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| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0061 Introduced 1/14/2021, by Rep. Terra Costa Howard SYNOPSIS AS INTRODUCED:
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| 5 ILCS 375/6.11 | | 55 ILCS 5/5-1069.3 | | 65 ILCS 5/10-4-2.3 | | 105 ILCS 5/10-22.3f | | 215 ILCS 5/356z.5 | | 215 ILCS 130/4003 | from Ch. 73, par. 1504-3 | 305 ILCS 5/5-16.8 | |
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Amends the Illinois Insurance Code. In provisions providing that a group or individual policy of accident and health insurance or managed care plan that provides coverage for prescription drugs shall not deny or limit coverage for prescription inhalants to enable persons to breathe when suffering from asthma or other life-threatening bronchial ailments based upon any restriction on the number of days before an inhaler refill may be obtained, requires coverage for prescription inhalants. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Illinois Public Aid Code to provide that health benefits under those Acts are subject to the provisions of the Illinois Insurance Code regarding prescription inhalants. Effective January 1, 2022.
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| | | FISCAL NOTE ACT MAY APPLY | | STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT |
| | A BILL FOR |
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| | HB0061 | | LRB102 02747 BMS 12750 b |
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| 1 | | AN ACT concerning regulation.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The State Employees Group Insurance Act of 1971 |
| 5 | | is amended by changing Section 6.11 as follows:
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| 6 | | (5 ILCS 375/6.11)
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| 7 | | Sec. 6.11. Required health benefits; Illinois Insurance |
| 8 | | Code
requirements. The program of health
benefits shall |
| 9 | | provide the post-mastectomy care benefits required to be |
| 10 | | covered
by a policy of accident and health insurance under |
| 11 | | Section 356t of the Illinois
Insurance Code. The program of |
| 12 | | health benefits shall provide the coverage
required under |
| 13 | | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, |
| 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.5, 356z.8, 356z.9, |
| 15 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, |
| 16 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
| 17 | | 356z.33, 356z.36, and 356z.41 of the
Illinois Insurance Code.
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| 18 | | The program of health benefits must comply with Sections |
| 19 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article |
| 20 | | XXXIIB of the
Illinois Insurance Code. The Department of |
| 21 | | Insurance shall enforce the requirements of this Section with |
| 22 | | respect to Sections 370c and 370c.1 of the Illinois Insurance |
| 23 | | Code; all other requirements of this Section shall be enforced |
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| 1 | | by the Department of Central Management Services.
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| 2 | | Rulemaking authority to implement Public Act 95-1045, if |
| 3 | | any, is conditioned on the rules being adopted in accordance |
| 4 | | with all provisions of the Illinois Administrative Procedure |
| 5 | | Act and all rules and procedures of the Joint Committee on |
| 6 | | Administrative Rules; any purported rule not so adopted, for |
| 7 | | whatever reason, is unauthorized. |
| 8 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
| 9 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
| 10 | | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, |
| 11 | | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; |
| 12 | | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
| 13 | | 1-1-21.)
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| 14 | | Section 10. The Counties Code is amended by changing |
| 15 | | Section 5-1069.3 as follows:
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| 16 | | (55 ILCS 5/5-1069.3)
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| 17 | | Sec. 5-1069.3. Required health benefits. If a county, |
| 18 | | including a home
rule
county, is a self-insurer for purposes |
| 19 | | of providing health insurance coverage
for its employees, the |
| 20 | | coverage shall include coverage for the post-mastectomy
care |
| 21 | | benefits required to be covered by a policy of accident and |
| 22 | | health
insurance under Section 356t and the coverage required |
| 23 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, |
| 24 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
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| 1 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
| 2 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of
the |
| 3 | | Illinois Insurance Code. The coverage shall comply with |
| 4 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois |
| 5 | | Insurance Code. The Department of Insurance shall enforce the |
| 6 | | requirements of this Section. The requirement that health |
| 7 | | benefits be covered
as provided in this Section is an
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| 8 | | exclusive power and function of the State and is a denial and |
| 9 | | limitation under
Article VII, Section 6, subsection (h) of the |
| 10 | | Illinois Constitution. A home
rule county to which this |
| 11 | | Section applies must comply with every provision of
this |
| 12 | | Section.
