SB2697 EnrolledLRB103 35895 RPS 65980 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, 356q, 356u, 356u.10,
14356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
15356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
16356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
17356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
18356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
19356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
20and 356z.70 of the Illinois Insurance Code. The program of
21health benefits must comply with Sections 155.22a, 155.37,
22355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
23Illinois Insurance Code. The program of health benefits shall

 

 

SB2697 Enrolled- 2 -LRB103 35895 RPS 65980 b

1provide the coverage required under Section 356m of the
2Illinois Insurance Code and, for the employees of the State
3Employee Group Insurance Program only, the coverage as also
4provided in Section 6.11B of this Act. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
16102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
171-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
18eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
19102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
201-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
21eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
22103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
238-11-23; revised 8-29-23.)
 
24    Section 10. The Counties Code is amended by changing
25Section 5-1069.3 as follows:
 

 

 

SB2697 Enrolled- 3 -LRB103 35895 RPS 65980 b

1    (55 ILCS 5/5-1069.3)
2    Sec. 5-1069.3. Required health benefits. If a county,
3including a home rule county, is a self-insurer for purposes
4of providing health insurance coverage for its employees, the
5coverage shall include coverage for the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10,
9356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
10356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
11356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
12356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
13356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
14356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
15of the Illinois Insurance Code. The coverage shall comply with
16Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
17Insurance Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this Section is an
20exclusive power and function of the State and is a denial and
21limitation under Article VII, Section 6, subsection (h) of the
22Illinois Constitution. A home rule county to which this
23Section applies must comply with every provision of this
24Section.
25    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB2697 Enrolled- 4 -LRB103 35895 RPS 65980 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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
81-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
9eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
10102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
111-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
12eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
13103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
148-29-23.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include
22coverage for the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t and the coverage required under Sections 356g,

 

 

SB2697 Enrolled- 5 -LRB103 35895 RPS 65980 b

1356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4,
2356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
3356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
4356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
5356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
6356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
7356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
8Insurance Code. The coverage shall comply with Sections
9155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
10Code. The Department of Insurance shall enforce the
11requirements of this Section. The requirement that health
12benefits be covered as provided in this is an exclusive power
13and function of the State and is a denial and limitation under
14Article VII, Section 6, subsection (h) of the Illinois
15Constitution. A home rule municipality to which this Section
16applies must comply with every provision of this Section.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
251-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
26eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

 

 

SB2697 Enrolled- 6 -LRB103 35895 RPS 65980 b

1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
3eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
58-29-23.)
 
6    Section 20. The School Code is amended by changing Section
710-22.3f as follows:
 
8    (105 ILCS 5/10-22.3f)
9    Sec. 10-22.3f. Required health benefits. Insurance
10protection and benefits for employees shall provide the
11post-mastectomy care benefits required to be covered by a
12policy of accident and health insurance under Section 356t and
13the coverage required under Sections 356g, 356g.5, 356g.5-1,
14356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,
15356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
16356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
17356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
18356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
19and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
20356z.70 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

 

 

SB2697 Enrolled- 7 -LRB103 35895 RPS 65980 b

1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
91-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
10eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
11102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
121-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
13eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
14103-551, eff. 8-11-23; revised 8-29-23.)
 
15    Section 25. The Illinois Insurance Code is amended by
16adding Section 356u.10 as follows:
 
17    (215 ILCS 5/356u.10 new)
18    Sec. 356u.10. Genetic testing and evidence-based
19screenings for an inherited gene mutation.
20    (a) In this Section, "genetic testing for an inherited
21mutation" means germline multi-gene testing for an inherited
22mutation associated with an increased risk of cancer in
23accordance with evidence-based, clinical practice guidelines.
24    (b) A group policy of accident and health insurance or

 

 

SB2697 Enrolled- 8 -LRB103 35895 RPS 65980 b

1managed care plan that is amended, delivered, issued, or
2renewed after January 1, 2026 shall provide coverage for
3clinical genetic testing for an inherited gene mutation for
4individuals with a personal or family history of cancer, as
5recommended by a health care professional in accordance with
6current evidence-based clinical practice guidelines,
7including, but not limited to, the current version of the
8National Comprehensive Cancer Network clinical practice
9guidelines. The coverage shall limit the total amount that a
10covered person is required to pay for a clinical genetic test
11under this subsection to an amount not to exceed $50, except
12for services for which cost sharing is prohibited under 42
13U.S.C. 300gg-13. This subsection (b) shall not apply to
14coverage of genetic testing to the extent such coverage would
15disqualify a high-deductible health plan from eligibility for
16a health savings account pursuant to Section 223 of the
17Internal Revenue Code.
18    (c) For individuals with a genetic test that is positive
19for an inherited mutation associated with an increased risk of
20cancer, coverage required under this Section shall include any
21evidence-based screenings, as recommended by a health care
22professional in accordance with current evidence-based
23clinical practice guidelines, to the extent that the
24management recommendation is not already covered by the
25policy, except that coverage for evidence-based screenings
26under this subsection (c) may be subject to a deductible,

