Public Act 102-0034
Public Act 0034 102ND GENERAL ASSEMBLY
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Public Act 102-0034
| | SB1096 Enrolled | LRB102 04919 CPF 14938 b |
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| AN ACT concerning regulation.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Illinois Insurance Code is amended by | adding Section 356z.43 as follows:
| (215 ILCS 5/356z.43 new) | Sec. 356z.43. Coverage for COVID-19 diagnostic testing for | nursing home employees. | (a) As used in this Section: | "COVID-19" means the disease caused by SARS-CoV-2 or any | further mutation. | "Department" means the Department of Public Health. | "Diagnostic testing" means testing administered for the | purposes of diagnosing COVID-19 or a related virus and the | administration of such tests if the test is: | (1) approved, cleared, or authorized under Section | 510(k), 513, 515, or 564 of the Federal Food, Drug, and | Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, and 360bbb-3); | (2) the subject of a request or intended request for | emergency use authorization under Section 564 of the | Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3) | until the emergency use authorization request has been | denied or the developer of the test does not submit a |
| request within a reasonable timeframe; | (3) developed and authorized by a state that has | notified the Secretary of the United States Department of | Health and Human Services of its intention to review a | test intended to diagnose COVID-19; or | (4) determined by the Secretary of the United States | Department of Health and Human Services or the Director of | the Centers for Disease Control and Prevention as | appropriate for the diagnosis of COVID-19. | "Enrollee" means a long-term care facility employee who is | covered by a health plan. | "Health plan" means (i) individual health insurance | coverage, as defined in Section 5 of the Illinois Health | Insurance Portability and Accountability Act, and (ii) group | health insurance coverage, as defined in Section 5 of the | Illinois Health Insurance Portability and Accountability Act | for employees of a licensed long-term care facility. | "Long-term care facility" means a long-term care facility | as defined in Section 1-113 of the Nursing Home Care Act, an | assisted living establishment as defined in Section 10 of the | Assisted Living and Shared Housing Act, a MC/DD facility as | defined in Section 1-113 of the MC/DD Act, an ID/DD facility as | defined in Section 1-113 of the ID/DD Community Care Act, a | facility as defined in Section 1-102 of the Specialized Mental | Health Rehabilitation Act of 2013, or a supportive living | facility as defined in Section 5.01a of the Illinois Public |
| Aid Code. | "Testing provider" means a provider that is authorized by | the Department of Public Health to perform diagnostic testing | for licensed long-term care facilities. | (b) A health plan amended, delivered, issued, or renewed | on or after the effective date of this amendatory Act of the | 102nd General Assembly shall provide coverage of diagnostic | testing for enrollees that is performed by a testing provider | in accordance with federal COVID-19 testing requirements as | set forth in subsection (h) of 42 CFR 483.80; emergency rules | adopted by the Department in 77 Ill. Adm. Code 295.4045, | 300.696, 330.340, 350.760, and 390.340; and applicable federal | and Department guidance. | (c) Testing performed in accordance with subsection (b) | shall be considered medically necessary for the purposes of | this Section. | (d) A health plan may inquire as to whether an enrollee is | an employee of the long-term care facility but shall not | require further evidence or verification of the enrollee's | employment status. | (e) The coverage requirements set forth in this Section | shall only apply when the testing requirements set forth in | subsection (b) are in effect. | (f) Any failure to provide coverage pursuant to this | Section shall be deemed a failure to substantially comply with | this Code. |
| (g) This Section is repealed on January 1, 2022.
| Section 10. The Health Maintenance Organization Act is | amended by changing Section 5-3 as follows:
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| Sec. 5-3. Insurance Code provisions.
| (a) Health Maintenance Organizations
shall be subject to | the provisions of Sections 133, 134, 136, 137, 139, 140, | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | Insurance Code.
| (b) For purposes of the Illinois Insurance Code, except | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | Health Maintenance Organizations in
the following categories | are deemed to be "domestic companies":
|
| (1) a corporation authorized under the
Dental Service | Plan Act or the Voluntary Health Services Plans Act;
| (2) a corporation organized under the laws of this | State; or
| (3) a corporation organized under the laws of another | state, 30% or more
of the enrollees of which are residents | of this State, except a
corporation subject to | substantially the same requirements in its state of
| organization as is a "domestic company" under Article VIII | 1/2 of the
Illinois Insurance Code.
