Sen. Mike Simmons

Filed: 3/23/2023

 

 


 

 


 
10300SB1282sam001LRB103 27271 BMS 59902 a

1
AMENDMENT TO SENATE BILL 1282

2    AMENDMENT NO. ______. Amend Senate Bill 1282 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    (Text of Section before amendment by P.A. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,

 

 

10300SB1282sam001- 2 -LRB103 27271 BMS 59902 a

1356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
2356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
3356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
4the Illinois Insurance Code. The program of health benefits
5must comply with Sections 155.22a, 155.37, 355b, 356z.19,
6370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
7Code. The Department of Insurance shall enforce the
8requirements of this Section with respect to Sections 370c and
9370c.1 of the Illinois Insurance Code; all other requirements
10of this Section shall be enforced by the Department of Central
11Management Services.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
19101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
201-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
21eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
22102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
231-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
24eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
25revised 12-13-22.)
 

 

 

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1    (Text of Section after amendment by P.A. 102-768)
2    Sec. 6.11. Required health benefits; Illinois Insurance
3Code requirements. The program of health benefits shall
4provide the post-mastectomy care benefits required to be
5covered by a policy of accident and health insurance under
6Section 356t of the Illinois Insurance Code. The program of
7health benefits shall provide the coverage required under
8Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
9356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
10356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
13356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
14356z.60, and 356z.61 of the Illinois Insurance Code. The
15program of health benefits must comply with Sections 155.22a,
16155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
17the Illinois Insurance Code. The Department of Insurance shall
18enforce the requirements of this Section with respect to
19Sections 370c and 370c.1 of the Illinois Insurance Code; all
20other requirements of this Section shall be enforced by the
21Department of Central Management Services.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on
26Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
3101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
41-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
5eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
6102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
71-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
8eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
9102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
10    Section 10. The Counties Code is amended by changing
11Section 5-1069.3 as follows:
 
12    (55 ILCS 5/5-1069.3)
13    Sec. 5-1069.3. Required health benefits. If a county,
14including a home rule county, is a self-insurer for purposes
15of providing health insurance coverage for its employees, the
16coverage shall include coverage for the post-mastectomy care
17benefits required to be covered by a policy of accident and
18health insurance under Section 356t and the coverage required
19under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
20356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
21356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
22356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
23356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
24356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61

 

 

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1of the Illinois Insurance Code. The coverage shall comply with
2Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
3Insurance Code. The Department of Insurance shall enforce the
4requirements of this Section. The requirement that health
5benefits be covered as provided in this Section is an
6exclusive power and function of the State and is a denial and
7limitation under Article VII, Section 6, subsection (h) of the
8Illinois Constitution. A home rule county to which this
9Section applies must comply with every provision of this
10Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
18101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
191-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
20eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
21102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
221-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
23eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
24102-1117, eff. 1-13-23.)
 
25    Section 15. The Illinois Municipal Code is amended by

 

 

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1changing Section 10-4-2.3 as follows:
 
2    (65 ILCS 5/10-4-2.3)
3    Sec. 10-4-2.3. Required health benefits. If a
4municipality, including a home rule municipality, is a
5self-insurer for purposes of providing health insurance
6coverage for its employees, the coverage shall include
7coverage for the post-mastectomy care benefits required to be
8covered by a policy of accident and health insurance under
9Section 356t and the coverage required under Sections 356g,
10356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
14356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
15356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
16Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
18Insurance Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.
25    Rulemaking authority to implement Public Act 95-1045, if

 

 

10300SB1282sam001- 7 -LRB103 27271 BMS 59902 a

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
7101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
81-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
9eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
10102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
111-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
12eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
13102-1117, eff. 1-13-23.)
 
14    Section 20. The School Code is amended by changing Section
1510-22.3f as follows:
 
16    (105 ILCS 5/10-22.3f)
17    Sec. 10-22.3f. Required health benefits. Insurance
18protection and benefits for employees shall provide the
19post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t and
21the coverage required under Sections 356g, 356g.5, 356g.5-1,
22356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
23356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
24356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

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1356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
3356z.61 of the Illinois Insurance Code. Insurance policies
4shall comply with Section 356z.19 of the Illinois Insurance
5Code. The coverage shall comply with Sections 155.22a, 355b,
6and 370c of the Illinois Insurance Code. The Department of
7Insurance shall enforce the requirements of this Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
15101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
161-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
17eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
18102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
191-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
20eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
21    Section 25. The Illinois Insurance Code is amended by
22adding Section 356z.61 as follows:
 
23    (215 ILCS 5/356z.61 new)
24    Sec. 356z.61. Coverage for liver disease screening. A

 

 

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1group or individual policy of accident and health insurance or
2a managed care plan that is amended, delivered, issued, or
3renewed on or after January 1, 2025 shall provide coverage for
4preventative liver disease screenings for individuals 35 years
5of age or older and under the age of 65 at high risk for liver
6disease, including liver ultrasounds and alpha-fetoprotein
7blood tests every 6 months, without imposing a deductible,
8coinsurance, copayment, or any other cost-sharing requirement
9on the coverage provided; except that this Section does not
10apply to coverage of liver disease screenings to the extent
11such coverage would disqualify a high-deductible health plan
12from eligibility for a health savings account pursuant to
13Section 223 of the Internal Revenue Code.
 