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| 13 | | Rulemaking authority to implement Public Act 95-1045, if |
| 14 | | any, is conditioned on the rules being adopted in accordance |
| 15 | | with all provisions of the Illinois Administrative Procedure |
| 16 | | Act and all rules and procedures of the Joint Committee on |
| 17 | | Administrative Rules; any purported rule not so adopted, for |
| 18 | | whatever reason, is unauthorized. |
| 19 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
| 20 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
| 21 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
| 22 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
| 23 | | 101-625, eff. 1-1-21.)
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| 24 | | Section 15. The Illinois Municipal Code is amended by |
| 25 | | changing Section 10-4-2.3 as follows:
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| 1 | | (65 ILCS 5/10-4-2.3)
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| 2 | | Sec. 10-4-2.3. Required health benefits. If a |
| 3 | | municipality, including a
home rule municipality, is a |
| 4 | | self-insurer for purposes of providing health
insurance |
| 5 | | coverage for its employees, the coverage shall include |
| 6 | | coverage for
the post-mastectomy care benefits required to be |
| 7 | | covered by a policy of
accident and health insurance under |
| 8 | | Section 356t and the coverage required
under Sections 356g, |
| 9 | | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.5, 356z.6, 356z.8, |
| 10 | | 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, |
| 11 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
| 12 | | 356z.33, 356z.36, and 356z.41 of the Illinois
Insurance
Code. |
| 13 | | The coverage shall comply with Sections 155.22a, 355b, |
| 14 | | 356z.19, and 370c of
the Illinois Insurance Code. The |
| 15 | | Department of Insurance shall enforce the requirements of this |
| 16 | | Section. The requirement that health
benefits be covered as |
| 17 | | provided in this is an exclusive power and function of
the |
| 18 | | State and is a denial and limitation under Article VII, |
| 19 | | Section 6,
subsection (h) of the Illinois Constitution. A home |
| 20 | | rule municipality to which
this Section applies must comply |
| 21 | | with every provision of this Section.
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| 22 | | Rulemaking authority to implement Public Act 95-1045, if |
| 23 | | any, is conditioned on the rules being adopted in accordance |
| 24 | | with all provisions of the Illinois Administrative Procedure |
| 25 | | Act and all rules and procedures of the Joint Committee on |
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| 1 | | Administrative Rules; any purported rule not so adopted, for |
| 2 | | whatever reason, is unauthorized. |
| 3 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
| 4 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
| 5 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
| 6 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
| 7 | | 101-625, eff. 1-1-21.)
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| 8 | | Section 20. The School Code is amended by changing Section |
| 9 | | 10-22.3f as follows:
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| 10 | | (105 ILCS 5/10-22.3f)
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| 11 | | Sec. 10-22.3f. Required health benefits. Insurance |
| 12 | | protection and
benefits
for employees shall provide the |
| 13 | | post-mastectomy care benefits required to be
covered by a |
| 14 | | policy of accident and health insurance under Section 356t and |
| 15 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, |
| 16 | | 356u, 356w, 356x, 356z.5,
356z.6, 356z.8, 356z.9, 356z.11, |
| 17 | | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, |
| 18 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of
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| 19 | | the
Illinois Insurance Code.
Insurance policies shall comply |
| 20 | | with Section 356z.19 of the Illinois Insurance Code. The |
| 21 | | coverage shall comply with Sections 155.22a, 355b, and 370c of
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| 22 | | the Illinois Insurance Code. The Department of Insurance shall |
| 23 | | enforce the requirements of this Section.
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| 24 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance |
| 2 | | with all provisions of the Illinois Administrative Procedure |
| 3 | | Act and all rules and procedures of the Joint Committee on |
| 4 | | Administrative Rules; any purported rule not so adopted, for |
| 5 | | whatever reason, is unauthorized. |
| 6 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
| 7 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. |
| 8 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
| 9 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; |
| 10 | | 101-625, eff. 1-1-21.)
