SB0011sam001 94TH GENERAL ASSEMBLY

Sen. Debbie DeFrancesco Halvorson

Filed: 4/8/2005

09400SB0011sam001 LRB094 06995 LJB 44663 a

AMENDMENT TO SENATE BILL 11

AMENDMENT NO. ______. Amend Senate Bill 11 by replacing everything after the enacting clause with the following:

"Article 1. GENERAL PROVISIONS

Section 1-1. Short title. This Act may be cited as the Healthy Illinois Act.

Section 1-5. Purpose. Health care costs are rising rapidly and challenging Illinois' capacity to provide accessible, high-quality health care. Small businesses and individuals do not have adequate access to affordable health insurance in this State. Large employers, providers, and insurers lack guidance concerning appropriate health care quality and cost containment. The absence of appropriate statewide data on health care hinders the planning needed to ensure access, quality, and affordability. This legislation creates Healthy Illinois, a 3-part program that will provide access to affordable coverage for small businesses and individuals through the Healthy Illinois Plan, initiate new strategies for health care quality improvement and cost containment through the Healthy Illinois Quality Forum, and gather and disseminate through the Health Resource Plan the information needed to ensure that all Illinoisans have access to quality, affordable health care.

Section 1-10. Definitions. As used in this Act:

"Eligible business" means a business that employs at least 2 but not more than 50 employees, at least two-thirds of whom are employed in the State, including a municipality or other public sector entity that has at least 2 but not more than 50 employees. Beginning one year after Healthy Illinois has been providing health insurance benefits, the Authority may, by rule, define "eligible business" to include larger public or private employers.

"Eligible employee" means an employee of an eligible business who works at least 20 hours per week for that eligible business. "Eligible employee" does not include an employee who works on a temporary or substitute basis or who does not work at least 26 weeks annually. New employees meet the 26-week requirement if they are expected to work at least 26 weeks in their first year of employment.

"Eligible individual" means any Illinois resident, including any dependents thereof.

"Healthy Illinois Plan" means the health insurance plan established by the Healthy Illinois Authority that is offered by a private health insurance carrier or carriers, or by the Healthy Illinois Authority itself.

"Resident" means any person whose primary home is in Illinois.

Article 5. THE HEALTHY ILLINOIS AUTHORITY

Section 5-5. Healthy Illinois Authority Established. The Healthy Illinois Authority is established as an agency in the executive branch of State government to arrange for the provision of comprehensive, affordable health care coverage to eligible businesses, including employees and their dependents, the self-employed and their dependents, and eligible individuals on a voluntary basis through the Healthy Illinois Plan. The Authority shall also monitor and improve the quality of health care in this State through administration of the Healthy Illinois Quality Forum. The Authority shall also develop the Health Resource Plan, focused on gathering and disseminating the information and plans needed to ensure the provision of quality, affordable employee health care in Illinois.

Section 5-10. Powers and duties of the Authority. Subject to any limitation contained in this Act or in any other law, the Authority shall have and exercise all powers necessary or convenient to effectuate the purposes for which the Authority is organized or to further the activities in which the Authority may lawfully be engaged, including, but not limited to, the establishment of the Healthy Illinois Plan, the administration of the Healthy Illinois Quality Forum, and the development and promulgation of the Health Resource Plan.

Section 5-15. The Healthy Illinois Authority Fund. The Healthy Illinois Authority Fund is created as a special fund in the State treasury for the deposit of any funds advanced for initial operating expenses, payments made by employers and individuals, any uncompensated care savings payments made pursuant to Section 10-20 of this Act, and any funds received from any public or private source. The Fund is exempt from the provisions of subsection (c) of Section 5 of the State Finance Act and shall not lapse, but must be carried forward to carry out the purposes of this Act.

Article 10. HEALTHY ILLINOIS PLAN

Section 10-5. Healthy Illinois Plan. The Authority shall begin to provide health benefits coverage through the Healthy Illinois Plan not later than 12 months after entering into contracts with one or more qualified bidders to administer plan benefits. The Healthy Illinois Plan must comply with all relevant requirements of this Article. The Authority shall select one or more entities to administer the Healthy Illinois Plan through a competitive request for proposal process to identify those that most fully meet qualifications described in this Article and any additional qualifications set by the Authority.

