Rep. Laura Faver Dias

Filed: 3/14/2024

 

 


 

 


 
10300HB5295ham001LRB103 38679 RPS 70766 a

1
AMENDMENT TO HOUSE BILL 5295

2    AMENDMENT NO. ______. Amend House Bill 5295 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.56 as follows:
 
6    (215 ILCS 5/356z.56)
7    Sec. 356z.56. Coverage for hormonal and non-hormonal
8hormone therapy to treat menopause. A group or individual
9policy of accident and health insurance or a managed care plan
10that is amended, delivered, issued, or renewed in this State
11on or after January 1, 2024 shall provide coverage for
12medically necessary hormone therapy treatment to treat
13menopause that has been induced by a hysterectomy. This
14coverage applies only to coverage provided on or after January
151, 2024 and before January 1, 2026.
16    A group or individual policy of accident and health

 

 

10300HB5295ham001- 2 -LRB103 38679 RPS 70766 a

1insurance or a managed care plan that is amended, delivered,
2issued, or renewed on or after January 1, 2026 shall provide
3coverage for medically necessary hormonal and non-hormonal
4therapy to treat menopausal symptoms if the therapy is
5recommended by a qualified health care provider who is
6licensed, accredited, or certified under Illinois law and the
7therapy has been proven safe and effective in peer-reviewed
8scientific studies. Coverage for therapy to treat menopausal
9symptoms shall include all federal Food and Drug
10Administration-approved modalities of hormonal and
11non-hormonal administration, including, but not limited to,
12oral, transdermal, topical, and vaginal rings.
13(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
14    Section 10. The Illinois Public Aid Code is amended by
15changing Section 5-16.8 and by adding Section 5-52 as follows:
 
16    (305 ILCS 5/5-16.8)
17    Sec. 5-16.8. Required health benefits. The medical
18assistance program shall (i) provide the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
22356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
23356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
24356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,

 

 

10300HB5295ham001- 3 -LRB103 38679 RPS 70766 a

1(ii) be subject to the provisions of Sections 356z.19,
2356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
3Insurance Code, and (iii) be subject to the provisions of
4subsection (d-5) of Section 10 of the Network Adequacy and
5Transparency Act.
6    The Department, by rule, shall adopt a model similar to
7the requirements of Section 356z.39 of the Illinois Insurance
8Code.
9    On and after July 1, 2012, the Department shall reduce any
10rate of reimbursement for services or other payments or alter
11any methodologies authorized by this Code to reduce any rate
12of reimbursement for services or other payments in accordance
13with Section 5-5e.
14    To ensure full access to the benefits set forth in this
15Section, on and after January 1, 2016, the Department shall
16ensure that provider and hospital reimbursement for
17post-mastectomy care benefits required under this Section are
18no lower than the Medicare reimbursement rate.
19(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
20102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
211-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
22eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
23102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
241-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
25    (305 ILCS 5/5-52 new)

 

 

10300HB5295ham001- 4 -LRB103 38679 RPS 70766 a

1    Sec. 5-52. Coverage for hormonal therapy to treat
2menopause. The medical assistance program shall provide
3coverage for medically necessary hormone therapy treatment to
4treat menopause that has been induced by a hysterectomy.
 
5    Section 99. Effective date. This Act takes effect January
61, 2026.".