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Public Act 095-0189
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| HB0147 Enrolled |
LRB095 03747 DRJ 23776 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. The State Employees Group Insurance Act of 1971 |
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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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 356g.5,
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356u, 356w, 356x, 356z.2, 356z.4, and 356z.6 of the
Illinois |
Insurance Code.
The program of health benefits must comply with |
Section 155.37 of the
Illinois Insurance Code.
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(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.)
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Section 2. The Department of Public Health Powers and |
Duties Law of the
Civil Administrative Code of Illinois is |
amended by changing Section 2310-345 as follows:
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(20 ILCS 2310/2310-345) (was 20 ILCS 2310/55.49)
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Sec. 2310-345. Breast cancer; written summary regarding |
early detection and
treatment. |
(a) From funds made available for this purpose, the
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Department shall publish, in layman's language, a
standardized |
written summary outlining methods for the early detection and
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diagnosis of breast cancer. The summary shall include |
recommended
guidelines for screening and detection of breast |
cancer through the use of
techniques that shall include but not |
be limited to self-examination, clinical breast exams, and
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diagnostic radiology.
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(b) The summary shall also suggest that women seek |
mammography
services from facilities that
are certified to |
perform mammography as required by the
federal Mammography |
Quality Standards Act of 1992.
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(c) The summary shall also include the medically viable
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alternative
methods for the treatment of breast cancer, |
including, but not limited to,
hormonal, radiological, |
chemotherapeutic, or surgical treatments or
combinations |
thereof. The summary shall contain information on breast
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reconstructive surgery, including, but not limited to, the use |
of breast
implants and their side effects.
The summary shall |
inform the
patient of the advantages, disadvantages, risks, and |
dangers of the various
procedures.
The summary shall include |
(i) a statement that mammography is the most
accurate method |
for making an early detection of breast cancer, however, no
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diagnostic tool is 100% effective, (ii) the benefits of |
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clinical breast exams, and (iii)
and (ii) instructions for
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instructions for performing breast self-examination and a |
statement that
it is
important to perform a breast |
self-examination monthly.
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(c-5) The summary shall specifically address the benefits
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of early detection and review the clinical standard |
recommendations by the Centers for Disease Control and |
Prevention and the American Cancer Society for mammography, |
clinical breast exams, and breast self-exams.
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(c-10) The summary shall also inform individuals that |
public and private insurance providers shall pay for clinical |
breast exams as part of an exam, as indicated by guidelines of |
practice.
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(d) In developing the summary, the Department shall consult |
with the
Advisory Board of Cancer Control, the Illinois State |
Medical Society and
consumer groups. The summary shall be |
updated by the Department every 2 years.
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(e) The summaries shall additionally be translated into |
Spanish, and
the Department shall conduct a public information |
campaign to distribute
the summaries to the Hispanic women of |
this State in order to inform them
of the importance of early |
detection and mammograms.
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(f) The Department shall distribute the summary to |
hospitals, public
health centers, and physicians who are likely |
to perform or order
diagnostic
tests for breast disease or |
treat breast cancer by surgical or other
medical methods. Those |
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hospitals, public health centers, and physicians
shall make the |
summaries available to the public. The Department shall
also |
distribute the summaries to any person, organization, or other
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interested parties upon request. The summaries may be |
duplicated by any
person, provided the copies are identical to |
the current summary
prepared
by the Department.
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(g) The summary shall display, on the inside of its cover, |
printed in
capital letters, in bold face type, the following |
paragraph:
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"The information contained in this brochure regarding |
recommendations for
early detection and diagnosis of breast |
disease and alternative breast
disease treatments is only for |
the purpose of assisting you, the patient,
in understanding the |
medical information and advice offered by your
physician. This |
brochure cannot serve as a substitute for the sound
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professional advice of your physician. The availability of this |
brochure
or the information contained within is not intended to |
alter, in any way,
the existing physician-patient |
relationship, nor the existing professional
obligations of |
your physician in the delivery of medical services to you,
the |
patient."