14    Section 30. The Health Maintenance Organization Act is
15amended by changing Section 5-3 as follows:
 
16    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
17    Sec. 5-3. Insurance Code provisions.
18    (a) Health Maintenance Organizations shall be subject to
19the provisions of Sections 133, 134, 136, 137, 139, 140,
20141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
21154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
22355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
23356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
24356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,

 

 

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1356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
2356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
3356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
4356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
5356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
6367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
7402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
8paragraph (c) of subsection (2) of Section 367, and Articles
9IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
10XXXIIB of the Illinois Insurance Code.
11    (b) For purposes of the Illinois Insurance Code, except
12for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
13Health Maintenance Organizations in the following categories
14are deemed to be "domestic companies":
15        (1) a corporation authorized under the Dental Service
16    Plan Act or the Voluntary Health Services Plans Act;
17        (2) a corporation organized under the laws of this
18    State; or
19        (3) a corporation organized under the laws of another
20    state, 30% or more of the enrollees of which are residents
21    of this State, except a corporation subject to
22    substantially the same requirements in its state of
23    organization as is a "domestic company" under Article VIII
24    1/2 of the Illinois Insurance Code.
25    (c) In considering the merger, consolidation, or other
26acquisition of control of a Health Maintenance Organization

 

 

10300SB1282sam001- 11 -LRB103 27271 BMS 59902 a

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

 

 

10300SB1282sam001- 12 -LRB103 27271 BMS 59902 a

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

 

 

10300SB1282sam001- 13 -LRB103 27271 BMS 59902 a

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

 

 

10300SB1282sam001- 14 -LRB103 27271 BMS 59902 a

1and upon request of any group or enrollment unit, provide to
2the group or enrollment unit a description of the method used
3to calculate (1) the Health Maintenance Organization's
4profitable experience with respect to the group or enrollment
5unit and the resulting refund to the group or enrollment unit
6or (2) the Health Maintenance Organization's unprofitable
7experience with respect to the group or enrollment unit and
8the resulting additional premium to be paid by the group or
9enrollment unit.
10    In no event shall the Illinois Health Maintenance
11Organization Guaranty Association be liable to pay any
12contractual obligation of an insolvent organization to pay any
13refund authorized under this Section.
14    (g) Rulemaking authority to implement Public Act 95-1045,
15if any, is conditioned on the rules being adopted in
16accordance with all provisions of the Illinois Administrative
17Procedure Act and all rules and procedures of the Joint
18Committee on Administrative Rules; any purported rule not so
19adopted, for whatever reason, is unauthorized.
20(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
21101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
221-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
23eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
251-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
26eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;

 

 

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1102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
21-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
3eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
4    Section 35. The Limited Health Service Organization Act is
5amended by changing Section 4003 as follows:
 
6    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
7    Sec. 4003. Illinois Insurance Code provisions. Limited
8health service organizations shall be subject to the
9provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
10141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
11154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
12355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
14356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
15356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
16408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
171/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
18Illinois Insurance Code. Nothing in this Section shall require
19a limited health care plan to cover any service that is not a
20limited health service. For purposes of the Illinois Insurance
21Code, except for Sections 444 and 444.1 and Articles XIII and
22XIII 1/2, limited health service organizations in the
23following categories are deemed to be domestic companies:
24        (1) a corporation under the laws of this State; or

 

 

10300SB1282sam001- 16 -LRB103 27271 BMS 59902 a

1        (2) a corporation organized under the laws of another
2    state, 30% or more of the enrollees of which are residents
3    of this State, except a corporation subject to
4    substantially the same requirements in its state of
5    organization as is a domestic company under Article VIII
6    1/2 of the Illinois Insurance Code.
7(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
91-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
10eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
11102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
121-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
13    Section 40. The Voluntary Health Services Plans Act is
14amended by changing Section 10 as follows:
 
15    (215 ILCS 165/10)  (from Ch. 32, par. 604)
16    Sec. 10. Application of Insurance Code provisions. Health
17services plan corporations and all persons interested therein
18or dealing therewith shall be subject to the provisions of
19Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
20143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
21356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
22356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
23356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
24356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,

 

 

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1356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
2356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
3356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
4367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
5and paragraphs (7) and (15) of Section 367 of the Illinois
6Insurance Code.
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
14101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
151-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
16eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
17102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
181-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
19eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
20102-1117, eff. 1-13-23.)
 
21    Section 45. The Illinois Public Aid Code is amended by
22changing Section 5-16.8 as follows:
 
23    (305 ILCS 5/5-16.8)
24    Sec. 5-16.8. Required health benefits. The medical

 

 

10300SB1282sam001- 18 -LRB103 27271 BMS 59902 a

1assistance program shall (i) provide the post-mastectomy care
2benefits required to be covered by a policy of accident and
3health insurance under Section 356t and the coverage required
4under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
5356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
6356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
7356z.61 of the Illinois Insurance Code, (ii) be subject to the
8provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
9370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
10subject to the provisions of subsection (d-5) of Section 10 of
11the Network Adequacy and Transparency Act.
12    The Department, by rule, shall adopt a model similar to
13the requirements of Section 356z.39 of the Illinois Insurance
14Code.
15    On and after July 1, 2012, the Department shall reduce any
16rate of reimbursement for services or other payments or alter
17any methodologies authorized by this Code to reduce any rate
18of reimbursement for services or other payments in accordance
19with Section 5-5e.
20    To ensure full access to the benefits set forth in this
21Section, on and after January 1, 2016, the Department shall
22ensure that provider and hospital reimbursement for
23post-mastectomy care benefits required under this Section are
24no lower than the Medicare reimbursement rate.
25(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
26101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.

 

 

10300SB1282sam001- 19 -LRB103 27271 BMS 59902 a

11-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
2eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
3102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
41-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
5eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
6    Section 95. No acceleration or delay. Where this Act makes
7changes in a statute that is represented in this Act by text
8that is not yet or no longer in effect (for example, a Section
9represented by multiple versions), the use of that text does
10not accelerate or delay the taking effect of (i) the changes
11made by this Act or (ii) provisions derived from any other
12Public Act.".