Section 10-10. Healthy Illinois Plan administration.

(a) The Healthy Illinois Plan shall include a comprehensive package that meets the requirements for mandated coverage for specific health services and specific diseases and for certain providers of health services under the Illinois Insurance Code and any supplemental benefits the Authority wishes to make available.

(b) The Authority shall establish the minimum required contribution levels, not to exceed 60%, to be paid by eligible businesses toward the aggregate payment. The Authority may establish a separate minimum contribution level to be paid by eligible businesses toward coverage for dependents of the eligible business's enrolled employees.

(c) The Authority shall require participating employers to certify that at least 75% of their employees that work 20 hours or more per week are either enrolled in the Healthy Illinois Plan or have other creditable coverage.

(d) The Authority shall reduce the required payment amounts for plan enrollees eligible for a subsidy under Section 10-15 of this Act in accordance with the enrollee's subsidy amount. The Authority shall notify both the plan enrollee and the employer, if applicable, of both the subsidy and the new required payment amount so that the employer, where applicable, can reduce the amount deducted or otherwise set aside for the enrollee's premium share.

(e) Participating employers shall make payments on behalf of both the employer and its enrolled employees.

Section 10-15. Subsidies. The Authority shall establish sliding-scale subsidies for the purchase of the Healthy Illinois Plan by eligible employees and individuals whose household income is under 300% of the federal poverty level and who are not eligible for Medicaid.

Section 10-20. Uncompensated care savings payments. For the purpose of providing the funds necessary to provide subsidies pursuant to Section 10-15 of this Act and support the Healthy Illinois Quality Forum and because the operation of the Healthy Illinois Plan will control health care costs through the reduction of uncompensated care, health insurance carriers and employee benefit excess insurance carriers shall pay to the Authority 4% of annual health insurance premiums and employee benefit excess insurance premiums on policies issued pursuant to the laws of this State that insure residents of this State.

Article 15. HEALTH CARE QUALITY

Section 15-5. Healthy Illinois Quality Forum. The Healthy Illinois Quality Forum, referred to in this Article as the "Forum", is established within the Authority. The Forum shall be funded, at least in part, through the uncompensated care savings payments made pursuant to Section 10-20 of this Act. Information obtained by the Forum is a public record within the meaning in Section 2 of the Freedom of Information Act. All duties performed by the Forum shall be done in a manner consistent with and not in duplication of the requirements of the Hospital Report Card Act.

Section 15-10. Duties. The Forum shall perform the following duties:

(1) Gathering and disseminating information on health care quality and patient safety.

(2) Research on best practice in Illinois, including, but not limited to, the following:

(A) Collecting information from Illinois health care providers, insurers, third party administrators, and others that are currently utilizing practices designed to increase health care quality and patient safety, focusing on those practices where a positive impact has been documented and where the information needed for others to replicate the practice is available. The Forum shall seek to include examples of effective uses of electronic technology for such things as medical records and physical order entry.

(B) Dissemination of information on effective practices in Illinois through public reports, conferences, and other appropriate vehicles. The Authority with guidance from the Forum, including its advisory council, shall provide technical assistance to health care providers, insurers, and other entities that plan to implement proven practices that have been demonstrated to have a material positive impact on health care quality and patient safety in Illinois.

(3) Evaluation and comparison of health care quality and provider performance, including, but not limited to, the following:

(A) The Forum shall identify existing valid and reliable measures of health care quality and provider performance that are already in use in Illinois and nationally.

(B) The Forum shall disseminate information on those measures to Illinois health care providers, insurers, and others.

(C) By the third year of operation, the Forum shall recommend an initial set of measures that all Illinois providers, insurers, and others, as appropriate, should adopt. If after a reasonable period one or more measures are not adopted, the Authority may adopt rules to better ensure the adoption of those measures. The Forum shall provide guidance on data collection and submission protocols with the minimum possible burden for the providers of data.

