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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 1. 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 provide | ||||||
9 | the post-mastectomy care benefits required to be covered
by a | ||||||
10 | policy of accident and health insurance under Section 356t of | ||||||
11 | the Illinois
Insurance Code. The program of health benefits | ||||||
12 | shall provide the coverage
required under Sections 356g.5,
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13 | 356u, 356w, 356x, 356z.2, 356z.4, and 356z.6 of the
Illinois | ||||||
14 | Insurance Code.
The program of health benefits must comply with | ||||||
15 | Section 155.37 of the
Illinois Insurance Code.
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16 | (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03; | ||||||
17 | 93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)
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18 | Section 2. The Department of Public Health Powers and | ||||||
19 | Duties Law of the
Civil Administrative Code of Illinois is | ||||||
20 | amended by changing Section 2310-345 as follows:
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21 | (20 ILCS 2310/2310-345) (was 20 ILCS 2310/55.49)
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1 | Sec. 2310-345. Breast cancer; written summary regarding | ||||||
2 | early detection and
treatment. | ||||||
3 | (a) From funds made available for this purpose, the
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4 | Department shall publish, in layman's language, a
standardized | ||||||
5 | written summary outlining methods for the early detection and
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6 | diagnosis of breast cancer. The summary shall include | ||||||
7 | recommended
guidelines for screening and detection of breast | ||||||
8 | cancer through the use of
techniques that shall include but not | ||||||
9 | be limited to self-examination , clinical breast exams, and
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10 | diagnostic radiology.
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11 | (b) The summary shall also suggest that women seek | ||||||
12 | mammography
services from facilities that
are certified to | ||||||
13 | perform mammography as required by the
federal Mammography | ||||||
14 | Quality Standards Act of 1992.
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15 | (c) The summary shall also include the medically viable
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16 | alternative
methods for the treatment of breast cancer, | ||||||
17 | including, but not limited to,
hormonal, radiological, | ||||||
18 | chemotherapeutic, or surgical treatments or
combinations | ||||||
19 | thereof. The summary shall contain information on breast
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20 | reconstructive surgery, including, but not limited to, the use | ||||||
21 | of breast
implants and their side effects.
The summary shall | ||||||
22 | inform the
patient of the advantages, disadvantages, risks, and | ||||||
23 | dangers of the various
procedures.
The summary shall include | ||||||
24 | (i) a statement that mammography is the most
accurate method | ||||||
25 | for making an early detection of breast cancer, however, no
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26 | diagnostic tool is 100% effective , (ii) the benefits of |
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1 | clinical breast exams, and (iii)
and (ii) instructions for
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2 | instructions for performing breast self-examination and a | ||||||
3 | statement that
it is
important to perform a breast | ||||||
4 | self-examination monthly.
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5 | (c-5) The summary shall specifically address the benefits
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6 | of early detection and review the clinical standard | ||||||
7 | recommendations by the Centers for Disease Control and | ||||||
8 | Prevention and the American Cancer Society for mammography, | ||||||
9 | clinical breast exams, and breast self-exams.
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10 | (c-10) The summary shall also inform individuals that | ||||||
11 | public and private insurance providers shall pay for clinical | ||||||
12 | breast exams as part of an exam, as indicated by guidelines of | ||||||
13 | practice.
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14 | (d) In developing the summary, the Department shall consult | ||||||
15 | with the
Advisory Board of Cancer Control, the Illinois State | ||||||
16 | Medical Society and
consumer groups. The summary shall be | ||||||
17 | updated by the Department every 2 years.
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18 | (e) The summaries shall additionally be translated into | ||||||
19 | Spanish, and
the Department shall conduct a public information | ||||||
20 | campaign to distribute
the summaries to the Hispanic women of | ||||||
21 | this State in order to inform them
of the importance of early | ||||||
22 | detection and mammograms.
