Full Text of HB1779 102nd General Assembly
HB1779ham001 102ND GENERAL ASSEMBLY | Rep. Mary E. Flowers Filed: 3/21/2021
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| 1 | | AMENDMENT TO HOUSE BILL 1779
| 2 | | AMENDMENT NO. ______. Amend House Bill 1779 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employees Group Insurance Act of | 5 | | 1971 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 | 9 | | provide the post-mastectomy care benefits required to be | 10 | | covered
by a policy of accident and health insurance under | 11 | | Section 356t of the Illinois
Insurance Code. The program of | 12 | | health benefits shall provide the coverage
required under | 13 | | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, | 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
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| 1 | | 356z.36, and 356z.41 , and 356z.43 of the
Illinois Insurance | 2 | | Code.
The program of health benefits must comply with Sections | 3 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article | 4 | | XXXIIB of the
Illinois Insurance Code. The Department of | 5 | | Insurance shall enforce the requirements of this Section with | 6 | | respect to Sections 370c and 370c.1 of the Illinois Insurance | 7 | | Code; all other requirements of this Section shall be enforced | 8 | | by the Department of Central Management Services.
| 9 | | Rulemaking authority to implement Public Act 95-1045, if | 10 | | any, is conditioned on the rules being adopted in accordance | 11 | | with all provisions of the Illinois Administrative Procedure | 12 | | Act and all rules and procedures of the Joint Committee on | 13 | | Administrative Rules; any purported rule not so adopted, for | 14 | | whatever reason, is unauthorized. | 15 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 16 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 17 | | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, | 18 | | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 19 | | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | 20 | | 1-1-21 .) | 21 | | Section 10. The Counties Code is amended by changing | 22 | | Section 5-1069.3 as follows: | 23 | | (55 ILCS 5/5-1069.3)
| 24 | | Sec. 5-1069.3. Required health benefits. If a county, |
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| 1 | | including a home
rule
county, is a self-insurer for purposes | 2 | | of providing health insurance coverage
for its employees, the | 3 | | coverage shall include coverage for the post-mastectomy
care | 4 | | benefits required to be covered by a policy of accident and | 5 | | health
insurance under Section 356t and the coverage required | 6 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 7 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 8 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 9 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 10 | | of
the Illinois Insurance Code. The coverage shall comply with | 11 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 12 | | Insurance Code. The Department of Insurance shall enforce the | 13 | | requirements of this Section. The requirement that health | 14 | | benefits be covered
as provided in this Section is an
| 15 | | exclusive power and function of the State and is a denial and | 16 | | limitation under
Article VII, Section 6, subsection (h) of the | 17 | | Illinois Constitution. A home
rule county to which this | 18 | | Section applies must comply with every provision of
this | 19 | | Section.
| 20 | | Rulemaking authority to implement Public Act 95-1045, if | 21 | | any, is conditioned on the rules being adopted in accordance | 22 | | with all provisions of the Illinois Administrative Procedure | 23 | | Act and all rules and procedures of the Joint Committee on | 24 | | Administrative Rules; any purported rule not so adopted, for | 25 | | whatever reason, is unauthorized. | 26 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
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| 1 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 2 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 3 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 4 | | 101-625, eff. 1-1-21 .) | 5 | | Section 15. The Illinois Municipal Code is amended by | 6 | | changing Section 10-4-2.3 as follows: | 7 | | (65 ILCS 5/10-4-2.3)
| 8 | | Sec. 10-4-2.3. Required health benefits. If a | 9 | | municipality, including a
home rule municipality, is a | 10 | | self-insurer for purposes of providing health
insurance | 11 | | coverage for its employees, the coverage shall include | 12 | | coverage for
the post-mastectomy care benefits required to be | 13 | | covered by a policy of
accident and health insurance under | 14 | | Section 356t and the coverage required
under Sections 356g, | 15 | | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, | 16 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 17 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 18 | | 356z.36, and 356z.41 , and 356z.43 of the Illinois
Insurance
| 19 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 20 | | 356z.19, and 370c of
the Illinois Insurance Code. The | 21 | | Department of Insurance shall enforce the requirements of this | 22 | | Section. The requirement that health
benefits be covered as | 23 | | provided in this is an exclusive power and function of
the | 24 | | State and is a denial and limitation under Article VII, |
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| 1 | | Section 6,
subsection (h) of the Illinois Constitution. A home | 2 | | rule municipality to which
this Section applies must comply | 3 | | with every provision of this Section.