Article 20. HEALTH RESOURCE PLAN

Section 20-5. Duties of the Authority related to the Health Resource Plan.

(a) The Authority shall do all of the following:

(1) develop and issue the biennial Health Resource Plan, referred to in this Article as the "plan". The first plan shall be issued by May 31, 2006;

(2) make an annual report to the public assessing the progress toward meeting goals of the plan and provide any needed updates to the plan; and

(3) issue an annual statewide health expenditure budget report that shall serve as the basis for establishing priorities within the plan.

(b) The Authority shall provide the reports specified in paragraphs (2) and (3) of subsection (a) of this Section to the General Assembly.

Section 20-10. Health Resource Plan. The plan, issued pursuant to Section 20-5 of this Act, must set forth a comprehensive, coordinated approach to the development of health care facilities and resources in the State based on statewide cost, quality, and access goals and strategies to ensure access to affordable health care, maintain a rational system of health care, and promote the development of the health care workforce.

Article 25. COST CONTAINMENT

Section 25-5. Voluntary restraint. In order to control the rate of growth of costs of health care and health coverage:

(1) Each health care practitioner licensed under the Medical Practice Act of 1987 shall make every effort to limit the growth of net revenue of the practitioner's practice to 3% for the practitioner's fiscal year beginning on or after July 1, 2006 and for every fiscal year thereafter.

(2) Each hospital licensed under the Hospital Licensing Act shall make every effort to restrain cost increases, as measured as expenses for case mix adjusted discharge, to no more than 3.5% for the hospital fiscal year beginning on or after July 1, 2006 and for every fiscal year thereafter. Each hospital licensed under the Hospital Licensing Act shall make every effort to hold hospital consolidated operating margins to no more than 3% for the hospital's fiscal year beginning on or after July 1, 2006 and for every fiscal year thereafter.

(3) Each health insurance carrier licensed in this State shall make every effort to limit the pricing of products it sells in this State to the level that supports no more than 3% underwriting gain less federal taxes for the carrier's fiscal year beginning on or after July 1, 2006 and for every fiscal year thereafter.

(4) By July 1, 2006, the Illinois Hospital Association and the Authority shall agree on a timetable, format, and methodology for the Illinois Hospital Association to report on hospital charges, cost efficiency, and consolidated operating margins. In accordance with the agreement, the Illinois Hospital Association shall submit an annual report to the Authority beginning January 1, 2007.

ARTICLE 95. AMENDATORY PROVISIONS

Section 95-5. The Illinois Health Facilities Planning Act is amended by changing Sections 3 and 12 as follows:

(20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)

(Section scheduled to be repealed on July 1, 2006)

Sec. 3. Definitions. As used in this Act:

"Health care facilities" means and includes the following facilities and organizations:

1. An ambulatory surgical treatment center required to be licensed pursuant to the Ambulatory Surgical Treatment Center Act;

2. An institution, place, building, or agency required to be licensed pursuant to the Hospital Licensing Act;

3. Skilled and intermediate long term care facilities licensed under the Nursing Home Care Act;

3. Skilled and intermediate long term care facilities licensed under the Nursing Home Care Act;

4. Hospitals, nursing homes, ambulatory surgical treatment centers, or kidney disease treatment centers maintained by the State or any department or agency thereof;

5. Kidney disease treatment centers, including a free-standing hemodialysis unit required to be licensed under the End Stage Renal Disease Facility Act; and

6. An institution, place, building, or room used for the performance of outpatient surgical procedures that is leased, owned, or operated by or on behalf of an out-of-state facility.

7. Limited service providers.

No federally owned facility shall be subject to the provisions of this Act, nor facilities used solely for healing by prayer or spiritual means.

No facility licensed under the Supportive Residences Licensing Act or the Assisted Living and Shared Housing Act shall be subject to the provisions of this Act.

A facility designated as a supportive living facility that is in good standing with the demonstration project established under Section 5-5.01a of the Illinois Public Aid Code shall not be subject to the provisions of this Act.

