102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2473

 

Introduced 2/19/2021, by Rep. Deanne M. Mazzochi

 

SYNOPSIS AS INTRODUCED:
 
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 5/356u
215 ILCS 5/356x
215 ILCS 5/356z.43 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. In provisions requiring insurance coverage for prostate-specific antigen tests and for colorectal cancer examination and screening, removes provisions requiring the testing be recommended or prescribed by a physician. Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require insurance policies to provide coverage for testing to establish the presence or absence of sexually transmitted diseases or infections. Effective immediately.


LRB102 13361 BMS 18705 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB2473LRB102 13361 BMS 18705 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

HB2473- 2 -LRB102 13361 BMS 18705 b

1by the Department of Central Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

HB2473- 3 -LRB102 13361 BMS 18705 b

1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

HB2473- 5 -LRB102 13361 BMS 18705 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB2473- 6 -LRB102 13361 BMS 18705 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12changing Sections 356u and 356x and by adding Section 356z.43
13as follows:
 
14    (215 ILCS 5/356u)
15    Sec. 356u. Pap tests and prostate-specific antigen tests.
16    (a) A group policy of accident and health insurance that
17provides coverage for hospital or medical treatment or
18services for illness on an expense-incurred basis and is
19amended, delivered, issued, or renewed after the effective
20date of this amendatory Act of 1997 shall provide coverage for
21all of the following:
22        (1) An annual cervical smear or Pap smear test for
23    female insureds.
24        (2) An annual digital rectal examination and a

 

 

HB2473- 7 -LRB102 13361 BMS 18705 b

1    prostate-specific antigen test, for male insureds upon the
2    recommendation of a physician licensed to practice
3    medicine in all its branches for:
4            (A) asymptomatic men age 50 and over;
5            (B) African-American men age 40 and over; and
6            (C) men age 40 and over with a family history of
7        prostate cancer.
8        (3) Surveillance tests for ovarian cancer for female
9    insureds who are at risk for ovarian cancer.
10    (b) This Section shall not apply to agreements, contracts,
11or policies that provide coverage for a specified disease or
12other limited benefit coverage.
13    (c) For the purposes of this Section:
14    "At risk for ovarian cancer" means:
15        (1) having a family history (i) with one or more
16    first-degree relatives with ovarian cancer, (ii) of
17    clusters of women relatives with breast cancer, or (iii)
18    of nonpolyposis colorectal cancer; or
19        (2) testing positive for BRCA1 or BRCA2 mutations.
20    "Surveillance tests for ovarian cancer" means annual
21screening using (i) CA-125 serum tumor marker testing, (ii)
22transvaginal ultrasound, (iii) pelvic examination.
23(Source: P.A. 94-122, eff. 1-1-06.)
 
24    (215 ILCS 5/356x)
25    Sec. 356x. Coverage for colorectal cancer examination and

 

 

HB2473- 8 -LRB102 13361 BMS 18705 b

1screening.
2    (a) An individual or group policy of accident and health
3insurance or a managed care plan that is amended, delivered,
4issued, or renewed on or after the effective date of this
5amendatory Act of the 93rd General Assembly that provides
6coverage to a resident of this State must provide benefits or
7coverage for all colorectal cancer examinations and laboratory
8tests for colorectal cancer as prescribed by a physician, in
9accordance with the published American Cancer Society
10guidelines on colorectal cancer screening or other existing
11colorectal cancer screening guidelines issued by nationally
12recognized professional medical societies or federal
13government agencies, including the National Cancer Institute,
14the Centers for Disease Control and Prevention, and the
15American College of Gastroenterology.
16    (b) Coverage required under this Section may not impose
17any deductible, coinsurance, waiting period, or other
18cost-sharing limitation that is greater than that required for
19other coverage under the policy.
20(Source: P.A. 93-568, eff. 1-1-04.)
 
21    (215 ILCS 5/356z.43 new)
22    Sec. 356z.43. Coverage for sexually transmitted disease
23testing. A group or individual policy of accident and health
24insurance amended, delivered, issued, or renewed after the
25effective date of this amendatory Act of the 102nd General

 

 

HB2473- 9 -LRB102 13361 BMS 18705 b

1Assembly shall provide coverage for testing to establish the
2presence or absence of sexually transmitted diseases or
3infections.
 
