Public Act 095-0422
 
SB0937 Enrolled LRB095 05755 KBJ 25845 b

    AN ACT concerning health.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
 
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356u, 356w,
356x, 356z.2, 356z.4, and 356z.6, and 356z.9 of the Illinois
Insurance Code. The program of health benefits must comply with
Section 155.37 of the Illinois Insurance Code.
(Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03;
93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)
 
    Section 10. The Department of Public Health Powers and
Duties Law of the Civil Administrative Code of Illinois is
amended by adding Section 2310-617 as follows:
 
    (20 ILCS 2310/2310-617 new)
    Sec. 2310-617. Human papillomavirus vaccine.
    (a) As used in this Section, "eligible individual" means a
female child under the age of 18, who is a resident of Illinois
who: (1) is not entitled to receive a human papillomavirus
(HPV) vaccination at no cost as a benefit under a plan of
health insurance, a managed care plan, or a plan provided by a
health maintenance organization, a health services plan
corporation, or a similar entity, and (2) meets the
requirements established by the Department of Public Health by
rule.
    (b) Subject to appropriation, the Department of Public
Health shall establish and administer a program, commencing no
later than July 1, 2011, under which any eligible individual
shall, upon the eligible individual's request, receive a series
of HPV vaccinations as medically indicated, at no cost to the
eligible individual.
    (c) The Department of Public Health shall adopt rules for
the administration and operation of the program, including, but
not limited to: determination of the HPV vaccine formulation to
be administered and the method of administration; eligibility
requirements and eligibility determinations; and standards and
criteria for acquisition and distribution of the HPV vaccine
and related supplies. The Department may enter into contracts
or agreements with public or private entities for the
performance of such duties under the program as the Department
may deem appropriate to carry out this Section and its rules
adopted under this Section.
 
    Section 15. The Counties Code is amended by changing
Section 5-1069.3 as follows:
 
    (55 ILCS 5/5-1069.3)
    Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes of
providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356u, 356w, 356x, and 356z.6, and 356z.9 of the
Illinois Insurance Code. The requirement that health benefits
be covered as provided in this Section is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule county to which this Section applies
must comply with every provision of this Section.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    Section 20. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
 
    (65 ILCS 5/10-4-2.3)
    Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include coverage
for the post-mastectomy care benefits required to be covered by
a policy of accident and health insurance under Section 356t
and the coverage required under Sections 356u, 356w, 356x, and
356z.6, and 356z.9 of the Illinois Insurance Code. The
requirement that health benefits be covered as provided in this
is an exclusive power and function of the State and is a denial
and limitation under Article VII, Section 6, subsection (h) of
the Illinois Constitution. A home rule municipality to which
this Section applies must comply with every provision of this
Section.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    Section 25. The School Code is amended by changing Sections
27-8.1 and 10-22.3f as follows:
 
    (105 ILCS 5/10-22.3f)
    Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356u, 356w, 356x, and
356z.6, and 356z.9 of the Illinois Insurance Code.
(Source: P.A. 93-853, eff. 1-1-05.)
 
