Public Act 102-0034
 
SB1096 EnrolledLRB102 04919 CPF 14938 b


  
    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.