Full Text of HB4460 103rd General Assembly
HB4460eng 103RD GENERAL ASSEMBLY | | | HB4460 Engrossed | | LRB103 36625 AWJ 66734 b |
|
| 1 | | AN ACT concerning government. | 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 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 | 9 | | provide coverage for joint mental health therapy services for | 10 | | any Illinois State Police officer and any spouse or partner of | 11 | | the officer who resides with the officer. | 12 | | (b) The joint mental health therapy services provided | 13 | | under subsection (a) shall be performed by a physician | 14 | | licensed to practice medicine in all of its branches, a | 15 | | licensed clinical psychologist, a licensed clinical social | 16 | | worker, a licensed clinical professional counselor, a licensed | 17 | | marriage and family therapist, a licensed social worker, or a | 18 | | licensed professional counselor. | 19 | | Section 10. The Counties Code is amended by changing | 20 | | Section 5-1069 as follows: | 21 | | (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069) |
| | | HB4460 Engrossed | - 2 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | Sec. 5-1069. Group life, health, accident, hospital, and | 2 | | medical insurance. | 3 | | (a) The county board of any county may arrange to provide, | 4 | | for the benefit of employees of the county, group life, | 5 | | health, accident, hospital, and medical insurance, or any one | 6 | | or any combination of those types of insurance, or the county | 7 | | board may self-insure, for the benefit of its employees, all | 8 | | or a portion of the employees' group life, health, accident, | 9 | | hospital, and medical insurance, or any one or any combination | 10 | | of those types of insurance, including a combination of | 11 | | self-insurance and other types of insurance authorized by this | 12 | | Section, provided that the county board complies with all | 13 | | other requirements of this Section. The insurance may include | 14 | | provision for employees who rely on treatment by prayer or | 15 | | spiritual means alone for healing in accordance with the | 16 | | tenets and practice of a well recognized religious | 17 | | denomination. The county board may provide for payment by the | 18 | | county of a portion or all of the premium or charge for the | 19 | | insurance with the employee paying the balance of the premium | 20 | | or charge, if any. If the county board undertakes a plan under | 21 | | which the county pays only a portion of the premium or charge, | 22 | | the county board shall provide for withholding and deducting | 23 | | from the compensation of those employees who consent to join | 24 | | the plan the balance of the premium or charge for the | 25 | | insurance. | 26 | | (b) If the county board does not provide for |
| | | HB4460 Engrossed | - 3 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | self-insurance or for a plan under which the county pays a | 2 | | portion or all of the premium or charge for a group insurance | 3 | | plan, the county board may provide for withholding and | 4 | | deducting from the compensation of those employees who consent | 5 | | thereto the total premium or charge for any group life, | 6 | | health, accident, hospital, and medical insurance. | 7 | | (c) The county board may exercise the powers granted in | 8 | | this Section only if it provides for self-insurance or, where | 9 | | it makes arrangements to provide group insurance through an | 10 | | insurance carrier, if the kinds of group insurance are | 11 | | obtained from an insurance company authorized to do business | 12 | | in the State of Illinois. The county board may enact an | 13 | | ordinance prescribing the method of operation of the insurance | 14 | | program. | 15 | | (d) If a county, including a home rule county, is a | 16 | | self-insurer for purposes of providing health insurance | 17 | | coverage for its employees, the insurance coverage shall | 18 | | include screening by low-dose mammography for all women 35 | 19 | | years of age or older for the presence of occult breast cancer | 20 | | unless the county elects to provide mammograms itself under | 21 | | Section 5-1069.1. The coverage shall be as follows: | 22 | | (1) A baseline mammogram for women 35 to 39 years of | 23 | | age. | 24 | | (2) An annual mammogram for women 40 years of age or | 25 | | older. | 26 | | (3) A mammogram at the age and intervals considered |
