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91_HB0154eng
HB0154 Engrossed LRB9100692JSpc
1 AN ACT concerning cancer, amending named Acts.
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
5 1971 is amended by changing Section 6.11 as follows:
6 (5 ILCS 375/6.11)
7 Sec. 6.11. Required health benefits. The program of
8 health benefits shall provide the post-mastectomy care
9 benefits required to be covered by a policy of accident and
10 health insurance under Section 356t of the Illinois Insurance
11 Code. The program of health benefits shall provide the
12 coverage required under Sections 356u, 356w, and 356x, 356y,
13 and 356z of the Illinois Insurance Code.
14 (Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98;
15 90-741, eff. 1-1-99.)
16 Section 10. The Civil Administrative Code of Illinois is
17 amended by adding Section 55.91 as follows:
18 (20 ILCS 2310/55.91 new)
19 Sec. 55.91. Breast Cancer Treatment Advisory Committee.
20 (a) The Breast Cancer Treatment Advisory Committee is
21 hereby created. The Committee shall be composed of the
22 following members:
23 (1) 8 members of the General Assembly, 2 each
24 appointed by the Speaker of the House, the President of
25 the Senate, the Minority Leader of the House, and the
26 Minority Leader of the Senate; and
27 (2) 8 members who have knowledge of breast cancer
28 treatment procedures, at least 4 of whom must be
29 physicians licensed to practice medicine in all its
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1 branches, 2 each appointed by the Speaker of the House,
2 the President of the Senate, the Minority Leader of the
3 House, and the Minority Leader of the Senate.
4 (b) Members of the committee shall serve for a term that
5 ends on the expiration of the General Assembly during which
6 they were appointed. Members of the committee who are not
7 members of the General Assembly shall receive a per diem of
8 $150 for each day of attendance at committee meetings. The
9 Speaker of the House and the President of the Senate shall
10 each designate one member of the committee to serve as
11 co-chairperson of the committee. The committee shall meet at
12 the times and places designated by the co-chairpersons.
13 (c) The committee shall review and study techniques and
14 modalities effective in the prevention, detection, treatment,
15 or cure of breast cancer and make recommendations to the
16 General Assembly of legislation necessary or desirable to
17 improve treatment of breast cancer.
18 (d) The Department of Public Health shall provide
19 necessary staff support to perform the functions of the
20 committee, including the preparation of its recommendations
21 to the General Assembly.
22 Section 20. The State Mandates Act is amended by adding
23 Section 8.23 as follows:
24 (30 ILCS 805/8.23 new)
25 Sec. 8.23. Exempt mandate. Notwithstanding Sections 6
26 and 8 of this Act, no reimbursement by the State is required
27 for the implementation of any mandate created by this
28 amendatory Act of 1999.
29 Section 25. The Illinois Income Tax Act is amended by
30 changing Section 509 as follows:
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1 (35 ILCS 5/509) (from Ch. 120, par. 5-509)
2 Sec. 509. Tax checkoff explanations. All individual
3 income tax return forms shall contain appropriate
4 explanations and spaces to enable the taxpayers to designate
5 contributions to the Child Abuse Prevention Fund, to the
6 Community Health Center Care Fund, to the Illinois Wildlife
7 Preservation Fund as required by the Illinois Non-Game
8 Wildlife Protection Act, to the Alzheimer's Disease Research
9 Fund as required by the Alzheimer's Disease Research Act, to
10 the Assistance to the Homeless Fund as required by this Act,
11 to the Heritage Preservation Fund as required by the Heritage
12 Preservation Act, to the Child Care Expansion Program Fund as
13 required by the Child Care Expansion Program Act, to the Ryan
14 White AIDS Victims Assistance Fund, to the Assistive
15 Technology for Persons with Disabilities Fund, to the
16 Domestic Violence Shelter and Service Fund, to the United
17 States Olympians Assistance Fund, to the Youth Drug Abuse
18 Prevention Fund, to the Persian Gulf Conflict Veterans Fund,
19 to the Literacy Advancement Fund, to the Ryan White Pediatric
20 and Adult AIDS Fund, to the Illinois Special Olympics
21 Checkoff Fund, to the Breast, and Cervical, and Prostate
22 Cancer Research Fund, to the Korean War Memorial Fund, to the
23 Heart Disease Treatment and Prevention Fund, to the
24 Hemophilia Treatment Fund, to the Mental Health Research
25 Fund, to the Children's Cancer Fund, to the American Diabetes
26 Association Fund, the Women in Military Service Memorial
27 Fund, and to the Meals on Wheels Fund. Each form shall
28 contain a statement that the contributions will reduce the
29 taxpayer's refund or increase the amount of payment to
30 accompany the return. Failure to remit any amount of
31 increased payment shall reduce the contribution accordingly.
