103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4460

 

Introduced 1/16/2024, by Rep. Mary Gill

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11D new
55 ILCS 5/5-1069  from Ch. 34, par. 5-1069
65 ILCS 5/10-4-2  from Ch. 24, par. 10-4-2

    Amends the State Employees Group Insurance Act of 1971, the Counties Code, and the Illinois Municipal Code. Provides that the State Employees Group Insurance Program (for Illinois State Police officers), a county (for members of the sheriff's office), and a municipality (for members of the police department or fire department) shall provide coverage for joint mental health therapy services for the officer or firefighter and a spouse or partner of the officer or firefighter who resides with officer or firefighter. Specifies that the coverage shall be provided without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, except that, for Illinois State Police officers and the spouse or partner of the officer under the State Employees Group Insurance Act of 1971, only if all resources available to those individuals through the State of Illinois' Employee Assistance Program and any first responder mental health program available are first exhausted. Directs the joint mental health therapy services to be provided by a physician licensed to practice medicine in all of its branches, a licensed clinical psychologist, a licensed clinical social worker, a licensed clinical professional counselor, a licensed marriage and family therapist, a licensed social worker, or a licensed professional counselor. Limits the concurrent exercise of home rule powers. Effective January 1, 2025.


LRB103 36625 AWJ 66734 b

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
MAY APPLY

 

 

A BILL FOR

 

HB4460LRB103 36625 AWJ 66734 b

1    AN ACT concerning government.
 
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 adding Section 6.11D as follows:
 
6    (5 ILCS 375/6.11D new)
7    Sec. 6.11D. Joint mental health therapy services.
8    (a) The State Employees Group Insurance Program shall
9provide coverage for joint mental health therapy services for
10any Illinois State Police officer and any spouse or partner of
11the officer who resides with the officer.
12    (b) No deductible, coinsurance, copayment, or any other
13cost-sharing requirement may be imposed for coverage provided
14under this Section if all resources available to the
15individuals described in subsection (a) through the State of
16Illinois' Employee Assistance Program and any first responder
17mental health program available are first exhausted.
18    (c) The joint mental health therapy services provided
19under subsection (a) shall be performed by a physician
20licensed to practice medicine in all of its branches, a
21licensed clinical psychologist, a licensed clinical social
22worker, a licensed clinical professional counselor, a licensed
23marriage and family therapist, a licensed social worker, or a

 

 

HB4460- 2 -LRB103 36625 AWJ 66734 b

1licensed professional counselor.
 
2    Section 10. The Counties Code is amended by changing
3Section 5-1069 as follows:
 
4    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)
5    Sec. 5-1069. Group life, health, accident, hospital, and
6medical insurance.
7    (a) The county board of any county may arrange to provide,
8for the benefit of employees of the county, group life,
9health, accident, hospital, and medical insurance, or any one
10or any combination of those types of insurance, or the county
11board may self-insure, for the benefit of its employees, all
12or a portion of the employees' group life, health, accident,
13hospital, and medical insurance, or any one or any combination
14of those types of insurance, including a combination of
15self-insurance and other types of insurance authorized by this
16Section, provided that the county board complies with all
17other requirements of this Section. The insurance may include
18provision for employees who rely on treatment by prayer or
19spiritual means alone for healing in accordance with the
20tenets and practice of a well recognized religious
21denomination. The county board may provide for payment by the
22county of a portion or all of the premium or charge for the
23insurance with the employee paying the balance of the premium
24or charge, if any. If the county board undertakes a plan under

 

 

