Full Text of HB2078 103rd General Assembly
HB2078 103RD GENERAL ASSEMBLY |
| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 HB2078 Introduced 2/7/2023, by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/356g | from Ch. 73, par. 968g |
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Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches).
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| | A BILL FOR |
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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 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356g as follows:
| 6 | | (215 ILCS 5/356g) (from Ch. 73, par. 968g)
| 7 | | Sec. 356g. Mammograms; mastectomies.
| 8 | | (a) Every insurer shall provide in each group or | 9 | | individual
policy, contract, or certificate of insurance | 10 | | issued or renewed for persons
who are residents of this State, | 11 | | coverage for screening by low-dose
mammography for all women | 12 | | 35 years of age or older for the presence of
occult breast | 13 | | cancer within the provisions of the policy, contract, or
| 14 | | certificate. The coverage shall be as follows:
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(1) A baseline mammogram for women 35 to 39 years of | 16 | | age.
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(2) An annual mammogram for women 40 years of age or | 18 | | older.
| 19 | | (3) A mammogram at the age and intervals considered | 20 | | medically necessary by the woman's health care provider | 21 | | for women under 40 years of age and having a family history | 22 | | of breast cancer, prior personal history of breast cancer, | 23 | | positive genetic testing, or other risk factors. |
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| 1 | | (4) For an individual or group policy of accident and | 2 | | health insurance or a managed care plan that is amended, | 3 | | delivered, issued, or renewed on or after the effective | 4 | | date of this amendatory Act of the 101st General Assembly, | 5 | | a comprehensive ultrasound screening and MRI of an entire | 6 | | breast or breasts if a mammogram demonstrates | 7 | | heterogeneous or dense breast tissue or when medically | 8 | | necessary as determined by a physician licensed to | 9 | | practice medicine in all of its branches. | 10 | | (5) A screening MRI or ultrasound when medically | 11 | | necessary, as determined by a physician licensed to | 12 | | practice medicine in all of its branches . | 13 | | (6) For an individual or group policy of accident and | 14 | | health insurance or a managed care plan that is amended, | 15 | | delivered, issued, or renewed on or after the effective | 16 | | date of this amendatory Act of the 101st General Assembly, | 17 | | a diagnostic mammogram when medically necessary, as | 18 | | determined by a physician licensed to practice medicine in | 19 | | all its branches, advanced practice registered nurse, or | 20 | | physician assistant. | 21 | | A policy subject to this subsection shall not impose a | 22 | | deductible, coinsurance, copayment, or any other cost-sharing | 23 | | requirement on the coverage provided; except that this | 24 | | sentence does not apply to coverage of diagnostic mammograms | 25 | | to the extent such coverage would disqualify a high-deductible | 26 | | health plan from eligibility for a health savings account |
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| 1 | | pursuant to Section 223 of the Internal Revenue Code (26 | 2 | | U.S.C. 223). | 3 | | For purposes of this Section: | 4 | | "Diagnostic
mammogram" means a mammogram obtained using | 5 | | diagnostic mammography. | 6 | | "Diagnostic
mammography" means a method of screening that | 7 | | is designed to
evaluate an abnormality in a breast, including | 8 | | an abnormality seen
or suspected on a screening mammogram or a | 9 | | subjective or objective
abnormality otherwise detected in the | 10 | | breast. | 11 | | "Low-dose mammography"
means the x-ray examination of the | 12 | | breast using equipment dedicated
specifically for mammography, | 13 | | including the x-ray tube, filter, compression
device, and | 14 | | image receptor, with radiation exposure delivery of less than
| 15 | | 1 rad per breast for 2 views of an average size breast. The | 16 | | term also includes digital mammography and includes breast | 17 | | tomosynthesis. As used in this Section, the term "breast | 18 | | tomosynthesis" means a radiologic procedure that involves the | 19 | | acquisition of projection images over the stationary breast to | 20 | | produce cross-sectional digital three-dimensional images of | 21 | | the breast.