This Act does not apply to facilities granted waivers under Section 3-102.2 of the Nursing Home Care Act. However, if a demonstration project under that Act applies for a certificate of need to convert to a nursing facility, it shall meet the licensure and certificate of need requirements in effect as of the date of application.

This Act does not apply to a dialysis facility that provides only dialysis training, support, and related services to individuals with end stage renal disease who have elected to receive home dialysis. This Act does not apply to a dialysis unit located in a licensed nursing home that offers or provides dialysis-related services to residents with end stage renal disease who have elected to receive home dialysis within the nursing home. The Board, however, may require these dialysis facilities and licensed nursing homes to report statistical information on a quarterly basis to the Board to be used by the Board to conduct analyses on the need for proposed kidney disease treatment centers.

This Act shall not apply to the closure of an entity or a portion of an entity licensed under the Nursing Home Care Act that elects to convert, in whole or in part, to an assisted living or shared housing establishment licensed under the Assisted Living and Shared Housing Act.

With the exception of those health care facilities specifically included in this Section, nothing in this Act shall be intended to include facilities operated as a part of the practice of a physician or other licensed health care professional, whether practicing in his individual capacity or within the legal structure of any partnership, medical or professional corporation, or unincorporated medical or professional group. Further, this Act shall not apply to physicians or other licensed health care professional's practices where such practices are carried out in a portion of a health care facility under contract with such health care facility by a physician or by other licensed health care professionals, whether practicing in his individual capacity or within the legal structure of any partnership, medical or professional corporation, or unincorporated medical or professional groups. This Act shall apply to construction or modification and to establishment by such health care facility of such contracted portion which is subject to facility licensing requirements, irrespective of the party responsible for such action or attendant financial obligation.

"Person" means any one or more natural persons, legal entities, governmental bodies other than federal, or any combination thereof.

"Consumer" means any person other than a person (a) whose major occupation currently involves or whose official capacity within the last 12 months has involved the providing, administering or financing of any type of health care facility, (b) who is engaged in health research or the teaching of health, (c) who has a material financial interest in any activity which involves the providing, administering or financing of any type of health care facility, or (d) who is or ever has been a member of the immediate family of the person defined by (a), (b), or (c).

"State Board" means the Health Facilities Planning Board.

"Construction or modification" means the establishment, erection, building, alteration, reconstruction, modernization, improvement, extension, discontinuation, change of ownership, of or by a health care facility, or the purchase or acquisition by or through a health care facility of equipment or service for diagnostic or therapeutic purposes or for facility administration or operation, or any capital expenditure made by or on behalf of a health care facility which exceeds the capital expenditure minimum; however, any capital expenditure made by or on behalf of a health care facility for (i) the construction or modification of a facility licensed under the Assisted Living and Shared Housing Act or (ii) a conversion project undertaken in accordance with Section 30 of the Older Adult Services Act shall be excluded from any obligations under this Act.

"Establish" means the construction of a health care facility or the replacement of an existing facility on another site.

"Major medical equipment" means medical equipment which is used for the provision of medical and other health services and which costs in excess of the capital expenditure minimum, except that such term does not include medical equipment acquired by or on behalf of a clinical laboratory to provide clinical laboratory services if the clinical laboratory is independent of a physician's office and a hospital and it has been determined under Title XVIII of the Social Security Act to meet the requirements of paragraphs (10) and (11) of Section 1861(s) of such Act. In determining whether medical equipment has a value in excess of the capital expenditure minimum, the value of studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition of such equipment shall be included.

"Capital Expenditure" means an expenditure: (A) made by or on behalf of a health care facility (as such a facility is defined in this Act); and (B) which under generally accepted accounting principles is not properly chargeable as an expense of operation and maintenance, or is made to obtain by lease or comparable arrangement any facility or part thereof or any equipment for a facility or part; and which exceeds the capital expenditure minimum.

For the purpose of this paragraph, the cost of any studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition, improvement, expansion, or replacement of any plant or equipment with respect to which an expenditure is made shall be included in determining if such expenditure exceeds the capital expenditures minimum. Donations of equipment or facilities to a health care facility which if acquired directly by such facility would be subject to review under this Act shall be considered capital expenditures, and a transfer of equipment or facilities for less than fair market value shall be considered a capital expenditure for purposes of this Act if a transfer of the equipment or facilities at fair market value would be subject to review.