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| 11 | | Section 25. The Illinois Insurance Code is amended by |
| 12 | | changing Section 356z.5 as follows:
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| 13 | | (215 ILCS 5/356z.5)
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| 14 | | Sec. 356z.5. Prescription inhalants. A group or individual
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| 15 | | policy of
accident and health insurance or managed care plan |
| 16 | | amended, delivered, issued,
or renewed on or
after the |
| 17 | | effective date of this amendatory Act of the 102nd General |
| 18 | | Assembly this amendatory Act of the 93rd General Assembly
that |
| 19 | | provides
coverage for prescription drugs must provide coverage |
| 20 | | for prescription inhalants and shall may not deny or limit |
| 21 | | coverage
for prescription inhalants to enable persons to |
| 22 | | breathe when suffering from
asthma or other life-threatening |
| 23 | | bronchial ailments based upon any restriction
on the number of |
| 24 | | days before an inhaler refill may be obtained if, contrary to
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| 1 | | those restrictions, the inhalants have been ordered or |
| 2 | | prescribed by the
treating physician and are medically |
| 3 | | appropriate.
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| 4 | | (Source: P.A. 95-331, eff. 8-21-07.)
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| 5 | | Section 30. The Limited Health Service Organization Act is |
| 6 | | amended by changing Section 4003 as follows:
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| 7 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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| 8 | | Sec. 4003. Illinois Insurance Code provisions. Limited |
| 9 | | health service
organizations shall be subject to the |
| 10 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, |
| 11 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
| 12 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, |
| 13 | | 355b, 356v, 356z.5, 356z.10, 356z.21, 356z.22, 356z.25, |
| 14 | | 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 368a, |
| 15 | | 401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and |
| 16 | | 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, |
| 17 | | XXV, and XXVI of the Illinois Insurance Code. For purposes of |
| 18 | | the
Illinois Insurance Code, except for Sections 444 and 444.1 |
| 19 | | and Articles XIII
and XIII 1/2, limited health service |
| 20 | | organizations in the following categories
are deemed to be |
| 21 | | domestic companies:
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| 22 | | (1) a corporation under the laws of this State; or
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| 23 | | (2) a corporation organized under the laws of another |
| 24 | | state, 30% or more
of the enrollees of which are residents |
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| 1 | | of this State, except a corporation
subject to |
| 2 | | substantially the same requirements in its state of |
| 3 | | organization as
is a domestic company under Article VIII |
| 4 | | 1/2 of the Illinois Insurance Code.
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| 5 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
| 6 | | 100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff. |
| 7 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, |
| 8 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
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| 9 | | Section 35. The Illinois Public Aid Code is amended by |
| 10 | | changing Section 5-16.8 as follows:
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| 11 | | (305 ILCS 5/5-16.8)
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| 12 | | Sec. 5-16.8. Required health benefits. The medical |
| 13 | | assistance program
shall
(i) provide the post-mastectomy care |
| 14 | | benefits required to be covered by a policy of
accident and |
| 15 | | health insurance under Section 356t and the coverage required
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| 16 | | under Sections 356g.5, 356u, 356w, 356x, 356z.5, 356z.6, |
| 17 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of |
| 18 | | the Illinois
Insurance Code and (ii) be subject to the |
| 19 | | provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of |
| 20 | | the Illinois
Insurance Code.
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| 21 | | The Department, by rule, shall adopt a model similar to |
| 22 | | the requirements of Section 356z.39 of the Illinois Insurance |
| 23 | | Code. |
| 24 | | On and after July 1, 2012, the Department shall reduce any |
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| 1 | | rate of reimbursement for services or other payments or alter |
| 2 | | any methodologies authorized by this Code to reduce any rate |
| 3 | | of reimbursement for services or other payments in accordance |
| 4 | | with Section 5-5e. |
| 5 | | To ensure full access to the benefits set forth in this |
| 6 | | Section, on and after January 1, 2016, the Department shall |
| 7 | | ensure that provider and hospital reimbursement for |
| 8 | | post-mastectomy care benefits required under this Section are |
| 9 | | no lower than the Medicare reimbursement rate. |
| 10 | | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; |
| 11 | | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. |
| 12 | | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, |
| 13 | | eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
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| 14 | | Section 99. Effective date. This Act takes effect January |
| 15 | | 1, 2022.
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