HB0147 Engrossed

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 
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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 
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Code
requirements.  The program of health
benefits shall provide 
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the post-mastectomy care benefits required to be covered
by a 
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policy of accident and health insurance under Section 356t of 
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the Illinois
Insurance Code.  The program of health benefits 
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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 
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Insurance Code.
The program of health benefits must comply with 
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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; 
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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 
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Duties Law of the
Civil Administrative Code of Illinois is 
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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 
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early detection and
treatment.
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    (a) From funds made available for this purpose, the

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Department shall publish, in layman's language, a
standardized 
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written summary outlining methods for the early detection and

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diagnosis of breast cancer.  The summary shall include 
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recommended
guidelines for screening and detection of breast 
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cancer through the use of
techniques that shall include but not 
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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 
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mammography
services from facilities that
are certified to 
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perform mammography as required by the
federal Mammography 
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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, 
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including, but not limited to,
hormonal, radiological, 
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chemotherapeutic, or surgical treatments or
combinations 
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thereof.  The summary shall contain information on breast

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reconstructive surgery, including, but not limited to, the use 
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of breast
implants and their side effects.
The summary shall 
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inform the
patient of the advantages, disadvantages, risks, and 
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dangers of the various
procedures.
The summary shall include 
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(i) a statement that mammography is the most
accurate method 
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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 
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statement that
it is
important to perform a breast 
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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 
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recommendations by the Centers for Disease Control and 
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Prevention and the American Cancer Society for mammography, 
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clinical breast exams, and breast self-exams.

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    (c-10) The summary shall also inform individuals that 
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public and private insurance providers shall pay for clinical 
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breast exams as part of an exam, as indicated by guidelines of 
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practice.

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    (d) In developing the summary, the Department shall consult 
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with the
Advisory Board of Cancer Control, the Illinois State 
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Medical Society and
consumer groups.  The summary shall be 
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updated by the Department every 2 years.

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    (e) The summaries shall additionally be translated into 
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Spanish, and
the Department shall conduct a public information 
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campaign to distribute
the summaries to the Hispanic women of 
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this State in order to inform them
of the importance of early 
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detection and mammograms.

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    (f) The Department shall distribute the summary to 
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hospitals, public
health centers, and physicians who are likely 
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to perform or order
diagnostic
tests for breast disease or 
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treat breast cancer by surgical or other
medical methods.  Those 
 


 






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hospitals, public health centers, and physicians
shall make the 
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summaries available to the public.  The Department shall
also 
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distribute the summaries to any person, organization, or other

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interested parties upon request.  The summaries may be 
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duplicated by any
person, provided the copies are identical to 
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the current summary
prepared
by the Department.

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    (g) The summary shall display, on the inside of its cover, 
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printed in
capital letters, in bold face type, the following 
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paragraph:

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    "The information contained in this brochure regarding 
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recommendations for
early detection and diagnosis of breast 
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disease and alternative breast
disease treatments is only for 
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the purpose of assisting you, the patient,
in understanding the 
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medical information and advice offered by your
physician.  This 
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brochure cannot serve as a substitute for the sound

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professional advice of your physician.  The availability of this 
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brochure
or the information contained within is not intended to 
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alter, in any way,
the existing physician-patient 
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relationship, nor the existing professional
obligations of 
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your physician in the delivery of medical services to you,
the 
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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 
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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, 
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including a home
rule
county, is a self-insurer for purposes of 
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providing health insurance coverage
for its employees, the 
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coverage shall include coverage for the post-mastectomy
care 
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benefits required to be covered by a policy of accident and 
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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 
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Illinois Insurance Code.  The requirement that health benefits 
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be covered
as provided in this Section is an
exclusive power 
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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 
13
Constitution.  A home
rule county to which this Section applies 
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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 
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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 
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municipality, including a
home rule municipality, is a 
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self-insurer for purposes of providing health
insurance 
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coverage for its employees, the coverage shall include coverage 
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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 
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and the coverage required
under Sections 356g.5, 356u, 356w, 
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356x and 356z.6 of the Illinois
Insurance
Code.  The requirement 
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that health
benefits be covered as provided in this is an 
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exclusive power and function of
the State and is a denial and 
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limitation under Article VII, Section 6,
subsection (h) of the 
7
Illinois Constitution.  A home rule municipality to which
this 
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Section applies must comply with every provision of this 
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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 
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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 
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protection and
benefits
for employees shall provide the 
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post-mastectomy care benefits required to be
covered by a 
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policy of accident and health insurance under Section 356t and 
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the
coverage required under Sections 356g.5, 356u, 356w, 356x 
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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 
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Section 356g.5 as follows:
 
 


 






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    (215 ILCS 5/356g.5  new)
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    Sec. 356g.5. Clinical breast exam.
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    (a) The General Assembly finds that clinical breast 
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examinations are a critical tool in the early detection of 
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breast cancer, while the disease is in its earlier and 
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potentially more treatable stages. Insurer reimbursement of 
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clinical breast examinations is essential to the effort to 
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reduce breast cancer deaths in Illinois.
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    (b) Every insurer shall provide, in each group or 
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individual policy, contract, or certificate of accident or 
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health insurance issued or renewed for persons who are 
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residents of Illinois, coverage for complete and thorough 
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clinical breast examinations as indicated by guidelines of 
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practice, performed by a physician licensed to practice 
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medicine in all its branches, an advanced practice nurse who 
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has a collaborative agreement with a collaborating physician 
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that authorizes breast
examinations, or a physician assistant 
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who has been delegated authority to provide breast 
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examinations, to check for lumps and other changes for the 
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purpose of early detection and prevention of breast cancer as 
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follows:
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        (1) at least every 3 years for women at least 20 years 
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    of age but less than 40 years of age; and
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        (2) annually for women 40 years of age or older.
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    (c) Upon approval of a nationally recognized separate and 
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distinct clinical breast exam code that is compliant with all 
 


 






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State and federal laws, rules, and regulations, public and 
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private insurance plans shall take action to cover clinical 
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breast exams on a separate and distinct basis.
 
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    Section 10. The Health Maintenance Organization Act is 
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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 
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Code
requirements.  A health maintenance organization is 
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subject to the provisions
of Sections 155.37, 356g.5, 356t, 
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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; 
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92-651, eff.
7-11-02.)

 
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    Section 15. The Voluntary Health Services Plans Act is 
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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 
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services
plan corporations and all persons interested therein 
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or dealing therewith
shall be subject to the provisions of 
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Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, 
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149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, 
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356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 364.01, 
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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; 
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92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 
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93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff. 
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1-1-05; revised 10-14-04.)

 
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    Section 20. The Illinois Public Aid Code is amended  by 
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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 
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assistance program
shall
(i) provide the post-mastectomy care 
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benefits required to be covered by a policy of
accident and 
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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 
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Illinois
Insurance Code and (ii) be subject to the provisions 
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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; 
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revised 10-14-04.)

 

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    Section 99. Effective date. This Act takes effect upon 
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becoming law.