 

 

SB2697 Enrolled- 9 -LRB103 35895 RPS 65980 b

1coinsurance, or other cost-sharing limitation so long as the
2limitation is not greater than that required for other related
3cancer risk management benefits covered under the policy. In
4this subsection, "evidence-based cancer screenings" means
5medically recommended evidence-based screening modalities in
6accordance with current clinical practice guidelines.
 
7    Section 30. The Health Maintenance Organization Act is
8amended by changing Section 5-3 as follows:
 
9    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
10    Sec. 5-3. Insurance Code provisions.
11    (a) Health Maintenance Organizations shall be subject to
12the provisions of Sections 133, 134, 136, 137, 139, 140,
13141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
14154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
15355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10,
16356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
19356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
20356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
21356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
22356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
23356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
24356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,

 

 

SB2697 Enrolled- 10 -LRB103 35895 RPS 65980 b

1356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
2368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
3408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
4subsection (2) of Section 367, and Articles IIA, VIII 1/2,
5XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
6Illinois Insurance Code.
7    (b) For purposes of the Illinois Insurance Code, except
8for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9Health Maintenance Organizations in the following categories
10are deemed to be "domestic companies":
11        (1) a corporation authorized under the Dental Service
12    Plan Act or the Voluntary Health Services Plans Act;
13        (2) a corporation organized under the laws of this
14    State; or
15        (3) a corporation organized under the laws of another
16    state, 30% or more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a "domestic company" under Article VIII
20    1/2 of the Illinois Insurance Code.
21    (c) In considering the merger, consolidation, or other
22acquisition of control of a Health Maintenance Organization
23pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24        (1) the Director shall give primary consideration to
25    the continuation of benefits to enrollees and the
26    financial conditions of the acquired Health Maintenance

 

 

SB2697 Enrolled- 11 -LRB103 35895 RPS 65980 b

1    Organization after the merger, consolidation, or other
2    acquisition of control takes effect;
3        (2)(i) the criteria specified in subsection (1)(b) of
4    Section 131.8 of the Illinois Insurance Code shall not
5    apply and (ii) the Director, in making his determination
6    with respect to the merger, consolidation, or other
7    acquisition of control, need not take into account the
8    effect on competition of the merger, consolidation, or
9    other acquisition of control;
10        (3) the Director shall have the power to require the
11    following information:
12            (A) certification by an independent actuary of the
13        adequacy of the reserves of the Health Maintenance
14        Organization sought to be acquired;
15            (B) pro forma financial statements reflecting the
16        combined balance sheets of the acquiring company and
17        the Health Maintenance Organization sought to be
18        acquired as of the end of the preceding year and as of
19        a date 90 days prior to the acquisition, as well as pro
20        forma financial statements reflecting projected
21        combined operation for a period of 2 years;
22            (C) a pro forma business plan detailing an
23        acquiring party's plans with respect to the operation
24        of the Health Maintenance Organization sought to be
25        acquired for a period of not less than 3 years; and
26            (D) such other information as the Director shall

 

 

SB2697 Enrolled- 12 -LRB103 35895 RPS 65980 b

1        require.
2    (d) The provisions of Article VIII 1/2 of the Illinois
3Insurance Code and this Section 5-3 shall apply to the sale by
4any health maintenance organization of greater than 10% of its
5enrollee population (including, without limitation, the health
6maintenance organization's right, title, and interest in and
7to its health care certificates).
8    (e) In considering any management contract or service
9agreement subject to Section 141.1 of the Illinois Insurance
10Code, the Director (i) shall, in addition to the criteria
11specified in Section 141.2 of the Illinois Insurance Code,
12take into account the effect of the management contract or
13service agreement on the continuation of benefits to enrollees
14and the financial condition of the health maintenance
15organization to be managed or serviced, and (ii) need not take
16into account the effect of the management contract or service
17agreement on competition.
18    (f) Except for small employer groups as defined in the
19Small Employer Rating, Renewability and Portability Health
20Insurance Act and except for medicare supplement policies as
21defined in Section 363 of the Illinois Insurance Code, a
22Health Maintenance Organization may by contract agree with a
23group or other enrollment unit to effect refunds or charge
24additional premiums under the following terms and conditions:
25        (i) the amount of, and other terms and conditions with
26    respect to, the refund or additional premium are set forth

