, is unauthorized. | 16 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 17 | | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 18 | | 95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 19 | | 1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000, | 20 | | eff. 7-2-10.) | 21 | | Section 25. The Illinois Insurance Code is amended by | 22 | | changing Section 364.01 as follows: | 23 | | (215 ILCS 5/364.01) |
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| 1 | | Sec. 364.01. Qualified clinical cancer trials. | 2 | | (a) No individual or group policy of accident and health | 3 | | insurance issued or renewed in this State may be cancelled or | 4 | | non-renewed for any individual based on that individual's | 5 | | participation in a qualified clinical cancer trial. | 6 | | (b) Qualified clinical cancer trials must meet the | 7 | | following criteria: | 8 | | (1) the effectiveness of the treatment has not been | 9 | | determined relative to established therapies; | 10 | | (2) the trial is under clinical investigation as part | 11 | | of an approved cancer research trial in Phase II, Phase | 12 | | III, or Phase IV of investigation; | 13 | | (3) the trial is: | 14 | | (A) approved by the Food and Drug Administration; | 15 | | or | 16 | | (B) approved and funded by the National Institutes | 17 | | of Health, the Centers for Disease Control and | 18 | | Prevention, the Agency for Healthcare Research and | 19 | | Quality, the United States Department of Defense, the | 20 | | United States Department of Veterans Affairs, or the | 21 | | United States Department of Energy in the form of an | 22 | | investigational new drug application, or a cooperative | 23 | | group or center of any entity described in this | 24 | | subdivision (B); and
| 25 | | (4) the patient's primary care physician, if any, is | 26 | | involved in the coordination of care.
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| 1 | | (c) No group policy of accident and health insurance shall | 2 | | exclude coverage for any routine patient care administered to | 3 | | an insured who is a qualified individual participating in a | 4 | | qualified clinical cancer trial, if the policy covers that same | 5 | | routine patient care of insureds not enrolled in a qualified | 6 | | clinical cancer trial. | 7 | | (d) The coverage that may not be excluded under subsection | 8 | | (c) of this Section is subject to all terms, conditions, | 9 | | restrictions, exclusions, and limitations that apply to the | 10 | | same routine patient care received by an insured not enrolled | 11 | | in a qualified clinical cancer trial, including the application | 12 | | of any authorization requirement, utilization review, or | 13 | | medical management practices. | 14 | | (e) If the group policy of accident and health insurance | 15 | | uses a preferred provider program and a preferred provider | 16 | | provides routine patient care in connection with a qualified | 17 | | clinical cancer trial, then the insurer may require the insured | 18 | | to use the preferred provider if the preferred provider agrees | 19 | | to provide to the insured that routine patient care. | 20 | | (f) A group policy of accident and health insurance with a | 21 | | preferred provider program shall reimburse: | 22 | | (1) a preferred provider for routine patient care in | 23 | | connection with a qualified clinical cancer trial at the | 24 | | preferred provider's negotiated rate, less any applicable | 25 | | insured cost sharing; and | 26 | | (2) a nonpreferred provider at rates comparable to |
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| 1 | | negotiated rates for preferred providers; the nonpreferred | 2 | | provider shall accept those amounts plus any applicable | 3 | | copayments, coinsurance, and deductible as payment in full | 4 | | for items billed. | 5 | | The preferred provider and the nonpreferred provider may | 6 | | bill the insured any applicable deductible, copayment, and | 7 | | coinsurance. | 8 | | (g) A qualified clinical cancer trial may not pay or refuse | 9 | | to pay for routine patient care of a individual participating | 10 | | in the trial, based in whole or in part on the person's having | 11 | | or not having coverage for routine patient care under a group | 12 | | policy of accident and health insurance. | 13 | | (h) Nothing in this Section shall be construed to limit an | 14 | | insurer's coverage with respect to clinical trials. | 15 | | (i) Nothing in this Section shall require coverage for | 16 | | out-of-network services where the underlying health benefit | 17 | | plan does not provide coverage for out-of-network services. | 18 | | (j) As used in this Section, "routine patient care" means | 19 | | all health care services provided in the qualified clinical | 20 | | cancer trial that are otherwise generally covered under the | 21 | | policy if those items or services were not provided in | 22 | | connection with a qualified clinical cancer trial consistent | 23 | | with the standard of care for the treatment of cancer, | 24 | | including the type and frequency of any diagnostic modality, | 25 | | that a provider typically provides to a cancer patient who is | 26 | | not enrolled in a qualified clinical cancer trial. "Routine |
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| 1 | | patient care" does not include, and a group policy of accident | 2 | | and health insurance may exclude, coverage for: | 3 | | (1) a health care service, item, or drug that is the | 4 | | subject of the cancer clinical trial; | 5 | | (2) a health care service, item, or drug provided | 6 | | solely to satisfy data collection and analysis needs for | 7 | | the qualified clinical cancer trial that is not used in the | 8 | | direct clinical management of the patient; | 9 | | (3) an investigational drug or device that has not been | 10 | | approved for market by the United States Food and Drug | 11 | | Administration; | 12 | | (4) transportation, lodging, food, or other expenses | 13 | | for the patient or a family member or companion of the | 14 | | patient that are associated with the travel to or from a | 15 | | facility providing the qualified clinical cancer trial; | 16 | | (5) a health care service, item, or drug customarily | 17 | | provided by the qualified clinical cancer trial sponsors | 18 | | free of charge for any patient; | 19 | | (6) a health care service or item, which except for the | 20 | | fact that it is being provided in a qualified clinical | 21 | | cancer trial, is otherwise specifically excluded from | 22 | | coverage under the insured's policy, including: | 23 | | (A) costs of extra treatments, services, | 24 | | procedures, tests, or drugs that would not be performed | 25 | | or administered except for the fact that the insured is | 26 | | participating in the cancer clinical trial; and |
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| 1 | | (B) costs of nonhealth care services that the | 2 | | patient is required to receive as a result of | 3 | | participation in the approved cancer clinical trial; | 4 | | (7) the cost of an oncologic drug, if the qualified | 5 | | clinical cancer trial's purpose is to study the use of the | 6 | | oncologic drug in the particular cancer in question or | 7 | | study the administration of the drug in a new manner; | 8 | | (8) costs for services, items, or drugs that are | 9 | | eligible for reimbursement from a source other than a | 10 | | patient's contract or policy providing for third-party | 11 | | payment or prepayment of health or medical expenses, | 12 | | including the sponsor of the approved cancer clinical | 13 | | trial; or | 14 | | (9) costs associated with approved cancer clinical | 15 | | trials designed exclusively to test toxicity or disease | 16 | | pathophysiology; or | 17 | | (10) a health care service or item that is eligible for | 18 | | reimbursement by a source other than the insured's policy, | 19 | | including the sponsor of the qualified clinical cancer | 20 | | trial. | 21 | | The definitions of the terms "health care services", | 22 | | "Non-Preferred Provider", "Preferred Provider", and "Preferred | 23 | | Provider Program", stated in 50 IL Adm. Code Part 2051 | 24 | | Preferred Provider Programs apply to these terms in this | 25 | | Section. | 26 | | (Source: P.A. 93-1000, eff. 1-1-05.)".
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