96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB5038

 

Introduced 1/25/2010, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
215 ILCS 5/356z.19 new
305 ILCS 5/5-16.8
410 ILCS 50/2.04   from Ch. 111 1/2, par. 5402.04
410 ILCS 50/5
410 ILCS 50/5.1 new
410 ILCS 50/5.2 new

    Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, Illinois Public Aid Code, and Illinois Insurance Code to provide that accident and health insurance policies and managed care plans shall cover all services ordered by a physician and provided in a hospital that are considered medically necessary. Amends the Medical Patient Rights Act. Includes limited health service organizations and voluntary health services plan in the definition of "insurance company". In the provision concerning statement of hospital patient's rights, provides that the statement shall include the right not to be discriminated against by the hospital due to the patient's race, color, or national origin. Sets forth provisions concerning discrimination grievance procedures and emergency room antidiscrimination notices. Effective immediately.


LRB096 17710 RPM 33074 b

 

 

A BILL FOR

 

HB5038 LRB096 17710 RPM 33074 b

1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The State Employees Group Insurance Act of 1971
5 is amended by changing Section 6.11 as follows:
 
6     (5 ILCS 375/6.11)
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, and
15 356z.13, and 356z.14, 356z.15 and 356z.14, and 356z.17 356z.15 ,
16 and 356z.19 of the Illinois Insurance Code. The program of
17 health benefits must comply with Section 155.37 of the Illinois
18 Insurance Code.
19     Rulemaking authority to implement Public Act 95-1045 this
20 amendatory Act of the 95th General Assembly, if any, is
21 conditioned on the rules being adopted in accordance with all
22 provisions of the Illinois Administrative Procedure Act and all
23 rules and procedures of the Joint Committee on Administrative

 

 

HB5038 - 2 - LRB096 17710 RPM 33074 b

1 Rules; any purported rule not so adopted, for whatever reason,
2 is unauthorized.
3 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
4 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
5 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
6 eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
7 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
8 revised 10-22-09.)
 
9     Section 10. The Counties Code is amended by changing
10 Section 5-1069.3 as follows:
 
11     (55 ILCS 5/5-1069.3)
12     Sec. 5-1069.3. Required health benefits. If a county,
13 including a home rule county, is a self-insurer for purposes of
14 providing health insurance coverage for its employees, the
15 coverage shall include coverage for the post-mastectomy care
16 benefits required to be covered by a policy of accident and
17 health insurance under Section 356t and the coverage required
18 under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
19 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, and
20 356z.13, and 356z.14, and 356z.15 356z.14 , and 356z.19 of the
21 Illinois Insurance Code. The requirement that health benefits
22 be covered as provided in this Section is an exclusive power
23 and function of the State and is a denial and limitation under
24 Article VII, Section 6, subsection (h) of the Illinois

 

 

HB5038 - 3 - LRB096 17710 RPM 33074 b

1 Constitution. A home rule county to which this Section applies
2 must comply with every provision of this Section.
3     Rulemaking authority to implement Public Act 95-1045 this
4 amendatory Act of the 95th General Assembly, if any, is
5 conditioned on the rules being adopted in accordance with all
6 provisions of the Illinois Administrative Procedure Act and all
7 rules and procedures of the Joint Committee on Administrative
8 Rules; any purported rule not so adopted, for whatever reason,
9 is unauthorized.
10 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
11 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
12 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
13 eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
14 96-328, eff. 8-11-09; revised 10-22-09.)
 
15     Section 15. The Illinois Municipal Code is amended by
16 changing 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
19 municipality, including a home rule municipality, is a
20 self-insurer for purposes of providing health insurance
21 coverage for its employees, the coverage shall include coverage
22 for the post-mastectomy care benefits required to be covered by
23 a policy of accident and health insurance under Section 356t
24 and the coverage required under Sections 356g, 356g.5,

 

 

HB5038 - 4 - LRB096 17710 RPM 33074 b

1 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
2 356z.11, 356z.12, and 356z.13, and 356z.14, and 356z.15
3 356z.14 , and 356z.19 of the Illinois Insurance Code. The
4 requirement that health benefits be covered as provided in this
5 is an exclusive power and function of the State and is a denial
6 and limitation under Article VII, Section 6, subsection (h) of
7 the Illinois Constitution. A home rule municipality to which
8 this Section applies must comply with every provision of this
9 Section.
10     Rulemaking authority to implement Public Act 95-1045 this
11 amendatory Act of the 95th General Assembly, if any, is
12 conditioned on the rules being adopted in accordance with all
13 provisions of the Illinois Administrative Procedure Act and all
14 rules and procedures of the Joint Committee on Administrative
15 Rules; any purported rule not so adopted, for whatever reason,
16 is unauthorized.
17 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
18 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
19 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
20 eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
21 96-328, eff. 8-11-09; revised 10-23-09.)
 
