State of Illinois
90th General Assembly
Legislation

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90_SB0711eng

      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 96 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.
                                                    SRS90SB0037MNbm
SB711 Engrossed                               SRS90SB0037MNbm
 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
SB711 Engrossed             -2-               SRS90SB0037MNbm
 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 is an
18    exclusive power and function of the State and is a denial and
19    limitation under Article VII, Section 6,  subsection  (h)  of
20    the Illinois Constitution.  A home rule municipality to which
21    this Section applies must comply with every provision of this
22    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.
SB711 Engrossed             -3-               SRS90SB0037MNbm
 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   or  managed  care  plan  that  provides  surgical
 7    coverage and is amended, delivered, issued, or renewed  after
 8    the  effective  date  of  this  amendatory  Act of 1997 shall
 9    provide inpatient  coverage  following  a  mastectomy  for  a
10    length  of  time  determined by the attending physician to be
11    medically necessary and  in  accordance  with  protocols  and
12    guidelines  based  on  sound  scientific  evidence  and  upon
13    evaluation   of   the   patient  and  the  coverage  for  and
14    availibility of a post-discharge physician  office  visit  or
15    in-home nurse visit to verify the condition of the patient in
16    the first 48 hours after discharge.
17        Section  35.  The  Health Maintenance Organization Act is
18    amended by adding Section 4-6.5 as follows:
19        (215 ILCS 125/4-6.5 new)
20        Sec. 4-6.5.  Post-mastectomy care.  A health  maintenance
21    organization  is subject to the provisions of Section 356t of
22    the Illinois Insurance Code.
23        Section 45.  The Voluntary Health Services Plans  Act  is
24    amended by changing Section 10 as follows:
25        (215 ILCS 165/10) (from Ch. 32, par. 604)
26        Sec.   10.  Application  of  Insurance  Code  provisions.
27    Health services plan corporations and all persons  interested
28    therein   or  dealing  therewith  shall  be  subject  to  the
29    provisions of Article XII 1/2 and  Sections  3.1,  133,  140,
SB711 Engrossed             -4-               SRS90SB0037MNbm
 1    143,  143c,  149,  354, 355.2, 356r, 356t, 367.2, 401, 401.1,
 2    402, 403, 403A, 408, 408.2, and 412, and paragraphs  (7)  and
 3    (15) of Section 367 of the Illinois Insurance Code.
 4    (Source: P.A. 89-514, eff. 7-17-96.)
 5        Section  50.  The  Illinois Public Aid Code is amended by
 6    adding Section 5-16.8 as follows:
 7        (305 ILCS 5/5-16.8 new)
 8        Sec.   5-16.8.  Post-mastectomy   care.    The    medical
 9    assistance  program  shall  provide  the post-mastectomy care
10    benefits required to be covered by a policy of  accident  and
11    health insurance under Section 356t of the Illinois Insurance
12    Code.

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