| | | HB4460 Engrossed | - 4 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | medically necessary by the woman's health care provider | 2 | | for women under 40 years of age and having a family history | 3 | | of breast cancer, prior personal history of breast cancer, | 4 | | positive genetic testing, or other risk factors. | 5 | | (4) For a group policy of accident and health | 6 | | insurance that is amended, delivered, issued, or renewed | 7 | | on or after the effective date of this amendatory Act of | 8 | | the 101st General Assembly, a comprehensive ultrasound | 9 | | screening of an entire breast or breasts if a mammogram | 10 | | demonstrates heterogeneous or dense breast tissue or when | 11 | | medically necessary as determined by a physician licensed | 12 | | to practice medicine in all of its branches, advanced | 13 | | practice registered nurse, or physician assistant. | 14 | | (5) For a group policy of accident and health | 15 | | insurance that is amended, delivered, issued, or renewed | 16 | | on or after the effective date of this amendatory Act of | 17 | | the 101st General Assembly, a diagnostic mammogram when | 18 | | medically necessary, as determined by a physician licensed | 19 | | to practice medicine in all its branches, advanced | 20 | | practice registered nurse, or physician assistant. | 21 | | A policy subject to this subsection shall not impose a | 22 | | deductible, coinsurance, copayment, or any other cost-sharing | 23 | | requirement on the coverage provided; except that this | 24 | | sentence does not apply to coverage of diagnostic mammograms | 25 | | to the extent such coverage would disqualify a high-deductible | 26 | | health plan from eligibility for a health savings account |
| | | HB4460 Engrossed | - 5 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | pursuant to Section 223 of the Internal Revenue Code (26 | 2 | | U.S.C. 223). | 3 | | For purposes of this subsection: | 4 | | "Diagnostic mammogram" means a mammogram obtained using | 5 | | diagnostic mammography. | 6 | | "Diagnostic mammography" means a method of screening that | 7 | | is designed to evaluate an abnormality in a breast, including | 8 | | an abnormality seen or suspected on a screening mammogram or a | 9 | | subjective or objective abnormality otherwise detected in the | 10 | | breast. | 11 | | "Low-dose mammography" means the x-ray examination of the | 12 | | breast using equipment dedicated specifically for mammography, | 13 | | including the x-ray tube, filter, compression device, and | 14 | | image receptor, with an average radiation exposure delivery of | 15 | | less than one rad per breast for 2 views of an average size | 16 | | breast. The term also includes digital mammography. | 17 | | (d-5) Coverage as described by subsection (d) shall be | 18 | | provided at no cost to the insured and shall not be applied to | 19 | | an annual or lifetime maximum benefit. | 20 | | (d-10) When health care services are available through | 21 | | contracted providers and a person does not comply with plan | 22 | | provisions specific to the use of contracted providers, the | 23 | | requirements of subsection (d-5) are not applicable. When a | 24 | | person does not comply with plan provisions specific to the | 25 | | use of contracted providers, plan provisions specific to the | 26 | | use of non-contracted providers must be applied without |
| | | HB4460 Engrossed | - 6 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | distinction for coverage required by this Section and shall be | 2 | | at least as favorable as for other radiological examinations | 3 | | covered by the policy or contract. | 4 | | (d-15) If a county, including a home rule county, is a | 5 | | self-insurer for purposes of providing health insurance | 6 | | coverage for its employees, the insurance coverage shall | 7 | | include mastectomy coverage, which includes coverage for | 8 | | prosthetic devices or reconstructive surgery incident to the | 9 | | mastectomy. Coverage for breast reconstruction in connection | 10 | | with a mastectomy shall include: | 11 | | (1) reconstruction of the breast upon which the | 12 | | mastectomy has been performed; | 13 | | (2) surgery and reconstruction of the other breast to | 14 | | produce a symmetrical appearance; and | 15 | | (3) prostheses and treatment for physical | 16 | | complications at all stages of mastectomy, including | 17 | | lymphedemas. | 18 | | Care shall be determined in consultation with the attending | 19 | | physician and the patient. The offered coverage for prosthetic | 20 | | devices and reconstructive surgery shall be subject to the | 21 | | deductible and coinsurance conditions applied to the | 22 | | mastectomy, and all other terms and conditions applicable to | 23 | | other benefits. When a mastectomy is performed and there is no | 24 | | evidence of malignancy then the offered coverage may be | 25 | | limited to the provision of prosthetic devices and | 26 | | reconstructive surgery to within 2 years after the date of the |