| 4 | | Rulemaking authority to implement Public Act 95-1045, if | 5 | | any, is conditioned on the rules being adopted in accordance | 6 | | with all provisions of the Illinois Administrative Procedure | 7 | | Act and all rules and procedures of the Joint Committee on | 8 | | Administrative Rules; any purported rule not so adopted, for | 9 | | whatever reason, is unauthorized. | 10 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 11 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 12 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 13 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 14 | | 101-625, eff. 1-1-21 .) | 15 | | Section 20. The School Code is amended by changing Section | 16 | | 10-22.3f as follows: | 17 | | (105 ILCS 5/10-22.3f)
| 18 | | Sec. 10-22.3f. Required health benefits. Insurance | 19 | | protection and
benefits
for employees shall provide the | 20 | | post-mastectomy care benefits required to be
covered by a | 21 | | policy of accident and health insurance under Section 356t and | 22 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 23 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 24 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
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| 1 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 2 | | of
the
Illinois Insurance Code.
Insurance policies shall | 3 | | comply with Section 356z.19 of the Illinois Insurance Code. | 4 | | The coverage shall comply with Sections 155.22a, 355b, and | 5 | | 370c of
the Illinois Insurance Code. The Department of | 6 | | Insurance shall enforce the requirements of this Section.
| 7 | | Rulemaking authority to implement Public Act 95-1045, if | 8 | | any, is conditioned on the rules being adopted in accordance | 9 | | with all provisions of the Illinois Administrative Procedure | 10 | | Act and all rules and procedures of the Joint Committee on | 11 | | Administrative Rules; any purported rule not so adopted, for | 12 | | whatever reason, is unauthorized. | 13 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 14 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 15 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 16 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 17 | | 101-625, eff. 1-1-21 .) | 18 | | Section 25. The Illinois Insurance Code is amended by | 19 | | adding Section 356z.43 as follows: | 20 | | (215 ILCS 5/356z.43 new) | 21 | | Sec. 356z.43. Biomarker testing. | 22 | | (a) As used in this Section: | 23 | | "Biomarker" means a characteristic that is objectively | 24 | | measured and evaluated as an indicator of normal biological |
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| 1 | | processes, pathogenic processes, or pharmacologic responses to | 2 | | a specific therapeutic intervention. "Biomarker" includes, but | 3 | | is not limited to, gene mutations or protein expression. | 4 | | "Biomarker testing" means the analysis of a patient's | 5 | | tissue, blood, or fluid biospecimen for the presence of a | 6 | | biomarker. "Biomarker testing" includes, but is not limited | 7 | | to, single-analyte tests, multi-plex panel tests, and partial | 8 | | or whole genome sequencing. | 9 | | (b) A group or individual policy of accident and health | 10 | | insurance or managed care plan amended, delivered, issued, or | 11 | | renewed on or after January 1, 2022 shall include coverage for | 12 | | biomarker testing as defined in this Section pursuant to | 13 | | criteria established under subsection (d). | 14 | | (c) Biomarker testing shall be covered and conducted in an | 15 | | efficient manner to provide the most complete range of results | 16 | | to the patient's health care provider without requiring | 17 | | multiple biopsies, biospecimen samples, or other delays or | 18 | | disruptions in patient care. | 19 | | (d) Biomarker testing must be covered for the purposes of | 20 | | diagnosis, treatment, appropriate management, or ongoing | 21 | | monitoring of an enrollee's disease or condition when the test | 22 | | is supported by medical and scientific evidence, including, | 23 | | but not limited to: | 24 | | (1) labeled indications for an FDA-approved test or | 25 | | indicated tests for an FDA-approved drug; | 26 | | (2) federal Centers for Medicare and Medicaid Services |
