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| [ Senate Amendment 002 ] |
90_SB0711ham001
LRB9005424JSmbam01
1 AMENDMENT TO SENATE BILL 711
2 AMENDMENT NO. . Amend Senate Bill 711 by replacing
3 the title with the following:
4 "AN ACT concerning medical coverage for mastectomies,
5 amending named Acts."; and
6 by replacing everything after the enacting clause with the
7 following:
8 "Section 5. The State Employees Group Insurance Act of
9 1971 is amended by adding Section 6.9 as follows:
10 (5 ILCS 375/6.9 new)
11 Sec. 6.9. Post-mastectomy care. The program of health
12 benefits shall provide the post-mastectomy care benefits
13 required to be covered by a policy of accident and health
14 insurance under Section 356t of the Illinois Insurance Code.
15 Section 10. The Illinois Health Finance Reform Act is
16 amended by adding Section 4-2.1 as follows:
17 (20 ILCS 2215/4-2.1 new)
18 Sec. 4-2.1. Hospital inpatient length of stay report.
19 The Council shall prepare a report on the average number of
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1 days a patient stays in a hospital following mastectomy
2 procedures. This report shall be prepared using available
3 inpatient discharge data for 1996 by August 1, 1997 and
4 updated annually thereafter.
5 Section 15. The State Mandates Act is amended by adding
6 Section 8.21 as follows:
7 (30 ILCS 805/8.21 new)
8 Sec. 8.21. Exempt mandate. Notwithstanding Sections 6
9 and 8 of this Act, no reimbursement by the State is required
10 for the implementation of any mandate created by this
11 amendatory Act of 1997.
12 Section 20. The Counties Code is amended by adding
13 Section 5-1069.3 as follows:
14 (55 ILCS 5/5-1069.3 new)
15 Sec. 5-1069.3. Post-mastectomy care. If a county,
16 including a home rule county, is a self-insurer for purposes
17 of providing health insurance coverage for its employees, the
18 coverage shall include coverage for the post-mastectomy care
19 benefits required to be covered by a policy of accident and
20 health insurance under Section 356t of the Illinois Insurance
21 Code. The requirement that post-mastectomy care be covered
22 as provided in this Section is an exclusive power and
23 function of the State and is a denial and limitation under
24 Article VII, Section 6, subsection (h) of the Illinois
25 Constitution. A home rule county to which this Section
26 applies must comply with every provision of this Section.
27 Section 25. The Illinois Municipal Code is amended by
28 adding Section 10-4-2.3 as follows:
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1 (65 ILCS 5/10-4-2.3 new)
2 Sec. 10-4-2.3. Post-mastectomy care. If a municipality,
3 including a home rule municipality, is a self-insurer for
4 purposes of providing health insurance coverage for its
5 employees, the coverage shall include coverage for the
6 post-mastectomy care benefits required to be covered by a
7 policy of accident and health insurance under Section 356t of
8 the Illinois Insurance Code. The requirement that
9 post-mastectomy care be covered as provided in this Section
10 is an exclusive power and function of the State and is a
11 denial and limitation under Article VII, Section 6,
12 subsection (h) of the Illinois Constitution. A home rule
13 municipality to which this Section applies must comply with
14 every provision of this Section.
15 Section 30. The School Code is amended by adding Section
16 10-22.3f as follows:
17 (105 ILCS 5/10-22.3f new)
18 Sec. 10-22.3f. Post-mastectomy care. Insurance
19 protection and benefits for employees shall provide the
20 post-mastectomy care benefits required to be covered by a
21 policy of accident and health insurance under Section 356t of
22 the Illinois Insurance Code.
23 Section 35. The Illinois Insurance Code is amended by
24 adding Section 356t as follows:
25 (215 ILCS 5/356t new)
26 Sec. 356t. Post-mastectomy care.
27 (a) An individual or group policy of accident and health
28 insurance or managed care plan that provides surgical
29 coverage and is amended, delivered, issued, or renewed after
30 the effective date of this amendatory Act of 1997 shall
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1 provide coverage for a minimum of the average number of days
2 a patient stays in the hospital following a mastectomy
3 procedure, as determined by the Illinois Health Care Cost
4 Containment Council annually, except as otherwise provided in
5 this Section.