22     Section 20. The Illinois Insurance Code is amended by
23 adding Section 356z.19 as follows:
 
24     (215 ILCS 5/356z.19 new)

 

 

HB5038 - 5 - LRB096 17710 RPM 33074 b

1     Sec. 356z.19. Hospital patient assessments. A group or
2 individual policy of accident and health insurance or managed
3 care plan amended, delivered, issued, or renewed after the
4 effective date of this amendatory Act of the 96th General
5 Assembly that provides coverage for hospital care shall include
6 in that coverage all services ordered by a physician and
7 provided in the hospital that are considered medically
8 necessary for the evaluation, assessment, and diagnosis of the
9 illness or condition that resulted in the hospital stay of the
10 enrollee or recipient. The services are subject to reasonable
11 review and utilization standards required by the policy or plan
12 for all hospital services, as defined by the Department or its
13 successor agency.
 
14     Section 25. The Illinois Public Aid Code is amended by
15 changing Section 5-16.8 as follows:
 
16     (305 ILCS 5/5-16.8)
17     Sec. 5-16.8. Required health benefits. The medical
18 assistance program shall (i) provide the post-mastectomy care
19 benefits required to be covered by a policy of accident and
20 health insurance under Section 356t and the coverage required
21 under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
22 356z.19 of the Illinois Insurance Code and (ii) be subject to
23 the provisions of Section 364.01 of the Illinois Insurance
24 Code.

 

 

HB5038 - 6 - LRB096 17710 RPM 33074 b

1 (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
2     Section 30. The Medical Patient Rights Act is amended by
3 changing Sections 2.04 and 5 and adding Sections 5.1 and 5.2 as
4 follows:
 
5     (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)
6     Sec. 2.04. "Insurance company" means (1) an insurance
7 company, fraternal benefit society, and any other insurer
8 subject to regulation under the Illinois Insurance Code; or (2)
9 a health maintenance organization, a limited health service
10 organization under the Limited Health Service Organization
11 Act, or a voluntary health services plan under the Voluntary
12 Health Services Plans Act.
13 (Source: P.A. 85-677; 85-679.)
 
14     (410 ILCS 50/5)
15     Sec. 5. Statement of hospital patient's rights.
16     (a) Each patient admitted to a hospital, and the guardian
17 or authorized representative or parent of a minor patient,
18 shall be given a written statement of all the rights enumerated
19 in this Act, or a similar statement of patients' rights
20 required of the hospital by the Joint Commission on
21 Accreditation of Healthcare Organizations or a similar
22 accrediting organization. The statement shall be given at the
23 time of admission or as soon thereafter as the condition of the

 

 

HB5038 - 7 - LRB096 17710 RPM 33074 b

1 patient permits.
2     (b) If a patient is unable to read the written statement, a
3 hospital shall make a reasonable effort to provide it to the
4 guardian or authorized representative of the patient.
5     (c) The statement shall also include the right not to be
6 discriminated against by the hospital due to the patient's
7 race, color, or national origin where such characteristics are
8 not relevant to the patient's medical diagnosis and treatment.
9 The statement shall further provide each admitted patient or
10 the patient's representative or guardian with notice of how to
11 initiate a grievance regarding improper discrimination with
12 the hospital and how the patient may lodge a grievance with the
13 Department of Public Health regardless of whether the patient
14 has first used the hospital's grievance process.
15 (Source: P.A. 88-56; 88-670, eff. 12-2-94.)
 
16     (410 ILCS 50/5.1 new)
17     Sec. 5.1. Discrimination grievance procedures. Upon
18 receipt of a grievance alleging unlawful discrimination on the
19 basis of race, color, or national origin, the hospital must
20 investigate the claim and work with the patient to address
21 valid or proven concerns in accordance with the hospital's
22 grievance process. At the conclusion of the hospital's
23 grievance process, the hospital shall inform the patient that
24 such grievances may be reported to the Department of Public
25 Health if not resolved to the patient's satisfaction at the

 

 

HB5038 - 8 - LRB096 17710 RPM 33074 b

1 hospital level.
 
2     (410 ILCS 50/5.2 new)
3     Sec. 5.2. Emergency room antidiscrimination notice. Every
4 hospital shall post a sign next to or in close proximity of its
5 sign required by Section 489.20 (q)(1) of Title 42 of the Code
6 of Federal Regulations stating the following:
7         "You have the right not to be discriminated against by
8     the hospital due to your race, color, or national origin if
9     these characteristics are unrelated to your diagnosis or
10     treatment. If you believe this right has been violated,
11     please call (insert number for hospital grievance
12     officer).".
 
13     Section 99. Effective date. This Act takes effect upon
14 becoming law.