HB4460- 3 -LRB103 36625 AWJ 66734 b

1which the county pays only a portion of the premium or charge,
2the county board shall provide for withholding and deducting
3from the compensation of those employees who consent to join
4the plan the balance of the premium or charge for the
5insurance.
6    (b) If the county board does not provide for
7self-insurance or for a plan under which the county pays a
8portion or all of the premium or charge for a group insurance
9plan, the county board may provide for withholding and
10deducting from the compensation of those employees who consent
11thereto the total premium or charge for any group life,
12health, accident, hospital, and medical insurance.
13    (c) The county board may exercise the powers granted in
14this Section only if it provides for self-insurance or, where
15it makes arrangements to provide group insurance through an
16insurance carrier, if the kinds of group insurance are
17obtained from an insurance company authorized to do business
18in the State of Illinois. The county board may enact an
19ordinance prescribing the method of operation of the insurance
20program.
21    (d) If a county, including a home rule county, is a
22self-insurer for purposes of providing health insurance
23coverage for its employees, the insurance coverage shall
24include screening by low-dose mammography for all women 35
25years of age or older for the presence of occult breast cancer
26unless the county elects to provide mammograms itself under

 

 

HB4460- 4 -LRB103 36625 AWJ 66734 b

1Section 5-1069.1. The coverage shall be as follows:
2        (1) A baseline mammogram for women 35 to 39 years of
3    age.
4        (2) An annual mammogram for women 40 years of age or
5    older.
6        (3) A mammogram at the age and intervals considered
7    medically necessary by the woman's health care provider
8    for women under 40 years of age and having a family history
9    of breast cancer, prior personal history of breast cancer,
10    positive genetic testing, or other risk factors.
11        (4) For a group policy of accident and health
12    insurance that is amended, delivered, issued, or renewed
13    on or after the effective date of this amendatory Act of
14    the 101st General Assembly, a comprehensive ultrasound
15    screening of an entire breast or breasts if a mammogram
16    demonstrates heterogeneous or dense breast tissue or when
17    medically necessary as determined by a physician licensed
18    to practice medicine in all of its branches, advanced
19    practice registered nurse, or physician assistant.
20        (5) For a group policy of accident and health
21    insurance that is amended, delivered, issued, or renewed
22    on or after the effective date of this amendatory Act of
23    the 101st General Assembly, a diagnostic mammogram when
24    medically necessary, as determined by a physician licensed
25    to practice medicine in all its branches, advanced
26    practice registered nurse, or physician assistant.

 

 

HB4460- 5 -LRB103 36625 AWJ 66734 b

1    A policy subject to this subsection shall not impose a
2deductible, coinsurance, copayment, or any other cost-sharing
3requirement on the coverage provided; except that this
4sentence does not apply to coverage of diagnostic mammograms
5to the extent such coverage would disqualify a high-deductible
6health plan from eligibility for a health savings account
7pursuant to Section 223 of the Internal Revenue Code (26
8U.S.C. 223).
9    For purposes of this subsection:
10    "Diagnostic mammogram" means a mammogram obtained using
11diagnostic mammography.
12    "Diagnostic mammography" means a method of screening that
13is designed to evaluate an abnormality in a breast, including
14an abnormality seen or suspected on a screening mammogram or a
15subjective or objective abnormality otherwise detected in the
16breast.
17    "Low-dose mammography" means the x-ray examination of the
18breast using equipment dedicated specifically for mammography,
19including the x-ray tube, filter, compression device, and
20image receptor, with an average radiation exposure delivery of
21less than one rad per breast for 2 views of an average size
22breast. The term also includes digital mammography.
23    (d-5) Coverage as described by subsection (d) shall be
24provided at no cost to the insured and shall not be applied to
25an annual or lifetime maximum benefit.
26    (d-10) When health care services are available through

 

 

HB4460- 6 -LRB103 36625 AWJ 66734 b

1contracted providers and a person does not comply with plan
2provisions specific to the use of contracted providers, the
3requirements of subsection (d-5) are not applicable. When a
4person does not comply with plan provisions specific to the
5use of contracted providers, plan provisions specific to the
6use of non-contracted providers must be applied without
7distinction for coverage required by this Section and shall be
8at least as favorable as for other radiological examinations
9covered by the policy or contract.
10    (d-15) If a county, including a home rule county, is a
11self-insurer for purposes of providing health insurance
12coverage for its employees, the insurance coverage shall
13include mastectomy coverage, which includes coverage for
14prosthetic devices or reconstructive surgery incident to the
15mastectomy. Coverage for breast reconstruction in connection
16with a mastectomy shall include:
17        (1) reconstruction of the breast upon which the
18    mastectomy has been performed;
19        (2) surgery and reconstruction of the other breast to
20    produce a symmetrical appearance; and
21        (3) prostheses and treatment for physical
22    complications at all stages of mastectomy, including
23    lymphedemas.
24Care shall be determined in consultation with the attending
25physician and the patient. The offered coverage for prosthetic
26devices and reconstructive surgery shall be subject to the