4    Section 30. The Health Maintenance Organization Act is
5amended by changing Section 5-3 as follows:
 
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 136, 137, 139, 140,
10141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
11154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
12355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
13356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
14356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
15356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
16356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
17356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
18368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
19408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
20(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
21XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
22Insurance Code.
23    (b) For purposes of the Illinois Insurance Code, except
24for Sections 444 and 444.1 and Articles XIII and XIII 1/2,

 

 

HB2473- 10 -LRB102 13361 BMS 18705 b

1Health Maintenance Organizations in the following categories
2are deemed to be "domestic companies":
3        (1) a corporation authorized under the Dental Service
4    Plan Act or the Voluntary Health Services Plans Act;
5        (2) a corporation organized under the laws of this
6    State; or
7        (3) a corporation organized under the laws of another
8    state, 30% or more of the enrollees of which are residents
9    of this State, except a corporation subject to
10    substantially the same requirements in its state of
11    organization as is a "domestic company" under Article VIII
12    1/2 of the Illinois Insurance Code.
13    (c) In considering the merger, consolidation, or other
14acquisition of control of a Health Maintenance Organization
15pursuant to Article VIII 1/2 of the Illinois Insurance Code,
16        (1) the Director shall give primary consideration to
17    the continuation of benefits to enrollees and the
18    financial conditions of the acquired Health Maintenance
19    Organization after the merger, consolidation, or other
20    acquisition of control takes effect;
21        (2)(i) the criteria specified in subsection (1)(b) of
22    Section 131.8 of the Illinois Insurance Code shall not
23    apply and (ii) the Director, in making his determination
24    with respect to the merger, consolidation, or other
25    acquisition of control, need not take into account the
26    effect on competition of the merger, consolidation, or

 

 

HB2473- 11 -LRB102 13361 BMS 18705 b

1    other acquisition of control;
2        (3) the Director shall have the power to require the
3    following information:
4            (A) certification by an independent actuary of the
5        adequacy of the reserves of the Health Maintenance
6        Organization sought to be acquired;
7            (B) pro forma financial statements reflecting the
8        combined balance sheets of the acquiring company and
9        the Health Maintenance Organization sought to be
10        acquired as of the end of the preceding year and as of
11        a date 90 days prior to the acquisition, as well as pro
12        forma financial statements reflecting projected
13        combined operation for a period of 2 years;
14            (C) a pro forma business plan detailing an
15        acquiring party's plans with respect to the operation
16        of the Health Maintenance Organization sought to be
17        acquired for a period of not less than 3 years; and
18            (D) such other information as the Director shall
19        require.
20    (d) The provisions of Article VIII 1/2 of the Illinois
21Insurance Code and this Section 5-3 shall apply to the sale by
22any health maintenance organization of greater than 10% of its
23enrollee population (including without limitation the health
24maintenance organization's right, title, and interest in and
25to its health care certificates).
26    (e) In considering any management contract or service

 

 

HB2473- 12 -LRB102 13361 BMS 18705 b

1agreement subject to Section 141.1 of the Illinois Insurance
2Code, the Director (i) shall, in addition to the criteria
3specified in Section 141.2 of the Illinois Insurance Code,
4take into account the effect of the management contract or
5service agreement on the continuation of benefits to enrollees
6and the financial condition of the health maintenance
7organization to be managed or serviced, and (ii) need not take
8into account the effect of the management contract or service
9agreement on competition.
10    (f) Except for small employer groups as defined in the
11Small Employer Rating, Renewability and Portability Health
12Insurance Act and except for medicare supplement policies as
13defined in Section 363 of the Illinois Insurance Code, a
14Health Maintenance Organization may by contract agree with a
15group or other enrollment unit to effect refunds or charge
16additional premiums under the following terms and conditions:
17        (i) the amount of, and other terms and conditions with
18    respect to, the refund or additional premium are set forth
19    in the group or enrollment unit contract agreed in advance
20    of the period for which a refund is to be paid or
21    additional premium is to be charged (which period shall
22    not be less than one year); and
23        (ii) the amount of the refund or additional premium
24    shall not exceed 20% of the Health Maintenance
25    Organization's profitable or unprofitable experience with
26    respect to the group or other enrollment unit for the

 

 

