Full Text of HB1779 102nd General Assembly
HB1779enr 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 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 | 9 | | provide the post-mastectomy care benefits required to be | 10 | | covered
by a policy of accident and health insurance under | 11 | | Section 356t of the Illinois
Insurance Code. The program of | 12 | | health benefits shall provide the coverage
required under | 13 | | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, | 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 17 | | 356z.36, and 356z.41 , and 356z.43 of the
Illinois Insurance | 18 | | Code.
The program of health benefits must comply with Sections | 19 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article | 20 | | XXXIIB of the
Illinois Insurance Code. The Department of | 21 | | Insurance shall enforce the requirements of this Section with | 22 | | respect to Sections 370c and 370c.1 of the Illinois Insurance | 23 | | Code; all other requirements of this Section shall be enforced |
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| 1 | | by the Department of Central Management Services.
| 2 | | Rulemaking authority to implement Public Act 95-1045, if | 3 | | any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 9 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 10 | | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, | 11 | | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 12 | | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | 13 | | 1-1-21 .) | 14 | | Section 10. The Counties Code is amended by changing | 15 | | Section 5-1069.3 as follows: | 16 | | (55 ILCS 5/5-1069.3)
| 17 | | Sec. 5-1069.3. Required health benefits. If a county, | 18 | | including a home
rule
county, is a self-insurer for purposes | 19 | | of providing health insurance coverage
for its employees, the | 20 | | coverage shall include coverage for the post-mastectomy
care | 21 | | benefits required to be covered by a policy of accident and | 22 | | health
insurance under Section 356t and the coverage required | 23 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 24 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
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| 1 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 2 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 3 | | of
the Illinois Insurance Code. The coverage shall comply with | 4 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 5 | | Insurance Code. The Department of Insurance shall enforce the | 6 | | requirements of this Section. The requirement that health | 7 | | benefits be covered
as provided in this Section is an
| 8 | | exclusive power and function of the State and is a denial and | 9 | | limitation under
Article VII, Section 6, subsection (h) of the | 10 | | Illinois Constitution. A home
rule county to which this | 11 | | Section applies must comply with every provision of
this | 12 | | Section.
| 13 | | Rulemaking authority to implement Public Act 95-1045, if | 14 | | any, is conditioned on the rules being adopted in accordance | 15 | | with all provisions of the Illinois Administrative Procedure | 16 | | Act and all rules and procedures of the Joint Committee on | 17 | | Administrative Rules; any purported rule not so adopted, for | 18 | | whatever reason, is unauthorized. | 19 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 20 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 21 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 22 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 23 | | 101-625, eff. 1-1-21 .) | 24 | | Section 15. The Illinois Municipal Code is amended by | 25 | | changing Section 10-4-2.3 as follows: |
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| 1 | | (65 ILCS 5/10-4-2.3)
| 2 | | Sec. 10-4-2.3. Required health benefits. If a | 3 | | municipality, including a
home rule municipality, is a | 4 | | self-insurer for purposes of providing health
insurance | 5 | | coverage for its employees, the coverage shall include | 6 | | coverage for
the post-mastectomy care benefits required to be | 7 | | covered by a policy of
accident and health insurance under | 8 | | Section 356t and the coverage required
under Sections 356g, | 9 | | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, | 10 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 11 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 12 | | 356z.36, and 356z.41 , and 356z.43 of the Illinois
Insurance
| 13 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 14 | | 356z.19, and 370c of
the Illinois Insurance Code. The | 15 | | Department of Insurance shall enforce the requirements of this | 16 | | Section. The requirement that health
benefits be covered as | 17 | | provided in this is an exclusive power and function of
the | 18 | | State and is a denial and limitation under Article VII, | 19 | | Section 6,
subsection (h) of the Illinois Constitution. A home | 20 | | rule municipality to which
this Section applies must comply | 21 | | with every provision of this Section.
