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91_HB0154eng HB0154 Engrossed LRB9100692JSpc 1 AN ACT concerning cancer, amending named Acts. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The State Employees Group Insurance Act of 5 1971 is amended by changing Section 6.11 as follows: 6 (5 ILCS 375/6.11) 7 Sec. 6.11. Required health benefits. The program of 8 health benefits shall provide the post-mastectomy care 9 benefits required to be covered by a policy of accident and 10 health insurance under Section 356t of the Illinois Insurance 11 Code. The program of health benefits shall provide the 12 coverage required under Sections 356u, 356w,and356x, 356y, 13 and 356z of the Illinois Insurance Code. 14 (Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98; 15 90-741, eff. 1-1-99.) 16 Section 10. The Civil Administrative Code of Illinois is 17 amended by adding Section 55.91 as follows: 18 (20 ILCS 2310/55.91 new) 19 Sec. 55.91. Breast Cancer Treatment Advisory Committee. 20 (a) The Breast Cancer Treatment Advisory Committee is 21 hereby created. The Committee shall be composed of the 22 following members: 23 (1) 8 members of the General Assembly, 2 each 24 appointed by the Speaker of the House, the President of 25 the Senate, the Minority Leader of the House, and the 26 Minority Leader of the Senate; and 27 (2) 8 members who have knowledge of breast cancer 28 treatment procedures, at least 4 of whom must be 29 physicians licensed to practice medicine in all its HB0154 Engrossed -2- LRB9100692JSpc 1 branches, 2 each appointed by the Speaker of the House, 2 the President of the Senate, the Minority Leader of the 3 House, and the Minority Leader of the Senate. 4 (b) Members of the committee shall serve for a term that 5 ends on the expiration of the General Assembly during which 6 they were appointed. Members of the committee who are not 7 members of the General Assembly shall receive a per diem of 8 $150 for each day of attendance at committee meetings. The 9 Speaker of the House and the President of the Senate shall 10 each designate one member of the committee to serve as 11 co-chairperson of the committee. The committee shall meet at 12 the times and places designated by the co-chairpersons. 13 (c) The committee shall review and study techniques and 14 modalities effective in the prevention, detection, treatment, 15 or cure of breast cancer and make recommendations to the 16 General Assembly of legislation necessary or desirable to 17 improve treatment of breast cancer. 18 (d) The Department of Public Health shall provide 19 necessary staff support to perform the functions of the 20 committee, including the preparation of its recommendations 21 to the General Assembly. 22 Section 20. The State Mandates Act is amended by adding 23 Section 8.23 as follows: 24 (30 ILCS 805/8.23 new) 25 Sec. 8.23. Exempt mandate. Notwithstanding Sections 6 26 and 8 of this Act, no reimbursement by the State is required 27 for the implementation of any mandate created by this 28 amendatory Act of 1999. 29 Section 25. The Illinois Income Tax Act is amended by 30 changing Section 509 as follows: HB0154 Engrossed -3- LRB9100692JSpc 1 (35 ILCS 5/509) (from Ch. 120, par. 5-509) 2 Sec. 509. Tax checkoff explanations. All individual 3 income tax return forms shall contain appropriate 4 explanations and spaces to enable the taxpayers to designate 5 contributions to the Child Abuse Prevention Fund, to the 6 Community Health Center Care Fund, to the Illinois Wildlife 7 Preservation Fund as required by the Illinois Non-Game 8 Wildlife Protection Act, to the Alzheimer's Disease Research 9 Fund as required by the Alzheimer's Disease Research Act, to 10 the Assistance to the Homeless Fund as required by this Act, 11 to the Heritage Preservation Fund as required by the Heritage 12 Preservation Act, to the Child Care Expansion Program Fund as 13 required by the Child Care Expansion Program Act, to the Ryan 14 White AIDS Victims Assistance Fund, to the Assistive 15 Technology for Persons with Disabilities Fund, to the 16 Domestic Violence Shelter and Service Fund, to the United 17 States Olympians Assistance Fund, to the Youth Drug Abuse 18 Prevention Fund, to the Persian Gulf Conflict Veterans Fund, 19 to the Literacy Advancement Fund, to the Ryan White Pediatric 20 and Adult AIDS Fund, to the Illinois Special Olympics 21 Checkoff Fund, to the Breast,andCervical, and Prostate 22 Cancer Research Fund, to the Korean War Memorial Fund, to the 23 Heart Disease Treatment and Prevention Fund, to the 24 Hemophilia Treatment Fund, to the Mental Health Research 25 Fund, to the Children's Cancer Fund, to the American Diabetes 26 Association Fund, the Women in Military Service Memorial 27 Fund, and to the Meals on Wheels Fund. Each form shall 28 contain a statement that the contributions will reduce the 29 taxpayer's refund or increase the amount of payment to 30 accompany the return. Failure to remit any amount of 31 increased payment shall reduce the contribution accordingly. 