Sen. Jil Tracy

Filed: 5/4/2021

 

 


 

 


 
10200SB2158sam001LRB102 14125 BMS 26120 a

1
AMENDMENT TO SENATE BILL 2158

2    AMENDMENT NO. ______. Amend Senate Bill 2158 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

10200SB2158sam001- 2 -LRB102 14125 BMS 26120 a

1356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
2Code. The program of health benefits must comply with Sections
3155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
4XXXIIB of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
18eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
19101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
201-1-21.)
 
21    Section 10. The Counties Code is amended by changing
22Section 5-1069.3 as follows:
 
23    (55 ILCS 5/5-1069.3)
24    Sec. 5-1069.3. Required health benefits. If a county,

 

 

10200SB2158sam001- 3 -LRB102 14125 BMS 26120 a

1including a home rule county, is a self-insurer for purposes
2of providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
10of the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an
15exclusive power and function of the State and is a denial and
16limitation under Article VII, Section 6, subsection (h) of the
17Illinois Constitution. A home rule county to which this
18Section applies must comply with every provision of this
19Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

10200SB2158sam001- 4 -LRB102 14125 BMS 26120 a

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4101-625, eff. 1-1-21.)
 
5    Section 15. The Illinois Municipal Code is amended by
6changing Section 10-4-2.3 as follows:
 
7    (65 ILCS 5/10-4-2.3)
8    Sec. 10-4-2.3. Required health benefits. If a
9municipality, including a home rule municipality, is a
10self-insurer for purposes of providing health insurance
11coverage for its employees, the coverage shall include
12coverage for the post-mastectomy care benefits required to be
13covered by a policy of accident and health insurance under
14Section 356t and the coverage required under Sections 356g,
15356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
19Code. The coverage shall comply with Sections 155.22a, 355b,
20356z.19, and 370c of the Illinois Insurance Code. The
21Department of Insurance shall enforce the requirements of this
22Section. The requirement that health benefits be covered as
23provided in this is an exclusive power and function of the
24State and is a denial and limitation under Article VII,

 

 

10200SB2158sam001- 5 -LRB102 14125 BMS 26120 a

1Section 6, subsection (h) of the Illinois Constitution. A home
2rule municipality to which this Section applies must comply
3with every provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
11100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
121-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
13eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
14101-625, eff. 1-1-21.)
 
15    Section 20. The School Code is amended by changing Section
1610-22.3f as follows:
 
17    (105 ILCS 5/10-22.3f)
18    Sec. 10-22.3f. Required health benefits. Insurance
19protection and benefits for employees shall provide the
20post-mastectomy care benefits required to be covered by a
21policy of accident and health insurance under Section 356t and
22the coverage required under Sections 356g, 356g.5, 356g.5-1,
23356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
24356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

10200SB2158sam001- 6 -LRB102 14125 BMS 26120 a

1356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
2of the Illinois Insurance Code. Insurance policies shall
3comply with Section 356z.19 of the Illinois Insurance Code.
4The coverage shall comply with Sections 155.22a, 355b, and
5370c of the Illinois Insurance Code. The Department of
6Insurance shall enforce the requirements of this Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
14100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
151-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
16eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
17101-625, eff. 1-1-21.)
 
18    Section 25. The Illinois Insurance Code is amended by
19adding Section 356z.43 as follows:
 
20    (215 ILCS 5/356z.43 new)
21    Sec. 356z.43. Coverage for port-wine stain treatment.
22    (a) A group or individual policy of accident and health
23insurance or managed care plan amended, delivered, issued, or
24renewed on or after January 1, 2022 shall provide coverage for

 

 

10200SB2158sam001- 7 -LRB102 14125 BMS 26120 a

1treatment to eliminate or provide maximum feasible treatment
2of nevus flammeus, also known as port-wine stains, including,
3but not limited to, port-wine stains caused by Sturge-Weber
4syndrome. For purposes of this Section, treatment or maximum
5feasible treatment shall include early intervention treatment,
6including topical, intralesional, or systemic medical therapy
7and surgery, in children aged 5 years and younger that is
8intended to prevent functional impairment related to vision
9and oral function, inflammation, bleeding, and infection.
10    (b) Coverage for treatment required under this Section
11shall not include treatment solely for cosmetic purposes.
 