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| 1 | | National Coverage Determinations; | 2 | | (3) nationally recognized clinical practice | 3 | | guidelines; | 4 | | (4) consensus statements; | 5 | | (5) professional society recommendations; | 6 | | (6) peer-reviewed literature, biomedical compendia, | 7 | | and other medical literature that meet the criteria of the | 8 | | National Institutes of Health's National Library of | 9 | | Medicine for indexing in Index Medicus, Excerpta Medicus, | 10 | | Medline, and MEDLARS database of Health Services | 11 | | Technology Assessment Research; and | 12 | | (7) peer-reviewed scientific studies published in or | 13 | | accepted for publication by medical journals that meet | 14 | | nationally recognized requirements for scientific | 15 | | manuscripts and that submit most of their published | 16 | | articles for review by experts who are not part of the | 17 | | editorial staff. | 18 | | (e) When coverage of biomarker testing for the purpose of | 19 | | diagnosis, treatment, or ongoing monitoring of any medical | 20 | | condition is restricted for use by a group or individual | 21 | | policy of accident and health insurance or managed care plan, | 22 | | the patient and prescribing practitioner shall have access to | 23 | | a clear, readily accessible, and convenient processes to | 24 | | request an exception. The process shall be made readily | 25 | | accessible on the insurer's website. |
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| 1 | | Section 30. The Health Maintenance Organization Act is | 2 | | amended 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 | 6 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 7 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 8 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 9 | | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 10 | | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 11 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 12 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 13 | | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 14 | | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 15 | | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 16 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 17 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 18 | | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | 19 | | Insurance Code.
| 20 | | (b) For purposes of the Illinois Insurance Code, except | 21 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 22 | | Health Maintenance Organizations in
the following categories | 23 | | are deemed to be "domestic companies":
| 24 | | (1) a corporation authorized under the
Dental Service | 25 | | Plan Act or the Voluntary Health Services Plans Act;
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| 1 | | (2) a corporation organized under the laws of this | 2 | | State; or
| 3 | | (3) a corporation organized under the laws of another | 4 | | state, 30% or more
of the enrollees of which are residents | 5 | | of this State, except a
corporation subject to | 6 | | substantially the same requirements in its state of
| 7 | | organization as is a "domestic company" under Article VIII | 8 | | 1/2 of the
Illinois Insurance Code.
| 9 | | (c) In considering the merger, consolidation, or other | 10 | | acquisition of
control of a Health Maintenance Organization | 11 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 12 | | (1) the Director shall give primary consideration to | 13 | | the continuation of
benefits to enrollees and the | 14 | | financial conditions of the acquired Health
Maintenance | 15 | | Organization after the merger, consolidation, or other
| 16 | | acquisition of control takes effect;
| 17 | | (2)(i) the criteria specified in subsection (1)(b) of | 18 | | Section 131.8 of
the Illinois Insurance Code shall not | 19 | | apply and (ii) the Director, in making
his determination | 20 | | with respect to the merger, consolidation, or other
| 21 | | acquisition of control, need not take into account the | 22 | | effect on
competition of the merger, consolidation, or | 23 | | other acquisition of control;
| 24 | | (3) the Director shall have the power to require the | 25 | | following
information:
| 26 | | (A) certification by an independent actuary of the |
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| 1 | | adequacy
of the reserves of the Health Maintenance | 2 | | Organization sought to be acquired;
| 3 | | (B) pro forma financial statements reflecting the | 4 | | combined balance
sheets of the acquiring company and | 5 | | the Health Maintenance Organization sought
to be | 6 | | acquired as of the end of the preceding year and as of | 7 | | a date 90 days
prior to the acquisition, as well as pro | 8 | | forma financial statements
reflecting projected | 9 | | combined operation for a period of 2 years;
| 10 | | (C) a pro forma business plan detailing an | 11 | | acquiring party's plans with
respect to the operation | 12 | | of the Health Maintenance Organization sought to
be | 13 | | acquired for a period of not less than 3 years; and
| 14 | | (D) such other information as the Director shall | 15 | | require.