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23 | (f) The Department shall distribute the summary to | ||||||
24 | hospitals, public
health centers, and physicians who are likely | ||||||
25 | to perform or order
diagnostic
tests for breast disease or | ||||||
26 | treat breast cancer by surgical or other
medical methods. Those |
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1 | hospitals, public health centers, and physicians
shall make the | ||||||
2 | summaries available to the public. The Department shall
also | ||||||
3 | distribute the summaries to any person, organization, or other
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4 | interested parties upon request. The summaries may be | ||||||
5 | duplicated by any
person, provided the copies are identical to | ||||||
6 | the current summary
prepared
by the Department.
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7 | (g) The summary shall display, on the inside of its cover, | ||||||
8 | printed in
capital letters, in bold face type, the following | ||||||
9 | paragraph:
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10 | "The information contained in this brochure regarding | ||||||
11 | recommendations for
early detection and diagnosis of breast | ||||||
12 | disease and alternative breast
disease treatments is only for | ||||||
13 | the purpose of assisting you, the patient,
in understanding the | ||||||
14 | medical information and advice offered by your
physician. This | ||||||
15 | brochure cannot serve as a substitute for the sound
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16 | professional advice of your physician. The availability of this | ||||||
17 | brochure
or the information contained within is not intended to | ||||||
18 | alter, in any way,
the existing physician-patient | ||||||
19 | relationship, nor the existing professional
obligations of | ||||||
20 | your physician in the delivery of medical services to you,
the | ||||||
21 | patient."
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22 | (h) The summary shall be updated when necessary.
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23 | (Source: P.A. 91-239, eff. 1-1-00; revised 10-19-05.)
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24 | Section 3. The Counties Code is amended by changing Section | ||||||
25 | 5-1069.3 as follows: |
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1 | (55 ILCS 5/5-1069.3)
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2 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
3 | including a home
rule
county, is a self-insurer for purposes of | ||||||
4 | providing health insurance coverage
for its employees, the | ||||||
5 | coverage shall include coverage for the post-mastectomy
care | ||||||
6 | benefits required to be covered by a policy of accident and | ||||||
7 | health
insurance under Section 356t and the coverage required | ||||||
8 | under Sections 356g.5, 356u,
356w, 356x and 356z.6 of
the | ||||||
9 | Illinois Insurance Code. The requirement that health benefits | ||||||
10 | be covered
as provided in this Section is an
exclusive power | ||||||
11 | and function of the State and is a denial and limitation under
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12 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
13 | Constitution. A home
rule county to which this Section applies | ||||||
14 | must comply with every provision of
this Section.
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15 | (Source: P.A. 93-853, eff. 1-1-05.)
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16 | Section 3.5. The Illinois Municipal Code is amended by | ||||||
17 | changing Section 10-4-2.3 as follows: | ||||||
18 | (65 ILCS 5/10-4-2.3)
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19 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
20 | municipality, including a
home rule municipality, is a | ||||||
21 | self-insurer for purposes of providing health
insurance | ||||||
22 | coverage for its employees, the coverage shall include coverage | ||||||
23 | for
the post-mastectomy care benefits required to be covered by |
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1 | a policy of
accident and health insurance under Section 356t | ||||||
2 | and the coverage required
under Sections 356g.5, 356u, 356w, | ||||||
3 | 356x and 356z.6 of the Illinois
Insurance
Code. The requirement | ||||||
4 | that health
benefits be covered as provided in this is an | ||||||
5 | exclusive power and function of
the State and is a denial and | ||||||
6 | limitation under Article VII, Section 6,
subsection (h) of the | ||||||
7 | Illinois Constitution. A home rule municipality to which
this | ||||||
8 | Section applies must comply with every provision of this | ||||||
9 | Section.
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10 | (Source: P.A. 93-853, eff. 1-1-05.)
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11 | Section 4. The School Code is amended by changing Section | ||||||
12 | 10-22.3f as follows: | ||||||
13 | (105 ILCS 5/10-22.3f)
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14 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
15 | protection and
benefits
for employees shall provide the | ||||||
16 | post-mastectomy care benefits required to be
covered by a | ||||||
17 | policy of accident and health insurance under Section 356t and | ||||||
18 | the
coverage required under Sections 356g.5, 356u, 356w, 356x | ||||||
19 | and 356z.6 of
the
Illinois Insurance Code.
