Full Text of HB4460 103rd General Assembly
HB4460enr 103RD GENERAL ASSEMBLY | | | HB4460 Enrolled | | 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 or police officer of an | 11 | | institution of higher education and any spouse or partner of | 12 | | the officer who resides with the officer. | 13 | | (b) The joint mental health therapy services provided | 14 | | under subsection (a) shall be performed by a physician | 15 | | licensed to practice medicine in all of its branches, a | 16 | | licensed clinical psychologist, a licensed clinical social | 17 | | worker, a licensed clinical professional counselor, a licensed | 18 | | marriage and family therapist, a licensed social worker, or a | 19 | | licensed professional counselor. | 20 | | Section 10. The Counties Code is amended by changing | 21 | | Section 5-1069 as follows: |
| | | HB4460 Enrolled | - 2 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069) | 2 | | Sec. 5-1069. Group life, health, accident, hospital, and | 3 | | medical insurance. | 4 | | (a) The county board of any county may arrange to provide, | 5 | | for the benefit of employees of the county, group life, | 6 | | health, accident, hospital, and medical insurance, or any one | 7 | | or any combination of those types of insurance, or the county | 8 | | board may self-insure, for the benefit of its employees, all | 9 | | or a portion of the employees' group life, health, accident, | 10 | | hospital, and medical insurance, or any one or any combination | 11 | | of those types of insurance, including a combination of | 12 | | self-insurance and other types of insurance authorized by this | 13 | | Section, provided that the county board complies with all | 14 | | other requirements of this Section. The insurance may include | 15 | | provision for employees who rely on treatment by prayer or | 16 | | spiritual means alone for healing in accordance with the | 17 | | tenets and practice of a well recognized religious | 18 | | denomination. The county board may provide for payment by the | 19 | | county of a portion or all of the premium or charge for the | 20 | | insurance with the employee paying the balance of the premium | 21 | | or charge, if any. If the county board undertakes a plan under | 22 | | which the county pays only a portion of the premium or charge, | 23 | | the county board shall provide for withholding and deducting | 24 | | from the compensation of those employees who consent to join | 25 | | the plan the balance of the premium or charge for the | 26 | | insurance. |
| | | HB4460 Enrolled | - 3 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | (b) If the county board does not provide for | 2 | | self-insurance or for a plan under which the county pays a | 3 | | portion or all of the premium or charge for a group insurance | 4 | | plan, the county board may provide for withholding and | 5 | | deducting from the compensation of those employees who consent | 6 | | thereto the total premium or charge for any group life, | 7 | | health, accident, hospital, and medical insurance. | 8 | | (c) The county board may exercise the powers granted in | 9 | | this Section only if it provides for self-insurance or, where | 10 | | it makes arrangements to provide group insurance through an | 11 | | insurance carrier, if the kinds of group insurance are | 12 | | obtained from an insurance company authorized to do business | 13 | | in the State of Illinois. The county board may enact an | 14 | | ordinance prescribing the method of operation of the insurance | 15 | | program. | 16 | | (d) If a county, including a home rule county, is a | 17 | | self-insurer for purposes of providing health insurance | 18 | | coverage for its employees, the insurance coverage shall | 19 | | include screening by low-dose mammography for all women 35 | 20 | | years of age or older for the presence of occult breast cancer | 21 | | unless the county elects to provide mammograms itself under | 22 | | Section 5-1069.1. The coverage shall be as follows: | 23 | | (1) A baseline mammogram for women 35 to 39 years of | 24 | | age. | 25 | | (2) An annual mammogram for women 40 years of age or | 26 | | older. |
| | | HB4460 Enrolled | - 4 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | (3) A mammogram at the age and intervals considered | 2 | | medically necessary by the woman's health care provider | 3 | | for women under 40 years of age and having a family history | 4 | | of breast cancer, prior personal history of breast cancer, | 5 | | positive genetic testing, or other risk factors. | 6 | | (4) For a group policy of accident and health | 7 | | insurance that is amended, delivered, issued, or renewed | 8 | | on or after the effective date of this amendatory Act of | 9 | | the 101st General Assembly, a comprehensive ultrasound | 10 | | screening of an entire breast or breasts if a mammogram | 11 | | demonstrates heterogeneous or dense breast tissue or when | 12 | | medically necessary as determined by a physician licensed | 13 | | to practice medicine in all of its branches, advanced | 14 | | practice registered nurse, or physician assistant. | 15 | | (5) For a group policy of accident and health | 16 | | insurance that is amended, delivered, issued, or renewed | 17 | | on or after the effective date of this amendatory Act of | 18 | | the 101st General Assembly, a diagnostic mammogram when | 19 | | medically necessary, as determined by a physician licensed | 20 | | to practice medicine in all its branches, advanced | 21 | | practice registered nurse, or physician assistant. | 22 | | A policy subject to this subsection shall not impose a | 23 | | deductible, coinsurance, copayment, or any other cost-sharing | 24 | | requirement on the coverage provided; except that this | 25 | | sentence does not apply to coverage of diagnostic mammograms | 26 | | to the extent such coverage would disqualify a high-deductible |