12    Section 30. The Health Maintenance Organization Act is
13amended by changing Section 5-3 as follows:
 
14    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
15    Sec. 5-3. Insurance Code provisions.
16    (a) Health Maintenance Organizations shall be subject to
17the provisions of Sections 133, 134, 136, 137, 139, 140,
18141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
19154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
20355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
21356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
23356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
24356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,

 

 

10200SB2158sam001- 8 -LRB102 14125 BMS 26120 a

1356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
2368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
3408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
4(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
5XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
6Insurance Code.
7    (b) For purposes of the Illinois Insurance Code, except
8for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9Health Maintenance Organizations in the following categories
10are deemed to be "domestic companies":
11        (1) a corporation authorized under the Dental Service
12    Plan Act or the Voluntary Health Services Plans Act;
13        (2) a corporation organized under the laws of this
14    State; or
15        (3) a corporation organized under the laws of another
16    state, 30% or more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a "domestic company" under Article VIII
20    1/2 of the Illinois Insurance Code.
21    (c) In considering the merger, consolidation, or other
22acquisition of control of a Health Maintenance Organization
23pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24        (1) the Director shall give primary consideration to
25    the continuation of benefits to enrollees and the
26    financial conditions of the acquired Health Maintenance

 

 

10200SB2158sam001- 9 -LRB102 14125 BMS 26120 a

1    Organization after the merger, consolidation, or other
2    acquisition of control takes effect;
3        (2)(i) the criteria specified in subsection (1)(b) of
4    Section 131.8 of the Illinois Insurance Code shall not
5    apply and (ii) the Director, in making his determination
6    with respect to the merger, consolidation, or other
7    acquisition of control, need not take into account the
8    effect on competition of the merger, consolidation, or
9    other acquisition of control;
10        (3) the Director shall have the power to require the
11    following information:
12            (A) certification by an independent actuary of the
13        adequacy of the reserves of the Health Maintenance
14        Organization sought to be acquired;
15            (B) pro forma financial statements reflecting the
16        combined balance sheets of the acquiring company and
17        the Health Maintenance Organization sought to be
18        acquired as of the end of the preceding year and as of
19        a date 90 days prior to the acquisition, as well as pro
20        forma financial statements reflecting projected
21        combined operation for a period of 2 years;
22            (C) a pro forma business plan detailing an
23        acquiring party's plans with respect to the operation
24        of the Health Maintenance Organization sought to be
25        acquired for a period of not less than 3 years; and
26            (D) such other information as the Director shall

 

 

10200SB2158sam001- 10 -LRB102 14125 BMS 26120 a

1        require.
2    (d) The provisions of Article VIII 1/2 of the Illinois
3Insurance Code and this Section 5-3 shall apply to the sale by
4any health maintenance organization of greater than 10% of its
5enrollee population (including without limitation the health
6maintenance organization's right, title, and interest in and
7to its health care certificates).
8    (e) In considering any management contract or service
9agreement subject to Section 141.1 of the Illinois Insurance
10Code, the Director (i) shall, in addition to the criteria
11specified in Section 141.2 of the Illinois Insurance Code,
12take into account the effect of the management contract or
13service agreement on the continuation of benefits to enrollees
14and the financial condition of the health maintenance
15organization to be managed or serviced, and (ii) need not take
16into account the effect of the management contract or service
17agreement on competition.
18    (f) Except for small employer groups as defined in the
19Small Employer Rating, Renewability and Portability Health
20Insurance Act and except for medicare supplement policies as
21defined in Section 363 of the Illinois Insurance Code, a
22Health Maintenance Organization may by contract agree with a
23group or other enrollment unit to effect refunds or charge
24additional premiums under the following terms and conditions:
25        (i) the amount of, and other terms and conditions with
26    respect to, the refund or additional premium are set forth

 

 

