Full Text of HB2109 102nd General Assembly
HB2109eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly:
| 4 | | Section 1. This Act may be referred to as Cal's Law. | 5 | | Section 5. The Illinois Insurance Code is amended by | 6 | | adding Section 356z.43 as follows: | 7 | | (215 ILCS 5/356z.43 new) | 8 | | Sec. 356z.43. Comprehensive cancer testing. | 9 | | (a) As used in this Section: | 10 | | "Comprehensive cancer testing" includes, but is not | 11 | | limited to, the following forms of testing: | 12 | | (1) Targeted cancer gene panels. | 13 | | (2) Whole-exome genome testing. | 14 | | (3) Whole-genome sequencing. | 15 | | (4) RNA sequencing. | 16 | | (5) Tumor mutation burden. | 17 | | "Prior authorization" means the process by which an | 18 | | insurer, or the insurer's designee, determines the medical | 19 | | necessity and medical appropriateness of otherwise covered | 20 | | health care services before the rendering of such health care | 21 | | services. "Prior authorization" includes any requirement that | 22 | | an enrollee, health care professional, or health care provider |
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| 1 | | notify the insurer, or the insurer's designee, before, at the | 2 | | time of, or concurrently with providing a health care service. | 3 | | "Testing of blood or constitutional tissue for cancer | 4 | | predisposition testing" includes, but is not limited to, the | 5 | | following forms of testing: | 6 | | (1) Targeted cancer gene panels. | 7 | | (2) Whole-exome genome testing. | 8 | | (3) Whole-genome sequencing. | 9 | | (b) An individual or group policy of accident and health | 10 | | insurance or managed care plan that is amended, delivered, | 11 | | issued, or renewed on or after the effective date of this | 12 | | amendatory Act of the 102nd General Assembly shall provide | 13 | | coverage for medically necessary comprehensive cancer testing | 14 | | and testing of blood or constitutional tissue for cancer | 15 | | predisposition testing as determined by a physician licensed | 16 | | to practice medicine in all of its branches. | 17 | | (c) The coverage provided under this Section shall be | 18 | | provided without any prior authorization requirements. | 19 | | Section 10. The Health Maintenance Organization Act is | 20 | | amended by changing Section 5-3 as follows:
| 21 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 22 | | Sec. 5-3. Insurance Code provisions.
| 23 | | (a) Health Maintenance Organizations
shall be subject to | 24 | | the provisions of Sections 133, 134, 136, 137, 139, 140, |
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| 1 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 2 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 3 | | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 4 | | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 5 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 6 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 7 | | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 8 | | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 9 | | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 10 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 11 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 12 | | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | 13 | | Insurance Code.
| 14 | | (b) For purposes of the Illinois Insurance Code, except | 15 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 16 | | Health Maintenance Organizations in
the following categories | 17 | | are deemed to be "domestic companies":
| 18 | | (1) a corporation authorized under the
Dental Service | 19 | | Plan Act or the Voluntary Health Services Plans Act;
| 20 | | (2) a corporation organized under the laws of this | 21 | | State; or
| 22 | | (3) a corporation organized under the laws of another | 23 | | state, 30% or more
of the enrollees of which are residents | 24 | | of this State, except a
corporation subject to | 25 | | substantially the same requirements in its state of
| 26 | | organization as is a "domestic company" under Article VIII |
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| 1 | | 1/2 of the
Illinois Insurance Code.
| 2 | | (c) In considering the merger, consolidation, or other | 3 | | acquisition of
control of a Health Maintenance Organization | 4 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 5 | | (1) the Director shall give primary consideration to | 6 | | the continuation of
benefits to enrollees and the | 7 | | financial conditions of the acquired Health
Maintenance | 8 | | Organization after the merger, consolidation, or other
| 9 | | acquisition of control takes effect;
| 10 | | (2)(i) the criteria specified in subsection (1)(b) of | 11 | | Section 131.8 of
the Illinois Insurance Code shall not | 12 | | apply and (ii) the Director, in making
his determination | 13 | | with respect to the merger, consolidation, or other
| 14 | | acquisition of control, need not take into account the | 15 | | effect on
competition of the merger, consolidation, or | 16 | | other acquisition of control;
| 17 | | (3) the Director shall have the power to require the | 18 | | following
information:
| 19 | | (A) certification by an independent actuary of the | 20 | | adequacy
of the reserves of the Health Maintenance | 21 | | Organization sought to be acquired;
| 22 | | (B) pro forma financial statements reflecting the | 23 | | combined balance
sheets of the acquiring company and | 24 | | the Health Maintenance Organization sought
to be | 25 | | acquired as of the end of the preceding year and as of | 26 | | a date 90 days
prior to the acquisition, as well as pro |
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| 1 | | forma financial statements
reflecting projected | 2 | | combined operation for a period of 2 years;
| 3 | | (C) a pro forma business plan detailing an | 4 | | acquiring party's plans with
respect to the operation | 5 | | of the Health Maintenance Organization sought to
be | 6 | | acquired for a period of not less than 3 years; and
| 7 | | (D) such other information as the Director shall | 8 | | require.
