Illinois General Assembly - Full Text of HB0579
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Full Text of HB0579  103rd General Assembly


Rep. Robyn Gabel

Filed: 3/16/2023





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2    AMENDMENT NO. ______. Amend House Bill 579 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.35 as follows:
6    (5 ILCS 100/5-45.35 new)
7    Sec. 5-45.35. Emergency rulemaking; Illinois Health
8Benefits Exchange Law. To provide for the expeditious and
9timely implementation of Section 5-23 of the Illinois Health
10Benefits Exchange Law, emergency rules implementing Section
115-23 of the Illinois Health Benefits Exchange Law may be
12adopted in accordance with Section 5-45 of this Act by the
13Department of Insurance and the Department of Healthcare and
14Family Services. The adoption of emergency rules authorized by
15Section 5-45 and this Section is deemed to be necessary for the
16public interest, safety, and welfare.



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1    This Section is repealed 3 years after the effective date
2of this amendatory Act of the 103rd General Assembly.
3    Section 10. The Illinois Health Benefits Exchange Law is
4amended by changing Section 5-5 and by adding Sections 5-21,
55-22, and 5-23 as follows:
6    (215 ILCS 122/5-5)
7    Sec. 5-5. State health benefits exchange. It is declared
8that this State, beginning October 1, 2013, in accordance with
9Section 1311 of the federal Patient Protection and Affordable
10Care Act, shall establish a State health benefits exchange to
11be known as the Illinois Health Benefits Exchange in order to
12help individuals and small employers with no more than 50
13employees shop for, select, and enroll in qualified,
14affordable private health plans that fit their needs at
15competitive prices. The Exchange shall separate coverage pools
16for individuals and small employers and shall supplement and
17not supplant any existing private health insurance market for
18individuals and small employers. The Department of Insurance
19shall operate the Illinois Health Benefits Exchange as a
20State-based exchange using the federal platform by plan year
212025 and as a State-based exchange by plan year 2026. The
22Director of Insurance may require that all plans in the
23individual and small group markets, other than grandfathered
24health plans, be made available for comparison on the Illinois



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1Health Benefits Exchange, but may not require that all plans
2in the individual and small group markets be purchased
3exclusively on the Illinois Health Benefits Exchange. The
4Director of Insurance may require that plans offered on the
5exchange conform with standardized plan designs that provide
6for standardized cost sharing for covered health services.
7Except when it is inconsistent with State law, the Department
8of Insurance may enforce the coverage requirements under the
9federal Patient Protection and Affordable Care Act that apply
10to the individual and small group markets. The Director of
11Insurance may elect to add a small business health options
12program to the Illinois Health Benefits Exchange to help small
13employers enroll their employees in qualified health plans in
14the small group market. The General Assembly shall appropriate
15funds to establish the Illinois Health Benefits Exchange.
16(Source: P.A. 97-142, eff. 7-14-11.)
17    (215 ILCS 122/5-21 new)
18    Sec. 5-21. Monthly assessments.
19    (a) The Director of Insurance may apply a monthly
20assessment to each health benefits plan sold on the Illinois
21Health Benefits Exchange. The assessment shall be paid by the
22issuer and to the Department of Insurance and shall be used
23only for the purpose of supporting the exchange through
24exchange operations, outreach, enrollment, and other means of
25supporting the exchange, including any efforts that may



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1increase market stabilization and that may result in a net
2benefit to policyholders. The assessment may be applied at a
3rate of:
4        (1) 0.5% of the total monthly premium charged by an
5    issuer for each health benefits plan during any period
6    that the State is on a State-based exchange using the
7    federal platform; or
8        (2) 2.75% of the total monthly premium charged by an
9    issuer for each health benefits plan during any period
10    that the State is on the State-based exchange. The
11    Director of Insurance may adjust this rate to ensure that
12    the Illinois Health Benefits Exchange is fully funded.
13    (b) The Director of Insurance shall notify an issuer of
14its assessment rate for the subsequent year. Issuers must
15remit the assessment due in monthly installments to the
16Department of Insurance.
17    (c) The assessment described in this Section shall be
18considered a special purpose obligation and may not be applied
19by issuers to vary premium rates at the plan level.
20    (d) There is created a revolving fund to be known as the
21Illinois Health Benefits Exchange Fund, to be held by the
22Department of Insurance. The Illinois Health Benefits Exchange
23Fund shall be the repository for moneys collected pursuant to
24fees or assessments on exchange issuers, federal financial
25participation as appropriate, and other moneys received as
26grants or otherwise appropriated for the purposes of



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1supporting health insurance outreach, enrollment efforts, and
2plan management operations through an exchange. All moneys in
3the Fund shall be used only for the purpose of supporting the
4exchange through exchange operations, outreach, enrollment,
5and other means of supporting the exchange, including any
6efforts that may increase market stabilization and that may
7result in a net benefit to policyholders.
8    (215 ILCS 122/5-22 new)
9    Sec. 5-22. State medical assistance program coordination.
10    (a) The Department of Insurance and the Department of
11Healthcare and Family Services shall coordinate the operations
12of the exchange with the operations of State medical
13assistance programs. The Department of Healthcare and Family
14Services shall oversee and operate the exchange eligibility
15rules engine to ensure accurate assessments and determinations
16of exchange and State medical assistance program eligibility.
17    (b) The exchange may determine eligibility for State
18medical assistance programs that use the modified adjusted
19gross income methodology.
20    (c) The exchange may be used for enrollment into State
21medical assistance program health plans.
22    (d) The Department of Healthcare and Family Services may
23request federal financial participation funds from the Centers
24for Medicare and Medicaid Services for any integrated
25eligibility and enrollment functions of the exchange.



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1    (215 ILCS 122/5-23 new)
2    Sec. 5-23. Department of Insurance and Department of
3Healthcare and Family Services authority.
4    (a) The Department of Insurance and the Department of
5Healthcare and Family Services, in addition to the powers
6granted under the Illinois Insurance Code and the Illinois
7Public Aid Code, have the power necessary to establish and
8operate the Illinois Health Benefits Exchange, including, but
9not limited to, the authority to:
10        (1) adopt rules deemed necessary by the departments to
11    implement this Law;
12        (2) employ or retain sufficient personnel to provide
13    administration, staffing, and necessary related support
14    required to adequately discharge the duties described in
15    this Law from funds held in the Illinois Health Benefits
16    Exchange Fund;
17        (3) procure services, including a call center, and
18    goods for the purpose of establishing the Illinois Health
19    Benefits Exchange as emergency purchases as set forth in
20    Section 20-30 of the Illinois Procurement Code; and
21        (4) require any exchange vendor to have experience
22    operating a State-based exchange in another state.
23    (b) The Department of Insurance has the authority to
24employ a Chief Operating Officer of the Illinois Health
25Benefits Exchange. The Chief Operating Officer shall be



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1subject to confirmation by the Senate.
2    Section 99. Effective date. This Act takes effect upon
3becoming law.".