| 22 | | Rulemaking authority to implement Public Act 95-1045, if | 23 | | any, is conditioned on the rules being adopted in accordance | 24 | | with all provisions of the Illinois Administrative Procedure | 25 | | Act and all rules and procedures of the Joint Committee on |
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| 1 | | Administrative Rules; any purported rule not so adopted, for | 2 | | whatever reason, is unauthorized. | 3 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 4 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 5 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 6 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 7 | | 101-625, eff. 1-1-21 .) | 8 | | Section 20. The School Code is amended by changing Section | 9 | | 10-22.3f as follows: | 10 | | (105 ILCS 5/10-22.3f)
| 11 | | Sec. 10-22.3f. Required health benefits. Insurance | 12 | | protection and
benefits
for employees shall provide the | 13 | | post-mastectomy care benefits required to be
covered by a | 14 | | policy of accident and health insurance under Section 356t and | 15 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 16 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 17 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 18 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 19 | | of
the
Illinois Insurance Code.
Insurance policies shall | 20 | | comply with Section 356z.19 of the Illinois Insurance Code. | 21 | | The coverage shall comply with Sections 155.22a, 355b, and | 22 | | 370c of
the Illinois Insurance Code. The Department of | 23 | | Insurance shall enforce the requirements of this Section.
| 24 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance | 2 | | with all provisions of the Illinois Administrative Procedure | 3 | | Act and all rules and procedures of the Joint Committee on | 4 | | Administrative Rules; any purported rule not so adopted, for | 5 | | whatever reason, is unauthorized. | 6 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 7 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 8 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 9 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 10 | | 101-625, eff. 1-1-21 .) | 11 | | Section 25. The Illinois Insurance Code is amended by | 12 | | adding Section 356z.43 as follows: | 13 | | (215 ILCS 5/356z.43 new) | 14 | | Sec. 356z.43. Biomarker testing. | 15 | | (a) As used in this Section: | 16 | | "Biomarker" means a characteristic that is objectively | 17 | | measured and evaluated as an indicator of normal biological | 18 | | processes, pathogenic processes, or pharmacologic responses to | 19 | | a specific therapeutic intervention. "Biomarker" includes, but | 20 | | is not limited to, gene mutations or protein expression. | 21 | | "Biomarker testing" means the analysis of a patient's | 22 | | tissue, blood, or fluid biospecimen for the presence of a | 23 | | biomarker. "Biomarker testing" includes, but is not limited | 24 | | to, single-analyte tests, multi-plex panel tests, and partial |
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| 1 | | or whole genome sequencing. | 2 | | (b) A group or individual policy of accident and health | 3 | | insurance or managed care plan amended, delivered, issued, or | 4 | | renewed on or after January 1, 2022 shall include coverage for | 5 | | biomarker testing as defined in this Section pursuant to | 6 | | criteria established under subsection (d). | 7 | | (c) Biomarker testing shall be covered and conducted in an | 8 | | efficient manner to provide the most complete range of results | 9 | | to the patient's health care provider without requiring | 10 | | multiple biopsies, biospecimen samples, or other delays or | 11 | | disruptions in patient care. | 12 | | (d) Biomarker testing must be covered for the purposes of | 13 | | diagnosis, treatment, appropriate management, or ongoing | 14 | | monitoring of an enrollee's disease or condition when the test | 15 | | is supported by medical and scientific evidence, including, | 16 | | but not limited to: | 17 | | (1) labeled indications for an FDA-approved test or | 18 | | indicated tests for an FDA-approved drug; | 19 | | (2) federal Centers for Medicare and Medicaid Services | 20 | | National Coverage Determinations; | 21 | | (3) nationally recognized clinical practice | 22 | | guidelines; | 23 | | (4) consensus statements; | 24 | | (5) professional society recommendations; | 25 | | (6) peer-reviewed literature, biomedical compendia, | 26 | | and other medical literature that meet the criteria of the |
