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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 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, | ||||||||||||||||||||||||||||||||||||
13 | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | ||||||||||||||||||||||||||||||||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||||||||||||||||||||||||||||||||
15 | 356z.14, 356z.15, and 356z.17 , and 356z.22 of the
Illinois | ||||||||||||||||||||||||||||||||||||
16 | Insurance Code.
The program of health benefits must comply with | ||||||||||||||||||||||||||||||||||||
17 | Sections 155.22a, 155.37, 355b, and 356z.19 of the
Illinois | ||||||||||||||||||||||||||||||||||||
18 | Insurance Code.
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19 | Rulemaking authority to implement Public Act 95-1045, if | ||||||||||||||||||||||||||||||||||||
20 | any, is conditioned on the rules being adopted in accordance | ||||||||||||||||||||||||||||||||||||
21 | with all provisions of the Illinois Administrative Procedure | ||||||||||||||||||||||||||||||||||||
22 | Act and all rules and procedures of the Joint Committee on | ||||||||||||||||||||||||||||||||||||
23 | Administrative Rules; any purported rule not so adopted, for |
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1 | whatever reason, is unauthorized. | ||||||
2 | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||||||
3 | eff. 7-13-12; 98-189, eff. 1-1-14.) | ||||||
4 | Section 10. The Counties Code is amended by changing | ||||||
5 | Section 5-1069.3 as follows: | ||||||
6 | (55 ILCS 5/5-1069.3)
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7 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
8 | including a home
rule
county, is a self-insurer for purposes of | ||||||
9 | providing health insurance coverage
for its employees, the | ||||||
10 | coverage shall include coverage for the post-mastectomy
care | ||||||
11 | benefits required to be covered by a policy of accident and | ||||||
12 | health
insurance under Section 356t and the coverage required | ||||||
13 | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
15 | 356z.14, and 356z.15 , and 356z.22 of
the Illinois Insurance | ||||||
16 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
17 | and 356z.19 of
the Illinois Insurance Code. The requirement | ||||||
18 | that health benefits be covered
as provided in this Section is | ||||||
19 | an
exclusive power and function of the State and is a denial | ||||||
20 | and limitation under
Article VII, Section 6, subsection (h) of | ||||||
21 | the Illinois Constitution. A home
rule county to which this | ||||||
22 | Section applies must comply with every provision of
this | ||||||
23 | 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||||||
7 | eff. 7-13-12; 98-189, eff. 1-1-14.) | ||||||
8 | Section 15. The Illinois Municipal Code is amended by | ||||||
9 | changing Section 10-4-2.3 as follows: | ||||||
10 | (65 ILCS 5/10-4-2.3)
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11 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
12 | municipality, including a
home rule municipality, is a | ||||||
13 | self-insurer for purposes of providing health
insurance | ||||||
14 | coverage for its employees, the coverage shall include coverage | ||||||
15 | for
the post-mastectomy care benefits required to be covered by | ||||||
16 | a policy of
accident and health insurance under Section 356t | ||||||
17 | and the coverage required
under Sections 356g, 356g.5, | ||||||
18 | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
19 | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 356z.22 of | ||||||
20 | the Illinois
Insurance
Code. The coverage shall comply with | ||||||
21 | Sections 155.22a, 355b, and 356z.19 of
the Illinois Insurance | ||||||
22 | Code. The requirement that health
benefits be covered as | ||||||
23 | provided in this is an exclusive power and function of
the | ||||||
24 | State and is a denial and limitation under Article VII, Section |
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1 | 6,
subsection (h) of the Illinois Constitution. A home rule | ||||||
2 | municipality to which
this Section applies must comply with | ||||||
3 | every provision of this Section.