32 If, on October 1 of any year, the total contributions to 33 any one of the funds, other than the Breast and Cervical 34 Cancer Research Fund, made under this Section do not equal HB0154 Engrossed -4- LRB9100692JSpc 1 $100,000 or more, the explanations and spaces for designating 2 contributions to the fund shall be removed from the 3 individual income tax return forms for the following and all 4 subsequent years and all subsequent contributions to the fund 5 shall be refunded to the taxpayer. If, on October 1, 2004 or 6 any year thereafter, the total contributions to the Breast 7 and Cervical Cancer Research Fund made under this Section do 8 not equal $100,000 or more, the explanations and spaces for 9 designating contributions to the fund shall be removed from 10 the individual income tax return forms for the following and 11 all subsequent years and all subsequent contributions to the 12 fund shall be refunded to the taxpayer. 13 (Source: P.A. 89-230, eff. 1-1-96; 89-324, eff. 8-13-95; 14 90-171, eff. 7-23-97.) 15 Section 30. The Counties Code is amended by changing 16 Section 5-1069.3 as follows: 17 (55 ILCS 5/5-1069.3) 18 Sec. 5-1069.3. Required health benefits. If a county, 19 including a home rule county, is a self-insurer for purposes 20 of providing health insurance coverage for its employees, the 21 coverage shall include coverage for the post-mastectomy care 22 benefits required to be covered by a policy of accident and 23 health insurance under Section 356t and the coverage required 24 under Sections 356u, 356w,and356x, and 356y of the Illinois 25 Insurance Code. The requirement that health benefits be 26 covered as provided in this Section is an exclusive power and 27 function of the State and is a denial and limitation under 28 Article VII, Section 6, subsection (h) of the Illinois 29 Constitution. A home rule county to which this Section 30 applies must comply with every provision of this Section. 31 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) HB0154 Engrossed -5- LRB9100692JSpc 1 Section 35. The Illinois Municipal Code is amended by 2 changing Section 10-4-2.3 as follows: 3 (65 ILCS 5/10-4-2.3) 4 Sec. 10-4-2.3. Required health benefits. If a 5 municipality, including a home rule municipality, is a 6 self-insurer for purposes of providing health insurance 7 coverage for its employees, the coverage shall include 8 coverage for the post-mastectomy care benefits required to be 9 covered by a policy of accident and health insurance under 10 Section 356t and the coverage required under Sections 356u, 11 356w,and356x, and 356y of the Illinois Insurance Code. The 12 requirement that health benefits be covered as provided in 13 this is an exclusive power and function of the State and is a 14 denial and limitation under Article VII, Section 6, 15 subsection (h) of the Illinois Constitution. A home rule 16 municipality to which this Section applies must comply with 17 every provision of this Section. 18 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) 19 Section 40. The School Code is amended by changing 20 Section 10-22.3f as follows: 21 (105 ILCS 5/10-22.3f) 22 Sec. 10-22.3f. Required health benefits. Insurance 23 protection and benefits for employees shall provide the 24 post-mastectomy care benefits required to be covered by a 25 policy of accident and health insurance under Section 356t 26 and the coverage required under Sections 356u, 356w,and356x 27 , and 356y of the Illinois Insurance Code. 28 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) 29 Section 45. The Illinois Insurance Code is amended by 30 adding Section 356y as follows: HB0154 Engrossed -6- LRB9100692JSpc 1 (215 ILCS 5/356y new) 2 Sec. 356y. Coverage for investigational cancer 3 treatments. 4 (a) An individual or group policy of accident and health 5 insurance issued, delivered, amended, or renewed in this 6 State after the effective date of this amendatory Act of the 7 91st General Assembly must provide coverage for patient care 8 of insureds, when medically appropriate, to participate in an 9 approved research trial and shall provide coverage for the 10 patient care provided pursuant to investigational cancer 11 treatments as provided in subsection (b). 12 (b) Coverage must be included for an item or service 13 that would otherwise be covered, subject to the limitations 14 and cost sharing requirements applicable to the item or 15 service, when that item or service is provided to an insured 16 in the course of an investigational cancer treatment if: 17 (1) the treatment is a qualifying cancer 18 investigational treatment ordered or prescribed by a 19 physician licensed to practice medicine in all its 20 branches; and 21 (2) the cancer treatment is administered as part of 22 the medical management of a life-threatening disease, 23 disorder, or health condition. 