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| 1 | | National Institutes of Health's National Library of | 2 | | Medicine for indexing in Index Medicus, Excerpta Medicus, | 3 | | Medline, and MEDLARS database of Health Services | 4 | | Technology Assessment Research; and | 5 | | (7) peer-reviewed scientific studies published in or | 6 | | accepted for publication by medical journals that meet | 7 | | nationally recognized requirements for scientific | 8 | | manuscripts and that submit most of their published | 9 | | articles for review by experts who are not part of the | 10 | | editorial staff. | 11 | | (e) When coverage of biomarker testing for the purpose of | 12 | | diagnosis, treatment, or ongoing monitoring of any medical | 13 | | condition is restricted for use by a group or individual | 14 | | policy of accident and health insurance or managed care plan, | 15 | | the patient and prescribing practitioner shall have access to | 16 | | a clear, readily accessible, and convenient processes to | 17 | | request an exception. The process shall be made readily | 18 | | accessible on the insurer's website. | 19 | | Section 30. The Health Maintenance Organization Act is | 20 | | amended by changing Section 5-3 as follows:
| 21 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 22 | | Sec. 5-3. Insurance Code provisions.
| 23 | | (a) Health Maintenance Organizations
shall be subject to | 24 | | the provisions of Sections 133, 134, 136, 137, 139, 140, |
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| 1 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 2 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 3 | | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 4 | | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 5 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 6 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 7 | | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 8 | | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 9 | | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 10 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 11 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 12 | | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | 13 | | Insurance Code.
| 14 | | (b) For purposes of the Illinois Insurance Code, except | 15 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 16 | | Health Maintenance Organizations in
the following categories | 17 | | are deemed to be "domestic companies":
| 18 | | (1) a corporation authorized under the
Dental Service | 19 | | Plan Act or the Voluntary Health Services Plans Act;
| 20 | | (2) a corporation organized under the laws of this | 21 | | State; or
| 22 | | (3) a corporation organized under the laws of another | 23 | | state, 30% or more
of the enrollees of which are residents | 24 | | of this State, except a
corporation subject to | 25 | | substantially the same requirements in its state of
| 26 | | organization as is a "domestic company" under Article VIII |
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| 1 | | 1/2 of the
Illinois Insurance Code.
| 2 | | (c) In considering the merger, consolidation, or other | 3 | | acquisition of
control of a Health Maintenance Organization | 4 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 5 | | (1) the Director shall give primary consideration to | 6 | | the continuation of
benefits to enrollees and the | 7 | | financial conditions of the acquired Health
Maintenance | 8 | | Organization after the merger, consolidation, or other
| 9 | | acquisition of control takes effect;
| 10 | | (2)(i) the criteria specified in subsection (1)(b) of | 11 | | Section 131.8 of
the Illinois Insurance Code shall not | 12 | | apply and (ii) the Director, in making
his determination | 13 | | with respect to the merger, consolidation, or other
| 14 | | acquisition of control, need not take into account the | 15 | | effect on
competition of the merger, consolidation, or | 16 | | other acquisition of control;
| 17 | | (3) the Director shall have the power to require the | 18 | | following
information:
| 19 | | (A) certification by an independent actuary of the | 20 | | adequacy
of the reserves of the Health Maintenance | 21 | | Organization sought to be acquired;
| 22 | | (B) pro forma financial statements reflecting the | 23 | | combined balance
sheets of the acquiring company and | 24 | | the Health Maintenance Organization sought
to be | 25 | | acquired as of the end of the preceding year and as of | 26 | | a date 90 days
prior to the acquisition, as well as pro |
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| 1 | | forma financial statements
reflecting projected | 2 | | combined operation for a period of 2 years;
| 3 | | (C) a pro forma business plan detailing an | 4 | | acquiring party's plans with
respect to the operation | 5 | | of the Health Maintenance Organization sought to
be | 6 | | acquired for a period of not less than 3 years; and
| 7 | | (D) such other information as the Director shall | 8 | | require.
