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Synopsis As Introduced Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act. Provides that every insurer shall provide, in each group or individual policy, contract, or certificate of accident or health insurance issued or renewed for persons who are residents of Illinois, coverage for a complete and thorough physical examination of the breast, including but not limited to a comprehensive clinical breast examination of 6-10 minutes in length (that is, an examination of 3-5 minutes in length for each breast), performed by a health care provider to check for lumps and other changes for the purpose of early detection and prevention of breast cancer as follows: (1) annually for women 18 years of age and older; and (2) at any time at the recommendation of the woman's health care provider. Provides that every insurer must establish a separate and distinct reimbursement code for comprehensive clinical breast examinations of 6-10 minutes in length. Makes these provisions applicable to health maintenance organizations and health services plan corporations. Effective immediately.
Replaces the provisions amending the Illinois Insurance Code. Inserts similar provisions amending the Illinois Insurance Code, but with changes that include the following: (1) removes references to a time period of "6-10 minutes" for breast examinations; (2) requires coverage for a comprehensive clinical breast examination by a physician, an advanced practice nurse, or a physician assistant (instead of by a health care provider); (3) provides for an examination at any time at the recommendation of a woman's health care professional (instead of her health care provider); and (4) requires that an insurance policy provide separate and distinct coverage for such breast examinations (instead of requiring that every insurer establish a separate and distinct reimbursement code for comprehensive clinical breast examinations). Also amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois to require the Department's written summary concerning breast cancer to specifically address the benefits of early detection and regular comprehensive clinical breast examinations as well as the mandate that health and government payers pay for the breast examinations.
Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Illinois Public Aid Code to require coverage of comprehensive clinical breast exams under each of those Acts as provided in the provisions added to the Illinois Insurance Code.
Fiscal Note, House Committee Amendment No. 1 (Financial & Professional Regulation)
There is no anticipated fiscal impact to the Department resulting from HB 147 (H-AM 1). However, this legislation may subject other State agencies to face additional fiscal responsibilities. Defer to the Department of Public Health for possible cost implications associated with publishing summary breast exam information.
Fiscal Note, House Committee Amendment No. 1 (Financial & Professional Regulation)
There is no anticipated fiscal impact to the Department resulting from HB 147 (H-AM 1). However, this legislation may subject other State agencies to face additional fiscal responsibilities. Defer to the Department of Public Health for possible cost implications associated with publishing summary breast exam information.
Fiscal Note, House Floor Amendment No. 2 (Financial & Professional Regulation)
There is no anticipated fiscal impact to the Department resulting from HB 147 (H-AM 2). However, this legislation may subject other State agencies to face additional fiscal responsibilities. Defer to the Department of Public Health for possible cost implications associated with publishing summary breast exam information.
House Floor Amendment No. 3 Requires that the Department of Public Health's summary concerning breast cancer include the benefits of clinical breast exams; also requires that the summary (1) review the clinical standard recommendations by the Centers for Disease Control and Prevention and the American Cancer Society for mammography, clinical breast exams, and breast self-exams (instead of requiring that the summary address regular comprehensive clinical breast examinations) and (2) inform individuals that public and private insurance providers shall pay for clinical breast exams as part of an exam, as indicated by guidelines of practice (instead of requiring that the summary address the mandate that health and government benefit payers pay for the breast examinations). In references to clinical breast examinations, deletes "comprehensive". Requires that insurers provide coverage of breast examinations (i) at least every 3 years for women ages 20 to 39 and (ii) annually for women age 40 and older (instead of annually for women age 18 and older and at any time at the recommendation of the woman's health care professional). Makes other changes.
Fiscal Note, House Floor Amendment No. 3 (Dept. of Healthcare & Family Services)
Clinical breast exams are currently billed as an office visit for Medicaid and the State Employees Group Health Insurance Program; therefore, services are already covered. There may be a minimal fiscal increase based upon utilization. Upon national approval of a separate and distinct billing code, there will be pressure for additional appropriations to cover this service for Medicaid and the State Employees Group Health Insurance Program.
Fiscal Note, House Floor Amendment No. 2 (Financial & Professional Regulation)
There is no anticipated fiscal impact to the Department resulting from HB 147 (H-AM 2). However, this legislation may subject other State agencies to face additional fiscal responsibilities. Defer to the Department of Public Health for possible cost implications associated with publishing summary breast exam information.
Fiscal Note, House Floor Amendment No. 3 (Financial & Professional Regulation)
There is no anticipated fiscal impact to the Department resulting from HB 147 (H-AM 3). However, this legislation may subject other State agencies to face additional fiscal responsibilities. Defer to the Department of Public Health for possible cost implications associated with publishing summary breast exam information.
State Mandates Fiscal Note, House Floor Amendment No. 3 (Dept. of Commerce & Economic Opportunity)
HB 147 (H-AM 3) does not create a State mandate under the State Mandates Act.
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