32 If, on October 1 of any year, the total contributions to
33 any one of the funds, other than the Breast and Cervical
34 Cancer Research Fund, made under this Section do not equal
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1 $100,000 or more, the explanations and spaces for designating
2 contributions to the fund shall be removed from the
3 individual income tax return forms for the following and all
4 subsequent years and all subsequent contributions to the fund
5 shall be refunded to the taxpayer. If, on October 1, 2004 or
6 any year thereafter, the total contributions to the Breast
7 and Cervical Cancer Research Fund made under this Section do
8 not equal $100,000 or more, the explanations and spaces for
9 designating contributions to the fund shall be removed from
10 the individual income tax return forms for the following and
11 all subsequent years and all subsequent contributions to the
12 fund shall be refunded to the taxpayer.
13 (Source: P.A. 89-230, eff. 1-1-96; 89-324, eff. 8-13-95;
14 90-171, eff. 7-23-97.)
15 Section 30. The Counties Code is amended by changing
16 Section 5-1069.3 as follows:
17 (55 ILCS 5/5-1069.3)
18 Sec. 5-1069.3. Required health benefits. If a county,
19 including a home rule county, is a self-insurer for purposes
20 of providing health insurance coverage for its employees, the
21 coverage shall include coverage for the post-mastectomy care
22 benefits required to be covered by a policy of accident and
23 health insurance under Section 356t and the coverage required
24 under Sections 356u, 356w, and 356x, and 356y of the Illinois
25 Insurance Code. The requirement that health benefits be
26 covered as provided in this Section is an exclusive power and
27 function of the State and is a denial and limitation under
28 Article VII, Section 6, subsection (h) of the Illinois
29 Constitution. A home rule county to which this Section
30 applies must comply with every provision of this Section.
31 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
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1 Section 35. The Illinois Municipal Code is amended by
2 changing Section 10-4-2.3 as follows:
3 (65 ILCS 5/10-4-2.3)
4 Sec. 10-4-2.3. Required health benefits. If a
5 municipality, including a home rule municipality, is a
6 self-insurer for purposes of providing health insurance
7 coverage for its employees, the coverage shall include
8 coverage for the post-mastectomy care benefits required to be
9 covered by a policy of accident and health insurance under
10 Section 356t and the coverage required under Sections 356u,
11 356w, and 356x, and 356y of the Illinois Insurance Code. The
12 requirement that health benefits be covered as provided in
13 this is an exclusive power and function of the State and is a
14 denial and limitation under Article VII, Section 6,
15 subsection (h) of the Illinois Constitution. A home rule
16 municipality to which this Section applies must comply with
17 every provision of this Section.
18 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
19 Section 40. The School Code is amended by changing
20 Section 10-22.3f as follows:
21 (105 ILCS 5/10-22.3f)
22 Sec. 10-22.3f. Required health benefits. Insurance
23 protection and benefits for employees shall provide the
24 post-mastectomy care benefits required to be covered by a
25 policy of accident and health insurance under Section 356t
26 and the coverage required under Sections 356u, 356w, and 356x
27 , and 356y of the Illinois Insurance Code.
28 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
29 Section 45. The Illinois Insurance Code is amended by
30 adding Section 356y as follows:
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1 (215 ILCS 5/356y new)
2 Sec. 356y. Coverage for investigational cancer
3 treatments.
4 (a) An individual or group policy of accident and health
5 insurance issued, delivered, amended, or renewed in this
6 State after the effective date of this amendatory Act of the
7 91st General Assembly must provide coverage for patient care
8 of insureds, when medically appropriate, to participate in an
9 approved research trial and shall provide coverage for the
10 patient care provided pursuant to investigational cancer
11 treatments as provided in subsection (b).
12 (b) Coverage must be included for an item or service
13 that would otherwise be covered, subject to the limitations
14 and cost sharing requirements applicable to the item or
15 service, when that item or service is provided to an insured
16 in the course of an investigational cancer treatment if:
17 (1) the treatment is a qualifying cancer
18 investigational treatment ordered or prescribed by a
19 physician licensed to practice medicine in all its
20 branches; and
21 (2) the cancer treatment is administered as part of
22 the medical management of a life-threatening disease,
23 disorder, or health condition.