| 9 | | (d) The provisions of Article VIII 1/2 of the Illinois | 10 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 11 | | any health maintenance
organization of greater than 10% of its
| 12 | | enrollee population (including without limitation the health | 13 | | maintenance
organization's right, title, and interest in and | 14 | | to its health care
certificates).
| 15 | | (e) In considering any management contract or service | 16 | | agreement subject
to Section 141.1 of the Illinois Insurance | 17 | | Code, the Director (i) shall, in
addition to the criteria | 18 | | specified in Section 141.2 of the Illinois
Insurance Code, | 19 | | take into account the effect of the management contract or
| 20 | | service agreement on the continuation of benefits to enrollees | 21 | | and the
financial condition of the health maintenance | 22 | | organization to be managed or
serviced, and (ii) need not take | 23 | | into account the effect of the management
contract or service | 24 | | agreement on competition.
| 25 | | (f) Except for small employer groups as defined in the | 26 | | Small Employer
Rating, Renewability and Portability Health |
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| 1 | | Insurance Act and except for
medicare supplement policies as | 2 | | defined in Section 363 of the Illinois
Insurance Code, a | 3 | | Health Maintenance Organization may by contract agree with a
| 4 | | group or other enrollment unit to effect refunds or charge | 5 | | additional premiums
under the following terms and conditions:
| 6 | | (i) the amount of, and other terms and conditions with | 7 | | respect to, the
refund or additional premium are set forth | 8 | | in the group or enrollment unit
contract agreed in advance | 9 | | of the period for which a refund is to be paid or
| 10 | | additional premium is to be charged (which period shall | 11 | | not be less than one
year); and
| 12 | | (ii) the amount of the refund or additional premium | 13 | | shall not exceed 20%
of the Health Maintenance | 14 | | Organization's profitable or unprofitable experience
with | 15 | | respect to the group or other enrollment unit for the | 16 | | period (and, for
purposes of a refund or additional | 17 | | premium, the profitable or unprofitable
experience shall | 18 | | be calculated taking into account a pro rata share of the
| 19 | | Health Maintenance Organization's administrative and | 20 | | marketing expenses, but
shall not include any refund to be | 21 | | made or additional premium to be paid
pursuant to this | 22 | | subsection (f)). The Health Maintenance Organization and | 23 | | the
group or enrollment unit may agree that the profitable | 24 | | or unprofitable
experience may be calculated taking into | 25 | | account the refund period and the
immediately preceding 2 | 26 | | plan years.
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| 1 | | The Health Maintenance Organization shall include a | 2 | | statement in the
evidence of coverage issued to each enrollee | 3 | | describing the possibility of a
refund or additional premium, | 4 | | and upon request of any group or enrollment unit,
provide to | 5 | | the group or enrollment unit a description of the method used | 6 | | to
calculate (1) the Health Maintenance Organization's | 7 | | profitable experience with
respect to the group or enrollment | 8 | | unit and the resulting refund to the group
or enrollment unit | 9 | | or (2) the Health Maintenance Organization's unprofitable
| 10 | | experience with respect to the group or enrollment unit and | 11 | | the resulting
additional premium to be paid by the group or | 12 | | enrollment unit.
| 13 | | In no event shall the Illinois Health Maintenance | 14 | | Organization
Guaranty Association be liable to pay any | 15 | | contractual obligation of an
insolvent organization to pay any | 16 | | refund authorized under this Section.
