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| [ Introduced ] | [ Engrossed ] | [ Senate Amendment 001 ] |
91_HB0154ham001
LRB9100692JSpcam02
1 AMENDMENT TO HOUSE BILL 154
2 AMENDMENT NO. . Amend House Bill 154 on page 1, line
3 17, by deleting "changing Section 55.70 and"; and
4 on page 1 by deleting lines 19 through 29; and
5 on page 2 by deleting lines 1 through 17; and
6 on page 2, line 28, by replacing "procedures" with
7 "procedures, at least 4 of whom must be physicians licensed
8 to practice medicine in all its branches,"; and
9 on page 3 by deleting lines 17 through 23; and
10 on page 4 by replacing lines 2 through 17 with the following:
11 "changing Section 509 as follows:"; and
12 on page 5 by replacing lines 18 and 19 with the following:
13 "any one of the funds, other than the Breast and Cervical
14 Cancer Research Fund, made under this Section do not"; and
15 on page 5 by replacing line 26 with the following:
16 "Breast and Cervical Cancer Research Fund made"; and
17 on page 6 by deleting lines 1 through 27; and
18 on page 7, line 5, by changing "356y, and 356z" to "and
19 356y"; and
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1 on page 7, line 24, by changing "356y, and 356z" to "and 356y
2 "; and
3 on page 8, line 9, by changing "356y, and 356z" to "and
4 356y"; and
5 on page 8 by replacing lines 12 and through 31 with the
6 following:
7 "adding Section 356y as follows:
8 (215 ILCS 5/356y new)
9 Sec. 356y. Coverage for investigational cancer
10 treatments.
11 (a) An individual or group policy of accident and health
12 insurance issued, delivered, amended, or renewed in this
13 State after the effective date of this amendatory Act of the
14 91st General Assembly must provide coverage for patient care
15 of insureds, when medically appropriate, to participate in an
16 approved research trial and shall provide coverage for the
17 patient care provided pursuant to investigational cancer
18 treatments as provided in subsection (b).
19 (b) Coverage must be included for an item or service
20 that would otherwise be covered, subject to the limitations
21 and cost sharing requirements applicable to the item or
22 service, when that item or service is provided to an insured
23 in the course of an investigational cancer treatment if:
24 (1) the treatment is a qualifying cancer
25 investigational treatment ordered or prescribed by a
26 physician licensed to practice medicine in all its
27 branches; and
28 (2) the cancer treatment is administered as part of
29 the medical management of a life-threatening disease,
30 disorder, or health condition.
31 Coverage must be included for an item or service when
32 that item or service is required to provide patient care
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1 pursuant to the design of a research trial, except those
2 items or services normally paid for by other funding sources,
3 such as the costs of certain investigational agents, the
4 costs of any nonhealth services that might be required for a
5 person to receive cancer treatment, and the costs of managing
6 the research; items or services subject to this exception may
7 be covered in addition to patient care at the discretion of
8 the health plan.
9 (c) For purposes of this Section, (A) "qualifying
10 investigational cancer treatment" means a treatment (i) the
11 effectiveness of which has not been determined and (ii) that
12 is under clinical investigation as part of an approved cancer
13 research trial in Phase II, Phase III, or Phase IV of
14 investigation and (B) "approved cancer research trial" means
15 (i) a cancer research trial approved by the U.S. Secretary of
16 Health and Human Services, the Director of the National
17 Institutes of Health, the Commissioner of the Food and Drug
18 Administration (through an investigational new drug exemption
19 under Section 505(1) of the federal Food, Drug and Cosmetic
20 Act or an investigational device exemption under Section
21 520(g) of that Act), the Secretary of Veterans Affairs, the
22 Secretary of Defense, or a qualified nongovernmental cancer
23 research entity as defined in guidelines of the National
24 Institutes of Health or (ii) a peer-reviewed and approved
25 cancer research program, as defined by the U.S. Secretary of
26 Health and Human Services, conducted for the primary purpose
27 of determining whether or not a cancer treatment is safe or
28 efficacious or has any other characteristic of a cancer
29 treatment that must be demonstrated in order for the cancer
30 treatment to be medically necessary or appropriate.
31 (d) This Section is repealed on January 1, 2003."; and
32 by deleting all of page 9; and
33 on page 10 by deleting lines 1 through 18; and
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1 on page 10, line 27, by deleting "356z,"; and
2 on page 14, line 19, by deleting "356z,".