"Capital expenditure minimum" means $6,000,000, which shall be annually adjusted to reflect the increase in construction costs due to inflation, for major medical equipment and for all other capital expenditures; provided, however, that when a capital expenditure is for the construction or modification of a health and fitness center, "capital expenditure minimum" means the capital expenditure minimum for all other capital expenditures in effect on March 1, 2000, which shall be annually adjusted to reflect the increase in construction costs due to inflation.

"Non-clinical service area" means an area (i) for the benefit of the patients, visitors, staff, or employees of a health care facility and (ii) not directly related to the diagnosis, treatment, or rehabilitation of persons receiving services from the health care facility. "Non-clinical service areas" include, but are not limited to, chapels; gift shops; news stands; computer systems; tunnels, walkways, and elevators; telephone systems; projects to comply with life safety codes; educational facilities; student housing; patient, employee, staff, and visitor dining areas; administration and volunteer offices; modernization of structural components (such as roof replacement and masonry work); boiler repair or replacement; vehicle maintenance and storage facilities; parking facilities; mechanical systems for heating, ventilation, and air conditioning; loading docks; and repair or replacement of carpeting, tile, wall coverings, window coverings or treatments, or furniture. Solely for the purpose of this definition, "non-clinical service area" does not include health and fitness centers.

"Areawide" means a major area of the State delineated on a geographic, demographic, and functional basis for health planning and for health service and having within it one or more local areas for health planning and health service. The term "region", as contrasted with the term "subregion", and the word "area" may be used synonymously with the term "areawide".

"Local" means a subarea of a delineated major area that on a geographic, demographic, and functional basis may be considered to be part of such major area. The term "subregion" may be used synonymously with the term "local".

"Areawide health planning organization" or "Comprehensive health planning organization" means the health systems agency designated by the Secretary, Department of Health and Human Services or any successor agency.

"Local health planning organization" means those local health planning organizations that are designated as such by the areawide health planning organization of the appropriate area.

"Physician" means a person licensed to practice in accordance with the Medical Practice Act of 1987, as amended.

"Licensed health care professional" means a person licensed to practice a health profession under pertinent licensing statutes of the State of Illinois.

"Director" means the Director of the Illinois Department of Public Health.

"Agency" means the Illinois Department of Public Health.

"Comprehensive health planning" means health planning concerned with the total population and all health and associated problems that affect the well-being of people and that encompasses health services, health manpower, and health facilities; and the coordination among these and with those social, economic, and environmental factors that affect health.

"Alternative health care model" means a facility or program authorized under the Alternative Health Care Delivery Act.

"Out-of-state facility" means a person that is both (i) licensed as a hospital or as an ambulatory surgery center under the laws of another state or that qualifies as a hospital or an ambulatory surgery center under regulations adopted pursuant to the Social Security Act and (ii) not licensed under the Ambulatory Surgical Treatment Center Act, the Hospital Licensing Act, or the Nursing Home Care Act. Affiliates of out-of-state facilities shall be considered out-of-state facilities. Affiliates of Illinois licensed health care facilities 100% owned by an Illinois licensed health care facility, its parent, or Illinois physicians licensed to practice medicine in all its branches shall not be considered out-of-state facilities. Nothing in this definition shall be construed to include an office or any part of an office of a physician licensed to practice medicine in all its branches in Illinois that is not required to be licensed under the Ambulatory Surgical Treatment Center Act.

"Change of ownership of a health care facility" means a change in the person who has ownership or control of a health care facility's physical plant and capital assets. A change in ownership is indicated by the following transactions: sale, transfer, acquisition, lease, change of sponsorship, or other means of transferring control.

"Related person" means any person that: (i) is at least 50% owned, directly or indirectly, by either the health care facility or a person owning, directly or indirectly, at least 50% of the health care facility; or (ii) owns, directly or indirectly, at least 50% of the health care facility.

"Charity care" means care provided by a health care facility for which the provider does not expect to receive payment from the patient or a third-party payer.