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(h) The summary shall be updated when necessary.
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(Source: P.A. 91-239, eff. 1-1-00; revised 10-19-05.)
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Section 3. The Counties Code is amended by changing Section |
5-1069.3 as follows:
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(55 ILCS 5/5-1069.3)
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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 356g.5, 356u,
356w, 356x and 356z.6 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
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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.
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(Source: P.A. 93-853, eff. 1-1-05.)
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Section 3.5. The Illinois Municipal Code is amended by |
changing Section 10-4-2.3 as follows:
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(65 ILCS 5/10-4-2.3)
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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 |
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a policy of
accident and health insurance under Section 356t |
and the coverage required
under Sections 356g.5, 356u, 356w, |
356x and 356z.6 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.
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(Source: P.A. 93-853, eff. 1-1-05.)
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Section 4. The School Code is amended by changing Section |
10-22.3f as follows:
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(105 ILCS 5/10-22.3f)
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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 356g.5, 356u, 356w, 356x |
and 356z.6 of
the
Illinois Insurance Code.
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(Source: P.A. 93-853, eff. 1-1-05.)
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Section 5. The Illinois Insurance Code is amended by adding |
Section 356g.5 as follows:
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(215 ILCS 5/356g.5 new) |
Sec. 356g.5. Clinical breast exam. |
(a) The General Assembly finds that clinical breast |
examinations are a critical tool in the early detection of |
breast cancer, while the disease is in its earlier and |
potentially more treatable stages. Insurer reimbursement of |
clinical breast examinations is essential to the effort to |
reduce breast cancer deaths in Illinois. |
(b) Every insurer shall provide, in each group or |
individual policy, contract, or certificate of accident or |
health insurance issued or renewed for persons who are |
residents of Illinois, coverage for complete and thorough |
clinical breast examinations as indicated by guidelines of |
practice, performed by a physician licensed to practice |
medicine in all its branches, an advanced practice nurse who |
has a collaborative agreement with a collaborating physician |
that authorizes breast
examinations, or a physician assistant |
who has been delegated authority to provide breast |
examinations, to check for lumps and other changes for the |
purpose of early detection and prevention of breast cancer as |
follows: |
(1) at least every 3 years for women at least 20 years |
of age but less than 40 years of age; and |
(2) annually for women 40 years of age or older. |
(c) Upon approval of a nationally recognized separate and |
distinct clinical breast exam code that is compliant with all |
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State and federal laws, rules, and regulations, public and |
private insurance plans shall take action to cover clinical |
breast exams on a separate and distinct basis.
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Section 10. The Health Maintenance Organization Act is |
amended by changing Section 4-6.5 as follows:
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(215 ILCS 125/4-6.5)
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Sec. 4-6.5. Required health benefits; Illinois Insurance |
Code
requirements. A health maintenance organization is |
subject to the provisions
of Sections 155.37, 356g.5, 356t, |
356u, and 356z.1 of the Illinois Insurance Code.
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(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; |
92-651, eff.
7-11-02.)
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Section 15. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows:
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(215 ILCS 165/10) (from Ch. 32, par. 604)
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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, 356g.5, 356r, 356t, 356u, 356v,
356w, |
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 364.01, |
367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
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and paragraphs (7) and (15) of Section 367 of the Illinois
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Insurance Code.
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(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; |
92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; |
93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff. |
1-1-05; revised 10-14-04.)
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Section 20. The Illinois Public Aid Code is amended by |
changing Section 5-16.8 as follows:
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(305 ILCS 5/5-16.8)
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Sec. 5-16.8. Required health benefits. The medical |
assistance program
shall
(i) 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
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under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the |
Illinois
Insurance Code and (ii) be subject to the provisions |
of Section 364.01 of the Illinois
Insurance Code.
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(Source: P.A. 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; |
revised 10-14-04.)
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Section 99. Effective date. This Act takes effect upon |
becoming law.
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