| | | HB4460 Enrolled | - 5 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | health plan from eligibility for a health savings account | 2 | | pursuant to Section 223 of the Internal Revenue Code (26 | 3 | | U.S.C. 223). | 4 | | For purposes of this subsection: | 5 | | "Diagnostic mammogram" means a mammogram obtained using | 6 | | diagnostic mammography. | 7 | | "Diagnostic mammography" means a method of screening that | 8 | | is designed to evaluate an abnormality in a breast, including | 9 | | an abnormality seen or suspected on a screening mammogram or a | 10 | | subjective or objective abnormality otherwise detected in the | 11 | | breast. | 12 | | "Low-dose mammography" means the x-ray examination of the | 13 | | breast using equipment dedicated specifically for mammography, | 14 | | including the x-ray tube, filter, compression device, and | 15 | | image receptor, with an average radiation exposure delivery of | 16 | | less than one rad per breast for 2 views of an average size | 17 | | breast. The term also includes digital mammography. | 18 | | (d-5) Coverage as described by subsection (d) shall be | 19 | | provided at no cost to the insured and shall not be applied to | 20 | | an annual or lifetime maximum benefit. | 21 | | (d-10) When health care services are available through | 22 | | contracted providers and a person does not comply with plan | 23 | | provisions specific to the use of contracted providers, the | 24 | | requirements of subsection (d-5) are not applicable. When a | 25 | | person does not comply with plan provisions specific to the | 26 | | use of contracted providers, plan provisions specific to the |
| | | HB4460 Enrolled | - 6 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | use of non-contracted providers must be applied without | 2 | | distinction for coverage required by this Section and shall be | 3 | | at least as favorable as for other radiological examinations | 4 | | covered by the policy or contract. | 5 | | (d-15) If a county, including a home rule county, is a | 6 | | self-insurer for purposes of providing health insurance | 7 | | coverage for its employees, the insurance coverage shall | 8 | | include mastectomy coverage, which includes coverage for | 9 | | prosthetic devices or reconstructive surgery incident to the | 10 | | mastectomy. Coverage for breast reconstruction in connection | 11 | | with a mastectomy shall include: | 12 | | (1) reconstruction of the breast upon which the | 13 | | mastectomy has been performed; | 14 | | (2) surgery and reconstruction of the other breast to | 15 | | produce a symmetrical appearance; and | 16 | | (3) prostheses and treatment for physical | 17 | | complications at all stages of mastectomy, including | 18 | | lymphedemas. | 19 | | Care shall be determined in consultation with the attending | 20 | | physician and the patient. The offered coverage for prosthetic | 21 | | devices and reconstructive surgery shall be subject to the | 22 | | deductible and coinsurance conditions applied to the | 23 | | mastectomy, and all other terms and conditions applicable to | 24 | | other benefits. When a mastectomy is performed and there is no | 25 | | evidence of malignancy then the offered coverage may be | 26 | | limited to the provision of prosthetic devices and |
| | | HB4460 Enrolled | - 7 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | reconstructive surgery to within 2 years after the date of the | 2 | | mastectomy. As used in this Section, "mastectomy" means the | 3 | | removal of all or part of the breast for medically necessary | 4 | | reasons, as determined by a licensed physician. | 5 | | A county, including a home rule county, that is a | 6 | | self-insurer for purposes of providing health insurance | 7 | | coverage for its employees, may not penalize or reduce or | 8 | | limit the reimbursement of an attending provider or provide | 9 | | incentives (monetary or otherwise) to an attending provider to | 10 | | induce the provider to provide care to an insured in a manner | 11 | | inconsistent with this Section. | 12 | | (d-20) The requirement that mammograms be included in | 13 | | health insurance coverage as provided in subsections (d) | 14 | | through (d-15) is an exclusive power and function of the State | 15 | | and is a denial and limitation under Article VII, Section 6, | 16 | | subsection (h) of the Illinois Constitution of home rule | 17 | | county powers. A home rule county to which subsections (d) | 18 | | through (d-15) apply must comply with every provision of those | 19 | | subsections. | 20 | | (d-25) If a county, including a home rule county, is a | 21 | | self-insurer for purposes of providing health insurance | 22 | | coverage, the insurance coverage shall include joint mental | 23 | | health therapy services for any member of the Sheriff's | 24 | | office, including the sheriff, and any spouse or partner of | 25 | | the member who resides with the member. | 26 | | The joint mental health therapy services provided under |