    (105 ILCS 5/27-8.1)  (from Ch. 122, par. 27-8.1)
    Sec. 27-8.1. Health examinations and immunizations.
    (1) In compliance with rules and regulations which the
Department of Public Health shall promulgate, and except as
hereinafter provided, all children in Illinois shall have a
health examination as follows: within one year prior to
entering kindergarten or the first grade of any public,
private, or parochial elementary school; upon entering the
sixth fifth and ninth grades of any public, private, or
parochial school; prior to entrance into any public, private,
or parochial nursery school; and, irrespective of grade,
immediately prior to or upon entrance into any public, private,
or parochial school or nursery school, each child shall present
proof of having been examined in accordance with this Section
and the rules and regulations promulgated hereunder.
    A tuberculosis skin test screening shall be included as a
required part of each health examination included under this
Section if the child resides in an area designated by the
Department of Public Health as having a high incidence of
tuberculosis. Additional health examinations of pupils,
including vision examinations, may be required when deemed
necessary by school authorities. Parents are encouraged to have
their children undergo vision examinations at the same points
in time required for health examinations.
    (1.5) In compliance with rules adopted by the Department of
Public Health and except as otherwise provided in this Section,
all children in kindergarten and the second and sixth grades of
any public, private, or parochial school shall have a dental
examination. Each of these children shall present proof of
having been examined by a dentist in accordance with this
Section and rules adopted under this Section before May 15th of
the school year. If a child in the second or sixth grade fails
to present proof by May 15th, the school may hold the child's
report card until one of the following occurs: (i) the child
presents proof of a completed dental examination or (ii) the
child presents proof that a dental examination will take place
within 60 days after May 15th. The Department of Public Health
shall establish, by rule, a waiver for children who show an
undue burden or a lack of access to a dentist. Each public,
private, and parochial school must give notice of this dental
examination requirement to the parents and guardians of
students at least 60 days before May 15th of each school year.
    (2) The Department of Public Health shall promulgate rules
and regulations specifying the examinations and procedures
that constitute a health examination, which shall include the
collection of data relating to obesity, (including at a
minimum, date of birth, gender, height, weight, blood pressure,
and date of exam), and a dental examination and may recommend
by rule that certain additional examinations be performed. The
rules and regulations of the Department of Public Health shall
specify that a tuberculosis skin test screening shall be
included as a required part of each health examination included
under this Section if the child resides in an area designated
by the Department of Public Health as having a high incidence
of tuberculosis. The Department of Public Health shall specify
that a diabetes screening as defined by rule shall be included
as a required part of each health examination. Diabetes testing
is not required.
    Physicians licensed to practice medicine in all of its
branches, advanced practice nurses who have a written
collaborative agreement with a collaborating physician which
authorizes them to perform health examinations, or physician
assistants who have been delegated the performance of health
examinations by their supervising physician shall be
responsible for the performance of the health examinations,
other than dental examinations and vision and hearing
screening, and shall sign all report forms required by
subsection (4) of this Section that pertain to those portions
of the health examination for which the physician, advanced
practice nurse, or physician assistant is responsible. If a
registered nurse performs any part of a health examination,
then a physician licensed to practice medicine in all of its
branches must review and sign all required report forms.
Licensed dentists shall perform all dental examinations and
shall sign all report forms required by subsection (4) of this
Section that pertain to the dental examinations. Physicians
licensed to practice medicine in all its branches, or licensed
optometrists, shall perform all vision exams required by school
authorities and shall sign all report forms required by
subsection (4) of this Section that pertain to the vision exam.
Vision and hearing screening tests, which shall not be
considered examinations as that term is used in this Section,
shall be conducted in accordance with rules and regulations of
the Department of Public Health, and by individuals whom the
Department of Public Health has certified. In these rules and
regulations, the Department of Public Health shall require that
individuals conducting vision screening tests give a child's
parent or guardian written notification, before the vision
screening is conducted, that states, "Vision screening is not a
substitute for a complete eye and vision evaluation by an eye
doctor. Your child is not required to undergo this vision
screening if an optometrist or ophthalmologist has completed
and signed a report form indicating that an examination has
been administered within the previous 12 months."
    (3) Every child shall, at or about the same time as he or
she receives a health examination required by subsection (1) of
this Section, present to the local school proof of having
received such immunizations against preventable communicable
diseases as the Department of Public Health shall require by
rules and regulations promulgated pursuant to this Section and
the Communicable Disease Prevention Act.
    (4) The individuals conducting the health examination or
dental examination shall record the fact of having conducted
the examination, and such additional information as required,
including for a health examination data relating to obesity,
(including at a minimum, date of birth, gender, height, weight,
blood pressure, and date of exam), on uniform forms which the
Department of Public Health and the State Board of Education
shall prescribe for statewide use. The examiner shall summarize
on the report form any condition that he or she suspects
indicates a need for special services, including for a health
examination factors relating to obesity. The individuals
confirming the administration of required immunizations shall
record as indicated on the form that the immunizations were
administered.
    (5) If a child does not submit proof of having had either
the health examination or the immunization as required, then
the child shall be examined or receive the immunization, as the
case may be, and present proof by October 15 of the current
school year, or by an earlier date of the current school year
established by a school district. To establish a date before
October 15 of the current school year for the health
examination or immunization as required, a school district must
give notice of the requirements of this Section 60 days prior
to the earlier established date. If for medical reasons one or
more of the required immunizations must be given after October
15 of the current school year, or after an earlier established
date of the current school year, then the child shall present,
by October 15, or by the earlier established date, a schedule
for the administration of the immunizations and a statement of
the medical reasons causing the delay, both the schedule and
the statement being issued by the physician, advanced practice
nurse, physician assistant, registered nurse, or local health
department that will be responsible for administration of the
remaining required immunizations. If a child does not comply by
October 15, or by the earlier established date of the current
school year, with the requirements of this subsection, then the
local school authority shall exclude that child from school
until such time as the child presents proof of having had the
health examination as required and presents proof of having
received those required immunizations which are medically
possible to receive immediately. During a child's exclusion
from school for noncompliance with this subsection, the child's
parents or legal guardian shall be considered in violation of
Section 26-1 and subject to any penalty imposed by Section
26-10. This subsection (5) does not apply to dental
examinations.
    (6) Every school shall report to the State Board of
Education by November 15, in the manner which that agency shall
require, the number of children who have received the necessary
immunizations and the health examination (other than a dental
examination) as required, indicating, of those who have not
received the immunizations and examination as required, the
number of children who are exempt from health examination and
immunization requirements on religious or medical grounds as
provided in subsection (8). Every school shall report to the
State Board of Education by June 30, in the manner that the
State Board requires, the number of children who have received
the required dental examination, indicating, of those who have
not received the required dental examination, the number of
children who are exempt from the dental examination on
religious grounds as provided in subsection (8) of this Section
and the number of children who have received a waiver under
subsection (1.5) of this Section. This reported information
shall be provided to the Department of Public Health by the
State Board of Education.
    (7) Upon determining that the number of pupils who are
required to be in compliance with subsection (5) of this
Section is below 90% of the number of pupils enrolled in the
school district, 10% of each State aid payment made pursuant to
Section 18-8.05 to the school district for such year shall be
withheld by the regional superintendent until the number of
students in compliance with subsection (5) is the applicable
specified percentage or higher.
    (8) Parents or legal guardians who object to health or
dental examinations or any part thereof, or to immunizations,
on religious grounds shall not be required to submit their
children or wards to the examinations or immunizations to which
they so object if such parents or legal guardians present to
the appropriate local school authority a signed statement of
objection, detailing the grounds for the objection. If the
physical condition of the child is such that any one or more of
the immunizing agents should not be administered, the examining
physician, advanced practice nurse, or physician assistant
responsible for the performance of the health examination shall
endorse that fact upon the health examination form. Exempting a
child from the health or dental examination does not exempt the
child from participation in the program of physical education
training provided in Sections 27-5 through 27-7 of this Code.
    (9) For the purposes of this Section, "nursery schools"
means those nursery schools operated by elementary school
systems or secondary level school units or institutions of
higher learning.
(Source: P.A. 92-703, eff. 7-19-02; 93-504, eff. 1-1-04;
93-530, eff. 1-1-04; 93-946, eff. 7-1-05; 93-966, eff. 1-1-05;
revised 12-1-05.)
 