"Limited service provider" means a health care facility, as defined in this Act, that focuses on a specific condition or procedure, including, but not limited to, specialty hospitals, pain centers, and imaging centers.

"Health Resource Plan" means the biennial Health Resource Plan developed under Article 20 of the Healthy Illinois Act.

(Source: P.A. 93-41, eff. 6-27-03; 93-766, eff. 7-20-04; 93-935, eff. 1-1-05; 93-1031, eff. 8-27-04; revised 10-25-04.)

(20 ILCS 3960/12) (from Ch. 111 1/2, par. 1162)

(Section scheduled to be repealed on July 1, 2006)

Sec. 12. Powers and duties of State Board. For purposes of this Act, the State Board shall exercise the following powers and duties:

(1) Prescribe rules, regulations, standards, criteria, procedures or reviews which may vary according to the purpose for which a particular review is being conducted or the type of project reviewed and which are required to carry out the provisions and purposes of this Act.

(2) Adopt procedures for public notice and hearing on all proposed rules, regulations, standards, criteria, and plans required to carry out the provisions of this Act.

(3) Prescribe criteria for recognition for areawide health planning organizations, including, but not limited to, standards for evaluating the scientific bases for judgments on need and procedure for making these determinations.

(4) Develop criteria and standards for health care facilities planning, conduct statewide inventories of health care facilities, maintain an updated inventory on the Department's web site reflecting the most recent bed and service changes and updated need determinations when new census data become available or new need formulae are adopted, and develop health care facility plans which shall be utilized in the review of applications for permit under this Act. Such health facility plans shall be coordinated by the Agency with the health care facility plans areawide health planning organizations and with other pertinent State Plans.

In developing health care facility plans, the State Board shall consider, but shall not be limited to, the following:

(a) The size, composition and growth of the population of the area to be served;

(b) The number of existing and planned facilities offering similar programs;

(c) The extent of utilization of existing facilities;

(d) The availability of facilities which may serve as alternatives or substitutes;

(e) The availability of personnel necessary to the operation of the facility;

(f) Multi-institutional planning and the establishment of multi-institutional systems where feasible;

(g) The financial and economic feasibility of proposed construction or modification; and

(h) In the case of health care facilities established by a religious body or denomination, the needs of the members of such religious body or denomination may be considered to be public need; and .

(i) The Health Resource Plan adopted by the Healthy Illinois Authority.

The health care facility plans which are developed and adopted in accordance with this Section shall form the basis for the plan of the State to deal most effectively with statewide health needs in regard to health care facilities.

(5) Coordinate with other state agencies having responsibilities affecting health care facilities, including those of licensure and cost reporting.

(6) Solicit, accept, hold and administer on behalf of the State any grants or bequests of money, securities or property for use by the State Board or recognized areawide health planning organizations in the administration of this Act; and enter into contracts consistent with the appropriations for purposes enumerated in this Act.

(7) The State Board shall prescribe, in consultation with the recognized areawide health planning organizations, procedures for review, standards, and criteria which shall be utilized to make periodic areawide reviews and determinations of the appropriateness of any existing health services being rendered by health care facilities subject to the Act. The State Board shall consider recommendations of the areawide health planning organization and the Agency in making its determinations.

(8) Prescribe, in consultation with the recognized areawide health planning organizations, rules, regulations, standards, and criteria for the conduct of an expeditious review of applications for permits for projects of construction or modification of a health care facility, which projects are non-substantive in nature. Such rules shall not abridge the right of areawide health planning organizations to make recommendations on the classification and approval of projects, nor shall such rules prevent the conduct of a public hearing upon the timely request of an interested party. Such reviews shall not exceed 60 days from the date the application is declared to be complete by the Agency.

(9) Prescribe rules, regulations, standards, and criteria pertaining to the granting of permits for construction and modifications which are emergent in nature and must be undertaken immediately to prevent or correct structural deficiencies or hazardous conditions that may harm or injure persons using the facility, as defined in the rules and regulations of the State Board. This procedure is exempt from public hearing requirements of this Act.