 

 

HB4460- 7 -LRB103 36625 AWJ 66734 b

1deductible and coinsurance conditions applied to the
2mastectomy, and all other terms and conditions applicable to
3other benefits. When a mastectomy is performed and there is no
4evidence of malignancy then the offered coverage may be
5limited to the provision of prosthetic devices and
6reconstructive surgery to within 2 years after the date of the
7mastectomy. As used in this Section, "mastectomy" means the
8removal of all or part of the breast for medically necessary
9reasons, as determined by a licensed physician.
10    A county, including a home rule county, that is a
11self-insurer for purposes of providing health insurance
12coverage for its employees, may not penalize or reduce or
13limit the reimbursement of an attending provider or provide
14incentives (monetary or otherwise) to an attending provider to
15induce the provider to provide care to an insured in a manner
16inconsistent with this Section.
17    (d-20) The requirement that mammograms be included in
18health insurance coverage as provided in subsections (d)
19through (d-15) is an exclusive power and function of the State
20and is a denial and limitation under Article VII, Section 6,
21subsection (h) of the Illinois Constitution of home rule
22county powers. A home rule county to which subsections (d)
23through (d-15) apply must comply with every provision of those
24subsections.
25    (d-25) If a county, including a home rule county, is a
26self-insurer for purposes of providing health insurance

 

 

HB4460- 8 -LRB103 36625 AWJ 66734 b

1coverage, the insurance coverage shall include joint mental
2health therapy services for any member of the Sheriff's
3office, including the sheriff, and any spouse or partner of
4the member who resides with the member.
5    No deductible, coinsurance, copayment, or any other
6cost-sharing requirement may be imposed for coverage provided
7under this subsection.
8    The joint mental health therapy services provided under
9this subsection shall be performed by a physician licensed to
10practice medicine in all of its branches, a licensed clinical
11psychologist, a licensed clinical social worker, a licensed
12clinical professional counselor, a licensed marriage and
13family therapist, a licensed social worker, or a licensed
14professional counselor.
15    This subsection is a limitation under subsection (i) of
16Section 6 of Article VII of the Illinois Constitution on the
17concurrent exercise by home rule units of powers and functions
18exercised by the State.
19    (e) The term "employees" as used in this Section includes
20elected or appointed officials but does not include temporary
21employees.
22    (f) The county board may, by ordinance, arrange to provide
23group life, health, accident, hospital, and medical insurance,
24or any one or a combination of those types of insurance, under
25this Section to retired former employees and retired former
26elected or appointed officials of the county.

 

 

HB4460- 9 -LRB103 36625 AWJ 66734 b

1    (g) Rulemaking authority to implement this amendatory Act
2of the 95th General Assembly, if any, is conditioned on the
3rules being adopted in accordance with all provisions of the
4Illinois Administrative Procedure Act and all rules and
5procedures of the Joint Committee on Administrative Rules; any
6purported rule not so adopted, for whatever reason, is
7unauthorized.
8(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 
9    Section 15. The Illinois Municipal Code is amended by
10changing Section 10-4-2 as follows:
 
11    (65 ILCS 5/10-4-2)  (from Ch. 24, par. 10-4-2)
12    Sec. 10-4-2. Group insurance.
13    (a) The corporate authorities of any municipality may
14arrange to provide, for the benefit of employees of the
15municipality, group life, health, accident, hospital, and
16medical insurance, or any one or any combination of those
17types of insurance, and may arrange to provide that insurance
18for the benefit of the spouses or dependents of those
19employees. The insurance may include provision for employees
20or other insured persons who rely on treatment by prayer or
21spiritual means alone for healing in accordance with the
22tenets and practice of a well recognized religious
23denomination. The corporate authorities may provide for
24payment by the municipality of a portion of the premium or