| | | HB4460 Enrolled | - 8 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | this subsection shall be performed by a physician licensed to | 2 | | practice medicine in all of its branches, a licensed clinical | 3 | | psychologist, a licensed clinical social worker, a licensed | 4 | | clinical professional counselor, a licensed marriage and | 5 | | family therapist, a licensed social worker, or a licensed | 6 | | professional counselor. | 7 | | This subsection is a limitation under subsection (i) of | 8 | | Section 6 of Article VII of the Illinois Constitution on the | 9 | | concurrent exercise by home rule units of powers and functions | 10 | | exercised by the State. | 11 | | (e) The term "employees" as used in this Section includes | 12 | | elected or appointed officials but does not include temporary | 13 | | employees. | 14 | | (f) The county board may, by ordinance, arrange to provide | 15 | | group life, health, accident, hospital, and medical insurance, | 16 | | or any one or a combination of those types of insurance, under | 17 | | this Section to retired former employees and retired former | 18 | | elected or appointed officials of the county. | 19 | | (g) Rulemaking authority to implement this amendatory Act | 20 | | of the 95th General Assembly, if any, is conditioned on the | 21 | | rules being adopted in accordance with all provisions of the | 22 | | Illinois Administrative Procedure Act and all rules and | 23 | | procedures of the Joint Committee on Administrative Rules; any | 24 | | purported rule not so adopted, for whatever reason, is | 25 | | unauthorized. | 26 | | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .) |
| | | HB4460 Enrolled | - 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 |
| | | HB4460 Enrolled | - 10 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | under which the municipality pays a portion of the premium or | 2 | | charge for a group insurance plan, the corporate authorities | 3 | | may provide for withholding and deducting from the | 4 | | compensation of those employees who consent thereto the | 5 | | premium or charge for any group life, health, accident, | 6 | | hospital, and medical insurance. | 7 | | (c) The corporate authorities may exercise the powers | 8 | | granted in this Section only if the kinds of group insurance | 9 | | are obtained from an insurance company authorized to do | 10 | | business in the State of Illinois, or are obtained through an | 11 | | intergovernmental joint self-insurance pool as authorized | 12 | | under the Intergovernmental Cooperation Act. The corporate | 13 | | authorities may enact an ordinance prescribing the method of | 14 | | operation of the insurance program. | 15 | | (d) If a municipality, including a home rule municipality, | 16 | | is a 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 municipality elects to provide mammograms itself | 21 | | under Section 10-4-2.1. 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 Enrolled | - 11 - | 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. | 13 | | (5) For a group policy of accident and health | 14 | | insurance that is amended, delivered, issued, or renewed | 15 | | on or after the effective date of this amendatory Act of | 16 | | the 101st General Assembly, a diagnostic mammogram when | 17 | | medically necessary, as determined by a physician licensed | 18 | | to practice medicine in all its branches, advanced | 19 | | practice registered nurse, or physician assistant. | 20 | | A policy subject to this subsection shall not impose a | 21 | | deductible, coinsurance, copayment, or any other cost-sharing | 22 | | requirement on the coverage provided; except that this | 23 | | sentence does not apply to coverage of diagnostic mammograms | 24 | | to the extent such coverage would disqualify a high-deductible | 25 | | health plan from eligibility for a health savings account | 26 | | pursuant to Section 223 of the Internal Revenue Code (26 |
| | | HB4460 Enrolled | - 12 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | U.S.C. 223). | 2 | | For purposes of this subsection: | 3 | | "Diagnostic mammogram" means a mammogram obtained using | 4 | | diagnostic mammography. | 5 | | "Diagnostic mammography" means a method of screening that | 6 | | is designed to evaluate an abnormality in a breast, including | 7 | | an abnormality seen or suspected on a screening mammogram or a | 8 | | subjective or objective abnormality otherwise detected in the | 9 | | breast. | 10 | | "Low-dose mammography" means the x-ray examination of the | 11 | | breast using equipment dedicated specifically for mammography, | 12 | | including the x-ray tube, filter, compression device, and | 13 | | image receptor, with an average radiation exposure delivery of | 14 | | less than one rad per breast for 2 views of an average size | 15 | | breast. The term also includes digital mammography. | 16 | | (d-5) Coverage as described by subsection (d) shall be | 17 | | provided at no cost to the insured and shall not be applied to | 18 | | an annual or lifetime maximum benefit. | 19 | | (d-10) When health care services are available through | 20 | | contracted providers and a person does not comply with plan | 21 | | provisions specific to the use of contracted providers, the | 22 | | requirements of subsection (d-5) are not applicable. When a | 23 | | person does not comply with plan provisions specific to the | 24 | | use of contracted providers, plan provisions specific to the | 25 | | use of non-contracted providers must be applied without | 26 | | distinction for coverage required by this Section and shall be |