| 16 | | (d) The provisions of Article VIII 1/2 of the Illinois | 17 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 18 | | any health maintenance
organization of greater than 10% of its
| 19 | | enrollee population (including without limitation the health | 20 | | maintenance
organization's right, title, and interest in and | 21 | | to its health care
certificates).
| 22 | | (e) In considering any management contract or service | 23 | | agreement subject
to Section 141.1 of the Illinois Insurance | 24 | | Code, the Director (i) shall, in
addition to the criteria | 25 | | specified in Section 141.2 of the Illinois
Insurance Code, | 26 | | take into account the effect of the management contract or
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| 1 | | service agreement on the continuation of benefits to enrollees | 2 | | and the
financial condition of the health maintenance | 3 | | organization to be managed or
serviced, and (ii) need not take | 4 | | into account the effect of the management
contract or service | 5 | | agreement on competition.
| 6 | | (f) Except for small employer groups as defined in the | 7 | | Small Employer
Rating, Renewability and Portability Health | 8 | | Insurance Act and except for
medicare supplement policies as | 9 | | defined in Section 363 of the Illinois
Insurance Code, a | 10 | | Health Maintenance Organization may by contract agree with a
| 11 | | group or other enrollment unit to effect refunds or charge | 12 | | additional premiums
under the following terms and conditions:
| 13 | | (i) the amount of, and other terms and conditions with | 14 | | respect to, the
refund or additional premium are set forth | 15 | | in the group or enrollment unit
contract agreed in advance | 16 | | of the period for which a refund is to be paid or
| 17 | | additional premium is to be charged (which period shall | 18 | | not be less than one
year); and
| 19 | | (ii) the amount of the refund or additional premium | 20 | | shall not exceed 20%
of the Health Maintenance | 21 | | Organization's profitable or unprofitable experience
with | 22 | | respect to the group or other enrollment unit for the | 23 | | period (and, for
purposes of a refund or additional | 24 | | premium, the profitable or unprofitable
experience shall | 25 | | be calculated taking into account a pro rata share of the
| 26 | | Health Maintenance Organization's administrative and |
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| 1 | | marketing expenses, but
shall not include any refund to be | 2 | | made or additional premium to be paid
pursuant to this | 3 | | subsection (f)). The Health Maintenance Organization and | 4 | | the
group or enrollment unit may agree that the profitable | 5 | | or unprofitable
experience may be calculated taking into | 6 | | account the refund period and the
immediately preceding 2 | 7 | | plan years.
| 8 | | The Health Maintenance Organization shall include a | 9 | | statement in the
evidence of coverage issued to each enrollee | 10 | | describing the possibility of a
refund or additional premium, | 11 | | and upon request of any group or enrollment unit,
provide to | 12 | | the group or enrollment unit a description of the method used | 13 | | to
calculate (1) the Health Maintenance Organization's | 14 | | profitable experience with
respect to the group or enrollment | 15 | | unit and the resulting refund to the group
or enrollment unit | 16 | | or (2) the Health Maintenance Organization's unprofitable
| 17 | | experience with respect to the group or enrollment unit and | 18 | | the resulting
additional premium to be paid by the group or | 19 | | enrollment unit.
| 20 | | In no event shall the Illinois Health Maintenance | 21 | | Organization
Guaranty Association be liable to pay any | 22 | | contractual obligation of an
insolvent organization to pay any | 23 | | refund authorized under this Section.