 

 

HB4460- 10 -LRB103 36625 AWJ 66734 b

1charge for the insurance with the employee paying the balance
2of the premium or charge. If the corporate authorities
3undertake a plan under which the municipality pays a portion
4of the premium or charge, the corporate authorities shall
5provide for withholding and deducting from the compensation of
6those municipal employees who consent to join the plan the
7balance of the premium or charge for the insurance.
8    (b) If the corporate authorities do not provide for a plan
9under which the municipality pays a portion of the premium or
10charge for a group insurance plan, the corporate authorities
11may provide for withholding and deducting from the
12compensation of those employees who consent thereto the
13premium or charge for any group life, health, accident,
14hospital, and medical insurance.
15    (c) The corporate authorities may exercise the powers
16granted in this Section only if the kinds of group insurance
17are obtained from an insurance company authorized to do
18business in the State of Illinois, or are obtained through an
19intergovernmental joint self-insurance pool as authorized
20under the Intergovernmental Cooperation Act. The corporate
21authorities may enact an ordinance prescribing the method of
22operation of the insurance program.
23    (d) If a municipality, including a home rule municipality,
24is a self-insurer for purposes of providing health insurance
25coverage for its employees, the insurance coverage shall
26include screening by low-dose mammography for all women 35

 

 

HB4460- 11 -LRB103 36625 AWJ 66734 b

1years of age or older for the presence of occult breast cancer
2unless the municipality elects to provide mammograms itself
3under Section 10-4-2.1. The coverage shall be as follows:
4        (1) A baseline mammogram for women 35 to 39 years of
5    age.
6        (2) An annual mammogram for women 40 years of age or
7    older.
8        (3) A mammogram at the age and intervals considered
9    medically necessary by the woman's health care provider
10    for women under 40 years of age and having a family history
11    of breast cancer, prior personal history of breast cancer,
12    positive genetic testing, or other risk factors.
13        (4) For a group policy of accident and health
14    insurance that is amended, delivered, issued, or renewed
15    on or after the effective date of this amendatory Act of
16    the 101st General Assembly, a comprehensive ultrasound
17    screening of an entire breast or breasts if a mammogram
18    demonstrates heterogeneous or dense breast tissue or when
19    medically necessary as determined by a physician licensed
20    to practice medicine in all of its branches.
21        (5) For a group policy of accident and health
22    insurance that is amended, delivered, issued, or renewed
23    on or after the effective date of this amendatory Act of
24    the 101st General Assembly, a diagnostic mammogram when
25    medically necessary, as determined by a physician licensed
26    to practice medicine in all its branches, advanced

 

 

HB4460- 12 -LRB103 36625 AWJ 66734 b

1    practice registered nurse, or physician assistant.
2    A policy subject to this subsection shall not impose a
3deductible, coinsurance, copayment, or any other cost-sharing
4requirement on the coverage provided; except that this
5sentence does not apply to coverage of diagnostic mammograms
6to the extent such coverage would disqualify a high-deductible
7health plan from eligibility for a health savings account
8pursuant to Section 223 of the Internal Revenue Code (26
9U.S.C. 223).
10    For purposes of this subsection:
11    "Diagnostic mammogram" means a mammogram obtained using
12diagnostic mammography.
13    "Diagnostic mammography" means a method of screening that
14is designed to evaluate an abnormality in a breast, including
15an abnormality seen or suspected on a screening mammogram or a
16subjective or objective abnormality otherwise detected in the
17breast.
18    "Low-dose mammography" means the x-ray examination of the
19breast using equipment dedicated specifically for mammography,
20including the x-ray tube, filter, compression device, and
21image receptor, with an average radiation exposure delivery of
22less than one rad per breast for 2 views of an average size
23breast. The term also includes digital mammography.
24    (d-5) Coverage as described by subsection (d) shall be
25provided at no cost to the insured and shall not be applied to
26an annual or lifetime maximum benefit.

