State of Illinois
90th General Assembly
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90_HB0011

      5 ILCS 375/6.9 new
      30 ILCS 805/8.21 new
      55 ILCS 5/5-1069.3 new
      65 ILCS 5/10-4-2.3
      105 ILCS 5/10-22.3f new
      215 ILCS 5/356t new
      215 ILCS 125/4-6.5 new
      215 ILCS 130/4002.2
      215 ILCS 165/10           from Ch. 32, par. 604
      305 ILCS 5/5-16.8 new
          Amends the State Employees Group Insurance Law  of  1971,
      Counties Code, Illinois Municipal Code, School Code, Illinois
      Insurance  Code, Health Maintenance Organization Act, Limited
      Health Service Organization Act,  Voluntary  Health  Services
      Plans  Act,  and Illinois Public Aid Code.  Requires coverage
      under those Acts for a minimum of 48 hours of inpatient  care
      following  a  mastectomy.   Permits  a shorter inpatient care
      period  if  certain  criteria  are  met.   Amends  the  State
      Mandates   Act   to   provide    that    reimbursement    for
      post-mastectomy care benefits is not required under that Act.
                                                     LRB9000130JSsb
                                               LRB9000130JSsb
 1        AN  ACT  concerning certain surgical procedures, amending
 2    named Acts.
 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:
 5        Section  5.   The  State Employees Group Insurance Act of
 6    1971 is amended by adding Section 6.9 as follows:
 7        (5 ILCS 375/6.9 new)
 8        Sec. 6.9.  Post-mastectomy care.  The program  of  health
 9    benefits  shall  provide  the  post-mastectomy  care benefits
10    required to be covered by a policy  of  accident  and  health
11    insurance under Section 356t of the Illinois Insurance Code.
12        Section  10.  The State Mandates Act is amended by adding
13    Section 8.21 as follows:
14        (30 ILCS 805/8.21 new)
15        Sec. 8.21.  Exempt mandate.  Notwithstanding  Sections  6
16    and  8 of this Act, no reimbursement by the State is required
17    for  the  implementation  of  any  mandate  created  by  this
18    amendatory Act of 1997.
19        Section 15.  The  Counties  Code  is  amended  by  adding
20    Section 5-1069.3 as follows:
21        (55 ILCS 5/5-1069.3 new)
22        Sec.   5-1069.3.  Post-mastectomy   care.  If  a  county,
23    including a home rule county, is a self-insurer for  purposes
24    of providing health insurance coverage for its employees, the
25    coverage  shall include coverage for the post-mastectomy care
26    benefits required to be covered by a policy of  accident  and
27    health insurance under Section 356t of the Illinois Insurance
                            -2-                LRB9000130JSsb
 1    Code.   The  requirement that post-mastectomy care be covered
 2    as provided  in  this  Section  is  an  exclusive  power  and
 3    function  of  the  State and is a denial and limitation under
 4    Article VII,  Section  6,  subsection  (h)  of  the  Illinois
 5    Constitution.   A  home  rule  county  to  which this Section
 6    applies must comply with every provision of this Section.
 7        Section 20.  The Illinois Municipal Code  is  amended  by
 8    adding Section 10-4-2.3 as follows:
 9        (65 ILCS 5/10-4-2.3 new)
10        Sec.  10-4-2.3.  Post-mastectomy care. If a municipality,
11    including a home rule municipality,  is  a  self-insurer  for
12    purposes  of  providing  health  insurance  coverage  for its
13    employees,  the  coverage  shall  include  coverage  for  the
14    post-mastectomy care benefits required to  be  covered  by  a
15    policy of accident and health insurance under Section 356t of
16    the   Illinois   Insurance   Code.    The   requirement  that
17    post-mastectomy care be covered as provided in  this  Section
18    is  an  exclusive  power  and  function of the State and is a
19    denial  and  limitation  under  Article   VII,   Section   6,
20    subsection  (h)  of  the  Illinois Constitution.  A home rule
21    municipality to which this Section applies must  comply  with
22    every provision of this Section.
23        Section 25.  The School Code is amended by adding Section
24    10-22.3f as follows:
25        (105 ILCS 5/10-22.3f new)
26        Sec.     10-22.3f.  Post-mastectomy    care.    Insurance
27    protection and  benefits  for  employees  shall  provide  the
28    post-mastectomy  care  benefits  required  to be covered by a
29    policy of accident and health insurance under Section 356t of
30    the Illinois Insurance Code.
                            -3-                LRB9000130JSsb
 1        Section 30.  The Illinois Insurance Code  is  amended  by
 2    adding Section 356t as follows:
 3        (215 ILCS 5/356t new)
 4        Sec. 356t.  Post-mastectomy care.
 5        (a)  An individual or group policy of accident and health
 6    insurance  that  provides  surgical  coverage and is amended,
 7    delivered, issued, or renewed after  the  effective  date  of
 8    this  amendatory  Act  of  1997  shall provide coverage for a
 9    minimum of 48 hours of inpatient care following a mastectomy,
10    except as otherwise provided in this Section.
11        (b)  A shorter length  of  hospital  inpatient  stay  for
12    services  related  to  a  mastectomy  may  be provided if the
13    attending physician  is  a  physician  licensed  to  practice
14    medicine in all of its branches and determines, in accordance
15    with  the  protocols and guidelines developed by the American
16    College of Surgeons, that the patient meets  the  appropriate
17    guidelines  for  that length of stay based upon evaluation of
18    the patient and  the  coverage  for  and  availability  of  a
19    post-discharge  physician office visit or in-home nurse visit
20    to verify the condition of the patient in the first 48  hours
21    after discharge.
22        Section  35.   The Health Maintenance Organization Act is
23    amended by adding Section 4-6.5 as follows:
24        (215 ILCS 125/4-6.5 new)
25        Sec. 4-6.5.  Post-mastectomy care.  A health  maintenance
26    organization  is subject to the provisions of Section 356t of
27    the Illinois Insurance Code.
28        Section  40.  The Limited Health Service Organization Act
29    is amended by adding Section 4002.2 as follows:
                            -4-                LRB9000130JSsb
 1        (215 ILCS 130/4002.2 new)
 2        Sec.  4002.2.  Post-mastectomy   care.   Limited   health
 3    service  organizations  are  subject  to  the  provisions  of
 4    Section 356t of the Illinois Insurance Code.
 5        Section   45.  The Voluntary Health Services Plans Act is
 6    amended by changing Section 10 as follows:
 7        (215 ILCS 165/10) (from Ch. 32, par. 604)
 8        Sec.  10.  Application  of  Insurance  Code   provisions.
 9    Health  services plan corporations and all persons interested
10    therein  or  dealing  therewith  shall  be  subject  to   the
11    provisions  of  Article  XII  1/2 and Sections 3.1, 133, 140,
12    143, 143c, 149, 354, 355.2, 356r, 356t,  367.2,  401,  401.1,
13    402,  403,  403A, 408, 408.2, and 412, and paragraphs (7) and
14    (15) of Section 367 of the Illinois Insurance Code.
15    (Source: P.A. 89-514, eff. 7-17-96.)
16        Section  50.  The Illinois Public Aid Code is amended  by
17    adding Section 5-16.8 as follows:
18        (305 ILCS 5/5-16.8 new)
19        Sec.    5-16.8.  Post-mastectomy   care.    The   medical
20    assistance program shall  provide  the  post-mastectomy  care
21    benefits  required  to be covered by a policy of accident and
22    health insurance under Section 356t of the Illinois Insurance
23    Code.

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