| 17 | | (g) Rulemaking authority to implement Public Act 95-1045, | 18 | | if any, is conditioned on the rules being adopted in | 19 | | accordance with all provisions of the Illinois Administrative | 20 | | Procedure Act and all rules and procedures of the Joint | 21 | | Committee on Administrative Rules; any purported rule not so | 22 | | adopted, for whatever reason, is unauthorized. | 23 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 24 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 25 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 26 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; |
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| 1 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 2 | | 1-1-20; 101-625, eff. 1-1-21 .) | 3 | | Section 35. The Limited Health Service Organization Act is | 4 | | amended by changing Section 4003 as follows:
| 5 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 6 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 7 | | health service
organizations shall be subject to the | 8 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | 9 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 10 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | 11 | | 355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, | 12 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a, | 13 | | 401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and | 14 | | 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, | 15 | | XXV, and XXVI of the Illinois Insurance Code. For purposes of | 16 | | the
Illinois Insurance Code, except for Sections 444 and 444.1 | 17 | | and Articles XIII
and XIII 1/2, limited health service | 18 | | organizations in the following categories
are deemed to be | 19 | | domestic companies:
| 20 | | (1) a corporation under the laws of this State; or
| 21 | | (2) a corporation organized under the laws of another | 22 | | state, 30% or more
of the enrollees of which are residents | 23 | | of this State, except a corporation
subject to | 24 | | substantially the same requirements in its state of |
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| 1 | | organization as
is a domestic company under Article VIII | 2 | | 1/2 of the Illinois Insurance Code.
| 3 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 4 | | 100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff. | 5 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 6 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21 .)
| 7 | | Section 40. The Voluntary Health Services Plans Act is | 8 | | amended by changing Section 10 as follows:
| 9 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 10 | | Sec. 10. Application of Insurance Code provisions. Health | 11 | | services
plan corporations and all persons interested therein | 12 | | or dealing therewith
shall be subject to the provisions of | 13 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 14 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 15 | | 356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, | 16 | | 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, | 17 | | 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, | 18 | | 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, | 19 | | 356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01, | 20 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | 21 | | and paragraphs (7) and (15) of Section 367 of the Illinois
| 22 | | Insurance Code.
| 23 | | Rulemaking authority to implement Public Act 95-1045, if | 24 | | any, is conditioned on the rules being adopted in accordance |
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| 1 | | with all provisions of the Illinois Administrative Procedure | 2 | | Act and all rules and procedures of the Joint Committee on | 3 | | Administrative Rules; any purported rule not so adopted, for | 4 | | whatever reason, is unauthorized. | 5 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 6 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 7 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 8 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 9 | | 101-625, eff. 1-1-21 .) | 10 | | Section 45. The Illinois Public Aid Code is amended by | 11 | | changing Section 5-16.8 as follows:
| 12 | | (305 ILCS 5/5-16.8)
| 13 | | Sec. 5-16.8. Required health benefits. The medical | 14 | | assistance program
shall
(i) provide the post-mastectomy care | 15 | | benefits required to be covered by a policy of
accident and | 16 | | health insurance under Section 356t and the coverage required
| 17 | | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, | 18 | | 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 , and 356z.43 | 19 | | of the Illinois
Insurance Code and (ii) be subject to the | 20 | | provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of | 21 | | the Illinois
Insurance Code.
| 22 | | The Department, by rule, shall adopt a model similar to | 23 | | the requirements of Section 356z.39 of the Illinois Insurance | 24 | | Code. |
| | | HB1779 Enrolled | - 17 - | LRB102 10161 BMS 18161 b |
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| 1 | | On and after July 1, 2012, the Department shall reduce any | 2 | | rate of reimbursement for services or other payments or alter | 3 | | any methodologies authorized by this Code to reduce any rate | 4 | | of reimbursement for services or other payments in accordance | 5 | | with Section 5-5e. | 6 | | To ensure full access to the benefits set forth in this | 7 | | Section, on and after January 1, 2016, the Department shall | 8 | | ensure that provider and hospital reimbursement for | 9 | | post-mastectomy care benefits required under this Section are | 10 | | no lower than the Medicare reimbursement rate. | 11 | | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; | 12 | | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. | 13 | | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, | 14 | | eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)
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