Sen. Jil Tracy

Filed: 5/7/2021

 

 


 

 


 
10200SB2158sam002LRB102 14125 BMS 26185 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,

 

 

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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,

 

 

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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;

 

 

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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,

 

 

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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,

 

 

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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

 

 

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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, and laser treatments approved by the U.S. Food
8and Drug Administration in children aged 18 years and younger
9that are intended to prevent functional impairment related to
10vision function, oral function, inflammation, bleeding,
11infection, and other medical complications associated with
12port-wine stains.
13    (b) Coverage for treatment required under this Section
14shall not include treatment solely for cosmetic purposes.
 
15    Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
 
17    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
18    Sec. 5-3. Insurance Code provisions.
19    (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140,
21141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
22154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
23355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
24356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,

 

 

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1356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
2356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
3356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
4356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
5368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
6408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
7(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
8XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
9Insurance Code.
10    (b) For purposes of the Illinois Insurance Code, except
11for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
12Health Maintenance Organizations in the following categories
13are deemed to be "domestic companies":
14        (1) a corporation authorized under the Dental Service
15    Plan Act or the Voluntary Health Services Plans Act;
16        (2) a corporation organized under the laws of this
17    State; or
18        (3) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a "domestic company" under Article VIII
23    1/2 of the Illinois Insurance Code.
24    (c) In considering the merger, consolidation, or other
25acquisition of control of a Health Maintenance Organization
26pursuant to Article VIII 1/2 of the Illinois Insurance Code,

 

 

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

 

 

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

 

 

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

 

 

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1the group or enrollment unit a description of the method used
2to calculate (1) the Health Maintenance Organization's
3profitable experience with respect to the group or enrollment
4unit and the resulting refund to the group or enrollment unit
5or (2) the Health Maintenance Organization's unprofitable
6experience with respect to the group or enrollment unit and
7the resulting additional premium to be paid by the group or
8enrollment unit.
9    In no event shall the Illinois Health Maintenance
10Organization Guaranty Association be liable to pay any
11contractual obligation of an insolvent organization to pay any
12refund authorized under this Section.
13    (g) Rulemaking authority to implement Public Act 95-1045,
14if any, is conditioned on the rules being adopted in
15accordance with all provisions of the Illinois Administrative
16Procedure Act and all rules and procedures of the Joint
17Committee on Administrative Rules; any purported rule not so
18adopted, for whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
22eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
23101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
241-1-20; 101-625, eff. 1-1-21.)
 
25    Section 35. The Limited Health Service Organization Act is

 

 

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1amended by changing Section 4003 as follows:
 
2    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
3    Sec. 4003. Illinois Insurance Code provisions. Limited
4health service organizations shall be subject to the
5provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
6141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
7154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
8355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
9356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
10401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
11444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
12XXV, and XXVI of the Illinois Insurance Code. For purposes of
13the Illinois Insurance Code, except for Sections 444 and 444.1
14and Articles XIII and XIII 1/2, limited health service
15organizations in the following categories are deemed to be
16domestic companies:
17        (1) a corporation under the laws of this State; or
18        (2) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a domestic company under Article VIII
23    1/2 of the Illinois Insurance Code.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
25100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.

 

 

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11-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
2eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
3    Section 40. The Voluntary Health Services Plans Act is
4amended by changing Section 10 as follows:
 
5    (215 ILCS 165/10)  (from Ch. 32, par. 604)
6    Sec. 10. Application of Insurance Code provisions. Health
7services plan corporations and all persons interested therein
8or dealing therewith shall be subject to the provisions of
9Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
10143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
11356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
12356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
13356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
14356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
15356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
16367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
17and paragraphs (7) and (15) of Section 367 of the Illinois
18Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.

 

 

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1(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
2100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
31-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
4eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
5101-625, eff. 1-1-21.)
 
6    Section 45. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
14356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
15of the Illinois Insurance Code and (ii) be subject to the
16provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
17the Illinois Insurance Code.
18    The Department, by rule, shall adopt a model similar to
19the requirements of Section 356z.39 of the Illinois Insurance
20Code.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate
24of reimbursement for services or other payments in accordance

 

 

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1with Section 5-5e.
2    To ensure full access to the benefits set forth in this
3Section, on and after January 1, 2016, the Department shall
4ensure that provider and hospital reimbursement for
5post-mastectomy care benefits required under this Section are
6no lower than the Medicare reimbursement rate.
7(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
8100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
97-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
10eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".