24 Coverage must be included for an item or service when
25 that item or service is required to provide patient care
26 pursuant to the design of a research trial, except those
27 items or services normally paid for by other funding sources,
28 such as the costs of certain investigational agents, the
29 costs of any nonhealth services that might be required for a
30 person to receive cancer treatment, and the costs of managing
31 the research; items or services subject to this exception may
32 be covered in addition to patient care at the discretion of
33 the health plan.
34 (c) For purposes of this Section, (A) "qualifying
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1 investigational cancer treatment" means a treatment (i) the
2 effectiveness of which has not been determined and (ii) that
3 is under clinical investigation as part of an approved cancer
4 research trial in Phase II, Phase III, or Phase IV of
5 investigation and (B) "approved cancer research trial" means
6 (i) a cancer research trial approved by the U.S. Secretary of
7 Health and Human Services, the Director of the National
8 Institutes of Health, the Commissioner of the Food and Drug
9 Administration (through an investigational new drug exemption
10 under Section 505(1) of the federal Food, Drug and Cosmetic
11 Act or an investigational device exemption under Section
12 520(g) of that Act), the Secretary of Veterans Affairs, the
13 Secretary of Defense, or a qualified nongovernmental cancer
14 research entity as defined in guidelines of the National
15 Institutes of Health or (ii) a peer-reviewed and approved
16 cancer research program, as defined by the U.S. Secretary of
17 Health and Human Services, conducted for the primary purpose
18 of determining whether or not a cancer treatment is safe or
19 efficacious or has any other characteristic of a cancer
20 treatment that must be demonstrated in order for the cancer
21 treatment to be medically necessary or appropriate.
22 (d) This Section is repealed on January 1, 2003.
23 Section 50. The Health Maintenance Organization Act is
24 amended by changing Section 5-3 as follows:
25 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
26 Sec. 5-3. Insurance Code provisions.
27 (a) Health Maintenance Organizations shall be subject to
28 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
29 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
30 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
31 356y, 367i, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
32 444, and 444.1, paragraph (c) of subsection (2) of Section
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1 367, and Articles VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
2 XXV, and XXVI of the Illinois Insurance Code.
3 (b) For purposes of the Illinois Insurance Code, except
4 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
5 Health Maintenance Organizations in the following categories
6 are deemed to be "domestic companies":
7 (1) a corporation authorized under the Dental
8 Service Plan Act or the Voluntary Health Services Plans
9 Act;
10 (2) a corporation organized under the laws of this
11 State; or
12 (3) a corporation organized under the laws of
13 another state, 30% or more of the enrollees of which are
14 residents of this State, except a corporation subject to
15 substantially the same requirements in its state of
16 organization as is a "domestic company" under Article
17 VIII 1/2 of the Illinois Insurance Code.
18 (c) In considering the merger, consolidation, or other
19 acquisition of control of a Health Maintenance Organization
20 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
21 (1) the Director shall give primary consideration
22 to the continuation of benefits to enrollees and the
23 financial conditions of the acquired Health Maintenance
24 Organization after the merger, consolidation, or other
25 acquisition of control takes effect;
26 (2)(i) the criteria specified in subsection (1)(b)
27 of Section 131.8 of the Illinois Insurance Code shall not
28 apply and (ii) the Director, in making his determination
29 with respect to the merger, consolidation, or other
30 acquisition of control, need not take into account the
31 effect on competition of the merger, consolidation, or
32 other acquisition of control;
33 (3) the Director shall have the power to require
34 the following information:
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1 (A) certification by an independent actuary of
2 the adequacy of the reserves of the Health
3 Maintenance Organization sought to be acquired;
4 (B) pro forma financial statements reflecting
5 the combined balance sheets of the acquiring company
6 and the Health Maintenance Organization sought to be
7 acquired as of the end of the preceding year and as
8 of a date 90 days prior to the acquisition, as well
9 as pro forma financial statements reflecting
10 projected combined operation for a period of 2
11 years;
12 (C) a pro forma business plan detailing an
13 acquiring party's plans with respect to the
14 operation of the Health Maintenance Organization
15 sought to be acquired for a period of not less than
16 3 years; and
17 (D) such other information as the Director
18 shall require.