HB2473- 13 -LRB102 13361 BMS 18705 b

1    period (and, for purposes of a refund or additional
2    premium, the profitable or unprofitable experience shall
3    be calculated taking into account a pro rata share of the
4    Health Maintenance Organization's administrative and
5    marketing expenses, but shall not include any refund to be
6    made or additional premium to be paid pursuant to this
7    subsection (f)). The Health Maintenance Organization and
8    the group or enrollment unit may agree that the profitable
9    or unprofitable experience may be calculated taking into
10    account the refund period and the immediately preceding 2
11    plan years.
12    The Health Maintenance Organization shall include a
13statement in the evidence of coverage issued to each enrollee
14describing the possibility of a refund or additional premium,
15and upon request of any group or enrollment unit, provide to
16the group or enrollment unit a description of the method used
17to calculate (1) the Health Maintenance Organization's
18profitable experience with respect to the group or enrollment
19unit and the resulting refund to the group or enrollment unit
20or (2) the Health Maintenance Organization's unprofitable
21experience with respect to the group or enrollment unit and
22the resulting additional premium to be paid by the group or
23enrollment unit.
24    In no event shall the Illinois Health Maintenance
25Organization Guaranty Association be liable to pay any
26contractual obligation of an insolvent organization to pay any

 

 

HB2473- 14 -LRB102 13361 BMS 18705 b

1refund authorized under this Section.
2    (g) Rulemaking authority to implement Public Act 95-1045,
3if any, is conditioned on the rules being adopted in
4accordance with all provisions of the Illinois Administrative
5Procedure Act and all rules and procedures of the Joint
6Committee on Administrative Rules; any purported rule not so
7adopted, for whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
11eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21.)
 
14    Section 35. The Limited Health Service Organization Act is
15amended by changing Section 4003 as follows:
 
16    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
17    Sec. 4003. Illinois Insurance Code provisions. Limited
18health service organizations shall be subject to the
19provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
21154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
22355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
23356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
24401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and

 

 

HB2473- 15 -LRB102 13361 BMS 18705 b

1444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
2XXV, and XXVI of the Illinois Insurance Code. For purposes of
3the Illinois Insurance Code, except for Sections 444 and 444.1
4and Articles XIII and XIII 1/2, limited health service
5organizations in the following categories are deemed to be
6domestic companies:
7        (1) a corporation under the laws of this State; or
8        (2) a corporation organized under the laws of another
9    state, 30% or more of the enrollees of which are residents
10    of this State, except a corporation subject to
11    substantially the same requirements in its state of
12    organization as is a domestic company under Article VIII
13    1/2 of the Illinois Insurance Code.
14(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
15100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
161-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
17eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
18    Section 40. The Voluntary Health Services Plans Act is
19amended by changing Section 10 as follows:
 
20    (215 ILCS 165/10)  (from Ch. 32, par. 604)
21    Sec. 10. Application of Insurance Code provisions. Health
22services plan corporations and all persons interested therein
23or dealing therewith shall be subject to the provisions of
24Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,

 

 

HB2473- 16 -LRB102 13361 BMS 18705 b

1143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
2356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
3356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
4356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
5356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
6356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
7367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
8and paragraphs (7) and (15) of Section 367 of the Illinois
9Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
19eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
20101-625, eff. 1-1-21.)
 
21    Section 45. The Illinois Public Aid Code is amended by
22changing Section 5-16.8 as follows:
 
23    (305 ILCS 5/5-16.8)
24    Sec. 5-16.8. Required health benefits. The medical

 

 

HB2473- 17 -LRB102 13361 BMS 18705 b

1assistance program shall (i) provide the post-mastectomy care
2benefits required to be covered by a policy of accident and
3health insurance under Section 356t and the coverage required
4under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
5356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
6of the Illinois Insurance Code and (ii) be subject to the
7provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
8the Illinois Insurance Code.
9    The Department, by rule, shall adopt a model similar to
10the requirements of Section 356z.39 of the Illinois Insurance
11Code.
12    On and after July 1, 2012, the Department shall reduce any
13rate of reimbursement for services or other payments or alter
14any methodologies authorized by this Code to reduce any rate
15of reimbursement for services or other payments in accordance
16with Section 5-5e.
17    To ensure full access to the benefits set forth in this
18Section, on and after January 1, 2016, the Department shall
19ensure that provider and hospital reimbursement for
20post-mastectomy care benefits required under this Section are
21no lower than the Medicare reimbursement rate.
22(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
23100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
247-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
25eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
 
26    Section 999. Effective date. This Act takes effect upon

 

 

HB2473- 18 -LRB102 13361 BMS 18705 b

1becoming law.