| 22 | | If, at any time, the Secretary of the United States | 23 | | Department of Health and Human Services, or its successor | 24 | | agency, promulgates rules or regulations to be published in | 25 | | the Federal Register or publishes a comment in the Federal | 26 | | Register or issues an opinion, guidance, or other action that |
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| 1 | | would require the State, pursuant to any provision of the | 2 | | Patient Protection and Affordable Care Act (Public Law | 3 | | 111-148), including, but not limited to, 42 U.S.C. | 4 | | 18031(d)(3)(B) or any successor provision, to defray the cost | 5 | | of any coverage for breast tomosynthesis outlined in this | 6 | | subsection, then the requirement that an insurer cover breast | 7 | | tomosynthesis is inoperative other than any such coverage | 8 | | authorized under Section 1902 of the Social Security Act, 42 | 9 | | U.S.C. 1396a, and the State shall not assume any obligation | 10 | | for the cost of coverage for breast tomosynthesis set forth in | 11 | | this subsection. | 12 | | (a-5) Coverage as described by subsection (a) shall be | 13 | | provided at no cost to the insured and shall not be applied to | 14 | | an annual or lifetime maximum benefit. | 15 | | (a-10) When health care services are available through | 16 | | contracted providers and a person does not comply with plan | 17 | | provisions specific to the use of contracted providers, the | 18 | | requirements of subsection (a-5) are not applicable. When a | 19 | | person does not comply with plan provisions specific to the | 20 | | use of contracted providers, plan provisions specific to the | 21 | | use of non-contracted providers must be applied without | 22 | | distinction for coverage required by this Section and shall be | 23 | | at least as favorable as for other radiological examinations | 24 | | covered by the policy or contract. | 25 | | (b) No policy of accident or health insurance that | 26 | | provides for
the surgical procedure known as a mastectomy |
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| 1 | | shall be issued, amended,
delivered, or renewed in this State | 2 | | unless
that coverage also provides for prosthetic devices
or | 3 | | reconstructive surgery
incident to the mastectomy.
Coverage | 4 | | for breast reconstruction in connection with a mastectomy | 5 | | shall
include:
| 6 | | (1) reconstruction of the breast upon which the | 7 | | mastectomy has been
performed;
| 8 | | (2) surgery and reconstruction of the other breast to | 9 | | produce a
symmetrical appearance; and
| 10 | | (3) prostheses and treatment for physical | 11 | | complications at all stages of
mastectomy, including | 12 | | lymphedemas.
| 13 | | Care shall be determined in consultation with the attending | 14 | | physician and the
patient.
The offered coverage for prosthetic | 15 | | devices and
reconstructive surgery shall be subject to the | 16 | | deductible and coinsurance
conditions applied to the | 17 | | mastectomy, and all other terms and conditions
applicable to | 18 | | other benefits. When a mastectomy is performed and there is
no | 19 | | evidence of malignancy then the offered coverage may be | 20 | | limited to the
provision of prosthetic devices and | 21 | | reconstructive surgery to within 2
years after the date of the | 22 | | mastectomy. As used in this Section,
"mastectomy" means the | 23 | | removal of all or part of the breast for medically
necessary | 24 | | reasons, as determined by a licensed physician.
| 25 | | Written notice of the availability of coverage under this | 26 | | Section shall be
delivered to the insured upon enrollment and |
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| 1 | | annually thereafter. An insurer
may not deny to an insured | 2 | | eligibility, or continued eligibility, to enroll or
to renew | 3 | | coverage under the terms of the plan solely for the purpose of
| 4 | | avoiding the requirements of this Section. An insurer may not | 5 | | penalize or
reduce or
limit the reimbursement of an attending | 6 | | provider or provide incentives
(monetary or otherwise) to an | 7 | | attending provider to induce the provider to
provide care to | 8 | | an insured in a manner inconsistent with this Section.
| 9 | | (c) Rulemaking authority to implement Public Act 95-1045, | 10 | | if any, is conditioned on the rules being adopted in | 11 | | accordance with all provisions of the Illinois Administrative | 12 | | Procedure Act and all rules and procedures of the Joint | 13 | | Committee on Administrative Rules; any purported rule not so | 14 | | adopted, for whatever reason, is unauthorized. | 15 | | (Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20 .)
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