| | | HB4460 Engrossed | - 7 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | mastectomy. As used in this Section, "mastectomy" means the | 2 | | removal of all or part of the breast for medically necessary | 3 | | reasons, as determined by a licensed physician. | 4 | | A county, including a home rule county, that is a | 5 | | self-insurer for purposes of providing health insurance | 6 | | coverage for its employees, may not penalize or reduce or | 7 | | limit the reimbursement of an attending provider or provide | 8 | | incentives (monetary or otherwise) to an attending provider to | 9 | | induce the provider to provide care to an insured in a manner | 10 | | inconsistent with this Section. | 11 | | (d-20) The requirement that mammograms be included in | 12 | | health insurance coverage as provided in subsections (d) | 13 | | through (d-15) is an exclusive power and function of the State | 14 | | and is a denial and limitation under Article VII, Section 6, | 15 | | subsection (h) of the Illinois Constitution of home rule | 16 | | county powers. A home rule county to which subsections (d) | 17 | | through (d-15) apply must comply with every provision of those | 18 | | subsections. | 19 | | (d-25) If a county, including a home rule county, is a | 20 | | self-insurer for purposes of providing health insurance | 21 | | coverage, the insurance coverage shall include joint mental | 22 | | health therapy services for any member of the Sheriff's | 23 | | office, including the sheriff, and any spouse or partner of | 24 | | the member who resides with the member. | 25 | | The joint mental health therapy services provided under | 26 | | this subsection shall be performed by a physician licensed to |
| | | HB4460 Engrossed | - 8 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | practice medicine in all of its branches, a licensed clinical | 2 | | psychologist, a licensed clinical social worker, a licensed | 3 | | clinical professional counselor, a licensed marriage and | 4 | | family therapist, a licensed social worker, or a licensed | 5 | | professional counselor. | 6 | | This subsection is a limitation under subsection (i) of | 7 | | Section 6 of Article VII of the Illinois Constitution on the | 8 | | concurrent exercise by home rule units of powers and functions | 9 | | exercised by the State. | 10 | | (e) The term "employees" as used in this Section includes | 11 | | elected or appointed officials but does not include temporary | 12 | | employees. | 13 | | (f) The county board may, by ordinance, arrange to provide | 14 | | group life, health, accident, hospital, and medical insurance, | 15 | | or any one or a combination of those types of insurance, under | 16 | | this Section to retired former employees and retired former | 17 | | elected or appointed officials of the county. | 18 | | (g) Rulemaking authority to implement this amendatory Act | 19 | | of the 95th General Assembly, if any, is conditioned on the | 20 | | rules being adopted in accordance with all provisions of the | 21 | | Illinois Administrative Procedure Act and all rules and | 22 | | procedures of the Joint Committee on Administrative Rules; any | 23 | | purported rule not so adopted, for whatever reason, is | 24 | | unauthorized. | 25 | | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .) |
| | | HB4460 Engrossed | - 9 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | Section 15. The Illinois Municipal Code is amended by | 2 | | changing Section 10-4-2 as follows: | 3 | | (65 ILCS 5/10-4-2) (from Ch. 24, par. 10-4-2) | 4 | | Sec. 10-4-2. Group insurance. | 5 | | (a) The corporate authorities of any municipality may | 6 | | arrange to provide, for the benefit of employees of the | 7 | | municipality, group life, health, accident, hospital, and | 8 | | medical insurance, or any one or any combination of those | 9 | | types of insurance, and may arrange to provide that insurance | 10 | | for the benefit of the spouses or dependents of those | 11 | | employees. The insurance may include provision for employees | 12 | | or other insured persons who rely on treatment by prayer or | 13 | | spiritual means alone for healing in accordance with the | 14 | | tenets and practice of a well recognized religious | 15 | | denomination. The corporate authorities may provide for | 16 | | payment by the municipality of a portion of the premium or | 17 | | charge for the insurance with the employee paying the balance | 18 | | of the premium or charge. If the corporate authorities | 19 | | undertake a plan under which the municipality pays a portion | 20 | | of the premium or charge, the corporate authorities shall | 21 | | provide for withholding and deducting from the compensation of | 22 | | those municipal employees who consent to join the plan the | 23 | | balance of the premium or charge for the insurance. | 24 | | (b) If the corporate authorities do not provide for a plan | 25 | | under which the municipality pays a portion of the premium or |