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4 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
5 | any, is conditioned on the rules being adopted in accordance | ||||||
6 | with all provisions of the Illinois Administrative Procedure | ||||||
7 | Act and all rules and procedures of the Joint Committee on | ||||||
8 | Administrative Rules; any purported rule not so adopted, for | ||||||
9 | whatever reason, is unauthorized. | ||||||
10 | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||||||
11 | eff. 7-13-12; 98-189, eff. 1-1-14.) | ||||||
12 | Section 20. The Illinois Insurance Code is amended by | ||||||
13 | adding Section 356z.22 as follows: | ||||||
14 | (215 ILCS 5/356z.22 new) | ||||||
15 | Sec. 356z.22. Hospital patient assessments. A group or | ||||||
16 | individual policy of accident and health insurance or managed | ||||||
17 | care plan amended, delivered, issued, or renewed after the | ||||||
18 | effective date of this amendatory Act of the 98th General | ||||||
19 | Assembly that provides coverage for hospital care shall include | ||||||
20 | in that coverage all services ordered by a physician and | ||||||
21 | provided in the hospital that are considered medically | ||||||
22 | necessary for the evaluation, assessment, and diagnosis of the | ||||||
23 | illness or condition that resulted in the hospital stay of the | ||||||
24 | enrollee or recipient. The services are subject to reasonable |
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1 | review and utilization standards required by the policy or plan | ||||||
2 | for all hospital services, as defined by the Department or its | ||||||
3 | successor agency. | ||||||
4 | Section 25. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-16.8 as follows:
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6 | (305 ILCS 5/5-16.8)
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7 | Sec. 5-16.8. Required health benefits. The medical | ||||||
8 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
9 | benefits required to be covered by a policy of
accident and | ||||||
10 | health insurance under Section 356t and the coverage required
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11 | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 , and | ||||||
12 | 356z.22 of the Illinois
Insurance Code and (ii) be subject to | ||||||
13 | the provisions of Sections 356z.19 and 364.01 of the Illinois
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14 | Insurance Code.
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15 | On and after July 1, 2012, the Department shall reduce any | ||||||
16 | rate of reimbursement for services or other payments or alter | ||||||
17 | any methodologies authorized by this Code to reduce any rate of | ||||||
18 | reimbursement for services or other payments in accordance with | ||||||
19 | Section 5-5e. | ||||||
20 | (Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
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21 | Section 30. The Medical Patient Rights Act is amended by | ||||||
22 | changing Section 2.04 and adding Section 5.3 as follows:
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1 | (410 ILCS 50/2.04) (from Ch. 111 1/2, par. 5402.04)
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2 | Sec. 2.04.
"Insurance company" means (1) an insurance | ||||||
3 | company, fraternal
benefit society, and any other insurer | ||||||
4 | subject to regulation under the
Illinois Insurance Code; or (2) | ||||||
5 | a health maintenance organization , a limited health service | ||||||
6 | organization under the Limited Health Service Organization | ||||||
7 | Act, or a voluntary health services plan under the Voluntary | ||||||
8 | Health Services Plans Act .
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9 | (Source: P.A. 85-677; 85-679.)
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10 | (410 ILCS 50/5.3 new) | ||||||
11 | Sec. 5.3. Patient notice of observation services. | ||||||
12 | (a) Every general hospital shall provide patients who are | ||||||
13 | placed into observation services by the general hospital with | ||||||
14 | an oral and written notice within 24 hours after placement that | ||||||
15 | the patient is not admitted to the hospital and is under | ||||||
16 | observation status. The written notice shall be signed by the | ||||||
17 | patient or the patient's legal representative to acknowledge | ||||||
18 | receipt and shall include, but not be limited to, the following | ||||||
19 | information: | ||||||
20 | (1) a statement that observation status may affect the | ||||||
21 | patient's Medicare, Medicaid, and private insurance | ||||||
22 | coverage for the current hospital services, including | ||||||
23 | medications and other pharmaceutical supplies, as well as | ||||||
24 | coverage for any subsequent discharge to a skilled nursing | ||||||
25 | facility or home and community based care; and |
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1 | (2) that the patient should contact his or her | ||||||
2 | insurance plan to better understand the implications of | ||||||
3 | being placed in observation status. | ||||||
4 | (b) The Director of Public Health shall develop and make | ||||||
5 | available guidance on the notice as described in this Section.
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6 | Section 99. Effective date. This Act takes effect upon | ||||||
7 | becoming law. |