 

 

SB2697 Enrolled- 13 -LRB103 35895 RPS 65980 b

1    in the group or enrollment unit contract agreed in advance
2    of the period for which a refund is to be paid or
3    additional premium is to be charged (which period shall
4    not be less than one year); and
5        (ii) the amount of the refund or additional premium
6    shall not exceed 20% of the Health Maintenance
7    Organization's profitable or unprofitable experience with
8    respect to the group or other enrollment unit for the
9    period (and, for purposes of a refund or additional
10    premium, the profitable or unprofitable experience shall
11    be calculated taking into account a pro rata share of the
12    Health Maintenance Organization's administrative and
13    marketing expenses, but shall not include any refund to be
14    made or additional premium to be paid pursuant to this
15    subsection (f)). The Health Maintenance Organization and
16    the group or enrollment unit may agree that the profitable
17    or unprofitable experience may be calculated taking into
18    account the refund period and the immediately preceding 2
19    plan years.
20    The Health Maintenance Organization shall include a
21statement in the evidence of coverage issued to each enrollee
22describing the possibility of a refund or additional premium,
23and upon request of any group or enrollment unit, provide to
24the group or enrollment unit a description of the method used
25to calculate (1) the Health Maintenance Organization's
26profitable experience with respect to the group or enrollment

 

 

SB2697 Enrolled- 14 -LRB103 35895 RPS 65980 b

1unit and the resulting refund to the group or enrollment unit
2or (2) the Health Maintenance Organization's unprofitable
3experience with respect to the group or enrollment unit and
4the resulting additional premium to be paid by the group or
5enrollment unit.
6    In no event shall the Illinois Health Maintenance
7Organization Guaranty Association be liable to pay any
8contractual obligation of an insolvent organization to pay any
9refund authorized under this Section.
10    (g) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in
12accordance with all provisions of the Illinois Administrative
13Procedure Act and all rules and procedures of the Joint
14Committee on Administrative Rules; any purported rule not so
15adopted, for whatever reason, is unauthorized.
16(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
17102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
181-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
19eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
20102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
211-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
22eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
23103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
246-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 

 

 

SB2697 Enrolled- 15 -LRB103 35895 RPS 65980 b

1    Section 35. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v,
10356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
14356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
15356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
16356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
17401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18and (15) of Section 367 of the Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

 

 

SB2697 Enrolled- 16 -LRB103 35895 RPS 65980 b

1102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
3eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
4102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
51-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
6eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7103-551, eff. 8-11-23; revised 8-29-23.)
 
8    Section 40. The Illinois Public Aid Code is amended by
9adding Section 5-52 as follows:
 
10    (305 ILCS 5/5-52 new)
11    Sec. 5-52. Genetic testing and evidence-based screenings
12for an inherited gene mutation.
13    (a) In this Section, "genetic testing for an inherited
14mutation" means germline multi-gene testing for an inherited
15mutation associated with an increased risk of cancer in
16accordance with evidence-based, clinical practice guidelines.
17    (b) Subject to federal approval, the medical assistance
18program, after January 1, 2026, shall provide coverage for
19clinical genetic testing for an inherited gene mutation for
20individuals with a personal or family history of cancer, as
21recommended by a health care professional in accordance with
22current evidence-based clinical practice guidelines,
23including, but not limited to, the current version of the
24National Comprehensive Cancer Network clinical practice

 

 

SB2697 Enrolled- 17 -LRB103 35895 RPS 65980 b

1guidelines.
2    (c) For individuals with a genetic test that is positive
3for an inherited mutation associated with an increased risk of
4cancer, coverage required under this Section shall include any
5evidence-based screenings, as recommended by a health care
6professional in accordance with current evidence-based
7clinical practice guidelines, to the extent that the
8management recommendation is not already covered by the
9medical assistance program. In this subsection,
10"evidence-based cancer screenings" means medically recommended
11evidence-based screening modalities in accordance with current
12clinical practice guidelines.
 
13    Section 99. Effective date. This Section and Section 40
14take effect January 1, 2025.