6 (b) A shorter length of hospital inpatient stay for
7 services related to a mastectomy procedure may be provided if
8 the attending physician determines in accordance with the
9 protocols and guidelines based on sound scientific research
10 deemed appropriate by the attending physician and based upon
11 evaluation of the patient and the coverage for and
12 availability of a post-discharge physician office visit or
13 in-home nurse visit to verify the condition of the patient in
14 the first 48 hours after discharge.
15 (c) For the purposes of this Section the following terms
16 are defined:
17 (1) "Attending physician" means a physician
18 licensed to practice medicine in all its branches
19 providing care to the patient.
20 (2) "Managed care plan" means a plan that
21 establishes, operates, or maintains a network of health
22 care providers that have entered into agreements with the
23 plan to provide health care services to enrollees where
24 the plan has the ultimate and direct contractual
25 obligation to the enrollee to arrange for the provision
26 of or pay for services through:
27 (A) organizational arrangements for ongoing
28 quality assurance, utilization review programs, or
29 dispute resolution; or
30 (B) financial incentives for persons enrolled
31 in the plan to use the participating providers and
32 procedures covered by the plan.
33 A managed care plan may be established or operated
34 by any entity including a licensed insurance company,
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1 hospital or medical service plan, health maintenance
2 organization, limited health service organization,
3 preferred provider organization, third party
4 administrator, or an employer or employee organization.
5 (d) The insurer or plan shall inform all insureds or
6 enrollees in writing of the right to this minimum coverage
7 under this Section as part of the insurer's or plan's regular
8 notice of coverage to insureds or enrollees and at the time
9 the insured or enrollee is admitted to a hospital for
10 procedures subject to this Section.
11 Section 40. The Comprehensive Health Insurance Plan Act
12 is amended by adding Section 8.7 as follows:
13 (215 ILCS 105/8.7 new)
14 Sec. 8.7. Post-mastectomy care. The plan is subject to
15 the provisions of Section 356t of the Illinois Insurance
16 Code.
17 Section 45. 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 50. The Limited Health Service Organization Act
24 is amended by changing Section 4003 as follows:
25 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
26 Sec. 4003. Illinois Insurance Code provisions. Limited
27 health service organizations shall be subject to the
28 provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
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1 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
2 154.6, 154.7, 154.8, 155.04, 355.2, 356t, 401, 401.1, 402,
3 403, 403A, 408, 408.2, and 412, and Articles VIII 1/2, XII,
4 XII 1/2, XIII, XIII 1/2, and XXVI of the Illinois Insurance
5 Code. For purposes of the Illinois Insurance Code, except
6 for Articles XIII and XIII 1/2, limited health service
7 organizations in the following categories are deemed to be
8 domestic companies:
9 (1) a corporation under the laws of this State; or
10 (2) a corporation organized under the laws of
11 another state, 30% of more of the enrollees of which are
12 residents of this State, except a corporation subject to
13 substantially the same requirements in its state of
14 organization as is a domestic company under Article VIII
15 1/2 of the Illinois Insurance Code.
16 (Source: P.A. 86-600; 87-587; 87-1090.)
17 Section 55. The Voluntary Health Services Plans Act is
18 amended by changing Section 10 as follows:
19 (215 ILCS 165/10) (from Ch. 32, par. 604)
20 Sec. 10. Application of Insurance Code provisions.
21 Health services plan corporations and all persons interested
22 therein or dealing therewith shall be subject to the
23 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
24 143, 143c, 149, 354, 355.2, 356r, 356t, 367.2, 401, 401.1,
25 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
26 (15) of Section 367 of the Illinois Insurance Code.
27 (Source: P.A. 89-514, eff. 7-17-96.)
28 Section 60. The Illinois Public Aid Code is amended by
29 adding Section 5-16.8 as follows:
30 (305 ILCS 5/5-16.8 new)
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1 Sec. 5-16.8. Post-mastectomy care. The medical
2 assistance program shall provide the post-mastectomy care
3 benefits required to be covered by a policy of accident and
4 health insurance under Section 356t of the Illinois Insurance
5 Code.
6 Section 99. Effective date. This Act takes effect June
7 1, 1997.".