| 9 | | (d) The provisions of Article VIII 1/2 of the Illinois | 10 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 11 | | any health maintenance
organization of greater than 10% of its
| 12 | | enrollee population (including without limitation the health | 13 | | maintenance
organization's right, title, and interest in and | 14 | | to its health care
certificates).
| 15 | | (e) In considering any management contract or service | 16 | | agreement subject
to Section 141.1 of the Illinois Insurance | 17 | | Code, the Director (i) shall, in
addition to the criteria | 18 | | specified in Section 141.2 of the Illinois
Insurance Code, | 19 | | take into account the effect of the management contract or
| 20 | | service agreement on the continuation of benefits to enrollees | 21 | | and the
financial condition of the health maintenance | 22 | | organization to be managed or
serviced, and (ii) need not take | 23 | | into account the effect of the management
contract or service | 24 | | agreement on competition.
| 25 | | (f) Except for small employer groups as defined in the | 26 | | Small Employer
Rating, Renewability and Portability Health |
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| 1 | | Insurance Act and except for
medicare supplement policies as | 2 | | defined in Section 363 of the Illinois
Insurance Code, a | 3 | | Health Maintenance Organization may by contract agree with a
| 4 | | group or other enrollment unit to effect refunds or charge | 5 | | additional premiums
under the following terms and conditions:
| 6 | | (i) the amount of, and other terms and conditions with | 7 | | respect to, the
refund or additional premium are set forth | 8 | | in the group or enrollment unit
contract agreed in advance | 9 | | of the period for which a refund is to be paid or
| 10 | | additional premium is to be charged (which period shall | 11 | | not be less than one
year); and
| 12 | | (ii) the amount of the refund or additional premium | 13 | | shall not exceed 20%
of the Health Maintenance | 14 | | Organization's profitable or unprofitable experience
with | 15 | | respect to the group or other enrollment unit for the | 16 | | period (and, for
purposes of a refund or additional | 17 | | premium, the profitable or unprofitable
experience shall | 18 | | be calculated taking into account a pro rata share of the
| 19 | | Health Maintenance Organization's administrative and | 20 | | marketing expenses, but
shall not include any refund to be | 21 | | made or additional premium to be paid
pursuant to this | 22 | | subsection (f)). The Health Maintenance Organization and | 23 | | the
group or enrollment unit may agree that the profitable | 24 | | or unprofitable
experience may be calculated taking into | 25 | | account the refund period and the
immediately preceding 2 | 26 | | plan years.
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| 1 | | The Health Maintenance Organization shall include a | 2 | | statement in the
evidence of coverage issued to each enrollee | 3 | | describing the possibility of a
refund or additional premium, | 4 | | and upon request of any group or enrollment unit,
provide to | 5 | | the group or enrollment unit a description of the method used | 6 | | to
calculate (1) the Health Maintenance Organization's | 7 | | profitable experience with
respect to the group or enrollment | 8 | | unit and the resulting refund to the group
or enrollment unit | 9 | | or (2) the Health Maintenance Organization's unprofitable
| 10 | | experience with respect to the group or enrollment unit and | 11 | | the resulting
additional premium to be paid by the group or | 12 | | enrollment unit.
| 13 | | In no event shall the Illinois Health Maintenance | 14 | | Organization
Guaranty Association be liable to pay any | 15 | | contractual obligation of an
insolvent organization to pay any | 16 | | refund authorized under this Section.
| 17 | | (g) Rulemaking authority to implement Public Act 95-1045, | 18 | | if any, is conditioned on the rules being adopted in | 19 | | accordance with all provisions of the Illinois Administrative | 20 | | Procedure Act and all rules and procedures of the Joint | 21 | | Committee on Administrative Rules; any purported rule not so | 22 | | adopted, for whatever reason, is unauthorized. | 23 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 24 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 25 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 26 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; |
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| 1 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 2 | | 1-1-20; 101-625, eff. 1-1-21 .)
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