10200SB2158sam001- 11 -LRB102 14125 BMS 26120 a

1    in the group or enrollment unit contract agreed in advance
2    of the period for which a refund is to be paid or
3    additional premium is to be charged (which period shall
4    not be less than one year); and
5        (ii) the amount of the refund or additional premium
6    shall not exceed 20% of the Health Maintenance
7    Organization's profitable or unprofitable experience with
8    respect to the group or other enrollment unit for the
9    period (and, for purposes of a refund or additional
10    premium, the profitable or unprofitable experience shall
11    be calculated taking into account a pro rata share of the
12    Health Maintenance Organization's administrative and
13    marketing expenses, but shall not include any refund to be
14    made or additional premium to be paid pursuant to this
15    subsection (f)). The Health Maintenance Organization and
16    the group or enrollment unit may agree that the profitable
17    or unprofitable experience may be calculated taking into
18    account the refund period and the immediately preceding 2
19    plan years.
20    The Health Maintenance Organization shall include a
21statement in the evidence of coverage issued to each enrollee
22describing the possibility of a refund or additional premium,
23and upon request of any group or enrollment unit, provide to
24the group or enrollment unit a description of the method used
25to calculate (1) the Health Maintenance Organization's
26profitable experience with respect to the group or enrollment

 

 

10200SB2158sam001- 12 -LRB102 14125 BMS 26120 a

1unit and the resulting refund to the group or enrollment unit
2or (2) the Health Maintenance Organization's unprofitable
3experience with respect to the group or enrollment unit and
4the resulting additional premium to be paid by the group or
5enrollment unit.
6    In no event shall the Illinois Health Maintenance
7Organization Guaranty Association be liable to pay any
8contractual obligation of an insolvent organization to pay any
9refund authorized under this Section.
10    (g) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in
12accordance with all provisions of the Illinois Administrative
13Procedure Act and all rules and procedures of the Joint
14Committee on Administrative Rules; any purported rule not so
15adopted, for whatever reason, is unauthorized.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
19eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
20101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
211-1-20; 101-625, eff. 1-1-21.)
 
22    Section 35. The Limited Health Service Organization Act is
23amended by changing Section 4003 as follows:
 
24    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)

 

 

10200SB2158sam001- 13 -LRB102 14125 BMS 26120 a

1    Sec. 4003. Illinois Insurance Code provisions. Limited
2health service organizations shall be subject to the
3provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
5154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
6355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
7356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
8401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
9444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
10XXV, and XXVI of the Illinois Insurance Code. For purposes of
11the Illinois Insurance Code, except for Sections 444 and 444.1
12and Articles XIII and XIII 1/2, limited health service
13organizations in the following categories are deemed to be
14domestic companies:
15        (1) a corporation under the laws of this State; or
16        (2) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a domestic company under Article VIII
21    1/2 of the Illinois Insurance Code.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
25eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 

 

 

10200SB2158sam001- 14 -LRB102 14125 BMS 26120 a

1    Section 40. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
10356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
11356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
12356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
14367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
15and paragraphs (7) and (15) of Section 367 of the Illinois
16Insurance Code.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
24100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
251-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,

 

 

10200SB2158sam001- 15 -LRB102 14125 BMS 26120 a

1eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
2101-625, eff. 1-1-21.)
 
3    Section 45. The Illinois Public Aid Code is amended by
4changing Section 5-16.8 as follows:
 
5    (305 ILCS 5/5-16.8)
6    Sec. 5-16.8. Required health benefits. The medical
7assistance program shall (i) provide the post-mastectomy care
8benefits required to be covered by a policy of accident and
9health insurance under Section 356t and the coverage required
10under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
11356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
12of the Illinois Insurance Code and (ii) be subject to the
13provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
14the Illinois Insurance Code.
15    The Department, by rule, shall adopt a model similar to
16the requirements of Section 356z.39 of the Illinois Insurance
17Code.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate
21of reimbursement for services or other payments in accordance
22with Section 5-5e.
23    To ensure full access to the benefits set forth in this
24Section, on and after January 1, 2016, the Department shall

 

 

10200SB2158sam001- 16 -LRB102 14125 BMS 26120 a

1ensure that provider and hospital reimbursement for
2post-mastectomy care benefits required under this Section are
3no lower than the Medicare reimbursement rate.
4(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
5100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
67-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
7eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".