 

 

HB4460- 13 -LRB103 36625 AWJ 66734 b

1    (d-10) When health care services are available through
2contracted providers and a person does not comply with plan
3provisions specific to the use of contracted providers, the
4requirements of subsection (d-5) are not applicable. When a
5person does not comply with plan provisions specific to the
6use of contracted providers, plan provisions specific to the
7use of non-contracted providers must be applied without
8distinction for coverage required by this Section and shall be
9at least as favorable as for other radiological examinations
10covered by the policy or contract.
11    (d-15) If a municipality, including a home rule
12municipality, is a self-insurer for purposes of providing
13health insurance coverage for its employees, the insurance
14coverage shall include mastectomy coverage, which includes
15coverage for prosthetic devices or reconstructive surgery
16incident to the mastectomy. Coverage for breast reconstruction
17in connection with a mastectomy shall include:
18        (1) reconstruction of the breast upon which the
19    mastectomy has been performed;
20        (2) surgery and reconstruction of the other breast to
21    produce a symmetrical appearance; and
22        (3) prostheses and treatment for physical
23    complications at all stages of mastectomy, including
24    lymphedemas.
25Care shall be determined in consultation with the attending
26physician and the patient. The offered coverage for prosthetic

 

 

HB4460- 14 -LRB103 36625 AWJ 66734 b

1devices and reconstructive surgery shall be subject to the
2deductible and coinsurance conditions applied to the
3mastectomy, and all other terms and conditions applicable to
4other benefits. When a mastectomy is performed and there is no
5evidence of malignancy then the offered coverage may be
6limited to the provision of prosthetic devices and
7reconstructive surgery to within 2 years after the date of the
8mastectomy. As used in this Section, "mastectomy" means the
9removal of all or part of the breast for medically necessary
10reasons, as determined by a licensed physician.
11    A municipality, including a home rule municipality, that
12is a self-insurer for purposes of providing health insurance
13coverage for its employees, may not penalize or reduce or
14limit the reimbursement of an attending provider or provide
15incentives (monetary or otherwise) to an attending provider to
16induce the provider to provide care to an insured in a manner
17inconsistent with this Section.
18    (d-20) The requirement that mammograms be included in
19health insurance coverage as provided in subsections (d)
20through (d-15) is an exclusive power and function of the State
21and is a denial and limitation under Article VII, Section 6,
22subsection (h) of the Illinois Constitution of home rule
23municipality powers. A home rule municipality to which
24subsections (d) through (d-15) apply must comply with every
25provision of those subsections.
26    (d-25) If a municipality, including a home rule

 

 

HB4460- 15 -LRB103 36625 AWJ 66734 b

1municipality, is a self-insurer for purposes of providing
2health insurance coverage for its employees, the insurance
3coverage shall include joint mental health therapy services
4for any member of the municipality's police department or fire
5department and any spouse or partner of the member who resides
6with the member.
7    No deductible, coinsurance, copayment, or any other
8cost-sharing requirement may be imposed for coverage provided
9under this subsection.
10    The joint mental health therapy services provided under
11this subsection shall be performed by a physician licensed to
12practice medicine in all of its branches, a licensed clinical
13psychologist, a licensed clinical social worker, a licensed
14clinical professional counselor, a licensed marriage and
15family therapist, a licensed social worker, or a licensed
16professional counselor.
17    This subsection is a limitation under subsection (i) of
18Section 6 of Article VII of the Illinois Constitution on the
19concurrent exercise by home rule units of powers and functions
20exercised by the State.
21    (e) Rulemaking authority to implement Public Act 95-1045,
22if any, is conditioned on the rules being adopted in
23accordance with all provisions of the Illinois Administrative
24Procedure Act and all rules and procedures of the Joint
25Committee on Administrative Rules; any purported rule not so
26adopted, for whatever reason, is unauthorized.

 

 

HB4460- 16 -LRB103 36625 AWJ 66734 b

1(Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20.)
 
2    Section 99. Effective date. This Act takes effect January
31, 2025.