19 (d) The provisions of Article VIII 1/2 of the Illinois
20 Insurance Code and this Section 5-3 shall apply to the sale
21 by any health maintenance organization of greater than 10% of
22 its enrollee population (including without limitation the
23 health maintenance organization's right, title, and interest
24 in and to its health care certificates).
25 (e) In considering any management contract or service
26 agreement subject to Section 141.1 of the Illinois Insurance
27 Code, the Director (i) shall, in addition to the criteria
28 specified in Section 141.2 of the Illinois Insurance Code,
29 take into account the effect of the management contract or
30 service agreement on the continuation of benefits to
31 enrollees and the financial condition of the health
32 maintenance organization to be managed or serviced, and (ii)
33 need not take into account the effect of the management
34 contract or service agreement on competition.
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1 (f) Except for small employer groups as defined in the
2 Small Employer Rating, Renewability and Portability Health
3 Insurance Act and except for medicare supplement policies as
4 defined in Section 363 of the Illinois Insurance Code, a
5 Health Maintenance Organization may by contract agree with a
6 group or other enrollment unit to effect refunds or charge
7 additional premiums under the following terms and conditions:
8 (i) the amount of, and other terms and conditions
9 with respect to, the refund or additional premium are set
10 forth in the group or enrollment unit contract agreed in
11 advance of the period for which a refund is to be paid or
12 additional premium is to be charged (which period shall
13 not be less than one year); and
14 (ii) the amount of the refund or additional premium
15 shall not exceed 20% of the Health Maintenance
16 Organization's profitable or unprofitable experience with
17 respect to the group or other enrollment unit for the
18 period (and, for purposes of a refund or additional
19 premium, the profitable or unprofitable experience shall
20 be calculated taking into account a pro rata share of the
21 Health Maintenance Organization's administrative and
22 marketing expenses, but shall not include any refund to
23 be made or additional premium to be paid pursuant to this
24 subsection (f)). The Health Maintenance Organization and
25 the group or enrollment unit may agree that the
26 profitable or unprofitable experience may be calculated
27 taking into account the refund period and the immediately
28 preceding 2 plan years.
29 The Health Maintenance Organization shall include a
30 statement in the evidence of coverage issued to each enrollee
31 describing the possibility of a refund or additional premium,
32 and upon request of any group or enrollment unit, provide to
33 the group or enrollment unit a description of the method used
34 to calculate (1) the Health Maintenance Organization's
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1 profitable experience with respect to the group or enrollment
2 unit and the resulting refund to the group or enrollment unit
3 or (2) the Health Maintenance Organization's unprofitable
4 experience with respect to the group or enrollment unit and
5 the resulting additional premium to be paid by the group or
6 enrollment unit.
7 In no event shall the Illinois Health Maintenance
8 Organization Guaranty Association be liable to pay any
9 contractual obligation of an insolvent organization to pay
10 any refund authorized under this Section.
11 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98;
12 90-177, eff. 7-23-97; 90-372, eff. 7-1-98; 90-583, eff.
13 5-29-98; 90-655, eff. 7-30-98; 90-741, eff. 1-1-99; revised
14 9-8-98.)
15 Section 55. The Voluntary Health Services Plans Act is
16 amended by changing Section 10 as follows:
17 (215 ILCS 165/10) (from Ch. 32, par. 604)
18 Sec. 10. Application of Insurance Code provisions.
19 Health services plan corporations and all persons interested
20 therein or dealing therewith shall be subject to the
21 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
22 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 356w,
23 356x, 356y, 367.2, 401, 401.1, 402, 403, 403A, 408, 408.2,
24 and 412, and paragraphs (7) and (15) of Section 367 of the
25 Illinois Insurance Code.
26 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97;
27 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 90-741, eff.
28 1-1-99.)
29 Section 99. Effective date. This Act takes effect upon
30 becoming law.
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1 INDEX
2 Statutes amended in order of appearance
3 5 ILCS 375/6.11
4 20 ILCS 2310/55.70
5 20 ILCS 2310/55.91 new
6 30 ILCS 105/5.362
7 30 ILCS 805/8.22 new
8 35 ILCS 5/507L
9 35 ILCS 5/509 from Ch. 120, par. 5-509
10 35 ILCS 5/510 from Ch. 120, par. 5-510
11 55 ILCS 5/5-1069.3
12 65 ILCS 5/10-4-2.3
13 105 ILCS 5/10-22.3f
14 215 ILCS 5/356y new
15 215 ILCS 5/356z new
16 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
17 215 ILCS 165/10 from Ch. 32, par. 604
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