(10) Prescribe rules, regulations, standards and criteria for the conduct of an expeditious review, not exceeding 60 days, of applications for permits for projects to construct or modify health care facilities which are needed for the care and treatment of persons who have acquired immunodeficiency syndrome (AIDS) or related conditions.

(Source: P.A. 93-41, eff. 6-27-03.)

Section 95-10. The State Finance Act is amended by adding Section 5.641 as follows:

(30 ILCS 105/5.641 new)

Sec. 5.641. The Healthy Illinois Authority Fund.

Section 95-15. The Illinois Insurance Code is amended by adding Article XLV as follows:

(215 ILCS 5/Art. XLV heading new)

ARTICLE XLV. HEALTH INSURANCE RATES

(215 ILCS 5/1502 new)

Sec. 1502. Purpose. The purpose of this Article is to promote the public welfare by regulating health insurance rates to the end that they shall not be excessive, inadequate or unfairly discriminatory, or erroneously applied and to authorize and regulate cooperative action among companies in rate making and in other matters within the scope of this Article. It is the express intent of the General Assembly pursuant to this Article to permit and encourage competition between companies on a sound financial basis and to establish a mechanism to ensure the provision of adequate insurance at reasonable rates to the citizens of this State. This Article shall be liberally interpreted to effectuate its purpose.

(215 ILCS 5/1503 new)

Sec. 1503. Scope of Article. This Article applies to health insurance. As used in this Article, "health insurance" means the kinds of insurance described in clause (b) of Class 1 and clause (a) of Class 2 of Section 4 of this Code.

(215 ILCS 5/1505 new)

Sec. 1505. Definitions. As used in this Article:

"Director" means the Director of the Division of Insurance of the Department of Financial and Professional Regulation.

"Division" means the Division of Insurance of the Department of Financial and Professional Regulation.

(215 ILCS 5/1510 new)

Sec. 1510. Making of Rates.

(a) Rate increases shall not be excessive, inadequate, or unfairly discriminatory, and shall not be more than 6% without adequate justification. A rate in a competitive market is presumed to be not excessive if it has not been increased by more than 6% without adequate justification. A rate in a noncompetitive market is excessive if it is likely to produce a long run profit that is unreasonably high for the insurance provided or if expenses are unreasonably high in relation to the services rendered. Unfair discrimination exists if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses.

(b) In making the determination of whether there is adequate justification for a rate increase of more than 6%, the Director shall, in accordance with generally accepted and reasonable actuarial techniques, consider the following factors:

(1) Past loss experience within and outside this State.

(2) Past expenses both allocated and unallocated.

(3) The degree of competition among insurers for the risk insured.

(4) Investment income reasonably expected by the insurer, consistent with the insurer's investment practices, from investable premiums anticipated in the filing, plus any other expected income from currently invested assets representing the amount expected on unearned premium reserves and loss reserves. The Division may adopt rules utilizing reasonable techniques of actuarial science and economics to specify the manner in which insurers shall calculate investment income attributable to classes of insurance written in this State and the manner in which the investment income shall be used in the calculation of insurance rates.

(5) The reasonableness of the judgment reflected in the filing.

(6) Dividends, savings, or unabsorbed premium deposits allowed or returned to Illinois policyholders, members, or subscribers.

(7) The adequacy of loss reserves.

(8) The cost of reinsurance.

(9) Trend factors, including trends to actual losses per insured unit for the insurer making the filing.

(10) A reasonable margin for profit and contingencies.

(11) Other relevant factors that impact upon the frequency or severity of claims or upon expenses.