    Section 30. The Illinois Insurance Code is amended by
adding Section 356z.9 as follows:
 
    (215 ILCS 5/356z.9 new)
    Sec. 356z.9. Human papillomavirus vaccine. A group or
individual policy of accident and health insurance or managed
care plan amended, delivered, issued, or renewed after the
effective date of this amendatory Act of the 95th General
Assembly must provide coverage for a human papillomavirus
vaccine (HPV) that is approved for marketing by the federal
Food and Drug Administration.
 
    Section 35. 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, 137, 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, 355.2, 356m, 356v, 356w, 356x,
356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 364.01,
367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 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, and XXVI 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.
(Source: P.A. 93-102, eff. 1-1-04; 93-261, eff. 1-1-04; 93-477,
eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, eff. 1-1-05;
93-1000, eff. 1-1-05; 94-906, eff. 1-1-07; 94-1076, eff.
12-29-06; revised 1-5-07.)
 
    Section 40. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
 
    (215 ILCS 165/10)  (from Ch. 32, par. 604)
    Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v, 356w, 356x,
356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
364.01, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
and 412, and paragraphs (7) and (15) of Section 367 of the
Illinois Insurance Code.
(Source: P.A. 93-102, eff. 1-1-04; 93-529, eff. 8-14-03;
93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; 94-1076, eff.
12-29-06.)
 
    Section 45. The Communicable Disease Prevention Act is
amended by adding Section 2e as follows:
 
    (410 ILCS 315/2e new)
    Sec. 2e. Cervical cancer prevention.
    (a) Notwithstanding the provisions of Section 2 of this
Act, beginning August 1, 2007, the Department of Public Health
must provide all female students who are entering sixth grade
and their parents or legal guardians written information about
the link between human papillomavirus (HPV) and cervical cancer
and the availability of a HPV vaccine.
    (b) The Director of Public Health shall prescribe the
content of the information required in subsection (a) of this
Section.
    (c) In order to provide for the expeditious and timely
implementation of the provisions of this amendatory Act of the
95th General Assembly, the Department of Public Health shall
adopt emergency rules in accordance with Section 5-45 of the
Illinois Administrative Procedure Act to the extent necessary
to administer the Department's responsibilities under this
amendatory Act of the 95th General Assembly. The adoption of
emergency rules authorized by this subsection (c) is deemed to
be necessary for the public interest, safety, and welfare.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 8/24/2007