Illinois General Assembly - Full Text of HB3673
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Full Text of HB3673  99th General Assembly

HB3673ham001 99TH GENERAL ASSEMBLY

Rep. Mike Smiddy

Filed: 3/23/2015

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 3673

2    AMENDMENT NO. ______. Amend House Bill 3673 as follows:
 
3on page 2, by replacing line 17 with the following:
4"mammography and shall include breast tomosynthesis. As used in
5this Section, the term "breast tomosynthesis" means a
6radiologic procedure that involves the acquisition of
7projection images over the stationary breast to produce
8cross-sectional digital three-dimensional images of the
9breast."; and
 
10on page 4, immediately below line 23, by inserting the
11following:
 
12    "Section 10. The Health Maintenance Organization Act is
13amended by changing Section 4-6.1 as follows:
 
14    (215 ILCS 125/4-6.1)  (from Ch. 111 1/2, par. 1408.7)

 

 

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1    Sec. 4-6.1. Mammograms; mastectomies.
2    (a) Every contract or evidence of coverage issued by a
3Health Maintenance Organization for persons who are residents
4of this State shall contain coverage for screening by low-dose
5mammography for all women 35 years of age or older for the
6presence of occult breast cancer. The coverage shall be as
7follows:
8        (1) A baseline mammogram for women 35 to 39 years of
9    age.
10        (2) An annual mammogram for women 40 years of age or
11    older.
12        (3) A mammogram at the age and intervals considered
13    medically necessary by the woman's health care provider for
14    women under 40 years of age and having a family history of
15    breast cancer, prior personal history of breast cancer,
16    positive genetic testing, or other risk factors.
17        (4) A comprehensive ultrasound screening of an entire
18    breast or breasts if a mammogram demonstrates
19    heterogeneous or dense breast tissue, when medically
20    necessary as determined by a physician licensed to practice
21    medicine in all of its branches.
22    For purposes of this Section, "low-dose mammography" means
23the x-ray examination of the breast using equipment dedicated
24specifically for mammography, including the x-ray tube,
25filter, compression device, and image receptor, with radiation
26exposure delivery of less than 1 rad per breast for 2 views of

 

 

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1an average size breast. The term also includes digital
2mammography and shall include breast tomosynthesis. As used in
3this Section, the term "breast tomosynthesis" means a
4radiologic procedure that involves the acquisition of
5projection images over the stationary breast to produce
6cross-sectional digital three-dimensional images of the
7breast.
8    (a-5) Coverage as described in subsection (a) shall be
9provided at no cost to the enrollee and shall not be applied to
10an annual or lifetime maximum benefit.
11    (b) No contract or evidence of coverage issued by a health
12maintenance organization that provides for the surgical
13procedure known as a mastectomy shall be issued, amended,
14delivered, or renewed in this State on or after the effective
15date of this amendatory Act of the 92nd General Assembly unless
16that coverage also provides for prosthetic devices or
17reconstructive surgery incident to the mastectomy, providing
18that the mastectomy is performed after the effective date of
19this amendatory Act. Coverage for breast reconstruction in
20connection with a mastectomy shall include:
21        (1) reconstruction of the breast upon which the
22    mastectomy has been performed;
23        (2) surgery and reconstruction of the other breast to
24    produce a symmetrical appearance; and
25        (3) prostheses and treatment for physical
26    complications at all stages of mastectomy, including

 

 

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1    lymphedemas.
2Care shall be determined in consultation with the attending
3physician and the patient. The offered coverage for prosthetic
4devices and reconstructive surgery shall be subject to the
5deductible and coinsurance conditions applied to the
6mastectomy and all other terms and conditions applicable to
7other benefits. When a mastectomy is performed and there is no
8evidence of malignancy, then the offered coverage may be
9limited to the provision of prosthetic devices and
10reconstructive surgery to within 2 years after the date of the
11mastectomy. As used in this Section, "mastectomy" means the
12removal of all or part of the breast for medically necessary
13reasons, as determined by a licensed physician.
14    Written notice of the availability of coverage under this
15Section shall be delivered to the enrollee upon enrollment and
16annually thereafter. A health maintenance organization may not
17deny to an enrollee eligibility, or continued eligibility, to
18enroll or to renew coverage under the terms of the plan solely
19for the purpose of avoiding the requirements of this Section. A
20health maintenance organization may not penalize or reduce or
21limit the reimbursement of an attending provider or provide
22incentives (monetary or otherwise) to an attending provider to
23induce the provider to provide care to an insured in a manner
24inconsistent with this Section.
25    (c) Rulemaking authority to implement this amendatory Act
26of the 95th General Assembly, if any, is conditioned on the

 

 

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1rules being adopted in accordance with all provisions of the
2Illinois Administrative Procedure Act and all rules and
3procedures of the Joint Committee on Administrative Rules; any
4purported rule not so adopted, for whatever reason, is
5unauthorized.
6(Source: P.A. 94-121, eff. 7-6-05; 95-431, eff. 8-24-07;
795-1045, eff. 3-27-09.)"; and
 
8on page 4, line 24, by replacing "Section 10." with "Section
915."; and
 
10on page 11, by replacing line 5 with the following:
11"includes digital mammography and shall include breast
12tomosynthesis. As used in this Section, the term "breast
13tomosynthesis" means a radiologic procedure that involves the
14acquisition of projection images over the stationary breast to
15produce cross-sectional digital three-dimensional images of
16the breast.".