Section 95-20. The Illinois Antitrust Act is amended by changing Section 5 as follows:

(740 ILCS 10/5) (from Ch. 38, par. 60-5)

Sec. 5. No provisions of this Act shall be construed to make illegal:

(1) the activities of any labor organization or of individual members thereof which are directed solely to labor objectives which are legitimate under the laws of either the State of Illinois or the United States;

(2) the activities of any agricultural or horticultural cooperative organization, whether incorporated or unincorporated, or of individual members thereof, which are directed solely to objectives of such cooperative organizations which are legitimate under the laws of either the State of Illinois or the United States;

(3) the activities of any public utility, as defined in Section 3-105 of the Public Utilities Act to the extent that such activities are subject to a clearly articulated and affirmatively expressed State policy to replace competition with regulation, where the conduct to be exempted is actively supervised by the State itself;

(4) The activities of a telecommunications carrier, as defined in Section 13-202 of the Public Utilities Act, to the extent those activities relate to the provision of noncompetitive telecommunications services under the Public Utilities Act and are subject to the jurisdiction of the Illinois Commerce Commission or to the activities of telephone mutual concerns referred to in Section 13-202 of the Public Utilities Act to the extent those activities relate to the provision and maintenance of telephone service to owners and customers;

(5) the activities (including, but not limited to, the making of or participating in joint underwriting or joint reinsurance arrangement) of any insurer, insurance agent, insurance broker, independent insurance adjuster or rating organization to the extent that such activities are subject to regulation by the Director of Insurance of this State under, or are permitted or are authorized by, the Insurance Code or any other law of this State, except, however, that this Act shall apply to the activities of any entity that provides health insurance in this State, including a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization, or any other entity providing a plan of health insurance or health benefits subject to State insurance regulation insofar as those activities relate to that health insurance;

(6) the religious and charitable activities of any not-for-profit corporation, trust or organization established exclusively for religious or charitable purposes, or for both purposes;

(7) the activities of any not-for-profit corporation organized to provide telephone service on a mutual or co-operative basis or electrification on a co-operative basis, to the extent such activities relate to the marketing and distribution of telephone or electrical service to owners and customers;

(8) the activities engaged in by securities dealers who are (i) licensed by the State of Illinois or (ii) members of the National Association of Securities Dealers or (iii) members of any National Securities Exchange registered with the Securities and Exchange Commission under the Securities Exchange Act of 1934, as amended, in the course of their business of offering, selling, buying and selling, or otherwise trading in or underwriting securities, as agent, broker, or principal, and activities of any National Securities Exchange so registered, including the establishment of commission rates and schedules of charges;

(9) the activities of any board of trade designated as a "contract market" by the Secretary of Agriculture of the United States pursuant to Section 5 of the Commodity Exchange Act, as amended;

(10) the activities of any motor carrier, rail carrier, or common carrier by pipeline, as defined in the Common Carrier by Pipeline Law of the Public Utilities Act, to the extent that such activities are permitted or authorized by the Act or are subject to regulation by the Illinois Commerce Commission;

(11) the activities of any state or national bank to the extent that such activities are regulated or supervised by officers of the state or federal government under the banking laws of this State or the United States;

(12) the activities of any state or federal savings and loan association to the extent that such activities are regulated or supervised by officers of the state or federal government under the savings and loan laws of this State or the United States;

(13) the activities of any bona fide not-for-profit association, society or board, of attorneys, practitioners of medicine, architects, engineers, land surveyors or real estate brokers licensed and regulated by an agency of the State of Illinois, in recommending schedules of suggested fees, rates or commissions for use solely as guidelines in determining charges for professional and technical services;

(14) Conduct involving trade or commerce (other than import trade or import commerce) with foreign nations unless:

(a) such conduct has a direct, substantial, and reasonably foreseeable effect:

(i) on trade or commerce which is not trade or commerce with foreign nations, or on import trade or import commerce with foreign nations; or

(ii) on export trade or export commerce with foreign nations of a person engaged in such trade or commerce in the United States; and

(b) such effect gives rise to a claim under the provisions of this Act, other than this subsection (14).

(c) If this Act applies to conduct referred to in this subsection (14) only because of the provisions of paragraph (a)(ii), then this Act shall apply to such conduct only for injury to export business in the United States which affects this State; or

(15) the activities of a unit of local government or school district and the activities of the employees, agents and officers of a unit of local government or school district.

(Source: P.A. 90-185, eff. 7-23-97; 90-561, eff. 12-16-97.)

ARTICLE 99. EFFECTIVE DATE

Section 99-99. Effective date. This Act takes effect upon becoming law.".