HB4857 100TH GENERAL ASSEMBLY

LRB100 18834 SMS 34076 b

100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4857

Introduced , by Rep. Marcus C. Evans, Jr.

SYNOPSIS AS INTRODUCED:

New Act

Creates the Cancer Patient Choice Act. Provides that commercial insurance that covers specified radiation therapy for the delivery of a biological effective dose shall cover the delivery of the same biological effective dose for the same indication with physician-prescribed proton therapy and pay the same aggregate amount as an in-network service. Provides that the appropriate course of radiation therapy shall be determined and prescribed by the patient's treating radiation oncologist. Provides that the benefits required under the Act are subject to deductible and co-insurance amounts within the policy if the deductible and co-insurance are no greater than the deductible and co-insurance established for all other similar benefits within that policy. Provides that the Act does not apply to certain insurance coverage. Effective January 1, 2019.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Cancer Patient Choice Act.

Section 5. Definitions. As used in this Act:

"Aggregate amount" means the total amount paid by a commercial insurer to deliver a biological effective dose.

"Biological effective dose" means the total prescribed radiation dose delivered in a course of radiation therapy treatments to induce tumor cell death.

"Commercial insurance" includes:

(1) an individual or group health insurance policy providing coverage on an expense incurred basis;

(2) an individual or group service contract issued by a hospital or medical service corporation;

(3) an individual or group service contract issued by a health maintenance organization;

(4) a self-insured group arrangement to the extent not preempted by federal law that is delivered, issued for delivery, or renewed in this State on or after the effective date of this Act; and

(5) a health insurance policy, health plan, group arrangement, or contract in effect on the effective date of this Act.

"Eligible adult patient" means a patient who is more than 18 years of age and is prescribed proton therapy for the treatment of cancer in place of intensity modulated radiation therapy.

"Intensity modulated radiation therapy" means a type of conformal radiation therapy that delivers x-ray radiation beams of different intensities from many angles for the treatment of tumors.

"Proton therapy" means the advanced form of radiation therapy that utilizes protons as an alternative radiation delivery method for the treatment of tumors.

"Radiation therapy" means the delivery of a biological effective dose with proton therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, 3-dimensional conformal radiation therapy, or other forms of therapy using radiation.

"Treatment dose" means the amount of radiation delivered in a single treatment or fraction of radiation therapy.

Section 10. Cancer patient's choice.

(a) To afford an eligible adult patient the right to choose the radiation therapy delivery method that his or her physician determines will result in the best clinical outcome and to establish parity among the various methods of delivering radiation therapy, all commercial insurance that covers intensity modulated radiation therapy for the delivery of a biological effective dose for a particular indication shall cover the delivery of the same biological effective dose for the same indication with physician-prescribed proton therapy and pay the same aggregate amount as an in-network service.

(b) The appropriate course of intensity modulated radiation therapy and, where appropriate, the alternative course of proton therapy to deliver the same biological effective dose shall be determined and prescribed by the eligible adult patient's treating radiation oncologist, who must be board certified or board eligible in the specialty of radiation oncology.

(c) The benefits required by this Act are subject to the annual deductible and co-insurance established for radiation therapy and other similar benefits within the policy or contract of insurance if the annual deductible and co-insurance for a radiation therapy delivery method permitted by this Section are no greater than the annual deductible and co-insurance established for all other similar benefits within that policy or contract of insurance.

(d) This Act does not apply to insurance coverage providing benefits for the following policies:

(1) hospital confinement indemnity;

(2) disability income;

(3) accident-only;

(4) long-term care;

(5) limited benefit health;

(6) specific disease indemnity;

(7) sickness or bodily injury or death by accident; or

(8) other limited benefit policies.

Section 99. Effective date. This Act takes effect January 1, 2019.