| (c) In considering the merger, consolidation, or other | acquisition of
control of a Health Maintenance Organization | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| (1) the Director shall give primary consideration to | the continuation of
benefits to enrollees and the | financial conditions of the acquired Health
Maintenance | Organization after the merger, consolidation, or other
| acquisition of control takes effect;
| (2)(i) the criteria specified in subsection (1)(b) of | Section 131.8 of
the Illinois Insurance Code shall not | apply and (ii) the Director, in making
his determination | with respect to the merger, consolidation, or other
| acquisition of control, need not take into account the | effect on
competition of the merger, consolidation, or | other acquisition of control;
| (3) the Director shall have the power to require the |
| following
information:
| (A) certification by an independent actuary of the | adequacy
of the reserves of the Health Maintenance | Organization sought to be acquired;
| (B) pro forma financial statements reflecting the | combined balance
sheets of the acquiring company and | the Health Maintenance Organization sought
to be | acquired as of the end of the preceding year and as of | a date 90 days
prior to the acquisition, as well as pro | forma financial statements
reflecting projected | combined operation for a period of 2 years;
| (C) a pro forma business plan detailing an | acquiring party's plans with
respect to the operation | of the Health Maintenance Organization sought to
be | acquired for a period of not less than 3 years; and
| (D) such other information as the Director shall | require.
| (d) The provisions of Article VIII 1/2 of the Illinois | Insurance Code
and this Section 5-3 shall apply to the sale by | any health maintenance
organization of greater than 10% of its
| enrollee population (including without limitation the health | maintenance
organization's right, title, and interest in and | to its health care
certificates).
| (e) In considering any management contract or service | agreement subject
to Section 141.1 of the Illinois Insurance | Code, the Director (i) shall, in
addition to the criteria |
| specified in Section 141.2 of the Illinois
Insurance Code, | take into account the effect of the management contract or
| service agreement on the continuation of benefits to enrollees | and the
financial condition of the health maintenance | organization to be managed or
serviced, and (ii) need not take | into account the effect of the management
contract or service | agreement on competition.
| (f) Except for small employer groups as defined in the | Small Employer
Rating, Renewability and Portability Health | Insurance Act and except for
medicare supplement policies as | defined in Section 363 of the Illinois
Insurance Code, a | Health Maintenance Organization may by contract agree with a
| group or other enrollment unit to effect refunds or charge | additional premiums
under the following terms and conditions:
| (i) the amount of, and other terms and conditions with | respect to, the
refund or additional premium are set forth | in the group or enrollment unit
contract agreed in advance | of the period for which a refund is to be paid or
| additional premium is to be charged (which period shall | not be less than one
year); and
| (ii) the amount of the refund or additional premium | shall not exceed 20%
of the Health Maintenance | Organization's profitable or unprofitable experience
with | respect to the group or other enrollment unit for the | period (and, for
purposes of a refund or additional | premium, the profitable or unprofitable
experience shall |
| be calculated taking into account a pro rata share of the
| Health Maintenance Organization's administrative and | marketing expenses, but
shall not include any refund to be | made or additional premium to be paid
pursuant to this | subsection (f)). The Health Maintenance Organization and | the
group or enrollment unit may agree that the profitable | or unprofitable
experience may be calculated taking into | account the refund period and the
immediately preceding 2 | plan years.
| The Health Maintenance Organization shall include a | statement in the
evidence of coverage issued to each enrollee | describing the possibility of a
refund or additional premium, | and upon request of any group or enrollment unit,
provide to | the group or enrollment unit a description of the method used | to
calculate (1) the Health Maintenance Organization's | profitable experience with
respect to the group or enrollment | unit and the resulting refund to the group
or enrollment unit | or (2) the Health Maintenance Organization's unprofitable
| experience with respect to the group or enrollment unit and | the resulting
additional premium to be paid by the group or | enrollment unit.
| In no event shall the Illinois Health Maintenance | Organization
Guaranty Association be liable to pay any | contractual obligation of an
insolvent organization to pay any | refund authorized under this Section.
| (g) Rulemaking authority to implement Public Act 95-1045, |
| if any, is conditioned on the rules being adopted in | accordance with all provisions of the Illinois Administrative | Procedure Act and all rules and procedures of the Joint | Committee on Administrative Rules; any purported rule not so | adopted, for whatever reason, is unauthorized. | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 1-1-20; 101-625, eff. 1-1-21.)
| (215 ILCS 195/Act rep.) | Section 15. The COVID-19 Medically Necessary Diagnostic | Testing Act is repealed.
| Section 99. Effective date. This Act takes effect upon | becoming law. |
Effective Date: 6/25/2021
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