| 24 | | (g) Rulemaking authority to implement Public Act 95-1045, | 25 | | if any, is conditioned on the rules being adopted in | 26 | | accordance with all provisions of the Illinois Administrative |
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| 1 | | Procedure Act and all rules and procedures of the Joint | 2 | | Committee on Administrative Rules; any purported rule not so | 3 | | adopted, for whatever reason, is unauthorized. | 4 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 5 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 6 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 7 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | 8 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 9 | | 1-1-20; 101-625, eff. 1-1-21 .) | 10 | | Section 35. The Limited Health Service Organization Act is | 11 | | amended by changing Section 4003 as follows:
| 12 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 13 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 14 | | health service
organizations shall be subject to the | 15 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | 16 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 17 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | 18 | | 355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, | 19 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a, | 20 | | 401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and | 21 | | 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, | 22 | | XXV, and XXVI of the Illinois Insurance Code. For purposes of | 23 | | the
Illinois Insurance Code, except for Sections 444 and 444.1 | 24 | | and Articles XIII
and XIII 1/2, limited health service |
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| 1 | | organizations in the following categories
are deemed to be | 2 | | domestic companies:
| 3 | | (1) a corporation under the laws of this State; or
| 4 | | (2) 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 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 11 | | 100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff. | 12 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 13 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21 .)
| 14 | | Section 40. The Voluntary Health Services Plans Act is | 15 | | amended by changing Section 10 as follows:
| 16 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 17 | | Sec. 10. Application of Insurance Code provisions. Health | 18 | | services
plan corporations and all persons interested therein | 19 | | or dealing therewith
shall be subject to the provisions of | 20 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 21 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 22 | | 356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, | 23 | | 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, | 24 | | 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, |
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| 1 | | 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, | 2 | | 356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01, | 3 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | 4 | | and paragraphs (7) and (15) of Section 367 of the Illinois
| 5 | | Insurance Code.
| 6 | | Rulemaking authority to implement Public Act 95-1045, if | 7 | | any, is conditioned on the rules being adopted in accordance | 8 | | with all provisions of the Illinois Administrative Procedure | 9 | | Act and all rules and procedures of the Joint Committee on | 10 | | Administrative Rules; any purported rule not so adopted, for | 11 | | whatever reason, is unauthorized. | 12 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 13 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 14 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 15 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 16 | | 101-625, eff. 1-1-21 .) | 17 | | Section 45. The Illinois Public Aid Code is amended by | 18 | | changing Section 5-16.8 as follows:
| 19 | | (305 ILCS 5/5-16.8)
| 20 | | Sec. 5-16.8. Required health benefits. The medical | 21 | | assistance program
shall
(i) provide the post-mastectomy care | 22 | | benefits required to be covered by a policy of
accident and | 23 | | health insurance under Section 356t and the coverage required
| 24 | | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, |
| | | 10200HB1779ham001 | - 17 - | LRB102 10161 BMS 23338 a |
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| 1 | | 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 , and 356z.43 | 2 | | of the Illinois
Insurance Code and (ii) be subject to the | 3 | | provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of | 4 | | the Illinois
Insurance Code.
| 5 | | The Department, by rule, shall adopt a model similar to | 6 | | the requirements of Section 356z.39 of the Illinois Insurance | 7 | | Code. | 8 | | On and after July 1, 2012, the Department shall reduce any | 9 | | rate of reimbursement for services or other payments or alter | 10 | | any methodologies authorized by this Code to reduce any rate | 11 | | of reimbursement for services or other payments in accordance | 12 | | with Section 5-5e. | 13 | | To ensure full access to the benefits set forth in this | 14 | | Section, on and after January 1, 2016, the Department shall | 15 | | ensure that provider and hospital reimbursement for | 16 | | post-mastectomy care benefits required under this Section are | 17 | | no lower than the Medicare reimbursement rate. | 18 | | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; | 19 | | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. | 20 | | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, | 21 | | eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".
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