| | | HB4460 Engrossed | - 10 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | charge for a group insurance plan, the corporate authorities | 2 | | may provide for withholding and deducting from the | 3 | | compensation of those employees who consent thereto the | 4 | | premium or charge for any group life, health, accident, | 5 | | hospital, and medical insurance. | 6 | | (c) The corporate authorities may exercise the powers | 7 | | granted in this Section only if the kinds of group insurance | 8 | | are obtained from an insurance company authorized to do | 9 | | business in the State of Illinois, or are obtained through an | 10 | | intergovernmental joint self-insurance pool as authorized | 11 | | under the Intergovernmental Cooperation Act. The corporate | 12 | | authorities may enact an ordinance prescribing the method of | 13 | | operation of the insurance program. | 14 | | (d) If a municipality, including a home rule municipality, | 15 | | is a self-insurer for purposes of providing health insurance | 16 | | coverage for its employees, the insurance coverage shall | 17 | | include screening by low-dose mammography for all women 35 | 18 | | years of age or older for the presence of occult breast cancer | 19 | | unless the municipality elects to provide mammograms itself | 20 | | under Section 10-4-2.1. The coverage shall be as follows: | 21 | | (1) A baseline mammogram for women 35 to 39 years of | 22 | | age. | 23 | | (2) An annual mammogram for women 40 years of age or | 24 | | older. | 25 | | (3) A mammogram at the age and intervals considered | 26 | | medically necessary by the woman's health care provider |
| | | HB4460 Engrossed | - 11 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | for women under 40 years of age and having a family history | 2 | | of breast cancer, prior personal history of breast cancer, | 3 | | positive genetic testing, or other risk factors. | 4 | | (4) For a group policy of accident and health | 5 | | insurance that is amended, delivered, issued, or renewed | 6 | | on or after the effective date of this amendatory Act of | 7 | | the 101st General Assembly, a comprehensive ultrasound | 8 | | screening of an entire breast or breasts if a mammogram | 9 | | demonstrates heterogeneous or dense breast tissue or when | 10 | | medically necessary as determined by a physician licensed | 11 | | to practice medicine in all of its branches. | 12 | | (5) For a group policy of accident and health | 13 | | insurance that is amended, delivered, issued, or renewed | 14 | | on or after the effective date of this amendatory Act of | 15 | | the 101st General Assembly, a diagnostic mammogram when | 16 | | medically necessary, as determined by a physician licensed | 17 | | to practice medicine in all its branches, advanced | 18 | | practice registered nurse, or physician assistant. | 19 | | A policy subject to this subsection shall not impose a | 20 | | deductible, coinsurance, copayment, or any other cost-sharing | 21 | | requirement on the coverage provided; except that this | 22 | | sentence does not apply to coverage of diagnostic mammograms | 23 | | to the extent such coverage would disqualify a high-deductible | 24 | | health plan from eligibility for a health savings account | 25 | | pursuant to Section 223 of the Internal Revenue Code (26 | 26 | | U.S.C. 223). |
| | | HB4460 Engrossed | - 12 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | For purposes of this subsection: | 2 | | "Diagnostic mammogram" means a mammogram obtained using | 3 | | diagnostic mammography. | 4 | | "Diagnostic mammography" means a method of screening that | 5 | | is designed to evaluate an abnormality in a breast, including | 6 | | an abnormality seen or suspected on a screening mammogram or a | 7 | | subjective or objective abnormality otherwise detected in the | 8 | | breast. | 9 | | "Low-dose mammography" means the x-ray examination of the | 10 | | breast using equipment dedicated specifically for mammography, | 11 | | including the x-ray tube, filter, compression device, and | 12 | | image receptor, with an average radiation exposure delivery of | 13 | | less than one rad per breast for 2 views of an average size | 14 | | breast. The term also includes digital mammography. | 15 | | (d-5) Coverage as described by subsection (d) shall be | 16 | | provided at no cost to the insured and shall not be applied to | 17 | | an annual or lifetime maximum benefit. | 18 | | (d-10) When health care services are available through | 19 | | contracted providers and a person does not comply with plan | 20 | | provisions specific to the use of contracted providers, the | 21 | | requirements of subsection (d-5) are not applicable. When a | 22 | | person does not comply with plan provisions specific to the | 23 | | use of contracted providers, plan provisions specific to the | 24 | | use of non-contracted providers must be applied without | 25 | | distinction for coverage required by this Section and shall be | 26 | | at least as favorable as for other radiological examinations |