| | | HB4460 Enrolled | - 13 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | at least as favorable as for other radiological examinations | 2 | | covered by the policy or contract. | 3 | | (d-15) If a municipality, including a home rule | 4 | | municipality, is a self-insurer for purposes of providing | 5 | | health insurance coverage for its employees, the insurance | 6 | | coverage shall include mastectomy coverage, which includes | 7 | | coverage for prosthetic devices or reconstructive surgery | 8 | | incident to the mastectomy. Coverage for breast reconstruction | 9 | | in connection with a mastectomy shall include: | 10 | | (1) reconstruction of the breast upon which the | 11 | | mastectomy has been performed; | 12 | | (2) surgery and reconstruction of the other breast to | 13 | | produce a symmetrical appearance; and | 14 | | (3) prostheses and treatment for physical | 15 | | complications at all stages of mastectomy, including | 16 | | lymphedemas. | 17 | | Care shall be determined in consultation with the attending | 18 | | physician and the patient. The offered coverage for prosthetic | 19 | | devices and reconstructive surgery shall be subject to the | 20 | | deductible and coinsurance conditions applied to the | 21 | | mastectomy, and all other terms and conditions applicable to | 22 | | other benefits. When a mastectomy is performed and there is no | 23 | | evidence of malignancy then the offered coverage may be | 24 | | limited to the provision of prosthetic devices and | 25 | | reconstructive surgery to within 2 years after the date of the | 26 | | mastectomy. As used in this Section, "mastectomy" means the |
| | | HB4460 Enrolled | - 14 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | removal of all or part of the breast for medically necessary | 2 | | reasons, as determined by a licensed physician. | 3 | | A municipality, including a home rule municipality, that | 4 | | is a self-insurer for purposes of providing health insurance | 5 | | coverage for its employees, may not penalize or reduce or | 6 | | limit the reimbursement of an attending provider or provide | 7 | | incentives (monetary or otherwise) to an attending provider to | 8 | | induce the provider to provide care to an insured in a manner | 9 | | inconsistent with this Section. | 10 | | (d-20) The requirement that mammograms be included in | 11 | | health insurance coverage as provided in subsections (d) | 12 | | through (d-15) is an exclusive power and function of the State | 13 | | and is a denial and limitation under Article VII, Section 6, | 14 | | subsection (h) of the Illinois Constitution of home rule | 15 | | municipality powers. A home rule municipality to which | 16 | | subsections (d) through (d-15) apply must comply with every | 17 | | provision of those subsections. | 18 | | (d-25) If a municipality, including a home rule | 19 | | municipality, is a self-insurer for purposes of providing | 20 | | health insurance coverage for its employees, the insurance | 21 | | coverage shall include joint mental health therapy services | 22 | | for any member of the municipality's police department or fire | 23 | | department and any spouse or partner of the member who resides | 24 | | with the member. | 25 | | The joint mental health therapy services provided under | 26 | | this subsection shall be performed by a physician licensed to |
| | | HB4460 Enrolled | - 15 - | 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) Rulemaking authority to implement Public Act 95-1045, | 11 | | if any, is conditioned on the rules being adopted in | 12 | | accordance with all provisions of the Illinois Administrative | 13 | | Procedure Act and all rules and procedures of the Joint | 14 | | Committee on Administrative Rules; any purported rule not so | 15 | | adopted, for whatever reason, is unauthorized. | 16 | | (Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20 .) | 17 | | Section 20. The Fire Protection District Act is amended by | 18 | | adding Section 6.3 as follows: | 19 | | (70 ILCS 705/6.3 new) | 20 | | Sec. 6.3. Health insurance; joint mental health therapy | 21 | | services. If a fire protection district is a self-insurer for | 22 | | purposes of providing health insurance coverage for officers | 23 | | and members of the fire department, the insurance coverage | 24 | | shall include joint mental health therapy services for any |
| | | HB4460 Enrolled | - 16 - | LRB103 36625 AWJ 66734 b |
|
| 1 | | officer or member of the fire department and any spouse or | 2 | | partner of the officer or member who resides with the officer | 3 | | or member. The joint mental health therapy services provided | 4 | | under this Section shall be performed by a physician licensed | 5 | | to practice medicine in all of its branches, a licensed | 6 | | clinical psychologist, a licensed clinical social worker, a | 7 | | licensed clinical professional counselor, a licensed marriage | 8 | | and family therapist, a licensed social worker, or a licensed | 9 | | professional counselor. | 10 | | Section 99. Effective date. This Act takes effect January | 11 | | 1, 2025. |
|