24 Coverage must be included for an item or service when 25 that item or service is required to provide patient care 26 pursuant to the design of a research trial, except those 27 items or services normally paid for by other funding sources, 28 such as the costs of certain investigational agents, the 29 costs of any nonhealth services that might be required for a 30 person to receive cancer treatment, and the costs of managing 31 the research; items or services subject to this exception may 32 be covered in addition to patient care at the discretion of 33 the health plan. 34 (c) For purposes of this Section, (A) "qualifying HB0154 Engrossed -7- LRB9100692JSpc 1 investigational cancer treatment" means a treatment (i) the 2 effectiveness of which has not been determined and (ii) that 3 is under clinical investigation as part of an approved cancer 4 research trial in Phase II, Phase III, or Phase IV of 5 investigation and (B) "approved cancer research trial" means 6 (i) a cancer research trial approved by the U.S. Secretary of 7 Health and Human Services, the Director of the National 8 Institutes of Health, the Commissioner of the Food and Drug 9 Administration (through an investigational new drug exemption 10 under Section 505(1) of the federal Food, Drug and Cosmetic 11 Act or an investigational device exemption under Section 12 520(g) of that Act), the Secretary of Veterans Affairs, the 13 Secretary of Defense, or a qualified nongovernmental cancer 14 research entity as defined in guidelines of the National 15 Institutes of Health or (ii) a peer-reviewed and approved 16 cancer research program, as defined by the U.S. Secretary of 17 Health and Human Services, conducted for the primary purpose 18 of determining whether or not a cancer treatment is safe or 19 efficacious or has any other characteristic of a cancer 20 treatment that must be demonstrated in order for the cancer 21 treatment to be medically necessary or appropriate. 22 (d) This Section is repealed on January 1, 2003. 23 Section 50. The Health Maintenance Organization Act is 24 amended by changing Section 5-3 as follows: 25 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) 26 Sec. 5-3. Insurance Code provisions. 27 (a) Health Maintenance Organizations shall be subject to 28 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2, 29 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 30 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 31 356y, 367i, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 32 444, and 444.1, paragraph (c) of subsection (2) of Section HB0154 Engrossed -8- LRB9100692JSpc 1 367, and Articles VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, 2 XXV, and XXVI of the Illinois Insurance Code. 3 (b) For purposes of the Illinois Insurance Code, except 4 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 5 Health Maintenance Organizations in the following categories 6 are deemed to be "domestic companies": 7 (1) a corporation authorized under the Dental 8 Service Plan Act or the Voluntary Health Services Plans 9 Act; 10 (2) a corporation organized under the laws of this 11 State; or 12 (3) a corporation organized under the laws of 13 another state, 30% or more of the enrollees of which are 14 residents of this State, except a corporation subject to 15 substantially the same requirements in its state of 16 organization as is a "domestic company" under Article 17 VIII 1/2 of the Illinois Insurance Code. 18 (c) In considering the merger, consolidation, or other 19 acquisition of control of a Health Maintenance Organization 20 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 21 (1) the Director shall give primary consideration 22 to the continuation of benefits to enrollees and the 23 financial conditions of the acquired Health Maintenance 24 Organization after the merger, consolidation, or other 25 acquisition of control takes effect; 26 (2)(i) the criteria specified in subsection (1)(b) 27 of Section 131.8 of the Illinois Insurance Code shall not 28 apply and (ii) the Director, in making his determination 29 with respect to the merger, consolidation, or other 30 acquisition of control, need not take into account the 31 effect on competition of the merger, consolidation, or 32 other acquisition of control; 33 (3) the Director shall have the power to require 34 the following information: HB0154 Engrossed -9- LRB9100692JSpc 1 (A) certification by an independent actuary of 2 the adequacy of the reserves of the Health 3 Maintenance Organization sought to be acquired; 4 (B) pro forma financial statements reflecting 5 the combined balance sheets of the acquiring company 6 and the Health Maintenance Organization sought to be 7 acquired as of the end of the preceding year and as 8 of a date 90 days prior to the acquisition, as well 9 as pro forma financial statements reflecting 10 projected combined operation for a period of 2 11 years; 12 (C) a pro forma business plan detailing an 13 acquiring party's plans with respect to the 14 operation of the Health Maintenance Organization 15 sought to be acquired for a period of not less than 16 3 years; and 17 (D) such other information as the Director 18 shall require. 