| | | HB4460 Engrossed | - 13 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | covered by the policy or contract. | 2 | | (d-15) If a municipality, including a home rule | 3 | | municipality, is a self-insurer for purposes of providing | 4 | | health insurance coverage for its employees, the insurance | 5 | | coverage shall include mastectomy coverage, which includes | 6 | | coverage for prosthetic devices or reconstructive surgery | 7 | | incident to the mastectomy. Coverage for breast reconstruction | 8 | | in connection with a mastectomy shall include: | 9 | | (1) reconstruction of the breast upon which the | 10 | | mastectomy has been performed; | 11 | | (2) surgery and reconstruction of the other breast to | 12 | | produce a symmetrical appearance; and | 13 | | (3) prostheses and treatment for physical | 14 | | complications at all stages of mastectomy, including | 15 | | lymphedemas. | 16 | | Care shall be determined in consultation with the attending | 17 | | physician and the patient. The offered coverage for prosthetic | 18 | | devices and reconstructive surgery shall be subject to the | 19 | | deductible and coinsurance conditions applied to the | 20 | | mastectomy, and all other terms and conditions applicable to | 21 | | other benefits. When a mastectomy is performed and there is no | 22 | | evidence of malignancy then the offered coverage may be | 23 | | limited to the provision of prosthetic devices and | 24 | | reconstructive surgery to within 2 years after the date of the | 25 | | mastectomy. As used in this Section, "mastectomy" means the | 26 | | removal of all or part of the breast for medically necessary |
| | | HB4460 Engrossed | - 14 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | reasons, as determined by a licensed physician. | 2 | | A municipality, including a home rule municipality, that | 3 | | is a self-insurer for purposes of providing health insurance | 4 | | coverage for its employees, may not penalize or reduce or | 5 | | limit the reimbursement of an attending provider or provide | 6 | | incentives (monetary or otherwise) to an attending provider to | 7 | | induce the provider to provide care to an insured in a manner | 8 | | inconsistent with this Section. | 9 | | (d-20) The requirement that mammograms be included in | 10 | | health insurance coverage as provided in subsections (d) | 11 | | through (d-15) is an exclusive power and function of the State | 12 | | and is a denial and limitation under Article VII, Section 6, | 13 | | subsection (h) of the Illinois Constitution of home rule | 14 | | municipality powers. A home rule municipality to which | 15 | | subsections (d) through (d-15) apply must comply with every | 16 | | provision of those subsections. | 17 | | (d-25) If a municipality, including a home rule | 18 | | municipality, is a self-insurer for purposes of providing | 19 | | health insurance coverage for its employees, the insurance | 20 | | coverage shall include joint mental health therapy services | 21 | | for any member of the municipality's police department or fire | 22 | | department and any spouse or partner of the member who resides | 23 | | with the member. | 24 | | The joint mental health therapy services provided under | 25 | | this subsection shall be performed by a physician licensed to | 26 | | practice medicine in all of its branches, a licensed clinical |
| | | HB4460 Engrossed | - 15 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | psychologist, a licensed clinical social worker, a licensed | 2 | | clinical professional counselor, a licensed marriage and | 3 | | family therapist, a licensed social worker, or a licensed | 4 | | professional counselor. | 5 | | This subsection is a limitation under subsection (i) of | 6 | | Section 6 of Article VII of the Illinois Constitution on the | 7 | | concurrent exercise by home rule units of powers and functions | 8 | | exercised by the State. | 9 | | (e) Rulemaking authority to implement Public Act 95-1045, | 10 | | if any, is conditioned on the rules being adopted in | 11 | | accordance with all provisions of the Illinois Administrative | 12 | | Procedure Act and all rules and procedures of the Joint | 13 | | Committee on Administrative Rules; any purported rule not so | 14 | | adopted, for whatever reason, is unauthorized. | 15 | | (Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20 .) | 16 | | Section 99. Effective date. This Act takes effect January | 17 | | 1, 2025. |
|