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20 | (Source: P.A. 93-853, eff. 1-1-05.)
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21 | Section 5. The Illinois Insurance Code is amended by adding | ||||||
22 | Section 356g.5 as follows: |
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1 | (215 ILCS 5/356g.5 new) | ||||||
2 | Sec. 356g.5. Clinical breast exam. | ||||||
3 | (a) The General Assembly finds that clinical breast | ||||||
4 | examinations are a critical tool in the early detection of | ||||||
5 | breast cancer, while the disease is in its earlier and | ||||||
6 | potentially more treatable stages. Insurer reimbursement of | ||||||
7 | clinical breast examinations is essential to the effort to | ||||||
8 | reduce breast cancer deaths in Illinois. | ||||||
9 | (b) Every insurer shall provide, in each group or | ||||||
10 | individual policy, contract, or certificate of accident or | ||||||
11 | health insurance issued or renewed for persons who are | ||||||
12 | residents of Illinois, coverage for complete and thorough | ||||||
13 | clinical breast examinations as indicated by guidelines of | ||||||
14 | practice, performed by a physician licensed to practice | ||||||
15 | medicine in all its branches, an advanced practice nurse who | ||||||
16 | has a collaborative agreement with a collaborating physician | ||||||
17 | that authorizes breast
examinations, or a physician assistant | ||||||
18 | who has been delegated authority to provide breast | ||||||
19 | examinations, to check for lumps and other changes for the | ||||||
20 | purpose of early detection and prevention of breast cancer as | ||||||
21 | follows: | ||||||
22 | (1) at least every 3 years for women at least 20 years | ||||||
23 | of age but less than 40 years of age; and | ||||||
24 | (2) annually for women 40 years of age or older. | ||||||
25 | (c) Upon approval of a nationally recognized separate and | ||||||
26 | distinct clinical breast exam code that is compliant with all |
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1 | State and federal laws, rules, and regulations, public and | ||||||
2 | private insurance plans shall take action to cover clinical | ||||||
3 | breast exams on a separate and distinct basis. | ||||||
4 | Section 10. The Health Maintenance Organization Act is | ||||||
5 | amended by changing Section 4-6.5 as follows:
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6 | (215 ILCS 125/4-6.5)
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7 | Sec. 4-6.5. Required health benefits; Illinois Insurance | ||||||
8 | Code
requirements. A health maintenance organization is | ||||||
9 | subject to the provisions
of Sections 155.37, 356g.5, 356t, | ||||||
10 | 356u, and 356z.1 of the Illinois Insurance Code.
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11 | (Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; | ||||||
12 | 92-651, eff.
7-11-02.)
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13 | Section 15. The Voluntary Health Services Plans Act is | ||||||
14 | amended by changing Section 10 as follows:
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15 | (215 ILCS 165/10) (from Ch. 32, par. 604)
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16 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
17 | services
plan corporations and all persons interested therein | ||||||
18 | or dealing therewith
shall be subject to the provisions of | ||||||
19 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
20 | 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | ||||||
21 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 364.01, | ||||||
22 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
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1 | and paragraphs (7) and (15) of Section 367 of the Illinois
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2 | Insurance Code.
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3 | (Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; | ||||||
4 | 92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; | ||||||
5 | 93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff. | ||||||
6 | 1-1-05; revised 10-14-04.)
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7 | Section 20. The Illinois Public Aid Code is amended by | ||||||
8 | changing Section 5-16.8 as follows:
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9 | (305 ILCS 5/5-16.8)
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10 | Sec. 5-16.8. Required health benefits. The medical | ||||||
11 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
12 | benefits required to be covered by a policy of
accident and | ||||||
13 | health insurance under Section 356t and the coverage required
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14 | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the | ||||||
15 | Illinois
Insurance Code and (ii) be subject to the provisions | ||||||
16 | of Section 364.01 of the Illinois
Insurance Code.
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17 | (Source: P.A. 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; | ||||||
18 | revised 10-14-04.)
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19 | Section 99. Effective date. This Act takes effect upon | ||||||
20 | becoming law.
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