19 (d) The provisions of Article VIII 1/2 of the Illinois 20 Insurance Code and this Section 5-3 shall apply to the sale 21 by any health maintenance organization of greater than 10% of 22 its enrollee population (including without limitation the 23 health maintenance organization's right, title, and interest 24 in and to its health care certificates). 25 (e) In considering any management contract or service 26 agreement subject to Section 141.1 of the Illinois Insurance 27 Code, the Director (i) shall, in addition to the criteria 28 specified in Section 141.2 of the Illinois Insurance Code, 29 take into account the effect of the management contract or 30 service agreement on the continuation of benefits to 31 enrollees and the financial condition of the health 32 maintenance organization to be managed or serviced, and (ii) 33 need not take into account the effect of the management 34 contract or service agreement on competition. HB0154 Engrossed -10- LRB9100692JSpc 1 (f) Except for small employer groups as defined in the 2 Small Employer Rating, Renewability and Portability Health 3 Insurance Act and except for medicare supplement policies as 4 defined in Section 363 of the Illinois Insurance Code, a 5 Health Maintenance Organization may by contract agree with a 6 group or other enrollment unit to effect refunds or charge 7 additional premiums under the following terms and conditions: 8 (i) the amount of, and other terms and conditions 9 with respect to, the refund or additional premium are set 10 forth in the group or enrollment unit contract agreed in 11 advance of the period for which a refund is to be paid or 12 additional premium is to be charged (which period shall 13 not be less than one year); and 14 (ii) the amount of the refund or additional premium 15 shall not exceed 20% of the Health Maintenance 16 Organization's profitable or unprofitable experience with 17 respect to the group or other enrollment unit for the 18 period (and, for purposes of a refund or additional 19 premium, the profitable or unprofitable experience shall 20 be calculated taking into account a pro rata share of the 21 Health Maintenance Organization's administrative and 22 marketing expenses, but shall not include any refund to 23 be made or additional premium to be paid pursuant to this 24 subsection (f)). The Health Maintenance Organization and 25 the group or enrollment unit may agree that the 26 profitable or unprofitable experience may be calculated 27 taking into account the refund period and the immediately 28 preceding 2 plan years. 29 The Health Maintenance Organization shall include a 30 statement in the evidence of coverage issued to each enrollee 31 describing the possibility of a refund or additional premium, 32 and upon request of any group or enrollment unit, provide to 33 the group or enrollment unit a description of the method used 34 to calculate (1) the Health Maintenance Organization's HB0154 Engrossed -11- LRB9100692JSpc 1 profitable experience with respect to the group or enrollment 2 unit and the resulting refund to the group or enrollment unit 3 or (2) the Health Maintenance Organization's unprofitable 4 experience with respect to the group or enrollment unit and 5 the resulting additional premium to be paid by the group or 6 enrollment unit. 7 In no event shall the Illinois Health Maintenance 8 Organization Guaranty Association be liable to pay any 9 contractual obligation of an insolvent organization to pay 10 any refund authorized under this Section. 11 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98; 12 90-177, eff. 7-23-97; 90-372, eff. 7-1-98; 90-583, eff. 13 5-29-98; 90-655, eff. 7-30-98; 90-741, eff. 1-1-99; revised 14 9-8-98.) 15 Section 55. The Voluntary Health Services Plans Act is 16 amended by changing Section 10 as follows: 17 (215 ILCS 165/10) (from Ch. 32, par. 604) 18 Sec. 10. Application of Insurance Code provisions. 19 Health services plan corporations and all persons interested 20 therein or dealing therewith shall be subject to the 21 provisions of Article XII 1/2 and Sections 3.1, 133, 140, 22 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 356w, 23 356x, 356y, 367.2, 401, 401.1, 402, 403, 403A, 408, 408.2, 24 and 412, and paragraphs (7) and (15) of Section 367 of the 25 Illinois Insurance Code. 26 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97; 27 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 90-741, eff. 28 1-1-99.) 29 Section 99. Effective date. This Act takes effect upon 30 becoming law. HB0154 Engrossed -12- LRB9100692JSpc 1 INDEX 2 Statutes amended in order of appearance 3 5 ILCS 375/6.11 4 20 ILCS 2310/55.70 5 20 ILCS 2310/55.91 new 6 30 ILCS 105/5.362 7 30 ILCS 805/8.22 new 8 35 ILCS 5/507L 9 35 ILCS 5/509 from Ch. 120, par. 5-509 10 35 ILCS 5/510 from Ch. 120, par. 5-510 11 55 ILCS 5/5-1069.3 12 65 ILCS 5/10-4-2.3 13 105 ILCS 5/10-22.3f 14 215 ILCS 5/356y new 15 215 ILCS 5/356z new 16 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 17 215 ILCS 165/10 from Ch. 32, par. 604